Care Home: Westwood House

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What the care home does well They manage the home well, and residents and staff benefit from the registered manager`s open and person-centred approach. The provider has effective arrangements to monitor the quality of services that the home provides. They offer prospective residents the information they need to enable them to decide whether the home is suitable. They make sure pre-admission assessments provide enough information to staff in meeting new residents` needs. They maintain good systems to monitor and meet residents` health care needs, and they make sure residents have ready access to health care services. They make visitors welcome and enable them to feel relaxed in the home and when communicating with staff. They make good effort to meet residents` varied dietary needs. They take any concerns, complaints or allegations seriously and manage them in accordance with the appropriate procedures. They give close attention to providing a safe and relaxed environment for residents, staff and visitors. They employ suitably qualified and competent staff to meet the needs of residents, and offer them training they need to carry out their work in the home. What has improved since the last inspection? They have addressed the requirements we made at our last inspection and considered the recommendations. This has resulted in improvements such as: developing the planned activities offered at the weekends; whenever possible, helping residents at mealtimes to get out of their wheelchairs and ensure they are in a comfortable position to eat their meal; making sure the interval between breakfast and lunch meets residents` needs and preferences; holding more fire drills for night staff and installing door closures linked to the fire alarm. Since our last inspection, the home`s manager has become registered with the commission, following a process of assessment by our regional registration team. Residents and their representatives may be assured that the manager has the necessary skills and experience to run the home well. They have begun to involve residents and their representatives in the selection of staff to work in the home. The home has been awarded `beacon status` Gold Standards Framework accreditation for palliative care, which is a commendable achievement. What the care home could do better: They promote people`s health and safety but are recommended to make sure it isclearly evident that all staff members complete fire prevention training as well as taking part in fire drills, as this is important for fire safety. Generally, the home is kept clean and tidy.However, they need to keep all communal bathrooms in good order.The bathrooms will then be more hygienic and residents may find them more pleasant places to bathe.They also need to make sure the temporary storage arrangements for hoists do not impact adversely on residents` access to assisted bathing facilities. They manage most aspects of medication administration well but should consider detailing in care plans the medication aspects of residents` care needs.They should also make sure that the person who administers a resident`s external cream or lotion signs the medicine administration record. Meal times at the home are generally enjoyable occasions but staff should make sure that residents with restricted mobility are not moved into the dining room too long before a meal is served, as this may cause some residents unecessary discomfort.All staff members assisting residents with feeding should do so without standing over the person. They should check safeguarding training always has effective outcomes.All staff members need to have a good understanding of the relevant procedures and of their roles and responsibilities for safeguarding residents. They have improved the arrangements for staff supervision but need to do more to ensure it is evident that all staff members have supervision regularly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westwood House 9 Westwood Hill Sydenham London SE26 6BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Lacey     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Westwood House 9 Westwood Hill Sydenham London SE26 6BQ 02087767065 02086591327 westwood@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 49 Number of places (if applicable): Under 65 Over 65 49 0 old age, not falling within any other category physical disability Additional conditions: 0 49 49 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male) Chronic sick patients aged 40 years and above, one of which can be under the age of 40. Within the total of 49 patients, up to a maximum of 6 patients with palliative care needs may be accommodated Date of last inspection Brief description of the care home Westwood House is a modern, purpose built care home providing nursing for 49 people. There are four floors with a shaft lift providing access to all floors. Residents accommodation is on the ground floor and first floor. Service facilities are located in the basement and on the top floor there are staff facilities and further communal facilities for residents. Single rooms are provided with all but three having en-suite toilets and there are three shared bedrooms. The home has a secure rear garden. The home is in a residential street in Sydenham, close to local public transport facilities and Care Homes for Older People Page 4 of 33 Brief description of the care home within a reasonable distance from shops and other community facilities. In June 2009, the fees for this care home ranged from 750-1000 pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included an unannounced visit to the home, carried out by two inspectors. The registered manager was present during the inspection and assisted with our visit. Our inspection visit included a tour of the premises, and discussions with residents, visitors and staff members. We observed practice and examined various pieces of documentation. As part of the inspection, we invited written comments from a sample of residents, staff members and visiting care professionals. Their feedback is included within this report and has been taken into account in forming our judgements. The care home provided us with its Annual Quality Assurance Assessment (AQAA) in Care Homes for Older People Page 6 of 33 April 2009, which we also took into account. This self-assessment document focuses on how outcomes are being met for people using the service and gives us some numerical information. As part of our inspection, we considered notifications and any other information we have received from or about the home, including some written evidence provided by the manager in response to issues raised during our site visit. We also considered the report of our Annual Service Review (ASR) of Westwood House, carried out in June 2008. The last inspection on this service was completed on 20 June 2007. What the care home does well: What has improved since the last inspection? What they could do better: They promote peoples health and safety but are recommended to make sure it is Care Homes for Older People Page 8 of 33 clearly evident that all staff members complete fire prevention training as well as taking part in fire drills, as this is important for fire safety. Generally, the home is kept clean and tidy.However, they need to keep all communal bathrooms in good order.The bathrooms will then be more hygienic and residents may find them more pleasant places to bathe.They also need to make sure the temporary storage arrangements for hoists do not impact adversely on residents access to assisted bathing facilities. They manage most aspects of medication administration well but should consider detailing in care plans the medication aspects of residents care needs.They should also make sure that the person who administers a residents external cream or lotion signs the medicine administration record. Meal times at the home are generally enjoyable occasions but staff should make sure that residents with restricted mobility are not moved into the dining room too long before a meal is served, as this may cause some residents unecessary discomfort.All staff members assisting residents with feeding should do so without standing over the person. They should check safeguarding training always has effective outcomes.All staff members need to have a good understanding of the relevant procedures and of their roles and responsibilities for safeguarding residents. They have improved the arrangements for staff supervision but need to do more to ensure it is evident that all staff members have supervision regularly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are admitted to the home based on the outcome of a pre-admission assessment. People thinking of moving into the home are given enough information to help them decide if it is the right place for them. Evidence: Both of the two residents who returned our survey questionnaire stated they had received enough information about the home before they moved in so they could decide if it was the right place for them. A relative told us they visited a number of homes before choosing Westwood House and also said they received information about the home. It was evident that residents are assessed before admission so that a decision can be made whether the home is suitable to meet their needs. Personal files relating to six people were viewed. They all contained pre-admission assessments and profiles of the Care Homes for Older People Page 11 of 33 Evidence: individual, and covered all areas of need. Of the files viewed, two contained some blank paperwork that should have been completed to ensure staff had full information about that person. For example, the life story section for a resident who had transferred from another care home had been left blank. A relative said that a member of staff visited their relative to assess her needs before she moved in to the home. Three health professionals who responded to our survey stated that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people. The homes AQAA confirmed residents have contracts and both of the residents who returned our survey stated they had received contracts with terms and conditions. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident the home will ensure their health and personal care needs are met, and that their privacy and dignity will be respected. All residents have care plans and good access to health care services. The administration of residents medication is carried out well. The home makes sure residents receive a high quality of care in their final days. Evidence: People appeared adequately groomed and appropriately dressed for the warm and sunny day of the inspection. We spoke to eight people living in the home and two relatives about the care provided. In general, people provided positive feedback about the care provided, and said that staff understood their needs and looked after them well. We were told people received appropriate assistance with their personal care and had access to relevant health professionals. One person told us that the home is excellent, no complaints whatsoever, and another said, Im very happy here. One resident and a relative told us there are areas that could be improved. The relative said, they do their tasks and not a lot more, and said that staff are not so available Care Homes for Older People Page 13 of 33 Evidence: in the afternoons or evenings as they are during the mornings. Of the two residents who responded to our survey, both stated they always receive the care and support they need. A relative commenting about her relative stated the home, takes care of his medical needs and personal care very well, I feel confident to leave him here. Both staff members who responded to our survey stated they always receive up to date information about residents needs, for example, in the care plan. Having been asked to consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation, both staff members also replied they always have enough support, experience and knowledge to meet residents different needs. Two of the three health professionals who replied to our survey stated the home usually responds to the diverse needs of individual people, with a third professional stating this is always the case. We had also asked the health professionals to consider needs relating to disability, gender, age, race, ethnicity, faith and sexual orientation. Care plans sampled for inspection had information about the individuals needs. It was apparent the plans had been reviewed regularly, although the information had not always been changed accordingly. For example, a person who is now cared for in bed and has a bodywash everyday had a care plan reflecting a shower or bath. Where someone had an infection, the plan stated the infection control procedures that are no longer in operation, such as the use of hibiscrub. It was positive that the care plans detailed the equipment in use for each person, such as hoists, slings and pressure relieving equipment. We would recommend that the care plan also details the medication aspects of the care needs as well as any health problems that the individual has and how these are being managed (see recommendations). Risk assessments were in place for mobility and for falls and, where required, tube (PEG) feeds and bedrails. We found good records of the delivery of healthcare and recording of weights. One person with pressure sores had appropriate information recorded about the pressure sore, its treatment and the monitoring provided to ensure its improvement. We found records of changes of dressing and what dressings are being used. The GP was visiting on the day of inspection, and told us he visits each week those residents who need to be seen and also tries to see all residents that have not been seen by a doctor for fourteen days. He told us that peoples health needs are well looked after, and that staff listen and ensure any treatment prescribed by health professionals is provided. It was evident from files seen that visits from health care professionals are recorded. These professionals included the GP, tissue viability nurse, speech and language therapist, podiatrist and community psychiatric nurse. Three health professionals who responded to our survey stated that peoples social and health care needs are always properly monitored, reviewed and met by the home. Two of these professionals stated the home usually seeks advice and acts upon it to manage and improve residents health care needs, the other stated this was always the case. Of the two residents who responded to our survey, both stated they always Care Homes for Older People Page 14 of 33 Evidence: receive the medical support they need. The lunch-time medication routine was observed taking place on the ground floor. Nursing staff administered medication while wearing a red apron to say do not disturb. This helps to ensure they can carry out the administration safely and in a timely fashion. Two of the three health professionals who responded to our survey stated the home always supports people to administer their own medication, or manage it correctly where this is not possible, the other stating this was usually the case. Medication was being stored appropriately, and the homes medication policy and procedures were readily accessible. Medicines requiring chilled storage were being stored in a drugs refrigerator and the opening dates of limited life medications had been recorded. Controlled drugs (CD) were being stored correctly and the stocks of those inspected matched the records in the homes CD register. The receipt and disposal of medicines was satisfactory. The sharps box was labelled and not overfilled. A record of specimen signatures for staff authorised to administer medication was available, though we were told the list on the upper floor needs updating. The homely remedies protocol had been signed by the GP in November 2008. Each person prescribed medication had a pre-printed medication administration record (MAR). From sampling MARs, we found that these were all completed and had medication profiles in place. We found appropriate administration and recording of medication, including separate recording of variable dose medications. The only issue that arose was the administration of external creams or lotions. The current procedure is that even where care staff administer prescribed creams or prescribed supplements, the nurse signs the MAR. We drew attention to our guidance that details the correct procedure, which is that the person who administers the medication should sign the record (see recommendations). The three health professionals who responded to our survey stated the home always respects peoples privacy and dignity. It is understood the home is currently working through a national tool for privacy and dignity, and has signed up as a dignity champion. Residents said they are treated with respect by staff members. Our previous recommendation about a more private location for the pay phone on the first floor had not been met. Touring the premises showed the phone was still in the same place, in a main corridor on a low table with armchairs either side. An inspector sat there a few minutes to write notes and found it was a busy corridor, with little opportunity for privacy for a resident making or receiving a phone call. The home may wish to reconsider our recommendation, and make sure residents are satisfied with the location of the phone. Discussion, examination of care records and comments from health professionals showed the home makes sure that residents receive quality care in their final days, Care Homes for Older People Page 15 of 33 Evidence: and that the needs of their families and friends are given attention. The home had been preparing for Gold Standards Framework (GSF) accreditation for palliative care and, shortly after the inspection visit, we were informed Westwood House had been awarded GSF beacon status. This is a commendable achievement. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good arrangements are in place to provide residents with social activities, and to support their continued contact with their families and friends. Where possible, residents are enabled to make personal choices. Residents are provided with a balanced and nutritious diet. Evidence: When the inspectors arrived in the home, staff were busy helping some people to go into the garden to make the most of the sunshine. We spoke to two people about the care provided whilst they enjoyed this informal time. They said the home has a new activity coordinator (now called a lifestyle facilitator) and that there are opportunities to join in a number of activities as well as being able to sit with the member of staff and just chat. One person said there is, plenty to do if you wanted to. People said they choose when they get up and go to bed. One person said they liked to rest on their bed in the afternoon and staff helped them with this. Both residents who replied to our survey stated the home always arranges activities that they can take part in if they want. The lifestyle facilitator said she started her new role in November 2008 and went on to outline the various activities on offer. The lifestyle facilitator also told us about the training she had delivered for staff, which occurs about twice a month and Care Homes for Older People Page 17 of 33 Evidence: was very relevant to the job role. There is a mixture of group and individual activities available, although outings are quite limited. It was positive to note that those who are able to do more have some involvement in the organising of activities. For example, one person who lives at the home is the bingo caller and also takes an active part in the skittles game. Residents also take responsibility for watering plants. The day after the inspection was taking place a Motown event was due to take place for residents and their families. Residents are able to have their hair done in the hairdressing room. We saw people having their hair done and were told this is a weekly event. People can choose to attend a monthly church service. Two of the three health professionals who responded to our survey stated that the home usually supports residents to live the life they choose, the third stating this was always the case. We had raised an issue at our last inspection about planned activities at weekends. At this present visit, an inspector asked about the activities made available at weekends and was told this is seen as family time and therefore activities would be difficult to arrange. In our view, it is good practice for the home to take into account that not all individuals have family members to visit them and also people may like to join in activities with their relatives. It was therefore reassuring to see evidence provided by the manager after our site visit showing activities and events that have taken place at the home during weekends. We were informed that the home is advertising for an activities coordinator for weekends, and it is to be hoped recruitment will be successful, as residents would benefit from such a person being in post. We looked at the quality of the food provided by observing the lunchtime meal and by speaking with people to get their views. We noted there had been environmental changes made to the dining facilities. There is now a main dining room, which has doors that open to the garden area. The main lounge also has a small dining area for people who are more independent to be seated together if they wish. We were told by people living in the home that they had been consulted about the changes and about the decor and furnishings. The changes have been successful and benefited residents. Dining tables were laid with the menus, condiments and flowers giving them a wellpresented look. They also had written aide-memoires for reminiscence discussions to take place during the meal-time.The lunch-time meal is a protected time when all staff are to assist and no unrelated tasks are undertaken. For example, medication is administered later on after people have finished eating. We spoke with people during the lunch to obtain feedback. Some of these chose to take their meal in their bedrooms, whilst others were eating in the dining room. The feedback was mainly positive with people telling us that the food had improved over the last twelve months. They said there were choices at each meal and that if you dont like something cook will always make something for you. One resident decided not to have what was on the menu, so a staff member phoned the kitchen to pass on her request for a ham Care Homes for Older People Page 18 of 33 Evidence: omelette to be prepared instead. On the day of inspection people had a main choice of beef stew and dumplings or spaghetti bolognaise, with other alternatives they could request. There was also a choice of desserts on the desserts trolley. We were told that refreshments were available throughout the day and we noticed this during our visit. Both residents who responded to our survey stated they usually like the meals at the home. Most people spoken to during lunch on the day of inspection enjoyed their meal and said that hot food is served while still hot. One relative felt the home does not get the food quite right for their family member and also said the suppertime menu was not so good. One other resident told us that the vegetarian options were limited. However, when asked did they get offered different foods they said, yes, at suppertime and went on to mention a variety of food provided. They did say they like bolognaise sauce without the meat. It might be helpful for the cook to discuss options with these individuals to think of other vegetarian meals, such as vegetarian curry or chilli. Our concern about the mealtime was that people were gathered in the lounge at least twenty minutes before the meal was ready to be served. One person said this was often the case and that is why she no longer sits in the dining room. She suffers with a bad back and could not sit and wait for that length of time, so now has her meal in her bedroom where she can wait in more comfort (see recommendations). Some people were given assistance with feeding and we noticed that most staff were seated to do this, allowing eye contact and interaction, but that one staff member was standing over a resident assisting them to eat. This is not good practice, as not only is it potentially bad for the persons back but also may be intimidating for the individual receiving the support (see recommendations). It was positive to note that people receiving meals in their rooms had trays with condiments and a small vase with flowers in. A resident said this was normal practice. However, for one person who had their meal in their room staff gave them their lunch but later on took it away with little eaten. No food supplements were offered or provided and had not been prescribed despite the poor intake of food. This was brought to the managers attention so she could take the appropriate action. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives may be assured that the home will address fully any complaints they raise, in accordance with its procedures. The home has procedures in place to safeguard its residents, and has used these effectively. Staff receive safeguarding training but the understanding of some staff members could be improved. Evidence: The home has a complaints policy and procedure that is prominently displayed and is also included in the information given to residents before they move into the home. Both residents who returned our questionnaire stated they knew how to make a formal complaint, and that there is someone they could speak to informally if they were not happy. Responses from two health professionals who returned our survey showed that the home either always or usually responds appropriately if they or a person using the service or another person raised any concerns. Both staff members responding to our survey confirmed they knew what to do if someone has concerns about the home. The homes complaints file was seen and the records of complaints received since our last visit were sampled for inspection. All information had been recorded and filed for easy retrieval, with all relevant correspondence available. Thus, our previous recommmendation to improve the filing and organisation of the complaints records had been met. The information included investigation notes, statements, details of the Care Homes for Older People Page 20 of 33 Evidence: complaint and the findings. Dates and times had been recorded, so it was possible to determine the home had addressed complaints within the timescales set out in its complaints procedure. A concern that had been raised with the home about pad supplies that a relative mentioned to an inspector during the visit was seen recorded on the file. We spoke with five staff members about their understanding of the safeguarding procedures. Three had a sound understanding of their role in referring to the person in charge, whilst one said she had not received training despite being employed for over six months. Her response to a scenario showed this staff member needed further guidance and/or training to ensure she could take appropriate action if a safeguarding incident occurred. A senior staff member had a reasonable understanding of her responsibility to safeguard residents but did not show awareness of the lead role of social services in this respect. We recommend people are made aware of the role of social services in the protection of people and whistle-blowing and its meaning to them (see requirements/recommendations). We are aware of two safeguarding alerts since our last key inspection. Both allegations were investigated by the local (Lewisham) social services, and were found to be unsubstantiated overall with one area inconclusive. It was reported that the care home liaised well with social services, providing them with a lot of helpful and detailed information, responding to all the concerns raised and taking action to ensure residents safety and well-being. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a comfortable and safe environment. Evidence: The inspectors toured the premises, accompanied by the manager. There has been a change of layout, as commented on earlier in relation to the dining facilities. Areas had been refurbished to a good standard and residents spoken to were happy with the changes, saying they had been consulted about them and about the choice of decor. The bedrooms we sampled for inspection met standards, having the furniture, furnishings and equipment required. Residents personal possessions gave bedrooms a more homely and comfortable feel. Some residents were enjoying the warm sunshine in the garden. The inspectors commented that more shade could be provided and, shortly after our visit, the manager confirmed a new gazebo had been erected in the garden for this purpose. At our previous inspection, we issued a requirement for the home to improve its storage arrangements. The manager told us this is still a problem, as storage space within the home is minimal. The home provided an action plan following our last inspection that one bathroom on each floor will be allocated to store hoists when not in use. Wheelchairs not in use will be stored in residents rooms. The home appeared to be following this action plan for the most part, except that items other than hoists Care Homes for Older People Page 22 of 33 Evidence: were also seen stored in a bathroom. For example, the bathroom behind the nurses station on the first floor contained three hoists, two linen skips and two wheelchairs. It was not possible to reach the bath because of these items, which would have had to be removed from the room before anyone could use the bath. However, two other bathrooms inspected on this floor at about the same time of day (late morning) were clean, tidy and free of any storage items. It was understood there were sufficient assisted bathing facilities to meet residents needs, particularly as there were a number of vacant rooms at the time of this inspection. This is a matter the home will need to continue to monitor, especially when current vacancies are filled (see recommendations). Overall, the home was clean, tidy and appeared to be maintained well. On viewing the bathrooms, we found they were fitted with the required equipment but the flooring in particular either needed a deep clean or replacement. In a shower room on the ground floor the radiator was rusty, possibly due to condensation (see requirements). It was evident that satisfactory infection control procedures were in place in the home, with equipment and resources available. A housekeeper spoken with had a sound knowledge of these procedures in relation to her work role. The home also benefits from a five star food hygiene rating from the most recent environmental health inspection by the local council. Both residents who replied to our survey stated the home is always fresh and clean. One commented, the home is a very comfortable place to live and the atmosphere and surroundings are A1. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by suitably trained and competent staff members. The homes recruitment practices are robust, and protect and support residents. Evidence: The registered manager was in charge of the home on the day of this unannounced inspection visit. There were thirty-five people in residence, who were being supported on the morning shift by two qualified nurses and six care workers. There were fourteen resident vacancies but the manager stated there were seven people waiting to be admitted to the home. Rotas examined showed appropriate staffing levels and skill mix had been maintained. Both of the residents who responded to our survey stated staff are always available when they need them. Both staff members who responded to our survey stated there are usually enough staff to meet residents individual needs. An inspector visited the first floor unit. There were nineteen people in residence on this unit, with a qualified nurse and three care workers on duty on the morning shift. Another care worker had been allocated to work one-to-one with a particular resident. For the afternoon shift, the unit had one less care worker on duty on the first floor but shared a carer who was floating between the floors of the home. It was understood from unit staff and later confirmed by the manager that the staffing level for the afternoon shift was to increase, as new residents were being admitted to the home. Care Homes for Older People Page 24 of 33 Evidence: This is important so that residents needs may continue to be met promptly. For example, during the afternoon of the inspection visit a resident was heard calling for assistance with toiletting. The two care workers on duty were busy with another resident and the floating carer was working on the ground floor unit. The carer working one to one with a resident was having to ask the person in charge if she could leave this resident so she could assist with the toiletting of the resident calling for help. Both of the staff members who responded to our survey stated their induction had covered everything very well that they needed to know to do the job when they started. Both also stated they were being given training that is relevant to their role, helps them understand and meet peoples individual needs, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. Staff members we interviewed told us they were provided with good training opportunities. Two of the three health professionals who responded to our survey stated the homes staff usually have the right skills and experience to support residents social and health care needs, with a third professional stating this is always the case. One of the residents who responded to our survey stated staff always listen and act on what they say, and the other resident stated staff usually do this. People living in the home were positive about the care provided and that staff understood their needs. One relative told us that there was a language barrier at times and their relative found it difficult to understand some of the staff. When we asked the question of others this did not appear to be a general problem. The personal files of three staff members were selected for inspection and found to contain the recruitment information required. The registered manager explained the homes recruitment process, in which residents are involved. The manager was interviewing a group of applicants for posts during the afternoon of the day of inspection, in order to draw up a shortlist. Shortlisted applicants are invited for a further interview, in which residents and relatives participate. We spoke to two of the people involved in this who confirmed they were involved in the process and were very keen about it. The staff members we interviewed during our visit had been recruited before residents started to get involved with this process, but they flet it was a positive development. Successful applicants have a third meeting with the manager and the necessary recruitment checks are completed. When questioned, the manager confirmed equality and diversity issues underpin the recruitment process, and stated that the home had recruited a more diverse workforce since residents had become involved in the selection of staff to work in the home. Both of the staff members who responded to our survey confirmed their employer had carried out checks, such as Criminal Records Bureau (CRB) checks and references, before they started work in the home. Care Homes for Older People Page 25 of 33 Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives may be assured that the manager has the necessary skills and experience to run the home well. Processes for assuring the quality of service provision are good. The home promotes the health and safety of its residents, visitors and staff members. Evidence: Since our last inspection, the homes manager had taken up her post and had subsequently become registered with the commission, following a process of assessment by our regional registration team. From observations and discussions during our inspection visit and from comments received, the manager has an open and inclusive management style and promotes equal opportunities. Discussion and examination of relevant documentation showed our previous recommendation for regular residents and relatives meetings had been addressed. An inspector spoke to four people living in the home, three staff and one relative about the management of the home. All but one person said the manager was very approachable, communicated Care Homes for Older People Page 27 of 33 Evidence: well and had a positive impact on the quality of care. Two respondents to our survey commented positively about the homes manager. A visiting health professional stated the manager is very engaged and enthusiastic. A staff member commented that the manager is a caring person and looks after the staff and the residents, nothing is too hard and she always has time for us. Another staff member told an inspector, Carons a really nice manager, her doors always open and you can talk to her. Both staff members responding to our survey stated the manager gives them enough support and regularly meets them to discuss how they are working. Both staff members also stated the ways in which they share information about residents with other carers and the manager always work well. It was evident the home hold regular meetings for staff, and the minutes of recent meetings were seen. The provider has formal auditing and quality assurance systems in place to monitor and improve the quality of care provided. We viewed the audits in respect of medication, health and safety and infection control and the reports of monthly monitoring visits by the provider. A satisfaction survey was also undertaken in October 2008 with a traffic light system in place for alerting management to any issues. The last survey showed the quality of food needed to be improved in some areas and that complaints management required improvement. The manager told us how she has addressed these and the action taken appeared to be appropriate, with resulting improvement in these areas. The homes AQAA had relevant information that was clear and supported by evidence. We were informed about changes made and how the home intends to make further improvements. The data section of the AQAA was completed accurately and fully. The home does not hold personal allowances on behalf of residents and no staff members assist residents with their financial affairs. Additional charges, such as for hairdressing, newspapers or toiletries are invoiced to either the residents or their representatives. It was understood that people may have access to their records as they wish. With regard to our previous requirements about supervision, the manager stated every other month is now designated as a supervision month. She explained the home uses a cascade system, whereby she supervises senior staff who in turn supervise other staff members. Staff told us they were supervised formally, although the records of formal supervision were mixed in respect of frequency. For example, one nurses file viewed showed a number of formal supervision sessions, whilst there was little in respect of the lifestyle facilitator (see recommendations). A care worker said she receives supervision three or four times each year, in the form of a one-to-one session in an office lasting about half an hour in which her training needs are identified and any issues with colleagues discussed. Care Homes for Older People Page 28 of 33 Evidence: A sample of health and safety service files were viewed and all were found to be satisfactory, with appropriate servicing and monitoring having been carried out. There were also satisfactory procedures in place to ensure risk of fire is reduced and therefore ensure peoples safety. Our previous requirement about the automatic door closures linked to the fire alarm had been met. The inspectors raised the issue of fire drills appearing to be mixed with the weekly fire alarm check and fire training, rather than drills being separate from the checks and the training (see recommendations). The providers training grid shows that all staff are expected to have at least two training sessions each year as well as attending at least two fire drills. Initially during our visit, it appeared there were issues with the frequency of fire drills taking place at night. This was concerning as we had made a previous requirement in this respect. However, the manager was able to show this requirement had been met by later providing evidence to show how permanent night staff attend fire drills, though it was again apparent that these drills were also being considered as fire training as they were entered on a training record form. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person must ensure bathrooms are kept in good order, specifically, deep cleaning or replacing flooring and repairing or replacing the rusting radiator in a ground floor shower room. The bathrooms will be more hygienic and residents may find them more pleasant places to bathe. 31/08/2009 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 9 The registered person should ensure that the care plan also details the medication aspects of a persons care needs and how these are being managed. The registered person should ensure that the person who administers a residents external cream or lotion should sign the medicine administration record. The registered person should ensure that residents with restricted mobility are not moved into the dining room too Page 31 of 33 2 9 3 15 Care Homes for Older People long before a meal is served. 4 15 The registered person should ensure that all staff members assisting residents with feeding do so without standing over the resident. The registered person should ensure all staff members have full understanding of the procedures and of their roles and responsibilities for safeguarding residents. The registered person should ensure the storage arrangements for hoists do not impact adversely on residents access to assisted bathing facilities. The registered person should ensure it is evident that all staff members have regular supervision. The registered person should ensure it is clearly evident that all staff members attend suitable training in fire prevention as well as taking part in fire drills. 5 18 6 22 7 8 36 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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