Inspection on 17/06/09 for Alexandra House

This is the latest available inspection report for this service, carried out on 17th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra House 19/06/07

Alexandra House 28/07/06

Alexandra House 15/11/05

Alexandra House 08/06/05

Alexandra House 06/01/05

Alexandra House 09/08/04

Alexandra House 10/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 24/11/2009.

Key inspection report Care homes for older people Name: Address: Alexandra House Masons Court Hillborough Road Solihull West Midlands B27 6PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 7 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alexandra House Masons Court Hillborough Road Solihull West Midlands B27 6PF 01212451081 01217071090 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.sjmt.org.uk Sir Josiah Mason`s Trust care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 36 Date of last inspection Brief description of the care home Alexandra House is a registered care home for older people. The home is located on the outskirts of Solihull, in a residential area, close to local amenities and a bus service, which provides access to surrounding areas. The home is a single storey building, registered for thirty-six beds; all rooms are for single occupancy. The home has two lounges; two areas for dining and a conservatory, there are four assisted bathrooms and one walk in shower room available plus toilets within close proximity to communal areas, these meet the needs of residents living at the home. There is level access for wheelchair users to the front entrance and throughout the home. Corridors Care Homes for Older People Page 4 of 31 Over 65 36 0 Brief description of the care home are wide and spacious and allow residents to move around the home freely and safely. The home has hoisting equipment available for residents who have decreased mobility. There is an accessible, well-maintained garden area with a pond. The home is approached through security gates where there is parking for visitors, alternatively there is off road parking. The organisations head office is on site; the complex also provides sheltered housing and domiciliary care from separate facilities. Information about the current charge for living at the home is available from the home. Additional charges include chiropody, hairdressing, newspapers and phone rental. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection included a visit to Alexandra House. The people at the home did not know beforehand that we were visiting. As part of the inspection process the registered manager of the home had completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Fifteen surveys were sent to service users. Thirteen were completed and returned to us. Two surveys to staff were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience Care Homes for Older People Page 6 of 31 of living in the care home by meeting or observing them, talking to their families( where possible) about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety, medication records. Discussions with the manager, staff, visitors and residents also took place. The inspection visit took place between 10:30am and 8:30pm. Care Homes for Older People Page 7 of 31 What the care home does well: The home provides sufficient information for people to be able to make a decision about whether they want to live at the home or not. There were many positive comments about staff made by residents and visitors, such as, the people make the home.; they are like gold. I can find no fault. Most of the care plans were appropriate and sufficiently detailed to inform staff of the care and support the person required. All care plans had been reviewed monthly in order for them include all with current care required. The medication system safeguards the health and well being of the people living at the home. Observations and discussion with staff, residents and visitors showed us that residents are cared for in a respectful manner. A resident said that they could find no fault in the food and all those spoken with on the subject said that they enjoyed the meals at Alexandra House. Visitors are made welcome, which was confirmed in discussion with visitors and their relatives. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. The home offers the people living there comfortable and pleasant surroundings, which are clean, free of offensive odour, safe and well maintained. The home has a full time activity organiser. Residents are offered stimulating activity and occupation, including movement exercise, quizzes, music sessions and visiting entertainers. Special occasions such as Christmas, St Patricks and St Georges Day, Birthdays and photograph albums were available of residents enjoying these celebrations. Surveys returned to us and discussion with residents showed us that they knew how to make complaints and who to talk to about any concerns. A hundred percent of the care staff at the home have achieved the National Vocational Qualification Level 2 and/or 3 which means that they have been assessed as competent in their role. This is commendable. Evidence available showed that there are sufficient staff to meet the needs of the people living at the home and to maintain standards of cleanliness and hygiene. Appropriate infection control measures are in place. A random check of records showed that equipment is regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. No health and safety concerns were noted at the visit. Care Homes for Older People Page 8 of 31 What has improved since the last inspection? What they could do better: The care files looked at included correspondence regarding the outcome of the persons pre-admission assessment but this had been addressed to the relative or representative of the prospective resident rather than to the person themselves. Contracts (terms and conditions) had also been signed by relatives than by the resident. There was no evidence to suggest that they would not have understood either or been unable to sign the contract. The mental health needs of the people case tracked were not always adequately reflected in the care plans, for example one plan omitted that a person had a mental health problem, as indicated by their medication. There was no evidence to show that residents and/or their representative had been involved in drawing up their care plan. Any medication, the reasons why it has been prescribed and any relevant needs should be included in the care plans in order that these needs can be met. The information for all medications together with the common side effects is accessible in the home in appropriate literature but the information related to current and individual medication used in the home should be more readily at hand. Crockery used for beverages was a mismatch of odd mugs, cups and saucers. We were also told that a selection of discoloured plastic beakers on the trolley transporting drinks were for those residents who find the cups and mugs too heavy. However apart from being unattractive the beakers are not age appropriate and diminish the dignity of anyone expected to use them. Areas around the base of some of the toilets were worn adn should be addressed in order to prevent the areas becoming a source of infection. Care Homes for Older People Page 9 of 31 In order to provide more robust recruitment practise and thereby safeguarding residents from the employment of unsuitable people the management should validate any applicants employment history and explore and record the reasons for any employment gaps. A risk assessment needs to be in place that shows what steps are taken to supervise any person who has been employed with a Protection of Vulnerable Adults First check (POVA 1st) but before a Criminal Records Bureau disclosure has been received in order to safeguard residents from the employment of unsuitable people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 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 11 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. Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: Residents spoken with and in the surveys said that they had received sufficient information to help decide if this was the right home for them. One resident spoken with told us that they had previously looked at several other homes and Alexandra House was the best of all of them. A statement of purpose and a service user guide were available to all residents and are given to those that show an interest in coming to the home. We met relatives at the home who were there on behalf of someone looking for a care home to move into. They had given these documents and a copy of our most recent inspection report for the home, were happy with the assistance they had been given by the manager and Care Homes for Older People Page 12 of 31 Evidence: staff and had been made to feel welcome. All people living at the home who completed the surveys said that they had been provided with sufficient information before moving in to help them to decide if Alexandra House was the right place for them. We looked at three care files as part of the case tracking process and pre-admission assessments were included in all of them. All assessments had the required headings and were dated and signed by the assessor. They were in sufficient detail for the home to be able to make a decision on whether they could meet the persons needs or not. Pre-admission assessment reflected the needs identified from observation and discussion with the person. The AQAA told us that there had been an improvement in the pre-admission assessments following the last inspection as they are now more thorough. The files also included a letter informing of the outcome of the pre-admission assessment but these were addressed to the relatives rather than the person assessed. It was also noted that the contracts (terms and conditions) in these files, between the home and the resident, had been signed by the persons representative. There was no evidence in the care files to support that these people did not have the mental capacity to have been able to receive and understand the letter or to be able to understand or sign the contract. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place that generally provide the information required by staff but with some shortfalls. Residents have access to health care professionals and are well cared for in a respectful manner. The medication system safeguards the residents well being but there is some lack of knowledge regarding the uses of medication. Evidence: Three care files were looked at as part of the case tracking process and each included a care plan to instruct staff of the care care needed by the person. The care plans were generally sufficiently detailed to provide this information but there were some omissions, for example the size of sling needed by the people who were transferred by means of a hoist was in the risk assessment but not the care plan; the size of pad required by a person with incontinence. There was also a lack of information regarding the medical history and current medical conditions of residents whose care plans were looked at and these were only realised by us by looking at the persons medication. One person was prescribed a medication that needed to be monitored for specific reactions but there was no information about this or of any Care Homes for Older People Page 14 of 31 Evidence: review being carried out by the GP. These omissions created the potential for these needs to be unmet, although staff spoken with had a good knowledge of the residents needs. Care plan information related to mental health needs were not always adequate. An example being a person taking antidepressants but with no reference to a depressive diagnosis or any related needs or required support in the care plan. The care plans seen included the social needs of the person and there was evidence that staff attempted to meet these needs. A person who had moved into the home shortly before our visit had said they enjoyed reading and wanted a newspaper delivered each day. Care staff had gone with them to the local newsagent and assisted in making the arrangements. Each care plan seen had been signed by the member of staff completing it but there was no evidence to show that the resident and/or their representative had been involved, or that they agreed with them. However we were told that other care plans had been signed by the resident. Records of falls, pressure areas, weight, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were in place. This format was a score chart but it did not have a code to show what scores meant apart from the lower the score the higher the risk. Risk assessments for moving and handling (transferring a person from one place to another) were also in place and these included the type of mobility equipment used by the person, the size of sling if a hoist was used and the need to ensure equipment and footwear were in a safe and satisfactory condition to use. These risk assessments would help to minimise risks in these areas. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. Care plans included the persons preferred name although one recorded preferred name and the actual name were both different to the one heard to be used by staff. Following discussion it was not clear if the name used was for convenience of staff as there were several people with the same given name, or if it was the persons first preference. Records showed evidence of the health needs of the residents being met by visits from the GP, District Nurse, Optician and chiropodist and visits to hospital out patient Care Homes for Older People Page 15 of 31 Evidence: appointments. All residents returning surveys answered Always or Usually to the questions, Do you receive the care and support you need? and Does the home make sure you get the medical care you need?. Residents were well groomed, were wearing appropriate clothing for the season and appeared well cared for. Many positive comments were made in surveys and by residents and visitors spoken with that told us residents are well cared for. The medication system was inspected. The pharmacist supplies most of the medicines in a monitored dosage system (MDS) where each medicine is dispensed in a blister pack from which to administer to residents on a daily basis. Some medication cannot be dispensed in this way and is received in original packets or bottles. There were only a very few tablets not in the MDS at this home, which assists in reducing errors. An audit was carried out on some of these tablets and no errors were found, with the tablets remaining being the same as the number calculated. As previously discussed the reasons for the use of some medication was not recorded on the care plans or known by staff spoken with. Detailed information regarding the need and reason for each prescribed medication should be included in each care plan. This information for all medications together with the common side effects is accessible in the home in appropriate literature but the information related to current and individual medication used in the home should be more readily at hand and staff should be more aware of this information. Medication was stored correctly. This included general medicines, in the medication fridge and controlled drugs. The room where medication was stored was cool although the temperature had not been recorded. This should be done to minimise the risk of medicines being stored above the necessary temperature of less than 25 degrees Centigrade. The medication administration record sheets (MARS) were looked at and had been satisfactorily completed, with no gaps or inappropriate codes in the MARS looked at. The Primary care Trust pharmacist had recently inspected the homes medication system and all recommendations made by them had been addressed by the home. All interaction observed between staff and the people living at the home showed that residents were cared for in a respectful manner and with recognition of the need for privacy and dignity, with a friendly and comfortable banter between them. Residents spoken with confirmed this respectful and caring approach from staff. Care Homes for Older People Page 16 of 31 Evidence: Care Homes for Older People Page 17 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. Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. Evidence: Alexandra House has a full time activity organiser who was not available at the time of the visit. On our arrival residents were enjoying a variety of of entertainment and occupation with an out of house contracted entertainer that included music, exercise, a quiz and singing. This takes place once a week and it was apparent that those taking part were enjoying the session. The activity programme showed that singing entertainers also attends once a month. Activities recorded in individual file showed that there had been adequate and varied activity and occupation on offer and photographs and discussion showed that that special occasions had been celebrated such as a recent 100th birthday, St Patrick Day, St Georges Day, Valentines Day, Halloween and Christmas. There had also been a Garden Party on the previous weekend. Two groups of visitors were spoken with who said that they were very satisfied with all the care provided for their relatives. One of them said that they have no cause for Care Homes for Older People Page 18 of 31 Evidence: complaint, that staff are very good, and I can have a good laugh with them. All visitors asked the question said that they were made to feel welcome. visitors were spoken with and both said that they were happy with the care provided and gave positive comments about the staff and said that they felt welcome at the home. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what activities to join in with and where to spend their time. Interaction between staff and residents showed that residents are cared for in a respectful manner. We joined the residents for lunch in the dining room. This room extended around a corner into an adjacent area. The main room was bright and was a pleasant dining space. Catering staff working at the home are external contractors who liaise well with the home and management. Food was served from the kitchen via a hatch and all our meals were pre-plated. Staff said that they knew what residents liked but our meal was served in the same way without any discussion about likes and dislikes. The meal, gammon cabbage and swede and potato was satisfactory. An alternative of corned beef hash was also available and some residents had chosen this. A choice of water or blackcurrant was available as drinks with the meal and ordinary glasses were in use. Tea and coffee was served after lunch from a trolley. There was a variety of mugs and a mixture of non-matching cups and saucers available for hot drinks. There was also a mixture of unattractive beakers on the bottom shelf of the trolley. A member of staff who was asked about these said that they were for people who found the others too heavy. Apart from their appearance plastic beakers are not age appropriate, diminishing the dignity of the people expected to use them. The main part of the dining room was bright and well furnished, and extended into an adjoining corridortype area. One member of staff was calling across the dining room to other staff about care related issues, which was disruptive for the people eating there. All residents spoken with about food said that they enjoyed the meals and one person said, I can find no fault with the food. 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. Quality in this outcome area is good. Complaints are addressed appropriately. The home has appropriate policies, procedures and practices to safeguard residents. Evidence: The home has a complaints procedure which is displayed in the reception and therefore easily accessible to residents and visitors. A copy of the policy is also included in the service user guide, which is distributed to all residents. Ten of the thirteen people returning the surveys said that they knew how to make a complaint and all of them said that there was someone to talk to informally if they were unhappy. Complaints records showed that the home had not had any formal complaints made about them since the last inspection but they also keep a record of minor concerns raised and how these have been addressed. The manager told us in the AQAA that there is easy access to the manager and to the Trustees of the home, which she feels facilitates matters of concern to be raised easily by relatives (and residents) directly with a responsible person. She also added that staff are encouraged to consider complaints as important indicators in improving the care practice. Residents spoken with knew how to make a complaint. This evidence indicates that the home is open to listening to complaints and residents and their visitors can be confident that they are taken seriously. Staff undertake annual training related to safeguarding vulnerable adults and the Care Homes for Older People Page 20 of 31 Evidence: home uses the Local Authority Safeguarding policy. Staff spoken with had an awareness of safeguarding procedures and how to identify abuse. The risk of abuse to residents should therefore be minimised, with staff knowing what to do if they did witness or suspect that abuse had occurred. Staff recruitment is sufficiently robust to minimise the risk of the employment of unsuitable people. Financial procedures and practices safeguard the financial interests of the people living at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. Evidence: Alexander House is built within an attractively laid out complex that also includes retirement homes, sheltered housing and domiciliary care facilities. The home provides accommodation on one floor that is fairly open plan with the main lounge being at the centre of the home with other communal rooms and offices opening on to it. Residents were using this room for activity with an external entertainer when we arrived. Communal space includes a conservatory and a smaller lounge that provide alternative and more homely living space. Both are decorated and furnished to a good standard. The smaller lounge was not occupied by residents during our visit and we were told that it tends to be used for entertaining visitors. These communal areas offer comfortable and attractive surroundings for the people living at the home. The main dining room can cater for approximately sixteen people with further dining space provided in an adjoining area. These areas were also well decorated and furnished and provided appropriate dining areas. All bedrooms are of single occupancy and those seen were free of offensive odour, had Care Homes for Older People Page 22 of 31 Evidence: been personalised with belongings brought in by the occupants and looked comfortable and appropriately decorated and furnished. Following the inspection visit one of the surveys completed on behalf of a resident by their relative included a comment that the persons bedroom had smelt of urine since before the resident had moved in, despite the home making several attempts to neutralise the odour. However the large majority of the people completing the surveys had said that the home was always fresh and clean and one person had added the comment, ......well kept, clean and tidy at all times. There are adequate assisted bathrooms and toilets to meet the needs of the residents. The spacious bathrooms were clean and odour free. Colourful shower curtains, some pictures and new toilet seats had been provided since the last inspection to improve their appearance, although they continued to look rather clinical. There were worn areas around the base of some toilets and this needs to be monitored to ensure that they do not become a source of infection. Cork tiles in the corridors were being replaced with an attractive non-slip floor covering with other areas having suitable carpeting. Staff had attended Infection Control training and the manager was currently undertaking training on infection control outside of hospitals. One of the other senior staff told us that they were championing the Clean Hands campaign with Solihull Hospital. All communal areas where residents and staff are expected to wash their hands have appropriate handwashing facilities that assist in maintaining infection control, although some of the clinical waste bins had rusty patches. The manager said that these were about to be replaced. Disposable aprons and gloves were readily available as protective clothing when assisting people with personal care, thereby further minimising cross infection. The laundry area was appropriately equipped to maintain infection control. 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. Quality in this outcome area is good. There are sufficient competent staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised by management and staff. Evidence: Residents and visitors spoken with made many positive comments regarding the staff, including they are like gold. I can find no fault.; staff are always friendly, helpful and cheerful; carers work hard and are friendly; Staff are wonderful.The people make the home. The AQAA told us that the home has a stable staff group. This provides continuity and experience to the people living at the home. Rotas were made available and show the hours that staff actually worked and include a key for the codes used. This showed that there are a minimum of four care staff, including team leaders but not the manager, on duty during the day and two care staff during the night. On Tuesdays there are a minimum of six care staff on duty for the early shift, giving the staff more time for such things as accompanying residents to the local shops. In addition to care staff there are domestic staff and designated laundry staff each day of the week. Catering staff are provided by an external contractor but know the home well. Any care staff absences are covered by existing staff or agency staff. Care Homes for Older People Page 24 of 31 Evidence: Observations, records and discussion with staff and residents indicated that there are sufficient staff available to meet the needs of the people living at the home and to good standards of cleanliness and hygiene. In the AQAA the manager told us that all care staff have the opportunity for staff development and assessment to NVQ Level 3 and 4. All of the care staff have National Vocational Qualification (NVQ) Level 2 and/or 3 in Care, and all three of the team leaders have NVQ Level 4, showing that the staff have been assessed as competent in their role. These achievements are commendable. Any new staff undertake induction training and the manager is reviewing this to ensure that it is in line with the Skills for Care. Other training undertaken by staff includes mandatory training, that is, Moving and Handling, Basic First Aid, Health and Safety, Fire Safety, Food Hygiene and safeguarding of vulnerable adults; nonmandatory training that related to dementia needs and also defibrillation training as they had acquired the relevant equipment. All this training give give them the knowledge and skills required to carry out their job safely and effectively. The AQAA told us that staff have continued to increase their appreciation of the need to attend training provided. Three staff records were looked at in order to assess the recruitment practice. One recently employed person had received a Protection of Vulnerable Adults (POVA) First check but the Criminal Records Bureau (CRB) disclosure had not been received before the person started work. This person was supervised in order to minimise risk in the meantime. There was a limited employment history for this person. The other two staff files had all the documentation required and evidence of interviews showing that the recruitment practice was fairly robust. However there was no evidence that gaps in employment had been explained. It is good practice to have as much information as possible about a persons previous employment and the reasons for gaps in their employment history to be explored to the homes satisfaction, and recorded, in order to make the recruitment more robust. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. A person undertaking the appropriate qualification and who has management experience manages the home. The monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. The home is a safe place to live and work. Evidence: The current registered manager has been in post for nine and a half years and has worked for the organisation for 21 years, thereby providing continuity of leadership. She has the Advanced Care management qualification and has undertaken units needed for the Registered Managers Award.She has continued training to enable her to keep up to date and for her own further development and is currently undertaking Infection Control training. The two surveys completed by staff members showed that they felt the home was well managed with one person commenting that the home is well run. and Very happy with my job. The lines of accountability in the home are the responsible individual and the other Care Homes for Older People Page 26 of 31 Evidence: Trustees, the registered manager, team leaders, deputy team leaders and other staff. The manager said that there have been benefits in implementing the post of deputy team leader for their own development and to increase the number of staff who are able to be responsible for the home in her absence. The home now has a quality assurance adviser who also makes monthly inspection visits after which they make a report from which the manager and the Trustees form an action plan. The manager told us that she has worked to progress the Quality Assurance system and in the AQAA told us that this was something they planned to develop further and involve key staff and the wider care team in delivering benefits to the residents. The residents money is held in a secure location and is now in appropriate packets. An audit of a random selection of the cash held and the relevant transaction records and receipts was carried out and all balances were correct. The practices safeguard the financial interests of the residents. There was evidence from the AQAA and a random check of records that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no health and safety concerns noted during the visit. 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 4 12 Residents must be assumed to have the mental capacity to act on their own behalf unless assessed otherwise. This will ensure that the persons rights are met. 21/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Any mental health needs and the subsequent care and support care staff are to provide should be identified and included in the care plans. A persons medication, the reason for it being prescribed and any relevant care or support should be included in care plans. There should be information regarding medication currently used in the home readily available and staff should familiarise themselves with its use. Care should be taken to ensure that an alternative name is only used if it is the persons first choice. All tableware should be in good condition and age appropriate for all residents, unless a persons care plan or Page 29 of 31 2 7 3 9 4 5 10 15 Care Homes for Older People 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 risk assessment suggests otherwise. 6 26 All residents bedrooms should be assessed for any unwanted or offensive odour. Any odour detected should be eradicated. Any gaps in the employment history of prospective and current employees should be explored, and recorded, and the reasons for the gaps satisfy the employer. Records should demonstrate that a risk assessment has been carried out and the appropriate action taken when it is necessary to employ a person without a Criminal Records Bureau disclosure. The home has to be in receipt of a current POVA 1st check for that person . 7 29 8 29 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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