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Inspection on 16/06/10 for Aldergrove Manor Nursing Home

Also see our care home review for Aldergrove Manor Nursing Home for more information

This is the latest available inspection report for this service, carried out on 16th June 2010.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who were able to speak with us told us they feel safe, supported and well cared for. People who weren`t able to give their views appeared content and comfortable. Observations made during the inspection found staff to be kind in their approaches with people. People are provided with meals and drinks which are based on their preferences and needs. Staff work together and provide stability to peoples lives.

What has improved since the last inspection?

People are provided with greater opportunities to enhance their wellbeing and are able to enjoy a range of activities based on their capabilities and preference. Staff are checked for their suitability to work with vulnerable adults before they start work at the home and staffing levels are sufficient staff to meet the needs, numbers and dependency of people living at the home. New staff are able to consolidate their induction with opportunity to work in a supernumerary capacity. Some members of the staff team have now attended awareness training in the Mental Capacity Act (2005) and/or Deprivation of Liberty Safeguards and they could explain how it applies to their work. Some improvements have taken place with how medicines are managed, although other improvements are still needed.

What the care home could do better:

A lot of effort has taken place to do most of the things we asked the home to do following our last key and random inspection. Further effort is needed to ensure care plans are kept up to date, so that staff have correct guidance to follow about how to meet people`s needs. More could be done, through the provision of equipment on the younger person`s unit to build on people`s abilities and promote independant living skills. Effective infection control and prevention processes should be developed and consistently followed so that people are provided with an environment which is clean and free from odour. We made three requirements and one recommendation for the home to improve the management and adminstration of people`s medicines. Fundamental to the service developing is the appointment and registration of a suitable and competent manager.

Key inspection report Care homes for older people Name: Address: Aldergrove Manor Nursing Home 280a Penn Road Penn Wolverhampton West Midlands WV4 4AD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rosalind Dennis     Date: 2 3 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Aldergrove Manor Nursing Home 280a Penn Road Penn Wolverhampton West Midlands WV4 4AD 01902621840 01902621841 aldergrovemanor@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 70 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 70, Old age, not falling within any other category (OP) 70, Physical disability (PD) 70 Date of last inspection 0 7 0 4 2 0 1 0 70 0 70 Over 65 0 70 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Aldergrove Manor is owned by Southern Cross Healthcare Ltd. It is a purpose built, two storey building, standing in its own grounds and is set back off the main road on one of the main routes into Wolverhampton city centre. It is on a main bus route, close to the city railway system and within easy access to local shops and community facilities. All 70 bedrooms are single with en-suite, some of which have interconnecting doors for couples. There is a passenger lift to enable access between floors. The home consists of a 19 bedded unit for older people with dementia, a 17 bedded unit for younger adults who have physical disabilities and a 34 bedded nursing unit. The door to the unit for people with dementia has a specific door entry system and the door is locked, to help keep people safe. Staff support people from this unit to access other parts of the home. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. The Service User Guide notes the current fees charged by the home as ranging from £449.87 (residential) to £789.36 (nursing) per week depending on care required. The reader is advised to seek information direct from the service. The last key inspection of the service took place on 14th January 2010. A random inspection which focussed on medication practices was undertaken on the 7th April 2010. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out over two days in total. The home did not know we were going to visit. Two compliance inspectors and our pharmacist inspector visited on the 16th June 2010. One of the inspectors returned on the 23rd June to complete the inspection. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. The purpose of this inspection was to assess all key standards - that is those areas of service delivery that are considered essential to the running of a care home - and to establish whether the provider has complied with requirements we have previously made. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home and information sent to us from other agencies. We had undertaken a random inspection on the 7th April 2010 and concluded that the home had made Care Homes for Older People Page 6 of 31 sufficient progress for CQC not to progress further down the enforcement pathway in respect of its management of medicines. We therefore wanted to look at whether the home had sustained and further improved medicines management. We also looked at the written improvement plan from the service which we had asked for after our last key inspection in January 2010. We case tracked some of the people we met during the inspection. Case tracking involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Five people who live in the part of the home where younger people live, were able to tell us about their day to day life at the home and the support they receive from staff. They told us they get the care and support they need. Other people living at the home were not fully able to comment on the care they receive and so we observed the support given by staff and how staff interacted with them. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move in, which ensures that people are only admitted if the service is confident it can meet their needs Evidence: We spoke with one person who has recently been admitted to the unit at the home where younger people with physical disabilities live. They told us how pleased they have been with the care and support since their admission. They told us how a representative from the home had met with them and assessed their needs before they were admitted. We looked at their care records which showed that the information obtained at the time of the assessment had been used to plan how their care needs will be met at the home. We also saw how the home had looked in detail at the needs of a person admitted as an emergency and planned how they could meet the persons needs. Observation of the persons care records indicated that the support provided at the time of their admission had a positive effect on their wellbeing. We had a discussion with the unit manager to confirm that the home must Care Homes for Older People Page 11 of 31 Evidence: ensure that it keeps to our registration criteria as we established that a person had been admitted with needs outside of the homes current registration. We also looked at the care records for three people who have moved to live on the nursing unit at the home and for another person admitted to Haven House, where people with Dementia live. One person told us that they had settled in well and described staff as being ever so kind. Three of these people were unable to tell us their views of the admission process but we saw from looking at the care records that a representative of the home had assessed their needs by meeting them before they were admitted and seeking information about their illness and care needs. Although we identified, on the nursing unit, that not all sections of the company admission documentation had been completed, overall we found that a good level of information had been obtained so that staff know would know how to give care based on the persons needs and wishes. We saw a copy of the service user guide and statement of purpose available for people to read in the main reception area. Both documents contain a good level of information about the home so that people know what the service provides, including the fees charged by the home. The guide can be made available in different formats, such as Braille, large print and audio-cassette so that people with varying communication needs can access the information. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally receiving their medication correctly and their health and personal care needs are now being met, although some gaps in written guidance available to staff might prevent some aspects of peoples care being met consistently. Evidence: We spent time in different areas of the home, speaking with people who live there, observing staff working, looking at documentation to show how peoples needs are met and speaking with staff. We also had opportunity to speak with some relatives. Throughout our inspection we found staff to be respectful in their approaches with people. In the area of the home where people with dementia live, we observed staff interacting very well with people, providing guidance when necessary and promoting positive reactions. There was a calm atmosphere, people appeared content, looked clean and showed signs of well-being. We looked at the care records for one person we case tracked. Their care plans were clear and assessments of possible risk to their health, safety and welfare were documented well. We saw that staff had sought Care Homes for Older People Page 13 of 31 Evidence: appropriate advice quickly from healthcare professionals regarding the persons condition. The persons care plans also contained a good level of information about most of the medication they take and possible side effects so that staff know when to seek advice. Three staff we spoke with had a good awareness of the persons needs, likes and dislikes, which reflected what was written in their care plan. A person we case tracked on the younger persons unit, gave us very positive feedback about the care they receive. We looked at their care plan which reflected their description of how they like their needs met and the action needed by staff to meet these needs. Four other people we spoke with on this unit told us they are satisfied with the care and support they receive and that staff react quickly to changes in their health. They also told us that staff respect and treat them as individuals. We discussed with the unit manager the process used by the home if a person requires additional intervention if they have an epileptic fit. The unit manager confirmed that the home seeks intervention from emergency services. We consider that it would also be advisable that the home looks at other measures of urgent epilepsy management, such as having staff who have received additional training and are assessed as competent to undertake the role. We met people who require nursing care, some of whom were able to give us feedback about the home. These people told us that they are happy with how they are looked after. We met three visitors who told us they are satisfied with the home and the care given to their relative and that staff keep them informed about their relatives condition. We spent time in one of the lounges observing how staff interacted with people and saw staff communicating effectively with people. Staff were aware which people had communication difficulties and which people needed longer to respond to questions and answers. When people needed assistance to move, staff provided reassurance and explanation and used the moving and handling equipment safely. We spoke with staff who had a good knowledge about peoples needs and the care needed to meet those needs. We found that most peoples care records provide a satisfactory overview of their needs, although some gaps in information meant that some care plans did not always reflect the care which is being given or needed. This could result in people not receiving the care they need. For example, we saw that one person shows behaviours of concern and staff explained that the person needs to be supported in a certain way. When we looked in their care records we could not find a care plan to provide guidance to staff about how to manage the behaviours of concern. The deputy manager confirmed one had been written but it could not be found during the inspection. One person who has a wound had documentation in their file about the wound but it Care Homes for Older People Page 14 of 31 Evidence: did not contain detail such as how often the dressing needs to be changed, although staff were able to confirm to us verbally the persons wound care regime. We saw that the home monitors wounds by measuring them and through the use of photography which is good practice. We observed that, for people assessed as being at risk of developing pressure sores they had specific mattresses on their beds and cushions on their chairs, which are designed to reduce the risk of pressure sores occurring. We also saw that checks are done to ensure the mattresses are at the correct settings for the person. However we saw that information in a persons care plan contained insufficient detail about the care needed whilst they are in bed or seated in chair. We found that staff monitor peoples weight but when a person lost 2 kgs there was nothing in the care records to inform staff whether they needed to put in place additional monitoring or review the persons dietary needs to promote weight gain. This highlights a need for staff to ensure they act quickly on findings and ensure care records are updated accordingly. We found that the quality of the administration records for oral medicines had improved further since our inspection to the home in April 2010 and overall the service was able to evidence the people using the service were receiving their oral medicines as prescribed. There was however a number of findings which raised concerns with the inspectors. The first of these concerns was found during the audit of the medicines on the nursing floor. We found that some antidepressant drops were opened on the 27th April 2010 and we calculated that since that date the nursing staff should have used 500 drops. We calculated that the bottle being used only held 300 drops and with some of the solution still remaining we concluded that this medicine had not been administered as prescribed. We asked the nursing staff for the administration records from the date of opening in order to establish any reasons why the medicine had not been administered but the administration records could not be found. We also found on the nursing floor that the records for the administration of external product such as creams and dressings were not being adequately maintained and therefore the service was not able to demonstrate that these products were being used as prescribed. We found on the dementia floor that a medicine that needed to be administered at least half an hour before food was being administered with breakfast. We found that the staff were not aware of the additional administration requirements of ensuring that the person concerned took the tablet with plenty of water and remained in an upright position for at least 30 minutes after taking the tablet. We found that the service had maintained the correct storage conditions for those medicines being stored in the fridge. We found that the service was monitoring and recording the maximum and minimum temperatures on a daily basis to ensure that the temperature of the fridge was kept between two and eight degrees Celsius. Care Homes for Older People Page 15 of 31 Evidence: We found that the home was recording the administration of a Controlled Drug medicine which was being administered on a daily basis. We found that the register showed that this medicine had been administered twice on the same day. The problem arose when the home changed from one strength of the medicine to another. Initially the strength of the medicine being administered was 50mg/5ml and the last entry showing that 4.5ml had been administered was on the 11th April 2010. Because of the change in strength the home had rightly started a new page in the Controlled Drugs register. The new strength of this medicine was 15mg/5ml and in order to meet the required dose the home had been instructed to administer 15ml daily. The first entry on this page showed that 15ml was administered on the 11th April 2010 the same day that 4.5ml of the old strength had been administered. The home was not able to provide a satisfactory explanation during the inspection and was given the opportunity to investigate the matter fully and report their finding to CQC. During discussion about this incident we found that the nursing staff were completing the Controlled Drugs register before the administration of the Controlled Drug had taken place. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities to enhance their social well-being although more could be done to build on some peoples abilities and enhance their life skills. People are offered a choice of meals to meet their dietary needs and preferences Evidence: Since the last key inspection the home has increased the provision of staff responsible to organise and promote social activities and there is now a staff member who oversees social activities on the younger persons and dementia care unit, as well as another member of staff allocated specifically to promote social well-being with people living on the nursing unit. In the reception we saw a notice board, which had details of activities planned for the week as well as up and coming events in the Aldergrove newsletter. It also listed peoples birthdays and World Cup football fixtures. We spoke with five people on the younger persons unit. They told us how they are able to take part in activities and events which take place at the home or in the wider community. They also told us improvements with meeting their social needs has taken place over the past twelve months and they confirmed there are now greater opportunities for them to be supported to do what they want to do. One person described what they were planning to do during the day, they went out to do this with Care Homes for Older People Page 17 of 31 Evidence: a staff member and on return spoke of how they had enjoyed their time. People told us how they like to go shopping or to the local pub and that staff support them to do this. We also saw part of the garden where people have grown plants and vegetables. The corridor on the unit is in the process of being painted and people told us that they were involved with choosing the colour of the paint and are involved with the decorating. One person told us that staff respect their decision not to join in with group activities, which shows that staff respect the decisions people make. We spoke with the unit manager about ways the service could promote and sustain independent living skills. We were informed that there have been ongoing discussions about converting a room attached to the dining area into a kitchenette and laundry facility. It is considered that the home needs to put these plans into place, so that people are offered greater opportunities to enhance their life skills. We saw that people with dementia related conditions have opportunities to enhance their social well-being. Staff showed us where they keep records of activities people take part in, which shows that people are provided with different activities, including visits from people outside of the home, such as singing entertainers. We also saw photographs of people participating in different activities including a coffee morning, cooking, singing, dancing, meal out, involvement in a dignity day, valentines day, trips out to town. We spent some time in one of the lounges on the nursing unit and saw that some people were engaged in passing a ball to each other, another person appeared content with looking and feeling a ball designed to enhance sensory stimulation. We spoke with the staff member designated to organising and providing suitable activities, who told us how they observe reactions people make towards different activities and record this information. This should assist with finding out whether the activity appears to benefit the person and whether they enjoy it, which is important when people may not be able to communicate their views. We saw that this staff member interacted well with people and had good understanding of their collective interests. We saw them involving people in selecting which music to play and also encouraged two people to watch a DVD in the afternoon. This staff member told us how they try and spend time with people, who because of their illness remain in their bedrooms, although demands in other parts of the home may sometimes impact on this. We fed this back to the Deputy Manager so that any impacts on activity provision will be kept under review. We observed staff serving and giving meals out to people at lunchtime and at tea. Meals reflected peoples preferences and specific dietary needs, such as swallowing and chewing difficulties. People appeared to enjoy their meal. We observed staff using good approaches with people who need help with eating and drinking and staff were Care Homes for Older People Page 18 of 31 Evidence: observed providing people with regular drinks of what they wanted throughout the day. We asked six people living on the younger persons unit for their feedback about meals at the home. They told us how meals and the choice of food had improved greatly over the past twelve months. They spoke highly of the chef who was on duty on both days of this inspection and told us how the chef always comes and speaks with them to get their views and whether improvements can be made to the menus. We spoke with the chef who demonstrated an enthusiasm to ensure people receive a varied and good diet, which reflects their tastes and needs. The chef confirmed they have received guidance on meeting the needs of people with additional nutritional needs. This could be further enhanced through the provision of additional training, which is an outstanding recommendation from the August 2009 key inspection. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure which ensures people and their representatives know how to raise concerns and complaints. Staff know how to safeguard adults from harm and abuse. Evidence: The complaints procedure is included in the Service User Guide and provides people with clear information on the process to follow and who to contact if people want to complain. We found a copy of the complaints procedure in the main reception area, but it wasnt easy to find and needed some amendments, we advised the deputy manager to look at ensuring this procedure is up to date and visible for people to read. Two visitors to the home told us they are satisfied with the home and would know what to do if they needed to complain. We also spoke with people who live on the younger persons unit and they told us they know how and who to complain to. They said they feel confident that the staff and unit manager would act to put things right. A comments and suggestions book was seen in the main reception which included two written comments noting different concerns. We brought it to the deputy managers attention of the need to check the book and to show the action taken in response to the comments. We looked at where the home records complaints which shows that there have not been any formal complaints made since our last key inspection. Care Homes for Older People Page 20 of 31 Evidence: We looked at a training planner which shows that staff receive training in safeguarding adults from abuse and two staff we spoke with could describe to us their role in safeguarding adults. Some members of the staff team have now attended awareness training in the Mental Capacity Act (2005) and/or Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. Staff gave good explanations to us about the Act and how it might apply to their work. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an environment which is safe but which needs more attention to ensure it is consistently kept clean and well-maintained. Evidence: On our first day of this inspection, we found that parts of the nursing unit, including carpets and bathrooms were not clean and there was a notable smell of urine in one of the lounges, chairs and three bedrooms. The Deputy Manager accompanied us during our observations and assured us that action would be taken. When we returned a week later we found considerable improvements had taken place with the cleanliness of these areas, but this highlights a need for increased vigilance and attention by staff to ensure people are consistently provided with a clean home. In the bedrooms we looked at in each of the units, we saw people are able to bring in items which are important to them, such as photographs, pictures, religious items and small pieces of furniture. Each persons bedroom has an en-suite and includes wash hand facilities of liquid soap and paper towels for staff. We saw the home has equipment to help move people safely such as hoists and there is a choice of stairs or passenger lift to the first floor. We saw that people who had been assessed as being at risk of developing pressure sores had mattresses on their beds, which are designed to provide relief of pressure when people are less mobile. Care Homes for Older People Page 22 of 31 Evidence: As noted earlier in the report, the unit where younger people live would benefit from additional facilities to promote independent living skills. We saw the unit was in the process of being decorated, assisted by staff and involving people who live there. The lounge on this unit continues to have furniture which does not really reflect the age group of the people who live here. We were informed that replacement furniture is planned. The dementia care unit was bright, colourful and well-decorated. The bedroom we saw and communal areas were clean and there were no noticeable offensive smells. At the time of our inspection the temperature of the unit appeared comfortable and satisfactory to the people who live there. People are provided with a choice of washing and bathing facilities and there is equipment to help people get in and out of the bath. Paint had peeled off part of a wall in two bathrooms we saw, which therefore meant that the walls would be difficult to clean. The maintenance person confirmed that an ongoing re-decoration programme exists and that these bathrooms are due to be attended to. Another bathroom we saw had a cracked bath panel, which we brought to the attention of the Deputy Manager and maintenance person so that action could be taken promptly. We spoke with laundry staff who had good awareness of practices to reduce the risk of the spread of infection. Whilst looking around the home we became aware that the home washes and makes available as routine, laundry items which are not specific to individuals, such as pants and hosiery. We made the Deputy Manager aware of this who agreed that this practice was not acceptable and should not be happening. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared and supported by staff who have the skills and knowledge to meet their needs and who are suitable to work with vulnerable adults. Evidence: On both days of our inspection there was a calm atmosphere throughout the home. Staff appeared cheerful in their work and we saw them attending to call bells and peoples needs promptly. At the time of our inspection sufficient staff appeared to be on duty to meet the needs of people living at the home and the staff we spoke with viewed that care and nursing staffing levels are now usually sufficient. The home is not currently full and we discussed with the deputy manager of the need for the company to review staffing levels on an ongoing basis according to the dependency, needs and numbers of people at the home. This should ensure people receive care when they need it. We looked at the process used by the home to recruit two new members of staff and found that all parts of the recruitment process were accurately recorded and demonstrated that pre-employment information, such as references and Criminal Record Bureau Disclosures had been sought prior to these staff working at the home. This helps to ensure only staff who are suitable to work with vulnerable adults are employed. These staff had evidence of completing an induction when they first started working at the home, so they know about the home and the care people need. We Care Homes for Older People Page 24 of 31 Evidence: spoke with a member of staff who told us that their induction had prepared them for their role, they also told us they feel supported to give good care. We looked at written records which showed the training which has been undertaken by staff and training which is planned. This demonstrates that regular staff training takes place, including training in safe working practice topics such as fire safety, moving and handling, safe use of bed rails as well as more specific training such as dementia care, challenging behaviour, palliative care and the prevention of falls. We saw from looking at the training planner and through discussion with one of the unit managers, that almost all care staff have now either achieved or are studying for a recognised qualification in care (National Vocation Qualification). The training undertaken by staff should contribute to ensuring all members of the staff team have an effective knowledge of social care and the skills and knowledge to meet the needs of people living at the home. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is without a manager, however the interim management arrangements in place ensure that the home is safe and run in the way that the people living there want. Evidence: The manager who was present at our last inspection is no longer working at the home. Management arrangements are currently being overseen by the Deputy Manager and a manager from another home. We were informed that a new manager for Aldergrove Manor has just been appointed. People living at the home have experienced significant changes in the overall management of the home over a short period of time however the Deputy Manager, unit managers and staff are providing stability for people at the home. We obtained good feedback from people about the care and support they are receiving. We were informed that a representative for the company has recently visited the home to speak with relatives, staff and has looked around the home. Staff also confirmed that they are able to keep in regular contact with this person via telephone and are able to raise queries and seek advice and support. Care Homes for Older People Page 26 of 31 Evidence: A representative of the company monitors quality at regular intervals with monthly unannounced visits. We observed the reports produced as a result of a visit in May 2010.This showed that a wide range of matters are looked at to see how the service is operating and identifies when action is needed. We looked at some other audits which are undertaken. An audit on pressure sores shows that for the week of this inspection three people have pressure sores and one persons sore had healed. We were informed that people have recently been given opportunity to comment on different aspects of the service by completing surveys. The results of these were not available for us to look at during our inspection as it was reported to us that they have been sent to the company head office. We looked at records relating to the management of small amounts of personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions, which should ensure peoples money is held safely. We saw a selection of written records showing that safety checks are undertaken, such as checks on the temperature of hot water, wheelchairs, window restrictors and bed rails. We saw a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. We looked at some written records which shows that servicing of equipment takes place, although at the time of our inspection we were unable to find written confirmation that work on electrical equipment which needed to be done has been completed. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The use of external treatments in the form of creams and ointments and dressings must be recorded. This is so the service can demonstrate that these products are being used as prescribed. 06/08/2010 2 9 13 The recording of the 06/08/2010 administration of Controlled Drugs must be carried out in accordance with the Misuse of Drugs Act 1971 and the guidelines of the Nursing and Midwifery Council and the Royal Pharmaceutical Society of Great Britain. This is to ensure medication is administered safely and correctly. 3 9 13 The service must ensure that medicines that have specific administration requirements are 06/08/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action administered in accordance with these requirements. This is to ensure people receive their medicines as intended by the prescriber. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 9 Consideration should be given to developing epilepsy management in an emergency situation. The disposal of medicines are recorded in a disposal register which includes the name of the medicine the strength and the quantity being disposed of. Staff involved in meal preparation should be provided with training to ensure they have the skills and knowledge to meet the varying nutritional needs of people living at the home. 16062010 Partially achieved. Consideration should be given to providing copies of the complaints procedure in different locations of the home. This is to ensure that the complaints procedure is accessible to all. Effective infection control and prevention processes should be developed and followed so that people are provided with an environment which is clean and free from odour. 3 15 4 16 5 26 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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