Inspection Report June 2019
HEALTH & SOCIAL CARE REGISTRATION AND INSPECTION OF
PRIVATE NURSING AND RESIDENTIAL HOMES
The Registration and Inspection unit of Health & Social Care has a statutory responsibility to inspect private nursing and residential homes within the Bailiwick of Guernsey at least twice per year. The Registration and Inspection Officer undertakes a minimum of one announced and one unannounced inspection per year.
The inspections are undertaken in order to establish whether the care home is meeting the legal requirements i.e. The Nursing and Residential Homes (Guernsey) Law 1976 and the associated Ordinances, together with the agreed standards.
In reading the report the following factors should be borne in mind:
- The report is only accurate for the period when the home was inspected.
- Alterations to physical facilities or care practices may subsequently have occurred in the home.
- Feedback will have been given orally to the senior person on duty at the time of the visit.
- Both the Inspector and the Registered Home Owner/Care Manager of the home to which it refers will agree the report as an accurate report.
- The report will show the compliance with the regulations and standards and the required actions on behalf of the provider.
Name of establishment: The Connaught Care Home, Le Val, Alderney, GY9 3U
Name of registered provider: The Royal Connaught Residential Home Limited
Name of registered manager: Ms Elizabeth Bowskill (RGN)
CATEGORIES/NUMBER OF REGISTERED BEDS: 25
Date of most recent inspection visit:
Announced - 20/03/18
Unannounced - 03/10/18
Date of inspection upon which this report is based: 20/06/19
Category of inspection: Announced
Registration and Inspection Officer Children & Adult Safeguarding Nurse - Governance
Vanessa Penney and Liz Lees-Thackery
The Inspection findings relate to the Projet de Loi and its associated Ordinances. These are supported by the agreed Guernsey Standards for Care Homes as examples of 'Best Practice' and it is against these that form the basis of the inspection and its findings. The report follows the format of the Guernsey Standards and the numbering shown in the report corresponds to that of the Standards.
Identified below are areas addressed in the main body of the report, which are seen as health and safety, and/or good practice issues which the Registered Provider should consider for implementation.
Refer to standard
Gaps in some of the care records were observed. These were noted as a lack of information in risk assessments, especially the falls risk assessment. Care plans were not always reviewed within a 3-month period and there were gaps in some of the medication records where carers had not signed for the medication administered or applied the correct code. It is recommended that audit be increased to further develop these areas until the information has been transferred on to the new Fusion recordkeeping system which should address some of these areas in the care records.
Replacement of carpets needed in some of the residents' rooms due to staining and wear and tear
Ironing room (managing both Connaught & Jubilee laundry) requires attention to support infection control e.g. re-decoration and new flooring required
Consider the provision of an assisted bathroom in the bathroom on the Jubilee side of the home, which is no longer fit for purpose. Currently residents from the Jubilee use the assisted bath in the Connaught which restricts the times the residents at the Connaught can use this facility
STANDARD 1: INFORMATION
OUTCOME: The intended outcomes for the following set of standards are:
- Service users have the information they need to make an informed choice about where to live.
- Each service user has a guide to the facilities
- Each service user has a written contract/statement of purpose setting out the aims and objectives of the home.
- Each service user understands how to contact the Health Services Inspector and other local health and social services.
The Connaught care home is registered to provide residential care for up to 25 people, including for people who have dementia. When an enquiry is made a marketing brochure is provided to inform the enquirer of the team's philosophy of care, environment of the home and of the services offered. The information in the brochure is reviewed and updated annually so people can be confident that the information provided is current. A person is also directed to the home's website www.connaughtcare.org for further information and pictures that provide an indication of the social side of living in the home (consent obtained prior to use of pictures on the website or on the home's Facebook page). The information also provides guidance for the home help service and Jubilee extra care housing, which is also managed by the care manager of the Connaught.
When a person or their next of kin (NOK) visit the home to have a look around, a residents' guide and an admission sheet is offered, which provides people with the information that they need in order to make an informed decision for moving into either Jubilee extra care housing, or into the Connaught for long-term care or for a period of respite. The information is updated annually to reflect changes e.g. annual fee increase or changes to the Connaught Board. The information is clear to read and is easy to understand and can be provided in large print to aid a person with visual impairment.
The information provides the following; number of residents the home is registered for, Needs Assessment Panel (NAP) procedure, philosophy of care, aims and objectives of the home, terms and conditions of residency, a description of both residential accommodation and of the communal areas, fee structure; including additional items to be paid for by the individual resident e.g. telephone bill, chiropody, hairdressing and newspapers etc. The programme for the type of activities offered is also included. There is a list of the members of the Board and also a summary of the knowledge and experience of the care manager and the staff who work in the home.
Stated within the information is the provision for special dietary requirements. It is also acknowledged that whenever possible residents will be offered a choice in the gender of the person who will be assisting him/her with personal care as there may not be a male carer on duty on every shift if a gentleman has a preference. The policy for smoking, alcohol and for pets in the home is also discussed.
The procedure for making a complaint is discussed, to include information for contacting the Treasury Department at the States Department in Alderney or the registration & inspection officer from within Health & Social Care (HSC) in Guernsey, if this becomes necessary. The information also indicates that copies of the home's inspection reports are available for residents and visitors to the home to read. The report also includes feedback from some of the residents who live in the home, relatives and friends and visiting healthcare professionals.
STANDARD 2: CONTRACT
OUTCOME: Each service user has a written contract/statement of terms and conditions with the home.
On admission to the Connaught each resident is provided with a contract of agreement for accommodation and care. The contract includes the following information; the room the resident will occupy, financial arrangements; to include the arrangements for periods of absence due to a hospital admission or holiday period. There is information for liability for a breach of contract, resident's rights and obligations, trial periods, assessment and care planning, facilities, insurance, privacy and confidentiality, security of personal effects, complaints procedure and the procedure for termination of the agreement. Residents are required to pay for some additional services and items, which are not covered by the monthly fee, such as hairdresser, chiropody, newspapers or personal items and toiletries and dry cleaning etc. This is explained in the information provided (resident's guide and/or contract). The contract is reviewed and updated yearly to inform of changes to services and annual increase in fee.
The resident or relevant person (NOK)/advocate) and the designated signatory for the home sign the contract and both parties retain a copy of the signed agreement. The contract can also be provided in large print to meet the needs of a person with visual impairment.
STANDARD 3: NEEDS ASSESSMENT
OUTCOME: No service user moves into a home without having had his/her needs assessed and been assured that these will be met.
A community nurse or social worker assesses each resident to provide the necessary information to the NAP for the relevant certificate to be provided. To provide clearer information with how the process works through NAP, the care manager has introduced a flow chart. To take up accommodation at the Connaught, the person is required to have a residential care certificate; unless the person is funding their place privately (not claiming the Long Term Care Benefit). However, as there is no care home on the island that provides nursing care, other than the long term care facility within the Mignot Memorial Hospital (MMH), 4 residents at the home currently have a nursing certificate. Case meetings have been held with the social worker, NOK, care manager at the Connaught and nurse from the MMH to ensure the person continues to receive the level of care required. Further discussions are taking place for the home to become dual registered.
The care manager also assesses a potential resident prior to the person taking up accommodation within the home. This is to ensure that the care team are able to meet the care needs of the person and also the person's expectations of the home and/or those of their NOK (where appropriate). All residents are assessed using an adaptation form for the activities of daily living model and a care plan is developed using the information obtained in the assessment. Further information is also obtained from the resident, their NOK, resident's GP and from other allied health care professionals as relevant e.g. social worker, community nurse and MMH team etc.
Prospective residents and/or their NOK are encouraged to visit the home to have a look around, to enable an informed decision to be made, prior to finally agreeing to take up respite care or long-term accommodation in the home.
There have been occasions where a resident has moved in to the home prior to the NAP assessment e.g. emergency admission or transfer from the MMH. An assessment has then taken place following the transfer, to ensure that the home is the most appropriate environment for the person. This also involves a review by a social worker.
STANDARD 4: MEETING NEEDS
OUTCOME: Service users and their representatives know that the home they enter will meet their needs.
The Connaught provides residential care for people with physical needs and some psychological needs and also for residents with early stage dementia. A dependency tool is used to evaluate the dependency level of each resident and this is also used to calculate staffing levels and to plan and organise training sessions.
The team have limited access to resources, which they can call upon for additional support when required e.g. community nurses, social worker, pharmacist, dietician, infection control team and the tissue viability specialist nurse etc. It is acknowledged that some areas are more challenging due to most of the support services being based in Guernsey. However, some of the support services visit Alderney regularly and appointments at clinics for a person who is a resident at the Connaught can be organised if needed. The MMH also provides a support network; however, the level of support able to be given, depends on the workload at the MMH.
Carers have access to the internet for updating on best practice and for undertaking research on topics commonly associated with providing care for their client group. They are also aware that they can contact the registration & inspection officer for advice if required. Much of the training provided is undertaken in-house with the home's trainer. Individual employees also attend training sessions, which are often held in Guernsey at the Institute of Health and Social Care Studies (IHSCS) within HSC.
New employees are required to complete a period of induction, which includes orientation to the home, information regarding meeting the care needs of the individual residents and for the homes policies and procedures. The home trainer supervises all inductions.
STANDARD 5: TRIAL VISITS
OUTCOME: Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home.
The Connaught is the only residential home in Alderney. Being such a small community, many of the residents would have previously visited the home socially, for day care, or possibly have resided in the home for respite care and have got to know the staff, before they move in to the home for long-term care. A stay for respite care is very often offered as the trial period and this is flexible depending on the person's care needs.
The Connaught offers day care; this is to provide carers of prospective residents a well-deserved break and it also introduces people to the other residents and staff in the home. These people would probably need to move into the home on a more permanent basis in the future, as relatives become unable to manage their relative's care needs at home. Day care residents stay for lunch and tea and are also able to have the use of the bathing facilities if this is required. Some people from within the wider community also visit the home to join in with activity sessions with the residents, which continues to be popular.
An emergency admission is a rare occurrence as the home generally has full occupancy. However, the care manager also manages the home help service so would organise emergency respite at the Connaught, following an assessment, if there was a vacant bed at the time that it was needed e.g. if a package of care breaks down in the community or where there are unforeseen difficulties.
STANDARD 6: INTERMEDIATE CARE
OUTCOME: Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home.
Residents requiring rehabilitation have a support programme in place, however, due to limited support from the community nurses, physiotherapists and occupational therapists because of their workload, the team are cautious when accepting persons for this type of care. Therefore a person would generally be admitted to the MMH if rehabilitation were required. If a person does not require further acute care but is not quite ready to return home, the person may transfer to the Connaught initially and as their condition improves, then transfer to Jubilee to encourage and offer support for more independent living, before the person finally transfers back to their home. This worked well while the home was not at full occupancy but occurs less frequently now due to the continued full occupancy with a waiting list.
STANDARD 7: SERVICE USER PLAN
OUTCOME: Service user's health and social care needs are set out in an individual plan of care.
Prior to admission, a prospective resident completes a questionnaire titled 'Things I can do for myself'. An initial assessment is undertaken and a care plan is developed incorporating this information. For a resident who has dementia there is a care support plan for mental health & wellbeing and a 'My Life Story' document, which is used to make person-centred care more meaningful.
On examination of some of the care plans, the information available and the quality of recordkeeping varied. Some files had comprehensive assessments of care and risk, care passports and health monitoring. Others had clear gaps in information and documents that needed updating and signing. This was discussed with the care manager at the time. The imminent implementation of Fusion electronic recordkeeping system will hopefully improve the quality of recordkeeping in these areas. In particular it was felt that the falls risk assessment and documentation could be improved.
A formal review of each resident's care plan should be undertaken at least 3-monthly. It was noted that there were gaps in some records where this has been overlooked, whereas in other care plans changes to elements of care and treatment had been made at the time of the change, which is good practice. A carer said changes are discussed with the team at handover and are also recorded in the diary to make staff aware that they need to refer to the care plan for the changes. The senior carer must therefore ensure that the care plans provide the most up-to-date information.
Prior to reviewing the care plan, risk assessments are also reviewed e.g. Braden score for skin integrity, bedrail assessments, moving and handling assessments, nutritional assessment and also a safeguard risk assessment. The home's policy is that all residents are weighed monthly, unless it becomes necessary to weigh a person more frequently if their nutritional status gives a cause for concern. On examination of the weight charts, not all residents are weighed monthly. A carer said some residents refuse to be weighed. It is recommended that where a resident refuses to be weighed this is documented. The care manager should then be informed so that she can review the person's weight gain/loss and can organise the necessary action.
Each shift completes an entry on every resident's care delivery sheet to demonstrate the care that a resident has been supported with on that shift, or observations noted. Staff receive a verbal handover on the changeover of each shift (confirmed by a senior carer & a carer).
A contents page at the front of each resident's care record has made it more user-friendly and is easier to locate individual elements of the care records; however, with the care manager also managing the Home Help Service and the Jubilee extra care service, the filing system did not make it easy to locate the files of the residents at the Connaught.
STANDARD 8: HEALTH AND PERSONAL CARE
OUTCOME: Service user's health care needs are fully met.
All examinations and consultations are undertaken in the resident's room. Results from appointments and treatments are recorded in the resident's care plan and are actioned accordingly. A tissue viability risk assessment is undertaken for each person using the Braden scoring system and advice is sought from other healthcare professionals as required.
There is one resident in the home with a pressure injury. On further exploration, the person was admitted to the home from the community with the pressure injury. A referral was made immediately to the community nurses and they are visiting to support the carers with the management of the pressure injury. A skin bundle is in place and all of the senior carers and some of the carers have undertaken training in how to use it. The resident also has the appropriate pressure relieving equipment in place. The care manager said she has introduced an algorithm for reporting where a community nurse is unable to provide support to the team at the Connaught. This is to enable her communicate with the relevant people where there is a gap in service provision so that this can be resolved. Within the safeguard training level 1, examples of pressure damage are also used for training purposes. This is to provide guidance to the carers as to the early identification of where pressure damage could develop and the importance of early intervention from the appropriate healthcare professional.
Residents are encouraged and supported to manage their own healthcare if they are able to. However, carers provide assistance where needed with meal supervision, mobility, personal hygiene, social inclusion and for decision-making etc. Two residents are insulin dependent diabetics. One resident is able to manage her own requirements, which is overseen by the care team and the other resident requires assistance by the care team. Both residents' blood sugars are stable. A person who is insulin diabetic attends the diabetic clinic 6-monthy for a review.
There is a clear pathway for emergencies and routine medical needs. Appointments and home visits are organised by the care manager, for residents who are not able to do this for him/herself and have no NOK to organise this e.g. GP, clinic appointments at the MMH, dentist, optician, social worker and advocate. If necessary, transport is also organised and a carer accompanies a resident to their appointment. This poses a challenge if the appointment is in Guernsey as most residents have limited mobility and getting in and out of the plane is difficult. The care manager said she makes every effort to try and organise appointments in Alderney, if possible and liaises with the MMH when visiting specialists are holding clinics there.
Residents who were spoken to provided very positive feedback in relation to the standard of care they receive. One resident offered that she has travelled and lived in many parts of the world and this is a good place to be. She said she had previously been living independently and accepted that she could no longer live alone and had settled in quickly and is happy.
STANDARD 9: MEDICATION
OUTCOME: Service users where appropriate, are responsible for their own medication, and are protected by the home's policies and procedures for dealing with medicines.
The Connaught uses the NOMAD system for the administration of medication. A community pharmacist in Alderney dispenses the resident's medication into the cassettes and this is administered at the correct times by a senior carer. All carers who administer medication have undertaken training with the community pharmacist and are required to work through a workbook to obtain competence to pass (updates as advised by pharmacist). Following the initial training, each carer has an annual competency assessment for medication management and administration. The care manager also undertakes a competency assessment with individual carers whenever there is a medication error to highlight areas where further training is required, or to review the current system, policy or procedure, to minimise the risk of a recurrence and the lessons learned. The senior carers who administer medication to residents wear a 'Do Not Disturb Administering Medication' tabard when undertaking this task. This is a further precaution against unnecessary disturbances at these times, which could contribute to a medication error, which is an excellent initiative. Carers and housekeeping staff also undertake basic training for medication management. The Care Manager said it is important for these staff to have some training so that they are able to report concerns e.g. medication found in a resident's room etc.
Each resident has a medication administration record (MAR) which displays the resident's name, date of birth, GP and known allergies. Of the MARs examined there were some gaps noted where staff have not signed or entered a code in the box on this monthly medication cycle. This was brought to the care manager's attention so that she can identify where further training is required with individual carers. It was acknowledged that the audit at the end of the month would highlight this so action would be taken.
There is provision in place for residents who wish to self-medicate e.g. a safe is provided in each resident's room for the safe storage of their medication. Residents have a risk assessment completed to indicate that they are safe to self-medicate and wish to undertake the responsibility for this aspect of their care (no resident currently self-medicating).
The trolley containing medication is kept locked and is chained to the wall in a locked office and the senior carer on each shift carries the keys for this. Controlled drugs are stored in a locked cupboard and are administered and are signed for by 2 members of staff, which is best practice and should continue to be maintained in the future. The senior carers have access to an up-to-date British National Formulary (BNF) to look up medication when required.
There are policies and procedures for receiving medication into the home, recording, storage, handling, administration, disposal of medication, self-medication, home remedies and for managing errors with medication (dispensing and administration). The senior carers are aware that an error in the process of dispensing or administering medication must be recorded in the resident's notes and in the accident/incident book. The resident's GP also needs to be informed so that advice can be given for the necessary action to be taken and the registration and inspection officer must also be informed (has done so previously).
A resident's GP is encouraged to undertake a 3-6 monthly medication review (reviews remain problematic and are mainly instigated by the care manager or senior carers). When a person is unwell, the care manager or senior carer on duty request that a full review of the person's medication is carried out at the time, so some people's medication is reviewed more frequently than others. Carers also undertake training for when to call out a GP and there is documented guidance to assist with the decision-making.
All residents are offered an annual flu vaccination and this is recorded in the resident's care record. Staff are also encouraged to have a vaccination at the GP surgery.
The deputy chief pharmacist from within HSC undertook a pharmacy inspection in September 2018. Recommendations made were actioned immediately.
STANDARD 10: PRIVACY AND DIGNITY
OUTCOME: Service users are treated with respect and their right to privacy is upheld.
All residents' rooms at the home are single en-suite rooms where residents can receive consultations, examinations, visits by their hairdresser or their visitors and all rooms have a lock on the door. Residents are able to have a telephone in their room for which the person is responsible for their own telephone bills. All residents wear and choose their own clothing, which is mostly labelled, which assists staff if searching for the odd mislaid item. Residents who were spoken to said the laundry service is very good; permanent loss of, or damage to an item of clothing continues to be rare.
Carers do not generally open a resident's mail; if a resident is unable to manage their own mail, this is forwarded to their NOK. Occasionally a resident's NOK may ask for the carer to open a piece of mail if it is a resident's birthday or if waiting for an appointment.
Staff address residents by the resident's preferred choice of name (confirmed by residents) and this is documented in the resident's care plan. Staff always knock on a resident's door and wait for a reply before entering (observed and confirmed by residents). During the day carers were observed assisting residents where a person required support and they did not appear to rush residents. Residents spoken to said all of the staff are very kind and caring; one resident said "They go out of their way to make sure we are well looked after and are comfortable", another resident said "Lovely people all of them. Nothing is ever too much trouble, I am really happy here".
Staff are provided with information for maintaining confidentiality of resident information on the day that they commence employment in the home (included in induction), are reminded periodically at both formal and informal discussions, at staff meetings and during in-house training sessions.
All staff have access to policies and procedures for adult protection and for privacy and dignity.
STANDARD 11: DYING AND DEATH
OUTCOME: Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect.
The Connaught has a policy that a resident who requires end of life care is cared for in the home for as long as possible, with community nurse support provided as required, rather than transferring a resident to the MMH. This is to prevent the resident from being transferred into unfamiliar surroundings, demonstrating empathy with the resident and their family at such difficult times. The care manager organises for the necessary equipment to be provided to the home during this period; ensuring that the resident has adequate pain relief, nutritional support and comfort etc.
Relatives who wish to sit with their relative are made as comfortable as possible and are offered meals and refreshments (if the home had a vacant room a relative would be offered this so they can remain in the home close by overnight). Staff endeavour to cater for both the needs of the resident and their family at this difficult time. There are policies in place for end of life care; including a person-centred end of life pathway and also for resuscitation. Carers also undertake training with the in-house trainer for end of life care. The trainer and care manager also hold debriefing sessions for staff as a group or on a one-to-one as needed.
STANDARD 12: SOCIAL CONTACTS AND ACTIVITIES
OUTCOME: Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs.
There is an activity co-ordinator within the team and 5 volunteer helpers. Thirty five hours plus, of activity and social engagement is offered each week. The activity co-ordinator attends a monthly meeting with other activity co-ordinators from Guernsey as a way of support for each other through sharing ideas and reflection on practice. This enables her to continue to keep residents motivated by the introduction of new activities so that the activities do not become too repetitive. There are photo boards throughout the home for people to see and these are regularly updated.
There is an excellent programme of social and recreational activities and each resident has an activity timetable if wanted (developed by the individual resident or their NOK). Activities offered are; armchair Yoga, flower arranging, church service, gardening club, sing-along, arts and crafts, baking and there is a visiting hairdresser. There are card games held at the home twice a week and a Bridge group meet at the home every Monday. There is also a big screen and a projector so that residents can enjoy movie sessions. Interestingly outside of the lounge there is an 'old' large dolls house, which continues to stimulate interest with individual residents as they walk about the home. The home has an organ, which can be played by residents, relatives or the staff to entertain everyone and the Healing Music Trust visit the home several times per year for a social session of singing and music, which residents really enjoy and look forward to.
On the day of inspection various activities were observed to be taking place throughout the day, which included both group and one-to-one activities and also with some residents who were in the garden as it was a lovely day. Residents who were spoken to said the activities are enjoyable and there is always something taking place each day. Two residents spoken to said they didn't take part in activities preferring to do their own past times in their room, or go on outings with family and friends, which is respected.
There are 2 small buses to take residents out for a drive and there is also access to the Age Concern minibus for residents who like to go to church on a Sunday and for transportation to meetings and for general excursions. An island drive is offered twice per week, which everyone enjoys.
Support is also offered to residents to enable them to undertake activities away from the home e.g. independent outings or for holidays off island for residents who are still able to manage this activity. Some residents go out to cinema evenings, afternoon tea parties, pub quizzes, art club and whist drives.
One-to-one activities are also organised specifically for residents who have dementia. The activity team take individual residents out for a walk, drive, sit and read, play scrabble, or chat to a person. A Tovetafel is now up and running. This is an interactive game for people with cognitive challenges. The games are easily accessible as they are projected on to a table top. It uses light, colour and sound to help with communication and social stimulation. The care manager said this has been an excellent introduction as residents really enjoy using it and it also encourages interaction between residents, carers and relatives.
The garden is secure and provides areas of interest throughout for all residents. There is a greenhouse and raised garden beds where residents grow produce and flowers. There is an area with a small boat, signposting and there are various seating areas with colourful shrubs and flowers.
Residents who have dementia also have the opportunity to visit a playgroup frequently to interact with the children. Residents and the children really enjoying this session so the care manager is hoping to keep this going with other residents in the future.
Residents have a flexible daily living routine and are able to get up and go to bed when it suits them (confirmed by residents). Residents are able to take part in the day-to-day work activities of the home if they want/able to e.g. potter around the garden, water the plants and can also help with small tasks such as collecting dishes. Within the kitchen adjacent to the dining rooms residents are able to make their own drinks (independently or with supervision as required).
STANDARD 13: COMMUNITY CONTACT
OUTCOME: Service users maintain contact with family/friends/ representatives and the local community as they wish.
There is opportunity for residents to receive visitors in their own room and there is an open visiting policy, although visitors are encouraged not to visit at mealtime unless they are having a meal with their relative, as a mark of respect to the other residents in the home. Relatives and friends are able to book to have a meal in the home for a small charge. There is a visitors' book in place for all visitors to the home to sign in and out.
The care team actively encourage members of the outside community into the home where it is viewed as a place for social events such as at the regular Bridge club meetings and fairs. Residents attend networks outside of the home e.g. Age Concern and Hard of Hearing meetings. There is also good charity involvement to support the home, residents and staff. In the summer an ice cream van visits the home frequently. Music associated with the arrival of the ice cream van provide reminiscence from when they were younger and the ice cream vans visited their street. Residents also have frequent outings to the cinema and for meals outside of the home to a restaurant, café or church hall.
Residents that were spoken to said they have freedom to come and go, as they wanted (if safe and able to do so). They are asked to inform a member of staff when they are going out and when they return, for fire and personal safety reasons and they felt this was a sensible request that did not restrict their freedom.
A newsletter is produced bi-monthly for residents, relatives and staff to read and this newsletter is also available on the home's website. The home has twinned with Milly's Village in Romania so one month the newsletter provides news about the Connaught and the following month about Milly's Village, which provides much discussion amongst the staff , residents and their relatives.
STANDARD 14: AUTONOMY AND CHOICE
OUTCOME: Service users are helped to exercise choice and control over their lives.
The care manager encourages residents to bring in small items to personalise their room; pictures, photographs and ornaments etc. Each resident has access to a secure lockable safe in their room for personal items/medication if they require it. There is also a safe in the care manager's office for the safekeeping of small amounts of money/valuables for residents who are unable to manage their own money (hairdresser, chiropodist and money for outings) and only the care manager and the office manager have access.
Residents are encouraged to manage their own finances or if this is not possible, the person's NOK or representative would do this. If a resident required access to an advocate, the care manager would organise through liaison with the person's social worker and has done so previously.
Residents who were spoken to said that they are able to do what they want to do each day, there were no strict rules in place as far as they were aware. Several residents discussed outings with family, friends and the activity team.
All staff have access to policies and procedures for adult protection, the safekeeping of valuables and for guardianship orders.
STANDARD 15: MEALS AND MEALTIMES
OUTCOME: Service users receive a wholesome, appealing, balanced diet in pleasing surroundings at times convenient to them.
The menus are varied, planned on a 4-week rotation and are reviewed regularly to include changes from residents' feedback. The daily menu consists of a minimum of two choices for each meal, however an alternative is provided for any resident if the main meals are something that they dislike; although this is unusual as likes and dislikes are recorded in the assessment documentation on admission and the chef has a copy. Residents' are asked for their choices for lunch and supper each morning for that day. The chef is able to prepare for special requests as necessary e.g. diabetic, gluten free, soft diet or food intolerances etc. To aid people with dementia, there are pictures of the meals for the day to assist them to make their choices.
Residents are encouraged to have both their lunch and supper in the dining room, with the residents joining them from the Jubilee extra care housing, which is linked to the Connaught through an interior link corridor. However, should a resident prefer to eat in their room, this is honoured and was also observed on the day of inspection. Residents' are able to invite friends or relatives to the home to join them for a meal if they wish. The chef who was spoken to said he will try and do whatever a resident fancies, if it is possible. He said he also creates menus to reflect certain events throughout the year such as Valentine's Day and St Patrick's Day etc.
The dining room in the Connaught is bright and spacious and is decorated to reflect homeliness and there is a lovely view out over the sea. The tables were nicely set; having a table pleasantly laid contributes to the ambience, making mealtimes into "an event," something for the residents to look forward to during their day.
All residents have their weight documented but not always regularly. More frequent monitoring would give early indication of weight gain/loss so that prompt action can be taken before it gives cause for concern in relation to a person's health & well-being. The graph on the electronic recordkeeping system will make it easy to identify concerns once it is in place. If there is a concern regarding a resident's nutritional intake, this is recorded in the resident's file, a person's weight is monitored more regularly and a food diary and/or a fluid chart is put in place if this is necessary (2 food and fluid charts observed in residents' rooms and were being completed at meal times or following a drink). Residents who often refuse their meals are offered food supplements (observed prescribed on MAR) or a lighter snack. The chef prepares high calorie meals for a resident who requires this type of dish. Staff support residents who require assistance or supervision with their meals and mealtimes are relaxed and supported to be a social occasion for resident and staff interaction.
If people request a snack in-between a meal or during the night, they are offered biscuits, sandwiches, soup, cereal, yoghurt or fruit etc. Residents said that there are regular hot and cold drinks and snacks offered throughout the day and during the evenings, in between meals. It was also observed that residents have a jug of water or juice in their room to help themselves to. When a resident asked a carer for a cold drink this was provided immediately without any hesitation.
Residents that were spoken to said the food at the home is very good, there is always a choice and the meals are well-presented and inviting. Residents raised no complaints with any element of the catering service. Comments offered were, "Good choice and lovely food, I have no complaints", "We can have what we want really, the chef will always do it for you if he has it available and even if he doesn't, he will offer it to you for the following day to give him time to get it and prepare it", "I love the food and keep putting on weight as I can't say no".
The main kitchen where the food is prepared and cooked is based in the Jubilee side of the home. The food is then transferred to the serving kitchen adjacent to the dining room in the Connaught home via the link corridor in a hot trolley. The kitchen and food preparation and serving areas in both sides of the home were spotlessly clean and are kept very tidy. The chef has a City and Guilds certificate for food hygiene training and this is up to date. An environmental health officer undertook a food hygiene inspection in June 2018 and the home retained their 5 star rating, which is excellent.
STANDARD 16: COMPLAINTS
OUTCOME: Service users and their relatives are confident that their complaints will be listened to, taken seriously and acted upon.
There is a written procedure for making a complaint and this is also discussed in the residents' guide. Each resident is provided with a copy when they move into the home. The complaints procedure identifies who will manage the complaint and includes a timescale. There is also a form to be completed to demonstrate that the complaint has been logged with the care manager (member of the Board in the absence of care manager).
There is written information for referring a complaint to a States representative in Alderney or to the registration and inspection officer from within HSC in Guernsey if the management of the home cannot resolve the complaint.
The care manager has responsibility for investigating and actioning complaints (Board member in care manager's absence). The complaints are mainly little 'niggles' that occur within a group living environment and are generally able to be addressed immediately. Records of formal complaints, action taken and correspondence are retained by the care manager and are reported to the registration and inspection officer from within HSC in Guernsey (has done so previously).
Residents who were spoken to said the care manager is very approachable and they felt comfortable to make a complaint if the need arose. They felt confident that their complaint would be listened to, taken seriously and would be actioned appropriately.
STANDARD 17: RIGHTS
OUTCOME: Service user's legal rights are protected.
Residents are able to access an advocate's service if necessary and can participate in any local political processes. A voting process is currently in progress and the care manager is organising for individual residents to be accompanied (where relevant) by a member of staff to enable them to place their vote.
Residents' medical records are kept locked away in the carers' office when a carer is not present, ensuring that confidentiality is maintained.
All staff have access to policies and procedures for adult protection and staff are aware of data protection and for maintaining confidentiality within the home. This also forms part of the staff induction programme.
STANDARD 18: PROTECTION
OUTCOME: Service users are protected from abuse.
Staff are required to read the home's policies and are provided with a copy which includes a statement that staff should not accept gifts or money from a resident or their NOK. All gifts offered should be reported to the care manager so that she can take the appropriate action.
There is a policy for adult protection and carers that were spoken to are aware of the process for raising concerns (to the Board in the absence of the care manager) and of the process for whistle-blowing and have undertaken training.
When recruiting new members of staff (usually local and known to the community), DBS checks are requested for all staff. Enhanced for the care manager and carers and a basic check for activity co-ordinator, catering, housekeeping and administrative staff. Two written references are taken up prior to a person being confirmed in post.
The care manager and the Board are aware that they must report an allegation of abuse that is made to them, or if they have a concern, to the registration and inspection officer and to the safeguard lead from within HSC in Guernsey and have done so previously.
STANDARD 19: PREMISES
OUTCOME: Service users live in a safe, well- maintained environment.
The Connaught is a purpose-built care home, which was registered in July 2011 providing residential care for the people of Alderney. The home provides en-suite rooms for 25 residents and the fittings and furnishings are homely, comfortable, non-institutional and are suitable for the client group. The doorways to residents' rooms and the communal areas are wide enough for wheelchair access. Since the previous inspection, the carpet has been replaced in the residents' lounge and the carpet in the ground floor corridor has been replaced with a hard floor covering for ease of cleaning in a 'high traffic' area. Re-decoration of several areas in the home has taken place since the previous inspection and this is ongoing.
There is a passenger lift which services both floors. There are plans in the future business plan to replace the lift with a larger passenger lift, which would accommodate a stretcher and would go to the top of the home where there is a large storage area. This will enable larger pieces of equipment to be stored in this area. Also for the administration office to be moved up to the top floor to create more communal rooms.
The corridors are spacious to enable residents to move around with a walking aid or if using a wheelchair. The inside of the building provides a safe environment for the residents to move around in and there are clear signs around the home for orientation to different rooms/areas e.g. toilets, bathrooms, fire exits, care manager office.
The garden has a level pathway all around the home and the garden is colourful with shrubs, flowers and lawn areas on the raised part of the garden, which is accessible via steps with a handrail. The home also provides care for people with early stage dementia and therefore additional measures have been put in place to ensure residents are able to walk around the garden without wandering away from the home. If a resident who has dementia is out in the garden, a carer is always close by (observing discreetly if necessary). The car park and walkway leading up to the home provides an even surface for people with reduced mobility that may require a walking aid etc. The gate in to the garden at the main entrance is kept locked to prevent a person from wandering away from the home unsupervised. Entry is via keypad access.
The link corridor between the Jubilee and the Connaught provides a variant grade incline and could be a potential falls risk. Unfortunately, with the nature of linking the 2 homes, it was not possible to do this any other way. The corridor is used frequently by both residents and staff throughout the day. A new handrail has been installed the full length of the corridor and there is a notice on display at both ends of the corridor to warn all persons of the sloping floor before they enter the corridor and all residents are informed of this area when they first move in to the home (no accidents in this area since the home opened).
Plans are currently being developed for an extension to the home for up to 13 beds as the home continues to operate at full capacity with a waiting list and there is no other residential care home on the island.
STANDARD 20: SHARED FACILITIES
OUTCOME: Service users have access to safe and comfortable indoor and outdoor communal facilities.
The residents and staff are aware of the smoking legislation; therefore residents and staff are permitted to smoke outside of the building only in a designated smoking area. The garden outside provides a secure environment for residents to walk around, there were no trip hazards noted and there are handrails appropriately installed and various seating areas for residents to enjoy. There is a resident's notice board to keep residents informed of articles of interest and there are photo boards along the corridors, of the activities residents enjoy.
The furnishings in the home are non-institutional and are homely and the home is kept free from unnecessary clutter; all fire exits had clear access.
STANDARD 21: LAVATORIES AND WASHING FACILITIES
OUTCOME: Service users have sufficient and suitable lavatories and washing facilities.
All residents' rooms are en-suite and there are also communal toilets and washing facilities throughout the home on both floors. There is clear signage on the doors to indicate these facilities. Each facility has equipment to support infection control. There is also a call bell and a lock on the door, which staff are able to access from the outside in an emergency. The toilets do not have a window but there is an extraction fan system. There are appropriately fitted grab rails in place in these facilities; bright lighting and the toilets are fairly spacious to enable wheelchair manoeuvrability. The housekeeping supervisor works with a team of housekeeping assistants and together they keep the home very clean and fresh.
STANDARD 22: ADAPTATIONS AND EQUIPMENT
OUTCOME: Service users have the specialist equipment they require to maximise independence.
Key findings/ Evidence:
The Connaught has been designed with the specialist equipment that is necessary to encourage independence; a level entry shower has been fitted in all of the en-suite rooms and there are grab rails appropriately installed. There is easy access to both floors via the stairs or a passenger lift and areas/rooms are clearly signposted. Doorways to resident rooms have good access for wheelchairs and the home also has a portable passive hoist and 2 active hoists (Sara Steady & Sara 3000).
The Connaught has a range of equipment available for their residents; demonstrating their commitment to supporting residents' needs. There is 1 assisted bath; however, it was noted that some residents in the Jubilee also now require an assisted bath and go over to the Connaught to use their assisted bath. This limits accessibility for residents and staff in the Connaught and has caused some issues. It was observed that there is a bathroom in the Jubilee that is rarely used as residents are unable to climb in and out of the bath. Consideration should be given to adapting this bathroom into an assisted bath facility, which will resolve this issue.
Pressure relieving equipment such as mattresses and cushions are also available for pressure relief for a resident whose skin integrity is at risk. All residents have an electronically operated profile bed with bed rails (risk assessment in place if bedrail used - 4 residents currently using and have assessment in place). The beds are wooden effect and therefore do not look institutional. If a resident does not require a profile bed and would prefer to have a different type e.g. divan, this is put in place if appropriate.
There are raised toilet seats, adapted crockery and cutlery to facilitate independence and a Zimmer type frame with integral seat which can be used if the resident needs to sit down suddenly, which is excellent. Sensor mats are available for a resident who is at risk of falling, which alerts a member of staff as soon as the person stands up so that a carer can go to the resident to assist the person immediately to minimise the risk of a fall (1 currently in place).
There is a call bell in each facility and interestingly there is a system where a resident can press a button both inside and outside of many of the communal rooms and in their own room, which will open and shut the door for a person who is unable to do this manually, which is excellent.
Advice can always be sought from the community nurses in Alderney, or from other healthcare professionals from within HSC if required. The care team also have limited access to a physiotherapist from Guernsey at MMH for advice and referrals if needed.
STANDARD 23: INDIVIDUAL ACCOMMODATION - SPACE REQUIREMENTS
OUTCOME: Service users own rooms suit their needs.
All residents' rooms are in excess of 14m2 and are single occupancy. The en-suites provide sufficient space for a person to move around in a wheelchair and there is a level entry shower. There is access to both sides of the bed and sufficient room to move around the room with a walking aid. The rooms on the ground floor also have the benefit of a small patio area outside where some have a small table and chairs set up for residents to enjoy the garden in the finer weather. The carpets in some of the residents' rooms require replacing; despite regular carpet cleaning they remain stained (discussed with care manager on day of inspection).
STANDARD 24: FURNITURE AND FITTINGS
OUTCOME: Service users live in safe, comfortable bedrooms with their own possessions around them.
All rooms in the home are en-suite. There is a built in wardrobe, dressing table/desk, bookcase, soft winged armchair and foot stool, visitor's chair, an occasional table, bedside table with drawers, a profile bed with a pressure mattress and a wall mounted television. All rooms also have under floor heating and natural light and ventilation. There is a call bell, telephone point and a computer outlet in each room and all ground floor rooms have access out into the garden. All lighting for the room and en-suite can be turned on and off from the bedside and there is a button both on the inside and outside of each room that can be pressed to open and close the doors as an alternative to using the door handle if a resident has difficulty with this, which is excellent.
The fittings, furnishings and décor are suitable for the client group and residents' are encouraged to bring in personal possessions in order to personalise their room. Rooms that were visited reflected the person's personality, hobbies and interests. There are occasions when a person is required to transfer rooms. For example, if a person occupies an upstairs room and requires a room on the ground floor as the person requires a higher level of supervision or observation, or their mobility has deteriorated. The care manager said the room is set out the same as their previous room to minimise the risk of a person becoming too unsettled, which is a good initiative.
Residents' are able to lock their room; however the type of lock installed enables staff to gain access from the outside in an emergency. Each room has a safe for residents' to store medication for those residents' who have been risk assessed as safe to self-medicate, or to store money and other valuable possessions or documents.
All rooms have a light clean each day with a deep clean once per week (unless required before this time) and the rooms were odour free. Bed linen and towels etc are changed at least weekly; however, generally they are changed as often as required, with some being changed daily.
Residents who were spoken to are satisfied with the cleanliness of their room and once again said that the staff are very respectful of their personal belongings.
STANDARD 25: SERVICES - HEATING AND LIGHTING
OUTCOME: Service users live in safe, comfortable surroundings.
Under floor heating has been installed throughout the home and there is adequate lighting to enable residents to undertake activities at various times of the day and during the evening. Emergency lighting is in place throughout the home and there is sufficient outdoor lighting around the home's grounds.
The temperature of the water in areas where residents have access is regulated at 43˚C in line with current care home regulations to prevent a person from sustaining a scald from excessively hot water. A system has been put in place for the control of Legionella and the office manager has undertaken training for this as she manages the contractors who undertake work in the home (further guidance for the management of Legionella can be sought by contacting the Health & Safety Executive in Guernsey if needed). The housekeeping supervisor also oversees the work necessary for the continuous management of Legionella in-house e.g. regular cleaning of shower heads and flushing through of taps that are not used regularly in some areas.
STANDARD 26: HYGIENE & CONTROL OF INFECTION
OUTCOME: The home is clean, pleasant and hygienic.
The home is clean and tidy throughout and the furniture and furnishings are suitable for the client group. As discussed previously in this report the carpet has been replaced in the communal lounge and 'hard' flooring has replaced the carpet in the corridor on the ground floor.
There is a sluicing facility on both floors and these are equipped to aid infection control. Alcohol hand rub, gloves and aprons are also available in several areas all around the home for staff and visitors to use, which is good practice.
All bathrooms and toilets have non-slip impermeable flooring and equipment available to aid infection control. The laundry, which is in the Jubilee (through the link corridor) has been totally revamped since the previous inspection and provides a much more workable area with the necessary measures in place to support infection control in the home. It was noted however, that the separate ironing room is in a poor state of repair and requires new flooring and re-decorating, which was discussed with the care manager on the day of inspection.
Clinical waste is stored securely outside while awaiting weekly collection for disposal. The National Colour Code for cleaning products has been installed for monitoring chemical dispensing (please ensure the housekeeping cupboard where cleaning products are stored is kept locked at all times when unsupervised).
The senior housekeeper has responsibility for overseeing the work of the housekeeping assistants and for reporting concerns to the care manager. The senior housekeeper attends a Head of Departments meeting every 6 weeks and also undertakes a monthly infection control audit within the home.
An infection control specialist nurse from within HSC undertook an infection control audit in April 2018 where a score of 100% was achieved, which is excellent and demonstrates that the team have a very good understanding of infection control within a care home environment.
All staff have access to policies and procedures for infection control as well as a copy of the HSC guidelines and all staff undertook refresher training for infection control in 2017/2018 (ongoing to ensure all staff complete 2-yearly).
STANDARD 27: STAFF COMPLEMENT
OUTCOME: Service user's needs are met by the numbers and skill mix of staff.
The Connaught can accommodate 25 residents and the home is currently at full occupancy. From examining the duty rota for the 4-week period prior to inspection, the staffing hours appear satisfactory for the number of residents and their current level of dependency. The care manager is a Registered General Nurse (RGN) and is on duty mainly office hours from Monday to Friday. However she said that this is flexible according to the needs of the residents and staff and she generally always visits the home at the weekend and is on-call. During a morning, afternoon and evening shift there is 1 senior carer and 4 carers on duty (2 senior carers on shift 2-3 days per week due to the increased workload for senior carers e.g. updating documentation and undertaking reviews for residents etc). Overnight there are 2 carers on duty. However, the sleep-in carer who is based in the sheltered accommodation overnight, works from 8-10pm in the evening on the Connaught side of the home and also from 6am-8am to assist the night staff at their busier times. The monthly dependency score for the residents also provides guidance for staffing levels and additional staff are also rostered on duty for some outings (as needed). The home is split up in to zones to try and further facilitate person-centred care and communication and this appears to be working well. There is also a dedicated trainer in the team. She works 5 days per week and undertakes occasional working 'on the floor' for supervision and additional training with individual carers.
On the day of inspection the residents appeared happy and relaxed and staff were observed to be assisting residents without rushing them; including undertaking activities with individuals. Call bells were answered promptly and residents who were spoken to said they did not have to wait for long periods at any time of the day or overnight, for assistance when they rang their call bell. The care manager said the staffing level is constantly under review and this is increased as necessary to ensure the residents' care needs are being met.
Housekeeping, catering, maintenance, activity and administration staff also provide support to the care team.
STANDARD 28: QUALIFICATIONS
OUTCOME: Service users are in safe hands at all times.
The care manager is a RGN and is also a VQ assessor. The trainer is a candidate assessor currently undertaking the VQ award. Eight carers are currently undertaking the VQ award at level 3. One carer within the team is an Ambulance Technician.
The trainer has undertaken training as a facilitator for the Stirling University course for dementia care and 4 carers have now completed this training.
STANDARD 29: RECRUITMENT
OUTCOME: Service users are protected by the home's recruitment policy and practices.
When recruiting new members of staff an enhanced police check (DBS) is undertaken for all care staff; a basic check for all other staff. Two written references are taken up before an applicant is confirmed in post. Gaps in employment are explored with the applicant and a prospective employee is questioned regarding their general health. Once a person commences employment at the home the care manager and the office manager develop a personal file for the employee, which is added to as necessary throughout the person's employment at the home. During induction a new employee is required to read relevant policies and procedures and to sign each policy to say they have read it and understand it (supported by the home's trainer and/or allocated supervisor).
All staff have access to policies and procedures at all times for; health and safety, dealing with fire and emergencies, whistle-blowing, adult protection and non-receipt of gifts or witnessing legal documentation e.g. Will.
STANDARD 30: STAFF TRAINING
OUTCOME: Staff are trained and competent to do their jobs.
The trainer provides most of the training and supervision in-house. More formal training is undertaken by trainers outside of the company as needed. All staff are supervised through an induction programme. Once the person has acquired the necessary knowledge and skill and has developed confidence in their practice, the trainer signs off the programme and the person would no longer need to work under continuous direct supervision. However, the trainer continues to monitor the person's progress and provides supervision as needed, as well as opportunistic learning.
Staff undertake regular training relevant for the role they undertake within the team, for example: fire safety (refresher due this year), moving & handling, infection control (refresher due this year), food hygiene (all carers need to undertake level 1); catering staff are up-to-date with food hygiene at level 2 and the chef holds an Advanced Certificate in Food Hygiene, International Dysphagia Diet Standardisation Initiative (4 carers have attended training), first aid at work, safeguarding and dementia care. Carers that administer medication also undertake training with the island pharmacist prior to undertaking this task. The care manager undertakes an annual competency assessment or when a medication error occurs. Four carers have completed the dementia course through Stirling University and carers are also supported to undertake the VQ awards. The housekeeping staff undertake training for the Control of Substances Hazardous to Health (COSH).
Other informal training sessions which are relevant to the client group continue to be undertaken in-house with the home's trainer. Some formal training sessions are provided in-house by a visiting healthcare professional or are held in Guernsey with other healthcare professionals.
STANDARD 31: STAFF SUPERVISION
OUTCOME: Staff are appropriately supervised.
Head of department meetings are held 8-weekly and a whole team meeting is also held 6-weekly, where practice issues and operational issues are discussed. These meetings were minuted and are available in the staff room for all staff to read. This is important as this avoids situations when staff claim not to have been informed of various issues.
As previously discussed in this report all staff undertake supervised induction. Appraisals are now biennial as staff have regular supervision sessions and there is a dedicated trainer in post who works with the staff 'on the floor' 2-3 days per month and these sessions are documented. Staff who were spoken to said they felt well-supported in their role by the care manager and the trainer. They said the trainer encourages and supports them to identify opportunities for further development and also for reflective practice sessions where they can learn from each other.
STANDARD 32: MANAGEMENT AND ADMINISTRATION - THE MANAGER
OUTCOME: Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his/her responsibilities fully.
The care manager is a RGN and has a degree in nursing practice. She has a diploma at level 7 for Strategic Management and Leadership and she is an A1 VQ assessor. Previously she has held positions as a, community nurse, adult Safeguarding lead, clinical governance nurse manager and as a nurse manager for drugs and alcohol service (UK local Trust). She has good experience of working with older people and undertakes regular refresher training with her team to maintain her skills in caring for her client group (also required for 3-yearly revalidation with her governing body the Nursing & Midwifery Council - NMC).
STANDARD 33: MANAGEMENT AND ADMINISTRATION - ETHOS
OUTCOME: Service users benefit from the ethos, leadership and management approach of the home.
The atmosphere of the home appeared relaxed and welcoming on the day of inspection and there were no restrictions on areas of the home; we were free to wander around the home and to speak to the residents and staff. The staff appeared organised while they interacted with residents or were engaged in tasks. Staff that were spoken to expressed that they enjoy their job and felt well-supported by the management; several staff have worked there for many years. The culture of the home appears open and transparent with the care manager encouraging staff to report when things haven't gone right, or a mistake is made, so that action can be taken and lessons can be learned.
Relatives and visitors to the home are able to speak to the care manager or to a senior carer whenever they want to; there is no need to make a private appointment unless this is preferred. Some relatives communicate via email or telephone; especially if they do not live on-island.
The care manager develops a report for a monthly meeting with the Board of the Connaught to discuss expenditure and the ongoing development of the home etc and minutes of the meeting are recorded. As the manager of the home, she is aware of the responsibility that her position holds and is accountable to the Board of the Connaught and to the States of Alderney. The care manager said a business plan is in place for the on-going development of the home, which is reviewed and updated as the home continues to grow.
As previously noted in standard 3, discussions are taking place for the home to become dual registered. Consideration will need to be given to the care home laws of both Guernsey and Alderney and also to the recruitment and retention of nurses. A dual registered care home is required to have a registered nurse on duty 24/7.
The care manager would like to work closely with the MMH to work on discharge packages and prevent bed blocking. The care manager feels that with more resources, the Connaught could provide more social support to allow the MMH to focus on acute nursing care.
STANDARD 34: QUALITY ASSURANCE
OUTCOME: The home is run in the best interest of service users.
Regular staff meetings and Board meetings are held, as discussed above. Feedback is encouraged from relatives, friends and visitors to the home. Residents said they are able to speak to the care manager at any time and the care manager said this is the same for relatives, visiting healthcare professions and staff. However, an appointment can also be made if preferred, which includes if a person would like to speak to a member of the Connaught Board. One of the directors visits the home very frequently to spend social time with the residents and to meet up with the care manager.
An activity co-ordinator and 5 volunteers provide in excess of 35hrs of social stimulation and activities each week. A variety of both group and one-to-one activities and outings are offered; including activities within the wider community and more purposeful activities for a person who has dementia. As discussed in standard 12, the Tovertafel has been an excellent introduction, which everyone enjoys. Various communal rooms and garden areas also enable residents to enjoy favourite hobbies and past-times.
Residents that were spoken to said they were involved in planning their individual programme of care, which enabled them to remain as independent as possible (NOK where resident not able to). Prior to, or during admission, several residents had completed a document titled 'Things I can do for myself'. Changes in the plan of care are discussed between the senior carers, care manager and the resident (and/or their NOK) and consent is given before final changes are made (confirmed by residents who were spoken to).
Residents who were spoken to said they enjoyed life at the Connaught. They said staff are kind and caring and nothing is ever too much trouble. Residents who are able to move around more independently said there were no restrictions. They could come and go from the home as they pleased. They said they tended to inform a member of staff when they are going out and when they are likely to return. Other residents who rely on the staff for a higher level of care felt their needs are being met. Several residents said they would be very happy to end their days living at the Connaught as everybody is wonderful.
The care manager undertakes audits for quality monitoring e.g. MAR charts (3-monthly), accidents and incidents in the home (monthly) and care plan audits. The senior housekeeper undertakes a monthly infection control audit for environmental cleanliness. Outside organisations within HSC and environmental health also undertake audits and inspections annually for medication management, care standards, infection control and for food hygiene.
STANDARD 35: FINANCIAL PROCEDURES
OUTCOME: Service users are safeguarded by the accounting and financial procedures of the home.
Employment & Social Security (ESS) in Guernsey receive accounts annually. KPMG also audit the home's accounts annually.
The home's insurance certificate is on display in the entrance to the home and is in date.
STANDARD 36: SERVICE USERS MONEY
OUTCOME: Service user's financial interests are safeguarded.
Residents are encouraged to manage their own finances if possible. However, there is a safe in the care manager's office for a resident who is not able to manage this. Each resident has their own record where money/valuables going in and out are recorded and signed for. It is preferred that a resident's NOK take money/valuables home for safekeeping and bring in small amounts of money as required e.g. outings, hairdresser etc (if appropriate).
STANDARD 37: RECORD KEEPING
OUTCOME: Service user's rights and best interests are safeguarded by the home's record keeping policies and procedures.
Staff have access to a policy and procedure for good record keeping (for recommendations see standards 7 & 8). Staff record in each resident's care record every day; documenting the care that has been delivered for each resident, together with observations for a person's wellbeing or outings. The daily record and plan of care is kept in the staff office, which is kept locked. Medical records are kept locked away in a cabinet. If a resident requested access to their care record, the care manager would organise this for him/her. However, residents asked said they were involved with providing information when they moved in to the home and in some cases it was the person's NOK. They said they are kept well informed of changes to obtain their agreement as their care needs change. One resident said "If the doctor comes to see me, the carer always returns to make sure I have understood what was said and if not explains it more clearly to me".
The care manager is aware of the data protection law, which was introduced last year and this has been communicated to the relevant members of the team. The care records are currently in the process of being transferred over to an electronic recordkeeping system, which will further support data protection as access to records are password protected.
STANDARD 38: SAFE WORKING PRACTICES
OUTCOME: The health, safety and welfare of service users and staff are promoted and protected.
There is a trainer in the staff team who works with the staff for their on-going development throughout their employment in the home. This commences with induction when the person first takes up their role within the team and is followed on with regular supervision and training sessions; either in a group or on a one-to-one.
An accident/incident book is in place and the care manager has created a spreadsheet to enable her to monitor trends more easily e.g. same person falling, same area of the home, or at the same time of day etc. Accident forms that are completed are signed off by the care manager to ensure that each accident/incident is followed up with a risk assessment and additional actions required are documented in the resident's care plan and all staff are informed at handover.
The Connaught building has some areas that require close monitoring. The link corridor between Jubilee and the Connaught has a variance in the slope between the 2 homes. There are notices displayed at each end of the corridor before residents enter, to warn them of this and all residents have been informed. There have been no slips, trips or falls in this area since the home opened. The flooring is non-slip and there is a handrail the whole length of the corridor from one end to the other.
The care manager and the maintenance person undertake a regular walk-through the home each day to identify any areas, which may require action to be taken e.g. maintenance or replacement etc. This is then reported to the Board or to the States of Alderney (as relevant) for the most appropriate action to be taken.
All rooms on the upper floors where residents have access have been fitted with a window restrictor. The heating throughout the home is under floor heating and a temperature regulator has been installed on all taps in areas where residents have access, to ensure that the temperature of the water does not exceed 43 ̊C to prevent a scald from excessively hot water.
The garden is secure to provide an area for residents to wander, including for a person with dementia. A person with dementia is able to walk around without constant direct supervision (discreet observation takes place if a resident with dementia is in the garden if direct supervision is not required). As the garden continues to develop, the needs of people with dementia are included to provide areas of interest and activity areas, as well as to sit and rest.
The clinical waste is stored safely and is transported each week for disposal. Hazardous substances such as cleaning agents are stored in a locked cupboard (was noted to be unlocked on this occasion - care manager informed).
All servicing of boilers and maintenance of equipment is up to date and a programme of monitoring for the prevention of Legionella is also now in place.
Registration and Inspection Officer's comments
The Connaught care home provides care and support for up to 25 people who have residential care needs, which includes for people with early stage dementia. The environment of the home, including the garden has been risk assessed and additional equipment has been installed to assist with keeping people safe.
Residents who were spoken to enjoy living at the Connaught and are happy with the care and services offered to them. Residents said staff are kind and respectful and will go out of their way to maximise their comfort and well-being. Throughout the day there was good interaction noted between residents and staff, with several residents discussing the activities they take part in both within the home and out in the wider community. Discussion with both carers and residents provided evidence that carers understand how to support residents with their preferences and chosen routines. Encouragement was also observed to be given to support residents to make choices and to maintain as much independence as possible.
Care records gave a good indication of peoples' abilities; the introduction of the Fusion recordkeeping system should provide reminders for carers where there are gaps in information e.g. reviews and more in-depth risk assessments.
There is a good programme of training in place to include regular supervision and annual appraisal and staff felt well supported by the trainer and the care manager.
Quality assurance systems are in place to monitor the quality of care and service delivery in the home. This includes the care manager's regular meetings with the Board, which is a good channel of communication with the States of Alderney. Internal audits are undertaken regularly along with audits and inspections that are undertaken by outside organisations. Residents and relatives also provide regular feedback to the administrator and care manager to enable the management to continue to develop the home to improve peoples' experiences of living in a care home.
The care manager has a very positive approach and is open to change and development to progress the service and meet the changing needs of the aging and vulnerable Alderney population.