Review of compliance. Ashbourne Homes Limited Lakeside. South East. Region: Brambling Watermead Aylesbury Buckinghamshire HP19 3WH.

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1 Review of compliance Ashbourne Homes Limited Lakeside Region: Location address: Type of service: South East Brambling Watermead Aylesbury Buckinghamshire HP19 3WH Care home service with nursing Date of Publication: August 2011 Overview of the service: Lakeside Nursing Home is a purposebuilt home situated in Watermead, a suburb of Aylesbury. The home provides personal and nursing care for up to 54 residents. Respite care and end of life care is also offered. Page 1 of 18

2 Summary of our findings for the essential standards of quality and safety Our current overall judgement Lakeside was meeting all the essential standards of quality and safety but, to maintain this, we have suggested that some improvements are made. The summary below describes why we carried out this review, what we found and any action required. Why we carried out this review We carried out this review as part of our routine schedule of planned reviews. How we carried out this review We reviewed all the information we hold about this provider, carried out a visit on 14 July 2011, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services. What people told us People said generally their experiences of the home and its staff had been good; one person said she felt safe in the home. People said they had been involved in making decisions about their care and had agreed the care given. People said staff were very friendly; one person said 'staff talk to you about your care; they listen; they are more like friends than carers'. People said there was enough staff although they recognised that staff were busy and work across the home rather than in one area. People said the home provides daily activities, including weekly pet therapy sessions and visits to the garden centre. One person said she goes out locally with a carer. People said they liked the food, were given choices and they had enough drinks. One person said her mothers' dietary and fluid intake had been monitored. One person said the cleaners were very good and said her room and the home were kept clean. What we found about the standards we reviewed and how well Lakeside was meeting them Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights Page 2 of 18

3 People's care and welfare needs were met. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Outcome 05: Food and drink should meet people's individual dietary needs People's nutritional needs were being met. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Outcome 07: People should be protected from abuse and staff should respect their human rights People felt supported and well cared for. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Outcome 08: People should be cared for in a clean environment and protected from the risk of infection People were protected against the risk of infections by appropriate standards of cleanliness and hygiene, although some infection control practices had been identified as requiring improvement. Overall, we found that Lakeside was meeting this essential standard but, to maintain this, we have suggested that some improvements are made. Outcome 16: The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Systems were in place to assess quality of care to ensure it met people's support needs. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Actions we have asked the service to take We have asked the provider to send us a report within 14 days of them receiving this report, setting out the action they will take to improve. We will check to make sure that the improvements have been made. Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal processes. We will publish a further report on any action we have taken. Other information Please see previous reports for more information about previous reviews. Page 3 of 18

4 What we found for each essential standard of quality and safety we reviewed Page 4 of 18

5 The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety Page 5 of 18

6 Outcome 04: Care and welfare of people who use services What the outcome says This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. What we found Our judgement The provider is compliant with Outcome 04: Care and welfare of people who use services Our findings What people who use the service experienced and told us People said generally their experiences of the home and its staff had been good. Staff were very friendly. One person said 'staff talk to you about your care; they listen; they are more like friends than carers'. People said they had been involved in making decisions about their care and had agreed the care given. People said that their personal care had been good. One person identified ongoing assessment and monitoring through a healthcare professional due to a health condition. People said there were enough staff although they recognised that staff were busy and work across the home rather than in one area. Generally, people said call bells had been answered quickly. People said they can personalise their rooms and can go out locally with carers. People said the home provides daily activities which include weekly pet therapy sessions and visits to the garden centre. Other evidence During the tour of the home staff were observed to be interacting well with people using the service; were speaking to people with respect and gave people choices. The home's manager said that staff discuss respect and dignity at induction to the home. The manager said she is developing formal respect and dignity training sessions with the assistance of the corporate training department. Page 6 of 18

7 We saw that people had identified key workers and named nurses. The names of these people were displayed in people's rooms. Information about staff was seen on a board in the home. The board displayed staff photographs and their names. Each room had a service user guide which informed the person using the service about the home. The manager confirmed that where possible people had been given a choice of rooms to choose from prior to coming to live at the home. The home has an activities coordinator who works Monday to Friday. We saw daily activity events written and displayed on the ground floor by the lounge and dining areas. When asked why a pictorial version was not available the activities coordinator said that people using the service had requested the written format. We saw the activities folder which detailed activities which people had attended. The activities records we reviewed for two people confirmed their attendance at a variety of activities. The types of activities provided include: Weekly coffee club six residents are invited; the event is made into a social experience and tries to include taste, touch and smell within the activity. Cinema afternoon 'the Lakeside Odeon' takes place occasionally, people using the service choose the film; the activities coordinator tries to create a cinema experience. Natural world afternoons Cheese and salami tasting events Memory lane bingo, domino and card clubs, quizzes, music, reminiscence, library and talking books. The manager who is new to the home is currently updating and reviewing all care profiles and associated documentation. New documentation is being introduced which include mental health and capacity assessments, consent for care plans content, photographs and medications. We saw that care plan reviews had been started by the manager and care plan training is to be offered to staff nurses and three senior carers; the training is to start in September Two people's care profiles were reviewed. Each person had a 'This is me' and service user assessment completed. Both had photographs in the file identifying the person using the service. The person's profiles and care plans included personalised information relating to risk and dependency ratings. Risk and dependencies had been reviewed monthly with outcomes documented. Systems of ongoing review were in place and documents relating to reviews for 2009 and 2010 seen. Care plans had been personalised, for example: safe environment risk of neglect if discharged home was identified for one person. Mental capacity assessments and mental health assessments had been completed for both people. We saw that monthly reviews and as required reviews had also taken place. Discussions with two staff showed that they had a good understanding of mental capacity and what they should do should a person require a mental capacity assessment. We saw evidence of professional visitor visits having taken place and individual healthcare needs being met. For example: one person had optical prescription records showing she had visited and been reviewed by the optician in October 2009 and October The manager said that a chiropodist visits the home to treat any people Page 7 of 18

8 who require treatment in this area. Our judgement People's care and welfare needs were met. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Page 8 of 18

9 Outcome 05: Meeting nutritional needs What the outcome says This is what people who use services should expect. People who use services: * Are supported to have adequate nutrition and hydration. What we found Our judgement The provider is compliant with Outcome 05: Meeting nutritional needs Our findings What people who use the service experienced and told us People said they liked the food, they had enough drinks; plus drinks trolleys come round at designated times. People said they had a choice of two meals at meal times and could request an alternative option if the meals were not to their liking. One person said you have a choice of where to eat your meals. One person said her mothers' dietary and fluid intake had been monitored. Other evidence The home was awarded a five star rating for food hygiene in May We saw a selection of the week's menus and next week's menus displayed in the homes main reception area. Two people's care profiles confirmed they had been assessed and detailed information had been obtained in the area of eating and drinking. We saw that dietetic referrals had taken place for one person and this review was to be followed up in three months time. We observed a lunchtime session. The main dining area was set up with five tables seating four people. It was observed that there was limited room between some tables. Most people eating sat in wheelchairs. People were asked which foods and drinks they wanted. Choice was given as to whether soup was served in a beaker, cup or bowl. People requested bread rolls; bread was only available. White and brown bread options given; people were happy with the choices given. Page 9 of 18

10 There was good staff interaction with people and some laughter. Food was well presented and looked nutritious. People were not rushed during their meals, there was sufficient time given between courses. Support was given where needed; one person was assisted with lunch by a carer. Our judgement People's nutritional needs were being met. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Page 10 of 18

11 Outcome 07: Safeguarding people who use services from abuse What the outcome says This is what people who use services should expect. People who use services: * Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld. What we found Our judgement The provider is compliant with Outcome 07: Safeguarding people who use services from abuse Our findings What people who use the service experienced and told us One person said she felt safe in the home. Other evidence The home has had one safeguarding event. The incident had been reported to the local safeguarding team. An investigation had been completed and the appropriate action taken. A protection of vulnerable adults' policy and whistle blowing policies are in place. We saw the home had followed their guidance when investigating and managing the above identified safeguarding event. All new staff to the home have had induction training's which include safeguarding of vulnerable adults. We were told that the home has an in-house trainer who does most of the training; although training can also be accessed through Buckinghamshire Safeguarding of Vulnerable Adults team. The in-house trainer has completed the 'train the trainer' course and has basic Safeguarding of Vulnerable Adults training. Training records showed that staff had attended yearly updates. Our judgement People felt supported and well cared for. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Page 11 of 18

12 Outcome 08: Cleanliness and infection control What the outcome says Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance. What we found Our judgement There are minor concerns with Outcome 08: Cleanliness and infection control Our findings What people who use the service experienced and told us One person said the cleaners were very good and confirmed that their room and the home were kept clean. Other evidence During the tour of the home we saw that it was clean and had been well maintained. The home's manager said that she was aware that some infection control practices required improvement, for example: staff wearing of gloves. We saw discussions of infection control practises had taken place relating to the cleaning of hoists and slings and had been communicated to staff through the staff meeting minutes dated the 17 April During the visit we observed one incident of poor practice during the lunch time observation session undertaken by the compliance inspector. This was raised immediately with the home's manager who investigated the concern. Discussions with staff confirmed that they had received six-monthly infection control training. Our judgement People were protected against the risk of infections by appropriate standards of cleanliness and hygiene, although some infection control practices had been identified as requiring improvement. Overall, we found that Lakeside was meeting this essential standard but, to maintain this, we have suggested that some improvements are made. Page 12 of 18

13 Outcome 16: Assessing and monitoring the quality of service provision What the outcome says This is what people who use services should expect. People who use services: * Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety. What we found Our judgement The provider is compliant with Outcome 16: Assessing and monitoring the quality of service provision Our findings What people who use the service experienced and told us People said they had been involved in making decisions about their care. Other evidence We saw evidence that people's personalised risk assessments had been audited by the home to inform future treatment and care plans. We saw that people had their care reviewed and changes had been made which were reflected within their care plans and care profiles. Additional audits carried out at the home include: 1. A six-monthly kitchen audit was undertaken by the manager in June 2011 which achieved a score of 95%. The action plan identified some areas for development. We saw that areas had been prioritised and that most actions had been completed. 2. Environmental Health Inspection on the 25 May 2011 identified three areas for action, all of which have been actioned and / or completed. The home achieved a five star rating for food hygiene. 3. A health & safety audit took place on the 18 May 2011 and the home achieved a 95% score. This audit was undertaken by an external person. 4. We saw that quarterly checks had taken place on boilers, emergency lights and nurse emergency call buttons. Staff and resident meetings had taken place, informing the home of issues and areas requiring further development. Page 13 of 18

14 Our judgement Systems were in place to assess quality of care to ensure it met people's support needs. On the basis of the evidence provided and the views of people using the service we found the service to be compliant with this outcome. Page 14 of 18

15 Action we have asked the provider to take Improvement actions The table below shows where improvements should be made so that the service provider maintains compliance with the essential standards of quality and safety. Regulated activity Regulation Outcome Accommodation for persons who require nursing or personal care Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 08: Cleanliness and infection control Why we have concerns: People were protected against the risk of infections by appropriate standards of cleanliness and hygiene, although some infection control practices had been identified as requiring improvement. Overall, we found that Lakeside was meeting this essential standard but, to maintain this, we have suggested that some improvements are made. Diagnostic and screening procedures Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 08: Cleanliness and infection control Why we have concerns: People were protected against the risk of infections by appropriate standards of cleanliness and hygiene, although some infection control practices had been identified as requiring improvement. Overall, we found that Lakeside was meeting this essential standard but, to maintain this, we have suggested that some improvements are made. Treatment of disease, disorder or injury Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 08: Cleanliness and infection control Why we have concerns: People were protected against the risk of infections by appropriate standards of cleanliness and hygiene, although some infection control practices had been Page 15 of 18

16 identified as requiring improvement. Overall, we found that Lakeside was meeting this essential standard but, to maintain this, we have suggested that some improvements are made. The provider must send CQC a report about how they are going to maintain compliance with these essential standards. This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent within 14 days of this report being received. CQC should be informed in writing when these improvement actions are complete. Page 16 of 18

17 What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people. Page 17 of 18

18 Information for the reader Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public / Copyright (2010) 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. Care Quality Commission Website Telephone address Postal address Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Page 18 of 18

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