Care Home: Trafalgar Care Home

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What the care home does well Trafalgar Care HomeDS0000030316.V376987.R01.S.docVersion 5.2Anybody who moves into the home only does so following an assessment of their needs and confirmation that the home can meet them. People who live in the home are able to maintain contact with people who are important to them. People are able to complain and should be confident that their complaints will be listened to, taken seriously and acted upon. People live in a safe and well maintained environment. The home has a system in place for seeking the views of people who use the service and their representatives. What has improved since the last inspection? At the end of the key inspection in August 2008 there were eight requirements and ten recommendations. To reduce the risk to people living in the home, the practice of keeping dental tablets and toiletries in people’s rooms was reviewed and risk assessments put in place. To ensure the home followed good practice in infection control waste bins are now foot operated and lined. Changes have been made to the number of staff on duty at peak times of activity in the home to fully meet the needs of people living there. Recruitment records have been improved and now contain the required information on staff to ensure that vulnerable people are protected. Improvements to training ensure that staff have the skills they need to meet the needs of the people living in the home. All fluids are clearly labelled to ensure there is no risk of harm to people. The homes fire risk assessment has been reviewed. All staff have completed moving and handling training. Risks such as uncapped razors have been removed from people’s rooms. People have access to tooth brushes and toothpaste to assist them in maintaining their oral hygiene. Policies in relation to protection have been updated.Trafalgar Care HomeDS0000030316.V376987.R01.S.docVersion 5.2People who work in the home are encouraged to participate in the training programme. Recruitment practice has been updated to ensure that declarations regarding convictions are made. All new staff complete induction training which meets the Skills for Care common induction standards. There is someone qualified in first aid on every shift. Practice has changed with regard to any monies kept for individuals in the home. All staff receive supervision in line with national minimum standards. What the care home could do better: At the end of this key inspection there are no requirements and seven recommendations. It is important for people’s wellbeing that information in care plans is detailed and precise about how they need to be supported. Improvements to the recording of PRN medication will ensure that people are getting the medication they need when they need it. It is important that staff think about the language they use and how it might affect someone. Activities should be available to people all the time not just when an activity person is working and they should consider the abilities of the people living in the home and current good practice in dementia care. People should be offered real choice at meal times which is mindful of their abilities and current good practice in dementia care. Staff should have training in equality and diversity to understand the needs of people living in the home. Consideration should be given to changing who does regulation 26 visits to the homes owned by the provider.Trafalgar Care HomeDS0000030316.V376987.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Trafalgar Care Home 207 Dorchester Road Weymouth Dorset DT4 7LF Lead Inspector Tracey Cockburn Key Unannounced Inspection 11th August 2009 09:30 DS0000030316.V376987.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trafalgar Care Home Address 207 Dorchester Road Weymouth Dorset DT4 7LF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 777567 01305 777567 office@trafalgarcare.plus.com Mr Derek Edwin Luckhurst Mrs Patricia Anne McIntyre Care Home 29 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (5) of places Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th August 2008 Brief Description of the Service: Trafalgar Care Home is registered to provide accommodation and personal care for up to 29 older people, five in the category of old age and 24 with dementia. The home is situated in a residential area of Weymouth about a mile from the sea front and the centre of town. It is set back from the main road and provides an area for parking at the front. The grounds are secured with fencing. People living in the home have access to the sheltered gardens at the front and rear of the home. The accommodation is provided on two floors with a passenger lift that enables people living there to access to the first floor. The home has 23 single bedrooms and 3 double bedrooms. There are two communal lounges and a dining room on the ground floor and a separate smaller lounge with a dining area on the first floor. People who use this room tend to be more physically frail and live mainly on the first floor. At the time of the inspection the home confirmed that the weekly fees ranged from £493 to £585 depending on individual assessed needs. Additional charges are made for services such as chiropody, hairdressing and personal toiletries. Information about these costs as well as the day to day operation of the home, including a copy of the last inspection report, can be found in the home’s office. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection which took place over one day with two inspectors spending a total of 5.5 hours in the home. We did not tell the home we were coming. Throughout the report the term ‘we’ is used to show that the report is the view of the Care Quality Commission. In planning the inspection we sent out surveys, we did receive any back. We looked at the information the home sent to us such as the annual quality assurance assessment (AQAA) as well as notifications of incidents and accidents and we reviewed the requirements and recommendations made at the key inspection in August 2008. People with dementia and complex needs are not always able to reliably communicate their views and experiences of a service so we developed a formal tool to enable us to observe people and help us understand their life in the home. This tool is called Short Observational Framework for Inspection (SOFI). This involves observing up to five people who live in the home for up to two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interact with members of staff, other people who use the service and the environment. We observed five people with dementia and communication needs in the ground floor lounge and dining area. The two hour period included lunchtime. Feedback on the outcome of the observation is given to the manager at the time of the inspection and detailed analysis is sent to the manager at a later date. During the site visit we spoke to the manager and staff, we looked at care records, recruitment records, training, health and safety and toured the building. What the service does well: Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 6 Anybody who moves into the home only does so following an assessment of their needs and confirmation that the home can meet them. People who live in the home are able to maintain contact with people who are important to them. People are able to complain and should be confident that their complaints will be listened to, taken seriously and acted upon. People live in a safe and well maintained environment. The home has a system in place for seeking the views of people who use the service and their representatives. What has improved since the last inspection? At the end of the key inspection in August 2008 there were eight requirements and ten recommendations. To reduce the risk to people living in the home, the practice of keeping dental tablets and toiletries in people’s rooms was reviewed and risk assessments put in place. To ensure the home followed good practice in infection control waste bins are now foot operated and lined. Changes have been made to the number of staff on duty at peak times of activity in the home to fully meet the needs of people living there. Recruitment records have been improved and now contain the required information on staff to ensure that vulnerable people are protected. Improvements to training ensure that staff have the skills they need to meet the needs of the people living in the home. All fluids are clearly labelled to ensure there is no risk of harm to people. The homes fire risk assessment has been reviewed. All staff have completed moving and handling training. Risks such as uncapped razors have been removed from people’s rooms. People have access to tooth brushes and toothpaste to assist them in maintaining their oral hygiene. Policies in relation to protection have been updated. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 7 People who work in the home are encouraged to participate in the training programme. Recruitment practice has been updated to ensure that declarations regarding convictions are made. All new staff complete induction training which meets the Skills for Care common induction standards. There is someone qualified in first aid on every shift. Practice has changed with regard to any monies kept for individuals in the home. All staff receive supervision in line with national minimum standards. What they could do better: At the end of this key inspection there are no requirements and seven recommendations. It is important for people’s wellbeing that information in care plans is detailed and precise about how they need to be supported. Improvements to the recording of PRN medication will ensure that people are getting the medication they need when they need it. It is important that staff think about the language they use and how it might affect someone. Activities should be available to people all the time not just when an activity person is working and they should consider the abilities of the people living in the home and current good practice in dementia care. People should be offered real choice at meal times which is mindful of their abilities and current good practice in dementia care. Staff should have training in equality and diversity to understand the needs of people living in the home. Consideration should be given to changing who does regulation 26 visits to the homes owned by the provider. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 8 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. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using the service have their needs assessed before any decision is made and are assured that the home has the ability to support them safely. EVIDENCE: We looked at the pre admission assessments of three people; this covers all the areas set out in the standard. Where someone is funded by a local authority there is a care management assessment in place. When the home completes an assessment there is sometimes limited information in some areas. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have individual plans of their care detailing how they need to be supported some of the information needs to be more precise so that people’s needs are fully met. People living in the home must be respected at all times. EVIDENCE: We looked at the care records for three people living in the home. We found that each person has a recent photograph of themselves on the files, there is also a fact sheet relating to their individual medical condition such as Parkinson’s disease or vascular dementia. There is also an information sheet on how the person likes to be supported and what is important to them. The manager has worked to develop the individual histories of people and is working on a person centred approach to the care plan. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 12 In the care file for one person we found clear information on their medical condition and what signs the care staff needed to look for if there might be a problem. Care plans we looked at did not always contain clear and precise information for staff to follow in relation to nutritional needs, however when we spoke to both the manager and staff it was clear that they understand the person really well and ensure that there is always food available for them to eat throughout the day. The person in question found it difficult to sit down to eat a meal. We found information in the care plans based on nutritional assessments, moving and handling assessments as well as assessments on an individual’s mental health, their ability to communicate and their skin condition. Some of the information in these assessments could have been fuller. For example one person’s communication assessment said ‘uses facial expression’ but did not expand on this, however in conversation with the manager and staff it was clear they new exactly what each facial expression meant. The manager told us that care plan reviews are now the delegated responsibility of senior carers, there are five senior carers working at the home, they have not had any training in care plan reviewing. We looked at the information for one person who is cared for in bed, we found the care plan was clear on how they need to be supported and the equipment they needed. We looked at risk assessments and found that they are updated following any incidents. The annual quality assurance assessment told us: “Trafalgar aims to keep all documentation regarding our Service Users up-todate with all changes being added in the appropriate place. As our Service User’s needs change we document this in their Care Plan for all Partner Agencies to see. We have added Individual slings for those who require these. Our meal time regime has been changed to incorporate supper especially for those Service users who need assistance with their meals, they are now encouraged to have supper at approx 8.3Opm as they do have their tea at about 4pm, all this is documented in the appropriate place. We have employed a carer from 8pm to 10pm to assist other staff members complete this task. Service users are assessed on a daily basis and if there is a problem then the appropriate partner agency is requested. Medication is received for all Service Users and any changes documented in the appropriate place. This is reordered on a monthly basis (unless there are changes). All medication is stored in the appropriate place. Our storage system has been updated to adhere to all rules and regulations. Our Medication Policy has just been re-vised with all new regulations being adhered too. All visitors are treated with respect and made welcome so that social contact can be kept for all Service Users. Two husbands regularly stay for lunch with their wife’s. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 13 Risk assessments are updated and reviewed on a regular basis. Staff received training on a regular basis.” We looked at medication and found that only staff who have completed safe handling medications training administer. Everything is in blister packs. We looked at PRN plans for people, which are plans for when medication is only administered now and then when required. We looked at the controlled drugs records and found that they all balanced with the record in the controlled drugs book. The manager told us that they had recently had a pharmacy inspection from the Primary Care Trust and there were no issues or recommendations. During the inspection we observed staff and found they were very respectful of the people living in the home while taking them in to lunch and while supporting them around the home. We did hear staff referring to people who need support with eating their food as ‘feeds’, in the context of “ could you go and assist with the feeds” This is not respectful and could be upsetting to relatives and the individual if they overheard this. This happened both during the two hour observation where we wrote: “The staff referred to people who required support to eat their meal as ‘feeds’. Staff need to think about the language they use and how this may affect the people they support.” and while staff where assisting people to walk into the dining room for lunch. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The availability of activities throughout the day will enhance people’s lives in the home. How people are offered choices will enhance their experience of living in the home. EVIDENCE: The commission’s guidance says: “Social care plays a major, if not the most important, role in supporting people with mental health problems to lead the lives they want to live.” The annual quality assurance assessment told us: “We now have an activities person 5 afternoons a week arranging a variety of activities for the Service Users. Music is still a favourite activity and we have been having visiting musicians invited to come and perform to Service users Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 15 and there families. We have bought new games which have been welcomed Musical Bingo, dominos After attending a training session we have now adapted our information and activity folder to be more person centred with history of there lifestyles and activities best suited to individuals this also includes a personalised photograph of the person. We have had quite a few new Service users in the last couple of months and they think it is a good idea. Where possible we enable all Service Users choices in all aspects of there daily lives. They can choice which lounge they would like to stay in, some Service Users like to stay upstairs as it seems to be quieter there and they do enjoy watching the Television We now have a new part-time cook and in the process of bringing another one on board, our other chef retired. The menus are updated and new ideas are being introduced. Service users are given the choice of where to have their meals, we try and ascertain when new Service users arrive what there likes and dislikes are and this is documented in there care plans and passed on to the kitchen staff. The Home has changed its meal regime as quite a few of our residents now need assistance with there meals so they have tea at approx 4pm, we introduced supper at approx 8.30 for those who need it. Services users who find it difficult to sleep are still offered something to eat and drink which may help them settle back to sleep. Many of our Service users have families and friends that do not live local. We have now introduced Trafalgar News. This is a small newspaper which is sent out to most Service users families/friends on a monthly basis. It seems to have been a big hit; it gives every one concerned an insight into what Trafalgar is doing every month. Comments in our Quality assurance so far have been very favourable. We now have a representative of the Catholic Church visit on a Sunday morning for one of our Service users which she does enjoy.” During the Short Observational framework for Inspection (SOFI) we observed the following: - People had nothing to hold or there was not anything around to hold or pick up and do so people could stimulate themselves. - Staff have good relationships with the people living at the home and were patient and encouraging - People with dementia freely approached staff and staff gave them appropriate reassurance when they seemed unsure, distressed or anxious. - Staff supported people to spend time how and where they choose. - Staff were observed to be relaxed with people. They reassured people by talking quietly, touching and supporting them when they were unsettled. - Staff responded ever time to one person who repeatedly called out. They tried different ways of engaging the individual each time. A majority of the time they were successful. - Staff spontaneously played with balloons with people when they took them down from the ceiling. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 16 - Staff and people laughed and chatted together and clearly enjoyed each other’s company. Overall people were either in a positive or passive state of being. There were good levels of engagement whilst there were staff doing activities with people (such as the balloon game and having drinks with them) and during lunch. At times when there wasn’t any activity from staff, people became more passive and there were lower levels of engagement. People are not given any choice of meal at lunchtime nor were people told what was for lunch. Staff did not describe to people they were assisting what their food was. There was generally a calm relaxed atmosphere over lunch. Staff quickly intervened and diffused any situations when people were becoming unsettled or agitated. People were given a verbal or visual choice of drink. However, these were then served in plastic coloured beakers. These beakers change the colour and appearance of the liquids inside and may add to people’s confusion about what they are drinking. The radio was on throughout the SOFI sessions and was on a local station. It was not clear whether it was the staff’s or people’s choice of station. We observed that people who are cared for in bed have sensory equipment available to them; in on person’s room images were projected onto the ceiling for them to see. There was also bean bags for them to hold. We also noted that the activity person had completed a piece of work detailing what individual’s might appreciate as activities and we found evidence that this was being put into practice. During the afternoon we spoke to the activity person who has completed a training course and another one is being sought at a local college, the person was encouraging people to come into a group and discuss the items in a local paper over a cup of tea, the afternoon was a hive of activity with people making the choice to join in. The environmental health unit from the local council visited the home’s kitchen in October 2008 and rated it as silver which means they won’t be visited again for another two years. The kitchen is very small in relation to the size of the home and the number of people living there. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be confident that their complaints will be listened to and acted upon. There are policies and training in place to ensure that people working in the home understand the importance of keeping people safe. EVIDENCE: The annual quality assurance assessment tells us: “We are now going to introduce into our Care Plans a Mental Capacity Act 2005 Section 4 Best Interests Assessment (Form B) after consultation with a couple of Social Workers advising that this is the best way to assist all our Service Users and Trafalgar.” We looked at the complaints record, three had been made since the last inspection and they had all been investigated with the outcomes recorded. There has been a safeguarding investigation relating to four people who live in the home. One person living in the home was responsible for physically harming three other people in the home. The outcome of the investigation found that the allegations were founded but that the manager and staff were Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 18 managing the situation well and had appropriate risk assessments in place which were reviewed and updated following the incidents. Health care professionals were also involved and supporting the situation. We found that all staff have undertaken safeguarding training and we found evidence of refresher training taking place for one member of staff who had not had this training since November 2006. Records show that fourteen members of staff have attended Deprivation of Liberty training in July 2009. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained home where training and practice in infection control has improved. EVIDENCE: The annual quality assurance assessment tells us: “We endeavour to ensure all equipment is maintained to a high standard and obtain new equipment as needed. We now have a new clothes dryer which is more efficient. We have changed the dosage system on the washing machine and are now using Horizon which cleans the sheets and clothes to a higher Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 20 standard. We have over the last year bought new sheets fitted and flat and new duvet covers and have kept a record of when these are purchased. We have purchased different coloured table clothes to put on the tables after Service users have had there meals. Bedrooms have been decorated when new service users have been admitted. We now have personalised identification for all Service Users on there bedroom doors to allow them to gain access to there own room. We have purchased 2 laundry Trolley’s to enable staff to collect dirty washing so that they follow Infection control procedures. We now have 2 cleaning trolley’s (1 for upstairs and 1 for the ground floor to assist the domestic staff maintain manual handling regulations. We also have a new aluminium trolley in the kitchen. We have hand washing facilities out side the front door to safeguard all visitors entering the Home which is also a safeguard for all our Service Users and staff. Trafalgar has also purchased soap dispensers for all bedrooms and areas that required washing your hands after certain procedures. The gardens are being regularly maintained with new plans and bushes being added to the back garden for the pleasure of all who use this part of the grounds. Trafalgar did obtain free Digital boxes for those Service Users who have their own TV in their rooms. We have up graded our system for informing/recording personal information and leisure activities for all residents by using a more personalised approach.” We found there is a weekly audit of the building. All bedroom doors have a photographs and the person’s name on them. We found some use of pictures such as a photograph of a toilet, the home needs to consider who will be using the bathroom and their height in relation to the picture. We found that all bathrooms had liquid soap and paper towels as well as pedal bins to minimise the risk of cross infection. The home has a sluice which is the old fashioned toilet type. We found there was good access to the wet room. During the site visit we found the patio doors to the garden were closed, it was a warm and sunny morning and the garden was not accessible to people in the home. The manager told us they were concerned that people might fall. The garden is secure, has a variety of seating and shade for people. The manager opened the doors so that people had the choice of going into the garden if they wished. While touring the building we found that some records are kept in the dining room, such as fluid charts, records of when people are shaved, a bath rota and nail rota as well as a book containing information on everyone’s personal care habits. We spoke to the maintenance person who told us that the woodwork on the outside of the building will be sanded and re painted later in the summer. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 21 Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to recruitment, staffing and training ensures that people living in the home are supported by staff who are learning about their role and its importance to the well being of people living there. Further training will enhance their understanding of equality and diversity. EVIDENCE: The annual quality assurance assessment tells us: “All new staff have CRB and Pova check relative to Trafalgar in place. We have now introduced a new system for recording our overseas workers addresses and workers registration confirmations and also Workers Permits. All new staff completes the Common Standard Induction and then continue on with the Homes Induction Pack which is also a Personal Development Plan which will then lead to being enrolled on an NVQII in care for those who do not have this certificate. Training on a broad spectrum of needs for the Home have been implemented for all staff. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 23 The Registered Manager has gained an ICEBreakers certificate to enable her to assist three of our overseas workers to speak/understand English to a standard that they can be enrolled on an NVQII course. 1 staff member finished her NVQII in May but is now on Maternity Leave. Two staff members started there NVQII on in January 09 and one in may 09 How we have improved in last 12 months. Our Homes Induction has been improved to assist new staff to be trained to a high standard and is then encouraged to do an NVQII in care. Supervisions are now done on a regular basis. Management team has attended more Training course regarding new legislation. We are now in the process of advertising for a 6am to 8am carer to assist those residents who may wish to get up between these times and to assist those Service Users who need assistance with their breakfast.” We looked at the recruitment records for three people that work in the home; all three had an application form with a health declaration as well as completion of a rehab of offender’s declaration. Gaps in employment were explored and there was the required proof of identity as well as confirmation of both a criminal records bureau check and POVA 1st check. We also saw two references on each file. We were told 23 staff have received training in infection control. The annual quality assurance assessment told us 10 staff have received training in malnutrition. There are 17 care staff and 4 catering staff that have training in food hygiene. Since the last key inspection over twenty staff have received training in Challenging behaviour. The staff roster now shows all the staff on duty who have had first aid training, we looked at the records for July and August 2009 and we could see that each shift had at least one person with first aid training. Staff would find training in equality and diversity useful bearing in mind some of the comments overheard about eating.( see outcome area health and personal care) Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and staff have worked hard to improve the service and ensure the home is run in the best interest of the people living there. EVIDENCE: The manager told us that since the last key inspection she has attended training in relation to self directed support and person centred approaches. The manager is developing information on people’s past and present life experiences, this information is now in each person’s individual care plans. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 25 The annual quality assurance assessment tells us: “Management team have endeavoured to attend all Training course relating to all new legislation implemented over the last year and will continue to do this as and when Training is offered by the Managing Authorities. This new wealth of information will be cascaded down to all staff at all levels. Registered Manager has completed training in the ICEBreaker to assist our overseas worker to improve there levels of English so that they will be able to enrol on an NVQII course. Our Induction has been upgraded for all new employees to ensure that the care they are giving is of the highest standard. New audits have been implemented to ensure that services and equipment with the building are working properly. We have implemented a new system for auditing our accidents. Service Users personal allowances have new plastic pockets for more protection from money falling out of any default in them. We now have a separate book which we keep a running total of the money in these plastic pockets as a backup to check what money we are holding for each individual. A system of supplying soap dispensers in all bedrooms and all rooms with hand washing facilities has been implemented and a Hand washing facility is now being encouraged for all visitors who visit/leave the building has been attached to the wall outside the front door. A new folder for all Regulations 37 has been put in place so that Partner agencies can obtain any further information if this is required. This also contains our RIDDOR reporting information. We now have a Registration Certificate in our Maintenance book for our Clinical Waste. We have over the last week had our first referral under the Deprivation of Liberties with the certificate in the relevant Service Users care Plan. We have also implemented a Best Interest Assessment for another Service User regarding her personal care.” We looked at health and safety records; the fire safety risk analysis was last reviewed on 4/08/09. The quarterly service of the fire system took place on 09/06/09. We looked at the record of Regulation 26 visits which take place each month and noticed that these visits are completed by the registered manager of another home owned by the provider. The regulations (26 c) do state: “Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by – (c) an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home” The provider should consider whether or not this is good practice as although another registered manager of another care home is not directly concerned Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 26 with the conduct of the care home they are in some respect in competition with the home. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 3 Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered manager should ensure care plans are clear and precise about the needs of individuals and how they will be addressed. This should be recorded consistently. The registered manager should ensure that care plans for PRN medication include times between doses and the maximum which can be taken. Anyone who is consistently and regularly taking PRN medication should have a review by the GP. The registered manager should ensure that all staff understand the importance of the language they use when talking about people who live in the home. The registered manager should consider what activities are available throughout the day for people with dementia, which takes into account current good practice and offers stimulation and recognises their abilities. The registered manager should consider what they do to DS0000030316.V376987.R01.S.doc Version 5.2 Page 29 2 OP9 3 4 OP10 OP12 5 OP15 Trafalgar Care Home 6 7 OP30 OP33 offer choice for people at meal times which takes into account current good practice in dementia care. The registered manager should arrange for all staff to undertake equality and diversity training to support their understanding of the needs of people living in the home. The registered provider should consider an alternative to the current practice of managers conducting regulation 26 visits on each others homes. Trafalgar Care Home DS0000030316.V376987.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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