Care Home: Westacre Nursing Home

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What the care home does well Westacre Nursing Home provides a clean pleasant environment for the people who live in the home and the house is surrounded by well maintained gardens that the service users can wander about in freely. Service users have their needs fully assessed before they move into the home. Staff provide good support for the residents, encouraging their independence and promoting their privacy and dignity whilst encouraging them to maintain contact with their families and friends. The chef provides varied and nutritious menu which demonstrates a choice at every meal time. Residents and relatives are confident that any complaints made to the home will be handled in an effective and responsive manner. Good recruitment procedures protect the welfare of those living at the home, the service meets relevant health and safety requirements and legalisation. Service users surveys returned to CQC said `The home gives excellent care`. `The home provides excellent food every day`. `The home provides excellent and unusual activities`. `The staff are helpful and caring`. `I have found it difficult to adapt to the new life and the staff have been so kind and helpful`. `By and large the staff of Westacre from the manager downwards are caring and do their best as far as is possible to make Westacre a happy home`. `The home has plenty of staff on each shift so care can be given appropriately without skimping on time for each resident`. `The home has a pleasant ambiance and is well managed, well staffed with good food and a regular programme of activities`. `The chef is very good, just ask for anything you want and he provides it for you`. `Overall the home is very good and the staff are caring and helpful`. `The staff are very attentive`. Comments from relatives and health care professionals who visit the home include `very clean and comfortable care home with motivated, caring staff` `the staff seem very capable and considerate, I am generally very impressed by Westacre` `the home provides very caring individual attention`. Staff surveys returned to CQC indicated that staff have regular support from the manager and that staff work well together. Comments say that `Staff meetings are held and are well attended. The staff maintain good communication with relatives and the manager is very reactive in matters affecting staff, service users and relatives`. `I think it is a good home with a nice atmosphere to work in`. What has improved since the last inspection? The activities programme has been developed further and service users who are confined to their rooms, either through choice or poor health, are visited by the activities co-ordinator regularly, to undertakes activities of their choice. The home has continues to purchase appropriate equipment for those with special needs. The new manager has identified the gaps in staff training and has implemented a training plan to ensure staff receive appropriate training. The manager has planned regular service user, relative and staff meetings at which any issues or suggestions for the home are heard and discussed. The manager has put in place an enhanced quality assurance system to ensure standards are maintained. What the care home could do better: The care planning system needs to be developed to be more person centered and reflect in detail how identified risks and needs are to be managed. Risk assessments for service users who use bed rails must be undertaken to ensure they are being used appropriately. Evidence must be recorded that either consent or discussion has taken place with the service user or their representative with regards to the outcome of the risk assessment and use of bed rails. Key inspection report Care homes for older people Name: Address: Westacre Nursing Home Sleepers Hill Winchester Hampshire SO22 4NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Westacre Nursing Home Sleepers Hill Winchester Hampshire SO22 4NE 01962855188 01962866284 watson.sue@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nursing Home Services Name of registered manager (if applicable) Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 52 The registered person may provide the following category/ies of service only: Care home with Nursing N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Westacre Nursing Home is located in a private road on the western side of Winchester, within easy reach of the city centre and other local amenities. Westacre offers nursing care for up to fifty two older people some of whom may have dementia. The home is a large house with many original features, standing in its own grounds. The house has been altered and extended over the years, increasing the Care Homes for Older People Page 4 of 34 Over 65 0 52 52 0 Brief description of the care home communal areas and adding more bedrooms. There are two double and forty-eight single bedrooms and all are en-suite with a basin and lavatory, some also have baths and showers. Communal areas in the home include sitting rooms, a library area, a television room and a quiet area. There are two passenger lifts to enable residents to access all communal areas of the home. The fees are available on request from the home. These would not include newspapers, chiropody, hairdressing and other personal items. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report details the evaluation of the quality of the service provided at Westacre Nursing Home and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in September 2007. For the purpose of this report the commission will be referred to throughout as we. The site visit inspection to Westacre, which was unannounced, took place over a oneday period on the 24th September 2009 was attended by one inspector who was assisted throughout the visit by the manager. An Annual Quality Assurance (AQAA) had been completed by the manager since the last inspection visit and information from this and the last inspection report was also used to inform this report. Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and users of the service. During the visit we spoke to a number of residents both in their bedrooms and in the Care Homes for Older People Page 6 of 34 communal areas, and also spoke to members of staff on duty at the time and a visiting relative. In order to prepare for the visit, surveys were sent to the people living in the home, staff and other professionals involved with the home. Seven (7) service user surveys, of which five were completed by relatives, three (3) staff and three (3) visiting professionals surveys were returned and most comments were positive about the care received, and the service in general. The general issues raised in the surveys are discussed in the main body of the report. There was positive feedback from the visiting health professionals. The home is registered to provide support for 52 service users and at the time of the inspection there were 48 people living in the home. One resident was in hospital. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? The activities programme has been developed further and service users who are confined to their rooms, either through choice or poor health, are visited by the activities co-ordinator regularly, to undertakes activities of their choice. Care Homes for Older People Page 8 of 34 The home has continues to purchase appropriate equipment for those with special needs. The new manager has identified the gaps in staff training and has implemented a training plan to ensure staff receive appropriate training. The manager has planned regular service user, relative and staff meetings at which any issues or suggestions for the home are heard and discussed. The manager has put in place an enhanced quality assurance system to ensure standards are maintained. What they could do better: 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use this service benefit from a comprehensive pre-admission assessment of their needs before moving into the home. The home does not provide intermediate care. Evidence: The AQAA stated that a pre-admission assessment is undertaken by a senior member of the nurse management team who visit the person in either their homes or in the clinical area. A sample of four assessments was viewed. For one service user who was living in another care home some distance from Westacre, the manager had visited them personally to ensure full assessments and reports were sought from the previous home and from the multi disciplinary team that had been involved with the persons Care Homes for Older People Page 11 of 34 Evidence: care. Hospital discharge reports are expected to be sent to the home if the person is being admitted from them. The pre-assessment document does include information such as the persons personal care needs and physical well-being, sight, hearing, mobility and dexterity, medication, mental state and cognition, social contacts and relationships. The family or friends are also invited to be involved by providing details of the persons social history and past recreational past times. The manager said that she has recognised that the preadmission assessment documentation needs reviewing to ensure that it covers all aspects of a persons care needs. She is in the process of reviewing this which the AQAA states will be completed within the next twelve months. The manager has reviewed the homes brochure which together with the Statement of Purpose and Service User Guide is given to all service users and their families if or when they visit the home, which is encouraged. An information booklet on funding is also given to the service user and family as a guide to how their care will be funded. The manager told us that she considers it important the service users and their families visit the home as many times as they wish and are given full information about the home to ensure the person makes an informed choice about moving into the home. Five of the seven service users surveys returned to CQC indicated that the service users and their families were given sufficient information about the home to help them decide if the home was the right place them. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a plan of care to meet their needs. However, they do not reflect a person centered approach to care. Service users health care needs are met by a multidisciplinary team of professional people. Medication administration practices protect the service users. Service users privacy is respected. Evidence: The AQAA states that the home ensure service users health, personal and social care needs are met as well as they can be. The home now operates a named nurse system so that every service user will have a specific named nurse they can relate to and who will liaise with families and other professionals ensuring there is a person centered approach to care provision and continuity of care. They are also responsible for reviewing the care plans. Currently the home operates a system of care plans which the manager told us she is reviewing and anticipates changing. Whilst within this system there is a range of Care Homes for Older People Page 13 of 34 Evidence: working tools which provides all information required to care, the system has been found to have short comings that the manager is to address. The manager has undertaken an audit of the care plans and it has been recognised that this system is more task orientated and not person centered. The manage proposes to continue with regular audits until such times as a new system can be introduced. We viewed a sample of four service users care plans. The care planning system that is currently being used does provide an assessment tool that covers all aspects of a persons care. This assessment is completed by the named nurse and it is dependant on them as to how much detail is documented for each area. However, the system does not lend itself to being person centered and does not identify easily each problem or need. Risk assessment are in place for moving and handling, nutritional assessments for those with specific needs, tissue viability and falls. Care plans did not always give detailed information how to manage the risk. An example of this was that when a hoist was identified as being needed to move a person, there was no stipulated type or size of sling to be used for that person. Another was a risk of breakdown of tissue. There was no care plan to support how the risk could be managed. There was no evidence of bed rail risk assessments being undertaken or consent sought for the use of bed rials. This was discussed with the manager who said she would put the risk assessments in place and was aware of the shortfalls in the care plan system and that she would address these issues with staff. The admission assessments record emotional and psychological needs and within this assessment, preferred daily routines, likes, dislikes, cultural and spiritual needs and a short profile of the persons cognitive state and their capacity to make decisions. There was evidence that, if they are able, service users sign their care plan as evidence of their participation and agreement. Reports from each shift are maintained in the care plans and this details how each service uses needs have been met throughout the day. The AQAA states that the new manager is addressing historical practices in the home such as people staying in wheelchairs for long periods of time and frequency of visits and checks on residents who are bed ridden or choose not to come out of their rooms. The manager has designed a chart for each service users room that will inform carers of the persons care and give information to agency staff, of their preferences, what time they like to go to bed and get up and what activities they like to attend and Care Homes for Older People Page 14 of 34 Evidence: generally how they prefer to spend their day. It was observed that fluid, nutrition and turning records were being maintained in the bedrooms of those who were unwell and were being nursed in bed at all times. These were seen to be recorded at appropriate intervals and are monitored by the manager daily to ensure they are being maintained as stated in the care plan. The health care needs of service users are met. The home has a good working relationship with the local GP surgery through which the service users access the multidisciplinary health care team. Discussion with visitors and people living in the home indicated that the home is responsive to health care needs, contacting the relevant health care professionals when the residents need them. Records in the care plans documented all visits from health professionals and the outcome of the visits. There was evidence that a physiotherapist does visit the home to see one service user, but this is funded by the service user themselves. The occupational therapist will also visit the home to undertake assessments if this is requested by the GP. The Speech and Language therapist visits the home to assess the people who have swallowing problems. The chiropodist, dentist and optician visit the home at appropriate intervals. The surveys returned by service users, some of which had been completed by relatives, indicated that they usually or always receive the health care they need. Surveys returned from visiting professionals said The staff are very caring and the home is well run. The staff are always willing to help if I need assistance. The residents appear well cared for and the staff use lifting equipment appropriately and safely. Westacre seems well staffed and the manager is keen to implement any advise that is given to help residents. Patient centered approach to care and the home is skilled at interventions with people with challenging behaviours. More training in dementia is needed for care assistants. The AQAA states that the organisation is giving consideration to the development of the service for those with moderate to severe dementia. The manager is in the process of viewing the latest research in dementia care so that Westacre will be able to provide researched based care for those with dementia. The home has good links with the local community mental health team who regularly visit their clients in the home. For those who need referral to this team this is done via the GP. Ongoing support for staff who care for the people with mental health needs, is provided by the homes clinical nurse specialist who is a registered mental health Care Homes for Older People Page 15 of 34 Evidence: nurse. The home has medication polices and procedures in place, which cover the ordering, receipt, administration and disposal of medications in the home. The medication is received into the home in individual boxes and bottles for each service user. The medication is stored in individual rooms in a locked cupboard and from this the medication is administered by the registered nurse on duty to each person within their own room. This is a person centered approach to medication administration but if the person is not in their room, the nurse then has to take the medications from the residents room and seek them out, wherever they are choosing to be in the home, to administer their due medications. A sample of medication administration record [MAR] sheets were looked at. These are the records that are kept of all medication received into the home and are also a signed record of when medication is given to a service user. It is clearly documented when a service user has not taken the medication and the reason why the medication has not been taken. It was noted that a photograph of each service user was on the front of each persons MAR sheet for identification purposes. There were no gaps identified in the recording of the MAR charts. The medication cupboards were viewed and were tidy with no overstocking of medications that are used on an as needed basis (PRN). The controlled drugs cupboard was viewed and the medications were stored appropriately and records were being maintained. The balance recorded in the register matched to that of the stock in the cupboard. The manager had undertaken a medication audit and identified that the drugs fridge temperatures were not being monitored daily. The records in the medication room evidenced that the temperatures are still not being recorded daily. During the course of the day the staff were generally observed being courteous and respectful to the residents, knocking on residents doors prior to entering their bedrooms and providing assistance in a sensitive manner. Staff were overheard to be listening to service users wishes and respecting their choices. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a service that provides a variety of meaningful activities that is developed from their interests and wishes. Service users are able to received visitors when they wish. Service users receive a healthy and nutritious diet that is taken in surroundings of their choice. Service users choice within their daily lives is respected. Evidence: Westacre employes a full time activities co-ordinator and 2 part-time assistants who provide a varied programme of activities. The programme of events is on display on the wall of the room that is used for activities. The programme advertised a variety of entertainment and activities which were available on most days for the coming month. Activities take place six days a week. At the time of this visit training was taking place in the activities room and the activities organiser undertook one to one sessions with service users who prefer to stay in their rooms or those who are nursed in bed. In the afternoon musical movements took place in the conservatory. There was a large number of service users attending and they looked to be enjoying the music whilst doing upper body exercises. Care Homes for Older People Page 17 of 34 Evidence: A female service user told us that she really enjoyed these sessions and always attended. The activities coordinator attempts to plan the activities around their previous recreational past times. A basic social history is recorded for each person and the coordinator told us that she is in the process of gaining more detailed information about peoples social history. The activities co-ordinator maintains records, which were seen by us, of all the activities that take place, who has attended and the level of participation of the service user. These records also include the one to one activities that take place with the service users in their own rooms. The hairdresser visits the home weekly and some of the lady service users told us they enjoy this very much and look forward to having their hair washed and set. The AQAA states that service users are treated as individuals and Westacre are responsive to their race, culture, religion, age, disability, gender and sexual orientation. The home has policies in place to support equality and diversity and other policies which promote independence, privacy, dignity and respect. The clergy visit the home monthly to offer communion and requests for visits from other religious denominations are respected and met. Currently the service users are of mixed religious beliefs. Residents were observed making choices about their daily activities, such as whether to join in with arranged activities, or whether to sit in the communal areas of the home or spend time in their private bedrooms. Staff were available to provide help or support if it was needed. Likes and dislikes and how service users wish to undertake their daily activities are recorded in the assessment document. The AQAA states that in the coming year the home is to develop the activity programme further and explore opportunities for life history activities which will be supported by the cordinator and clinical nurse specialist who is a trained mental health nurse. The AQAA also stated that the service will review the opportunities for the service users to go on outings in the local community. Visitors are welcomed to the home and there are no restrictions on visiting times. The visitors book evidenced that the home do have a regular number of visitors most days. On the day of this visit there were a number of visitors in the home. It was observed that good relationships existed between the staff and visitors who visited the managers office freely to ask questions or exchange information. A relatives told us Care Homes for Older People Page 18 of 34 Evidence: that she was very pleased with the standard of care her husband was receiving. The meals are planned to be appertising, nutritious and suitable for the various needs of the residents, such as organic food or for those with swallowing problems. Meals can be taken in the dining room or where ever the service user chooses, such as the sitting room or their bedroom. The manager said that drinks are freely available and offered regularly to th residents. It was observed throughout the visit that drinks were regularly being served. There is also a kitchenette in the home to enable families and friends to make drinks for themselves or for the residents when they are visiting. The kitchen was visited and the chef was spoken to. He told us that he is familiar with the service users food likes and dislikes. He caters for various diets and says there is always a choice of food at every mealtime. The lunchtime meal was observed, service users told us that is was very good and that generally the food was excellent. Nutritional assessments are undertaken on those who have had a problem identified i.e. swallowing problems, lose of weight. This is referred to the GP, who may prescribe supplement drinks or a referral to the speech and language therapist for assessment. There was evidence in the care plans of weights being recorded regularly for those identified as being at risk. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and others associated with the home are confident that complaints will be handled effectively and efficiently. Service users are protected from the effects of abuse by a work force that has a good understanding of adult protection procedures Evidence: The complaints policy and procedure is part of the Statement of Purpose and Service User Guide and is distributed to all service users. The manager has an open door policy and encourages service users and visitors to visit her office is they wish to speak to her on any issues. This was confirmed on this visit, relatives were going into the office to communicate with the manager openly. The AQAA said that if service users are unhappy they know how to complain and the complaint is looked into and action taken to put things right. All complaints are taken seriously. Complaints are recorded in a log and the action taken and outcome from the complaint is recorded. The log demonstrated that the home had received one complaint in the past year which was resolved within the stated timescales. A survey returned from a relative said the home manager can be contacted quite easily during the week days to talk to. Surveys returned to CQC from service users Care Homes for Older People Page 20 of 34 Evidence: and those completed by relatives, indicated that they would know who to speak to if they were not happy about any issue. A comment on a survey said I have generally found the management take note of any dissatisfaction expressed and respond positively. The manager told us that any complaints received are viewed as an opportunity to learn lessons and improve the service. The AQAA states that two safeguarding referrals to Social Services have been undertaken in the past year. Currently there remains one ongoing issue being investigated. Appropriate procedures were followed with both referrals. The AQAA told us that the manager has bought with her past experience and the expertise in dealing with complaints and allegations in a professional manner. Westacre follow the Hampshire County Council Safeguarding Adult Protection Policy and procedures. The staff receive training on this as part of the induction programme to the home and is ongoing as part of the mandatory training. Training records evidenced this and the manager told us that she has identified staff who need this training and dates are arranged for them to attend. Staff spoken with are aware of the Whistle Blowing policy and understand the procedures and how they must report any form of suspected or witnessed abuse. The manager has drawn up a flow chart for staff to refer to on how to proceed when dealing with allegations of abuse. One service users has been assessed for the Deprivation of Liberty Safeguarding process and the manager showed us the outcome letter from the assessment, which made the judgment that their was no restriction on this persons liberty. The service has a robust recruitment process and all appropriate Criminal Record Bureau and Protection of Vulnerable Adults checks are undertaken before the person commences employment and to ensure the safety of the service users. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home that is maintained in a safe and homely manner and has the aids and adaptations to meet their needs. Good hygiene and infection control practices protect the wellbeing of those living at the home. Evidence: The AQAA states that the home is a safe and well-maintained homely home that is pleasant and with enough space and appropriate facilities for service users to lead as much of a fulfilling life as they can. The AQAA told us that the home is clean and hygienic. The AQAA states that the home provides specialist equipment for those who need it and have purchased appropriate seating for residents with special needs, 5 new profile beds and a new air mattress. New soft furnishings have also be purchased for some of the rooms. The manager told us that the home is maintained to a high standard and provides a pleasant environment for the people who live there. A programme of regular maintenance is in place and rooms, when vacated, are redecorated and carpeted. The home accommodates up to fifty-two residents. There are three double and forty-seven single bedrooms and all are en-suite with a basin and lavatory, some also have baths and showers. There are several bathrooms in the home with assisted baths or wet Care Homes for Older People Page 22 of 34 Evidence: rooms with level access shower facilities, which are favoured by many service users. The bedrooms and bathrooms are adapted and equipped to suit the needs of the residents and they are also encouraged to personalise their bedrooms with small pieces of furniture, pictures and personal items. Service users spoken with said they were very content with their rooms. One service user was moving rooms on the day of this visit and this has been at their request and with their consent. The home is decorated and furnished in a homely manner, with some of the owners art and furniture collection being displayed. There are a variety of communal areas that are available for service users to make use of, including sitting rooms, a library area, television room and a quiet area. There are two passenger lifts to enable residents to access all communal areas of the home. Risk assessments of the environment have been completed to ensure that people living in the home are protected from risks associated with the building and environment of the home. The gardens were seen to provide secure areas for the residents to wander in, with lawns and flower borders and tables and chairs. The home has a variety of lifting and moving equipment and the manager told us that where this equipment is quite large and bulky, the home has not a great deal of storage space and the equipment is stored in the bathrooms during the day when the bathing and showering has been completed. The service employs a separate housekeeping staff to maintain the cleanliness of the home. The house was generally very clean, there was an occasional odour detected and this was brought to the attention of the manager by a visiting relative who felt she was able to tell the manager about this. This was explored and reasons were identified. There was evidence of a regular carpet cleaning schedule being in operation and of carpets being cleaned regularly. The AQAA said that 20 staff have received infection control training, the training matrix evidenced this. On the day of this visit a large number of staff were undertaking the infection control and food handling and hygiene training that was being undertaken by an outside training provider. Suitable protective equipment is made available to staff, such as aprons and gloves and staff were seen to be using them. Hand washing facilities were observed to be in place in all bathrooms and toilets. The kitchen was visited. This was clean and well organised and the chef showed us the Care Homes for Older People Page 23 of 34 Evidence: cleaning schedules and the audits he undertakes to ensure the standards of environmental health are maintained. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are cared for by a staff team that have the skills and knowledge to meet their needs. Good recruitment procedures protect the wellbeing of those living at the home. Evidence: The AQAA told us that the home has 10 full time registered nurses and 7 part time registered nurses, with 5 registered bank nurses who are supported by 33 ancillary workers. The AQAA identifies that the service employs a mixed gender work force who come from various cultural backgrounds. The manager told us that the home is currently accommodating 51 service users. The rota identified that there are two registered nurses on duty throughout the twenty four hour period. Eleven carers are on duty in the mornings and eight in the afternoon/evening shift. The manager and deputy are also on duty throughout the day and stay in the home until 18:00. The deputy manager and senior clinical nurse work week-ends on a rotational basis. A staff comment on a survey returned said: The manager must ensure that there is enough staff to cover each shift otherwise quality of care is diluted and staff become stressed. This was discussed with the manager who told us that she in currently recruiting staff Care Homes for Older People Page 25 of 34 Evidence: to increase the p.m. shift to nine carers to be on duty. She is anticipating that with extra staff there will not be the need for using agency staff, but if agency staff are used, she ensures the agency supplies the same carers to the home for continuity of care for the service users. She also takes into consideration the dependancy levels of each of the service users when planning the rotas. The house keeping staff are managed separately by the administrator, who undertakes their supervision and arranges their training. From observation and speaking to service users it is suggested that there is sufficient numbers of staff on duty throughout the 24 hour period to meet the service users needs. The AQAA says that service users needs are met and well supported by staff who have received training and support from their manager. The home has an induction programme, training and development with supervision and support for all staff. The AQAA says the new manager has identified gaps in the staff training and has taken steps to improve the training needs of staff. A training matrix is being developed to address both mandatory and specialist training over the next year. The manager has introduced a new induction programme that is over a two day period. This includes a local induction which goes through policies and procedures, introduces the person to the home and mandatory training of moving and handling, both theory and practical and introduces the employee to the Skills for Care induction programme booklet that is completed within the first three months of their employ. There was evidence in one newly employed carers file of the completed local induction. The manager told us that the Skills for Care Induction booklets were, at the time of this visit, either with the carer or with their supervisor. The AQAA told us that the Clinical Senior Nurse will take the lead role for induction and ongoing facilitation of Skills for Care programme. Once the care staff have completed their induction programme they are then offered and encouraged to continue to undertake the NVQ level 2. The AQAA says that 10 of the 31 permanent carers have achieved their NVQ level 2 and above. Two carers have just commenced their training and some of the other carers are trained nurses in their own countries. The manager said it would be inappropriate for them to do the NVQ level 2. The manager has put in place a training matrix and has identified training needs for each member of staff through supervision and appraisal. Staff have supervision every Care Homes for Older People Page 26 of 34 Evidence: twelve weeks and the manager is in the process of ensuring all staff have received a performance appraisal. Records told us that 95 per cent of staff are up to date with their supervision meetings. Staff surveys returned to CQC indicated that staff are well supported by the management team and work well together. The training matrix was viewed. This identified training that has taken place and includes health and safety, fire safety, moving and handling, food hygiene, adult protection and dementia awareness. At the time of this visit staff training was taking place for infection control and food hygiene. The manager told us that she was putting a large number of staff through the training all at once, hence the number of agency staff on duty that day. The manager has a working knowledge of the Mental Capacity Act and the Deprivation of Liberty Safeguards and this is on the training agenda for all staff in the coming months. The home has robust recruitment polices and procedures in place. We viewed four staff files, which evidenced that these procedures were followed, including all the statutory checks required, such as a reference from a previous employer, a satisfactory Criminal Records Bureau (CRB) disclosure and the Protection of Vulnerable Adults (POVA) check. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a clear development plan and vision for the home and is supported by a senior staff team that provide leadership throughout the home. The home is run in the best interests of the service users and their finances are protected by the financial procedures in place. The service is meeting relevant health and safety requirements and legislation. Evidence: The AQAA states that the service users get good support from the home because the manager runs it well with an open approach that makes them feel valued and respected. The provider visits the home and talks to service users and an independent person carries out the Reg 26 visits monthly. Service users are invited to participate in service users meetings and in support of comments from visitors a letter has gone out to service users relatives or significant others to invite them to a relatives meeting Care Homes for Older People Page 28 of 34 Evidence: that will be facilitated by the manager. The current manager has been in post for approximately three months and is in the process of applying for registration with CQC. She is a qualified mental health nurse and has had many years experience in working with people with mental health problems and has a degree in Health Service Management. Surveys returned from staff and service users indicate that the manager has an open door policy and is supportive to service users, staff and relatives and is available to talk to them at any time when she is in the home. The manager has instigated a quality audit system where a care standard is audited every month. She has also undertaken an audit of the care planning system and is in the process of investigating introducing a new system that will be more person centered. She told us that the deputy manager and senior nurse clinician are involved with undertaking the quality audits in the clinical area, which include the medication charts twice monthly and the supplying pharmacist undertook a recent audit of all medication. The reports from the visits by the organisations representative (Regulation 26) visits were seen. These are comprehensive and address all aspects of the service and include interviews with the service users and staff. The manager is currently reviewing all policies and procedures and told us that this is an ongoing process. The manager has introduced service user, relatives and staff meetings. Separate meetings are held for trained staff and night staff to enable the manager to attend and address specific issues that staff may wish to raise. The relatives meetings are to be held bimonthly and fourteen relatives attended the first meeting, which was chaired by the manager. The service user meeting held was not very successful with only one service user attending. The manager has minuted these meetings for the records. Service user questionnaires have not yet been distributed to service users and relatives and the manager told us that this will take place in the coming months as part of the evaluation of the service. The home has two comments books in the reception area that relatives and service users are welcome to make comments in. Comments made are mainly about the food and are very complementary. Care Homes for Older People Page 29 of 34 Evidence: The AQAA says that the service users control their own monies and choose how to spend it. If, for some reason they or their family cannot manage their monies, this will then be undertaken by Westacre. There are policies and procedures in place for safe custody, record keeping and auditing of these monies. The home does not currently handle any of the service users monies. The home has implemented major health and safety and fire audits and subsequent strategy meetings have taken place to action the outcome from the audits. Each service user has an emergency evacuation plan that is in a prominent position in their room. The fire risk assessment was undertaken in March 2009. A sample of servicing certificates were viewed for equipment and systems and showed that all systems and equipment is regularly serviced. The fire log was examined and this evidenced that all appropriate checks are undertaken. The home has a fire warden who undertakes all the daily, weekly and monthly checks. There was evidence that staff have received fire training twice yearly. There was evidence that staff have received the mandatory training in health and safety, moving and handling, infection control, food handling and hygiene and first aid. No outstanding health and safety issues were observed during this visit. The accident recording book was viewed. There had been a number of reported accidents in recent months and these had been audited and analysed by the manager as part of the quality assurance system and were also recorded on the Regulation 26 visit reports. Regulation 37 notices of incidents that effect service users had been reported to CQC appropriately. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered person must ensure that all service users who have bed rails in use must be risk assessed and agreement sought from them for their use. You must risk assess service users before bed rails are used to rationalise the reason for their use and to ensure they are being used for their own safety. Agreement for their use must be obtained from them or a record of discussion with relatives of their agreement for their use. 30/10/2009 2 7 15 The registered person must 30/11/2009 ensure that care plans reflect the risks and needs of the service users and how those needs are to be met. Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Care plans must be person centred and reflect how risks are managed and how needs are met. 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 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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