Care Home: Valentine House

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What the care home does well Visitors to the home are made to feel welcome and are offered refreshments. Several members of staff have been employed at Valentine House for some considerable time, providing stability and continuity of care to the people who live there. People who use the service are able to raise concerns and feel confident to do this. Where safeguarding alerts are raised and initiated, there is evidence to show that the management and staff team of the home are proactive so as to ensure positive outcomes for people and they are protected from possible harm and/or abuse. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. There is a safe and robust system in place to ensure that recruitment procedures within the home ensure people`s safety and wellbeing. What has improved since the last inspection? Staff are now receiving regular formal supervision. Improvements have been made and continue to be made to the home environment. New flooring has been laid in the main dining room and several areas of the home have been redecorated. What the care home could do better: Further development of the home`s care planning and risk assessing processes is required, so as to ensure that these clearly identify individual`s care needs and staff have the most up to date information about the individual. This will ensure that care delivery is in line with people`s care needs, taking into account their personal preferences. Further improvements are required in relation to some aspects of medication practices and procedures so as to ensure people`s health and wellbeing are maintained. The deployment of staff within the care home and staff interactions with people who live there need to be improved so as to ensure positive outcomes. All people living at the home must receive a varied social care programme that meets their needs. For people who have poor cognitive ability and/or dementia, a range of suitable activities must be provided. Ensure improvements are made to the home`s environment (first floor) and that it is suitable to specifically meet the needs of people who have a diagnosis of dementia. Information relating to the home`s Statement of Purpose and Service Users Guide is reviewed and updated and that information recorded within these documents is accurate. Key inspection report Care homes for older people Name: Address: Valentine House Broadway Silver End Witham Essex CM8 3RF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love     Date: 2 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Valentine House Broadway Silver End Witham Essex CM8 3RF 01376585965 01376585916 valentine@atlantishealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Atlantis Healthcare Limited Name of registered manager (if applicable) Mrs Virginia Mickle Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Only the room agreed with the Commission (room number 17) can be used as a double room Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 12 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 49 persons) The total number of service users accommodated must not exceed 49 persons Date of last inspection 1 4 1 0 2 0 0 8 0 0 Over 65 12 49 Care Homes for Older People Page 4 of 35 Brief description of the care home Valentine House is a large detached house, situated opposite a small parade of shops in a village location. The home has three floors that are accessed by a through floor passenger lift, and residents are accommodated in single bedrooms, all with ensuite toilets. Facilities include lounge areas on all three floors, a large dining room, a number of bathrooms (some with assisted bathing facilities), and a secure garden area with seating available. The home is registered to provide 24-hour personal care and support for up to 49 older people (i.e. over the age of 65), including up to twelve people who suffer with dementia. The home provides both permanent accommodation and also short (respite) stays. Care Homes for Older People Page 5 of 35 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: one star adequate 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: This was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 16 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to people who live at the home, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of care staff were spoken with and their comments are used throughout the main text of the report. Prior to the Care Homes for Older People Page 6 of 35 site visit, surveys for people who live at the home and staff were requested to be sent to the home for distribution. At the time of writing this report we had received 5 completed staff surveys and 8 from people who live at the home. Where comments have been recorded these have been incorporated into the main body of the report. The manager, deputy manager and other members of the staff team assisted the inspector on each of the days of the site visit. Feedback on the inspection findings were given to the manager and deputy manager during both days and the opportunity for discussion and/or clarification was given. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Further development of the homes care planning and risk assessing processes is required, so as to ensure that these clearly identify individuals care needs and staff have the most up to date information about the individual. This will ensure that care delivery is in line with peoples care needs, taking into account their personal preferences. Further improvements are required in relation to some aspects of medication practices and procedures so as to ensure peoples health and wellbeing are maintained. The deployment of staff within the care home and staff interactions with people who live there need to be improved so as to ensure positive outcomes. All people living at the home must receive a varied social care programme that meets their needs. For people who have poor cognitive ability and/or dementia, a range of suitable activities must be provided. Ensure improvements are made to the homes environment (first floor) and that it is suitable to specifically meet the needs of people who have a diagnosis of dementia. Information relating to the homes Statement of Purpose and Service Users Guide is reviewed and updated and that information recorded within these documents is accurate. Care Homes for Older People Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic care needs are assessed so as to ensure the service can meet the prospective persons care needs. However people cannot be assured they will be given accurate information about the services and facilities at the home. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. From discussions with the manager we were advised that the above information is used to inform the persons plan of care. Of 5 staff surveys returned to us, all confirmed they are given up to date information about the needs of the people they care for. The care files for the two newest people admitted to Valentine House were requested. Care Homes for Older People Page 11 of 35 Evidence: Records showed that a pre admission assessment was completed for each person prior to them being admitted to the home. However information recorded was seen to be basic and it was unclear as to how the management team had determined the persons needs could be met based on the information gathered at the initial pre admission assessment stage. In addition records showed that not all elements of one persons pre admission assessment had been fully completed e.g. information relating to their dietary needs, communication and social care needs were not completed. We discussed this with the manager and were told that one of the two people admitted to Valentine House was placed as an emergency admission. The manager confirmed that little paperwork and information was provided by the discharging hospital and they had felt pressurised by the discharge team to admit the person to the home. Consideration should be given to ensure there is clear evidence available to demonstrate that the prospective person has been actively involved in the admission process and that their views have been incorporated where possible as this was unclear from inspection of their pre admission assessment and both people were unable to clarify to us if they had been involved in the assessment process. The manager confirmed that usual practice is for the prospective person and/or their representative to be given the opportunity to visit Valentine House prior to admission so as to look around the premises, to have a meal, to meet people who already live in the home and to meet staff. Visits to the home by a prospective person and/or their representative do not require prior arrangement so as to allow people to obtain a true working reflection of the home. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. Both documents require amendment to reflect there is a specific unit within the home for people with dementia and how their needs are to be met. In addition information relating to complaints needs to be amended to reflect the Care Quality Commission contact details and not the previous regulatory body. The Service User Guide needs to be compiled in a more user friendly format so as to enable people with dementia and/or poor cognitive ability to have an understanding of the services and facilities provided at the home as currently this is in a standard format. Care Homes for Older People Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Valentine House are potentially at risk of not having all of their care needs clearly recorded. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition a formal manual handling assessment is completed for each person and of those people case tracked these were seen to be detailed and comprehensive. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and as stated previously, from other associated information provided by external stakeholders. As part of the inspection process we looked at 5 peoples care files (2 in full and 3 in relation to a specific healthcare need). Records showed that improvements need to be made to the current care planning system so as to ensure it provides clear information about the individual persons care Care Homes for Older People Page 13 of 35 Evidence: needs, is person centred, provides appropriate guidance to care staff as to how the persons care needs are to be met and identified risks to the individual person are recorded detailing the specific risk and the measures to be taken to reduce the risk so as to ensure peoples health and welfare. At the time of the site visit care records were observed to provide basic information about the individuals care needs. In addition there was little information recorded relating to peoples strengths and abilities and the areas where they require assistance from staff. The care plans for two people recorded them as exhibiting challenging behaviours on occasions. No information was recorded detailing the specific nature of the persons challenging behaviours, known triggers and there was little evidence to show that guidelines were devised and in place detailing the persons care needs and the action to be taken by care staff to ensure the needs of each person are met and other people protected. We looked at daily care records and these confirmed occasions whereby both people could become verbally and physically challenging towards others, however records lacked detail and clarity. This refers specifically to generic comments recorded by staff which included little aggressive and [name of person] was agitated and no information recorded as to staffs interventions and outcomes. Another plan of care recorded the person as having poor mental health care needs and expressing a threat to harm themselves if they were not able to return to their home. It was unclear from the records examined as to how this was to be proactively managed. In addition there was no information recorded as to how their mental health needs were being monitored and the steps to be taken should this deteriorate to an unacceptable level. We looked at one persons care file in relation to pressure area care following a discussion with the manager. Records showed there was no plan of care detailing information relating to the pressure sore or guidance for staff as to the on-going treatment to be provided in the absence of interventions provided by a healthcare professional e.g. District Nurse. In addition there was no risk assessment in place identifying the measures to be taken by staff to reduce the risk. A formal pressure sore risk assessment was completed each month and this showed the person was at risk. District Nurse records confirmed the person was currently being seen by them and their pressure area wound re-dressed on a regular basis. The home is registered to admit people who have a formal diagnosis of dementia. Out of 5 care files examined 3 people were noted to have a formal diagnosis of dementia however there was little information recorded as to how their dementia impacts on their ability to carry out everyday tasks and the challenges this may pose each day. A multi-disciplinary visit record is available for each person within their care file. This Care Homes for Older People Page 14 of 35 Evidence: identifies the date, role of visiting professional, reason for visit and outcome. Records showed that people living at Valentine House continue to have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include attendance at hospital appointments, optician, dentist, District Nurse Services, Community Psychiatric Nurse, GP, Dietician etc. We spoke with two visiting healthcare professionals on the first day of inspection. In general terms they advised that staff working at the home provide a reasonable level of care to people who live at Valentine House. They also told us that the majority of staff follow any guidance and instructions provided in relation to individual people and their treatment. Interactions by staff with people in the home was variable throughout the day with interactions centred primarily around tasks and routines e.g. providing personal care, assisting people to eat their meals or to have a drink. During the first day of inspection and shortly after the lunchtime meal, one person was observed to use their call alarm facility so as to summon assistance from staff. The call alarm was observed to sound for a continuous period of 20 minutes without support being provided by staff and when it was provided this was as a result of our intervention. Several members of staff were observed to walk past this persons room and to ignore their calling out and to not look at the call alarm facility on the wall to see who was summoning assistance. During this period the person was heard to shout out repeatedly please help me, help me, come on please hurry and please please come. This was not an isolated incident as another person was overheard to shout out somebody help me on several occasions. Staff were observed to walk past this persons room and to ignore their calling out. When we told a senior member of staff they advised us that this person regularly calls out. This is concerning as all staff have a duty of care to ensure peoples health and welfare. During the afternoon on the dementia unit on the first floor we observed several occasions whereby the lounge/dining area was not staffed for up to 10-15 minutes and of five people in this area, at least one person was known to exhibit challenging behaviour towards others. A recent resident meeting recorded not enough staff at tea time and a long time to answer the bell. Of 8 surveys returned to us by people who live in the home, all recorded their care needs as being met and staff being available when they needed assistance. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. The temperature of the medication storage area was not being monitored so as to ensure that medication is stored appropriately and remains effective. The temperature of the dedicated fridge used to store medication that requires cold storage was recorded and we looked at the records for the period January to May 2010. Records showed some occasions whereby the fridge Care Homes for Older People Page 15 of 35 Evidence: temperature was noted to not be within the recommended guidelines. There was no evidence to show this had been picked up by staff and the actions taken to address this. Care must be taken to ensure that medication is stored correctly in line with the prescribers instructions. This refers to one persons eye drops that were located in the medication trolley and which should have been stored in the homes dedicated fridge. We observed the administration of medication at lunchtime and saw an acceptable level of good practice. We completed an audit for 6 people who are prescribed Controlled Drug medication. Records and actual stocks of medication were observed to tally with records well maintained. We looked at the Medication Administration Records (MAR) for a random sample of 13 people. These showed that records were of a good standard with few unexplained gaps or omissions. Where people are prescribed medication in a variable dose e.g. one or two tablets, the actual dose administered was not recorded on the MAR record. This means there is a potential risk of people receiving too much or too little medication. In addition the MAR record for one person showed two of their medications were not administered as prescribed as the home were awaiting delivery and awaiting delivery delay with GP. Although we acknowledge the delay by the GP, further steps should have been taken earlier to ensure continuity of treatment. As part of good practice procedures all packets and bottles of medication should be signed and dated when first commenced so as to enhance the homes auditing processes. Care Homes for Older People Page 16 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited opportunities for people who have dementia to have their social care needs met and further improvements need to be made to ensure that all people who live at Valentine House have a positive dining experience. Evidence: An activities co-ordinator is employed at Valentine House for 35 hours per week Monday to Friday and alternate weekends. The activities co-ordinator has completed training relating to Therapeutic Activities In Dementia Care and the Level 2 Asset Course in Dementia. An activities programme was displayed on a notice board on the ground floor. Advice was given to the manager in relation to the activity programme being compiled in a more user friendly format e.g. larger print and/or pictorial so as to ensure that people who have a poor cognitive ability are enabled to make an informed choice. An activity record is maintained to evidence activities undertaken each day. Records include the date, brief description of the activity undertaken, equipment used, names of people attending and outcome of the activity. Activities provided include quizzes, watching films, sing-a-longs, colouring, bingo, hairdresser, 1 to 1, religious Care Homes for Older People Page 17 of 35 Evidence: observance and arts and crafts. Records showed there are limited activities provided for people who have dementia and/or poor cognitive ability and often it is the same people within the home who participate in the activities provided. On the first day of inspection the only activity provided throughout the day, to people within the newly created dementia unit, were 3 films, one of which was shown in the morning and the afternoon. We discussed our findings with the manager during feedback and they confirmed their awareness of some of the deficits and shortfalls. In addition the manager voiced her disappointment at the lack of stimulation and opportunity for activities provided to people in the home and stated I do not know why staff are being like this, there are normally activities. Of those care files case tracked not all had a plan of care detailing the individuals social care needs. On one care file examined there was information relating to the persons life history and a Getting To Know You sheet detailing their personal preferences, likes and dislikes however these were inconsistently completed in some cases. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. We observed on the first day of inspection, the dining experience for people who live at Valentine House. There is a white board in the dining room detailing the menu choices of the day. We advised the manager to consider devising this in a more user friendly design and layout e.g. in larger print and/or pictorial format so as to ensure that people with poor cognitive ability are able to make an informed choice. In addition to the main meal of the day, alternatives to the menu are readily available and we observed during the lunchtime period some people taking up this option. Out of 6 people spoken with, only 2 people were able to tell us what was available on the menu that day and their meal choice. People who live at the home are able to choose where they have their meals e.g. in the main dining room or in the comfort of their room. The manager told us that it was her intention for people in the newly created dementia unit to have their meals up there as they had found mealtimes in the main dining room were often chaotic and people had found this and the level of noise on occasions distressing. While we recognise the difficulties posed by having people with dementia and people who do not have dementia in the dining room at the same time, the lounge/dining area within the dementia unit on the first floor is too small for the numbers of people that are needed Care Homes for Older People Page 18 of 35 Evidence: to be accommodated. When added to the numbers of staff who will need to be available to support them, this increases the numbers of people in a small area significantly, which could potentially pose a health and safety risk as well as detract from the purpose of trying to create a calm environment. The dining experience for people was not observed to be positive. None of the tables in the dining room had a tablecloth placed on it, there were no placemats, cutlery or serviettes and only a few tables had condiments placed on the table. While we acknowledge there may be some people who as a result of their dementia and/or poor cognitive ability may touch or remove items placed on the dining table, consideration should be made to ensure that others are empowered to maintain their abilities and skills where possible. The lunchtime meal was seen to be provided in sufficient quantity and looked appetising. Where people are provided with a pureed meal, each item of food was portioned individually. Verbal interactions by staff with people during the meal time were observed to be limited and where some people had stopped eating they were not given prompt assistance or support to continue to eat their meal. This was largely due to the lack of staff presence in the dining room and although the activities coordinator was initially providing support and assistance during this period, they left the dining room when it was at its most busiest to have their break, leaving one member of staff with 22 people for over 10 minutes. We observed three members of staff providing one-to-one assistance to people to eat their meal. Two out of three staff members were observed to provide limited verbal interactions, while one member of staff was observed to not verbally interact for a continuous period of 15 minutes while the person was assisted to eat their meal. People were not informed as to the items of food on their plate and people were not asked if they had enjoyed their meal or asked if they wanted additional helpings. The most positive interaction was by the male senior member of staff who was administering medication. People who live at the home were noted to enjoy the verbal exchange and friendly banter provided by him. We spoke with 4 people and they confirmed they had enjoyed their meal and that the quality of food provided in the home is very good. Comments included that was very nice, the curry was very nice, no room for anything else and the food is good. Care Homes for Older People Page 19 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was displayed at Valentine House within the main reception area. The manager was advised that the complaints procedure needs to be amended to include the correct contact details of the Care Quality Commission and to include information relating to Social Care Direct and other Local Authorities. The AQAA details the management at Valentine House has an open door policy and people who live at the home, their relatives and others are welcome to approach the management teams should they have any feedback they wish to share or to raise other matters. A comments box has been installed in the foyer for all so that anonymous reporting or opinion can be undertaken. On inspection of the complaint log, records showed that within the past 12 months there have been 2 complaints which relate to alleged poor care practices. Records showed that the management team of the home had completed an investigation for one of the issues raised however it was unclear as to how some of the conclusions and actions taken had been reached based on the information available. For the second complaint viewed the evidence of the investigation undertaken was incomplete, outcomes and actions not properly recorded. Care Homes for Older People Page 20 of 35 Evidence: We also looked at the homes records of compliments. These included To all the staff we would just like to say a big thank you for all your kindness you showed towards or relative. We all know your job is not an easy one but over the years our relative was very well looked after and Just had to write a note of thanks to you all for the way in which you looked after our relative at Valentine House. You treated my relative with dignity, respect and care. It is so refreshing to be able to write this when you hear of all the bad reports of the other homes! and We just wanted to express our deep gratitude to you for the love and care which you have all shown to our relative over the last months and particularly in their last days. There are appropriate safeguarding policies and procedures in place. There has been 5 safeguarding referrals within the past 12 months which have been instigated by an external agency and which the Care Quality Commission has been made aware. Details of the allegations are recorded however the manager has yet to receive copies of the outcome from 4 of the investigations by the external agency. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the senior in charge of the shift and/or the deputy manager or manager. On inspection of the staff training matrix this showed that all but 3 people have up to date SOVA (Safeguarding of Vulnerable Adults) training. We are aware from discussions with the management team and members of staff that there are some people living at Valentine House who display challenging behaviour on occasions. The staff training matrix showed that out of 24 members of care staff employed at the home, 4 people have training relating to challenging behaviour. This is viewed as inadequate and must be addressed for the future. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a safe, well maintained and comfortable environment. Further consideration needs to be made by the organisation to ensure the dementia unit on the first floor is suitable to meet peoples needs. Evidence: A partial tour of the premises was undertaken throughout the first day of inspection. At the time of the site visit there were 38 people living at Valentine House. On inspection of the ground floor this was decorated and furnished to a reasonable standard and is both homely and comfortable to meet the needs of people who live there. Furnishings and fittings were domestic in nature and were of a good quality and in keeping with the environment however the carpet on the ground floor looks tired and worn in places. There is sufficient communal space and this refers specifically to two lounge areas and a large dining room on the ground floor. There are sufficient bathing and communal toileting facilities available on the ground floor which enable immediate access and these are fitted with appropriate aids and adaptations. A random sample of residents bedrooms on the ground floor were inspected and all were observed to be personalised and individualised. People spoken with told us they are happy with their personal space. The manager told us that a newly created dementia unit has been developed on the first floor for 12 people and had been operational 5 days prior to our site visit. On a Care Homes for Older People Page 22 of 35 Evidence: tour of the unit there was little evidence of appropriate signage in place to better support recognition and orientation for people living with dementia. There is little in the corridor to break up the space and some people may find it difficult to distinguish between the different rooms e.g. their bedroom, the bathroom, the toilet and the lounge. There was little evidence that sensory items for the unit had been purchased and/or were in use. As stated previously we discussed with the manager the inappropriateness of creating a combined lounge/dining area on the dementia unit as this could potentially be too cramped for the numbers of people residing on the unit and the staff required to support people during meal times. We discussed with the manager the rationale for the newly created dementia unit and while we acknowledge the motivation for the decision, in hind-sight further consideration should have been made to ensure the environment was ready to meet the needs of people with dementia. All areas of the home on the day of the site visit were observed to be clean, tidy and odour free. A random sample of hot water from baths and wash hand basins were tested and the hot water temperature was seen to be satisfactory and within recommended levels. We looked at the hot water temperature records from January to May 2010 and found that the temperature range on some occasions varied from between 31 degrees centigrade to 43 degrees centigrade. This must be reviewed so as to ensure an effective system is implemented that provides people with a safe, but comfortable, water temperature that is not below blood temperature. The gardens to the rear of the property are well maintained and enclosed for peoples safety. There are a number of seating areas for people to access and shade is provided by gazebos. On the second day of the site visit several people were observed to spend time outside and to enjoy the good weather. A maintenance person is employed at the home 40 hours per week Monday to Friday however their hours are flexible to cover emergencies at evenings and weekends. There is a maintenance programme within the home so as to ensure that the home environment and equipment is well maintained and records to evidence this are kept up to date. A random sample of fire and maintenance records were inspected and these were observed to be satisfactory and in date. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the homes recruitment and training practices for staff. Evidence: The manager told us there were 38 people living at Valentine House and current staffing levels are 6 care staff (including 2 seniors) between 07.00 and 14.30, 5 care staff (including 2 seniors) between 14.30 and 22.00 and 3 to 4 waking night staff (including 1 senior) between 22.00 and 07.00 each day. It was unclear from our discussions with the manager as to how the above staffing levels are determined as no dependency tool is currently being used to inform the above figures. The manager advised that as far as she was aware the above figures had been previously agreed with the Commission and the last key inspection report dated October 2008 confirms this. The manager was advised that it is the registered providers responsibility to staff the home in accordance with the assessed needs of people living at Valentine House. The management team and care staff confirmed it was their opinion that the dependency needs of people being admitted to the home was now much higher and more complex. Both the managers and deputy managers hours are supernumerary to the above figures, however where cover is required as a result of staff sickness and/or annual leave, both provide hands on care where needed. In addition to the above, ancillary staff are employed and these include a chef, kitchen assistant, housekeeper and domestic staff. Care Homes for Older People Page 24 of 35 Evidence: On inspection of 4 weeks staff rosters, records showed that the above figures have been maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. The manager advised that the home has not used agency staff for the past 2 years and where there are staff shortages these are covered by members of the existing staff team. However as detailed within the Health and Personal Care section of the report the deployment of staff within the home needs to be improved so as to ensure that people have access to staff at regular intervals throughout the day so as to ensure peoples needs are met. Out of 5 staff surveys returned to us all recorded usually to the question, Are there enough staff to meet the needs of people who use the service. Three staff files were viewed for those people newly employed at Valentine House within the past 12 months. The purpose of this was to check the recruitment process in the home. Records showed there is a good recruitment procedure and process in place and required documentation is received prior to the employee starting work. Each member of staff was noted to have received the homes in house induction and completed Skills for Care Induction. Out of 5 staff surveys returned to us all but one confirmed their induction covered all areas necessary for their role. We requested a copy of the staff training matrix and advised the manager this would be examined following the site visit. Records showed that the majority of staff have up to date training in core subject areas such as fire safety awareness, food hygiene, moving and handling, first aid, infection control, SOVA, COSHH (Control of Substances Hazardous to Health) and health and safety. Additional training for staff needs to be considered and provided for those conditions associated with the specific needs of older people e.g. Diabetes Awareness, Parkinsons Awareness, pressure area care, nutrition, sensory impairment etc. Records showed that out of 24 members of care staff employed at Valentine House, 14 have not undertaken dementia awareness training. Some staff have received training relating to funeral and bereavement, pressure area care, person centred care, care planning, effective communication, risk assessments, equality and diversity and both the manager and deputy manager have received training relating to the Mental Capacity Act. National Vocational Qualification (NVQ) records provided to us by the manager show that out of 24 care/senior staff employed at the home, 7 have completed NVQ Level 2 and 4 have completed NVQ Level 3. There are currently 5 people working towards their NVQ qualification. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well run and provides positive outcomes for people. Evidence: The manager has worked at the home for the past 5 years, having previously held posts as a carer, senior carer, deputy manager and became the manager to Valentine House in 2008. Since the last key inspection to the service in October 2008 the manager has been formally registered with the Commission as of April 2010 and following a Fit Person Interview. The manager has attained NVQ Level 4 in Health and Social Care, the Registered Managers Award and additional training in both core and specialist subject areas. The manager was able to demonstrate a clear understanding of the ethos, aims and objectives of the service that she wishes to provide at Valentine House. The manager confirmed this as providing good quality care and ensuring there is peace and tranquillity in peoples lives. Staff spoken with were very complimentary about the manager and stated they found her to be approachable. The deputy manager spoke of Care Homes for Older People Page 26 of 35 Evidence: a very positive relationship with the manager and together he felt they worked cohesively as a team and the manager brought with her a good knowledge and sound experience of the needs of older people and people with dementia. Comments received from 5 staff surveys included Its a warm friendly home, staff work well as a team and management are very supportive and we are friendly and homely. Staff are happy in their work. Both the manager and deputy manager recognise from feedback of the inspection findings during both days, that there are shortfalls and deficits which require addressing so as to ensure positive outcomes for people living at Valentine House. They discussed their disappointment with the inspection findings and confirmed on the second day of the inspection that issues had been discussed with the registered provider following the first day of the site visit. In addition an emergency staff meeting was to be undertaken to look at the issues and to devise strategies so as to ensure regulatory requirements are met and improvement sustained. The manager stated that she did not believe that we saw the home in its true light. All sections of the AQAA were completed and the document returned to us when requested. The AQAA lets us know about the changes they have made, where they still need to make improvements and how they are going to do this. The evidence to support the comments made is generally satisfactory, although some of the information does not fully concur with our findings. Both the manager and deputy manager undertake supervisions for staff. On inspection of 4 members of staff supervision records, records for 3 people showed they were receiving regular formal supervision and this included periodic observations of practice. The supervision format was seen to be satisfactory and included outstanding issues from the previous supervision, issues discussed, professional development, training needs, personal issues, annual leave and sickness and identified tasks and actions. The manager has not conducted a quality assurance survey since 2008. We were given assurances by the manager that surveys would be forwarded to people living at the home, their relatives and/or representatives, professionals and staff within the next 2 weeks. The results of the surveys will be collated and an action plan produced. Regulation 26 visits are conducted by the registered provider. However since January 2010 these have been conducted bi-monthly and not each month. Staff meetings and resident meetings are conducted bi-monthly and the discussions from these are minuted. The manager advised us that relatives meetings are not held as these have Care Homes for Older People Page 27 of 35 Evidence: been poorly represented in the past although relatives are invited to attend the resident meetings. Accident records for people in the home were inspected and seen to be were well maintained and completed to a satisfactory level. The management team of the home are proactive in advising us of notifiable events under Regulation 37. Corporate health and safety policies and procedures were observed to be in place within the home. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 16/07/2010 devised for all areas of assessed risk so that risks to people in the home can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and the steps to be taken to reduce the risk. So as to ensure peoples safety and wellbeing. 2 7 15 There is a plan of care, 16/07/2010 clearly identifying all aspects of the persons care needs and how these are to be met by staff. This will ensure that staff, have the information they need so as to provide appropriate care to meet the individuals care needs. Care Homes for Older People Page 30 of 35 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 3 9 13 Where a variable dose of medication is recorded, the specific dose administered must be recorded on the MAR record. So as to ensure peoples health and welfare. Where medication requires cold storage, this must be within recommended guidelines and the temperature recorded each day. This will ensure that medication remains effective. 25/06/2010 4 9 13 25/06/2010 5 12 16 All people are given the opportunity to engage in appropriate in house and community based activities. So that people have their social care needs met. 05/07/2010 6 16 22 Ensure there is a clear audit trail depicting the specific nature of the complaint, the investigation, actions taken and outcome. So there is a clear audit trail to show actions taken. 01/07/2010 7 18 13 Ensure that care staff 01/10/2010 receive training relating to how to deal with challenging behaviour. Care Homes for Older People Page 31 of 35 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 So that staff feel confident and able to deal with situations that may arise. 8 19 23 People who live at the care 30/06/2010 home must be provided with a sufficient supply of hot water at all times. So as to enable people to have a wash, bath and/or shower in the knowledge that the water will be at a reasonable temperature for their comfort. 9 19 23 The home environments 01/08/2010 design and layout must ensure it meets the needs of all people in the home. This refers specifically to the Dementia Unit on the first floor. So as to ensure it is suitable for the people who live on the dementia unit. 10 27 18 Ensure the deployment of staff within the home is appropriate for the numbers and needs of people who live there. So as to ensure people have their care needs met. 30/06/2010 Care Homes for Older People Page 32 of 35 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 11 29 18 Ensure that all staff receive 01/10/2010 training in specialist subjects areas appropriate for the needs of older people. So that staff are trained and competent to do their job. 12 33 24 Ensure there is a system for reviewing and monitoring the quality of care provided at the home. So as to ensure the views of people who live at the home and others are taken into account and actions taken to improve the quality of care. 12/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Ensure that the Statement of Purpose and Service Users Guide is reviewed and updated and information recorded within both documents is accurate. Ensure the pre admission assessment is detailed and comprehensive and that the information recorded enables the management team of the home to determine if the persons needs can be fully met. Ensure all packets and bottles of medication when opened are signed and dated. Arrangements must be made to ensure that people receive their prescribed medication. So as to ensure their health and wellbeing. Review the routines of the day with staff to ensure that a Page 33 of 35 2 3 3 9 4 9 5 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations person centred approach is being adopted by care staff. 6 7 15 15 Consideration needs to be given to improving the dining experience for people in the home. Ensure measures are undertaken to empower people to maintain skills and abilities. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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