Inspection on 08/01/10 for Bank House

This is the latest available inspection report for this service, carried out on 8th January 2010.

CQC found this care home to be providing an Excellent 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.

Other inspections for this house

Bank House 01/03/06

Bank House 03/08/05

Bank House 25/11/04

Bank House 12/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Inspirations

Westmead

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Bank House Bank House Bank House Chetwynd End Newport Shropshire TF10 7JE     The quality rating for this care home is:   three star excellent 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: Tina Smith     Date: 0 8 0 1 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 30 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 30 Information about the care home Name of care home: Address: Bank House Bank House Bank House Chetwynd End Newport Shropshire TF10 7JE 01952814371 01952814350 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Colin James Richard Davies,Mrs Sylvia Davies care home 20 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: 20 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) 20 Date of last inspection Brief description of the care home Bank House, owned and managed by the Proprietor since 1995, provides care and accommodation for up to 20 older people. It is close to local amenities and public transport. Car parking is at the front of the detached and extended property. It is accessible for wheelchair users throughout the home, and a ramp at the entrance. An enclosed patio garden has raised flower beds for the service users garden club. The home is pet friendly and currently has a bird. The office is on the top floor. Care Homes for Older People Page 4 of 30 Over 65 20 0 Brief description of the care home There are 14 single and 2 double bedrooms on two floors, most are ensuite and there is a passenger lift. Assisted bathrooms are on each floor and communal toilets are throughout the home. Communal areas include the ground floor lounge, conservatory and dining room. Weekly fees range in the service user guide from £373 to £450. Additional charges apply to: hairdressing, dry cleaning, private chiropody, opticians, dentists, escorts, toiletries not included in the fee, day centres, magazines and some newspapers, phone calls, some outings or meals out. This information applied at the time of our visit; enquiries should be made to the manager for up to date information. Care Homes for Older People Page 5 of 30 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: three star excellent 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: The service was last inspected on 07/02/07, when quality was excellent and no requirements were made. The home sent us information we asked for on three occasions about running the home, what has improved and is planned for the future in their Annual Quality Assurance Assessment (AQAA). Their self assessments show good analyses and understanding of value for money, along with seeking continuous learning and improvement. Information from AQAAs, our Annual Service Review report 09/05/08 and from other sources was also used when forming judgments on the quality of the service. We received 22 out of 35 surveys we sent to people, relatives, health professionals and staff. The home keeps us informed about legally required events, and we receive reports from other sources. One inspector visited the home 09:30 am to 19:00 pm. The home was not expecting our visit. We spoke to eight people, two relatives, staff on duty and saw two peoples care and health records. The building and grounds were seen, a meal was observed Care Homes for Older People Page 6 of 30 and we examined the medication system and records about peoples money. We tested hot water and saw records about: staffing and training, maintenance and contractor certificates, complaint and incident logs, resident and staff meetings, the homes published information and certificates. We saw or discussed reports by Environmental Health, an infection control audit by the Primary Care Trust, policies and procedures about medication, safeguarding, mental capacity laws and fire safety. We discussed our findings with the proprietor/manager and administrator who were present throughout the inspection. No requirements were made as people were safe and well cared for, and any matters we raised were acted upon. We complimented a variety of staff and management. Recommendations are at the end of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? People are regularly consulted about activities, food, equipment, furniture, facilities and colour schemes and their interests and preferences are catered for. New wheelchairs, mattresses and a new hoist were purchased, along with an upgraded computer to run the home smoothly, and the home referred people to obtain personal mobility aids. Communal areas and facilities are being improved to better meet sensory needs, socialising and to provide more choice about where activities and exercise, watching TV take place. There is a greater variety of activities and themed events in the home, and people take part in community events - won local awards for their garden. Environmental Health and the Primary Care Trust found good standards of food safety and infection control in 2009 and there are plans progressing for best practice improvements. Refurbishment and redecoration plans keep the home up to date, clean and comfortable. Ensuite facilities and equipment storage improved, and a leak in the cellar was addressed. Care Homes for Older People Page 8 of 30 The deputy manager left and a new system of delegation and shift patterns provides more flexibility. The council visited the manager about new mental capacity laws and new legal duties and the manager updated staff, policies and procedures about peoples rights. The staff development plan has led to more staff with care qualifications, training to supervise staff and about first aid; mandatory training is up to date and staff are undertaking additional level 2 courses about dementia care. Training materials were purchased, and obtained from the Health Protection Agency, to improve in-house inductions and refreshers about nutrition, infection control and abuse. What they could do better: 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 9 of 30 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 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission process ensures relevant information is given to people, gathered and visits take place to the home so that decisions can be mutually made. Equipment and health arrangements are in place where needs can be met and personalities match. Evidence: There is useful written information about the service, staff and fees in the service user guide, which is available in large print. The guide dated February 2009 is no longer accurate as management and quality assurance has changed, and so has the Commission. The guide, terms and conditions could further clarify escorts and toiletries included in the fee, and any subsidies but is generally transparent. On our visit there were two vacancies and 18 people living in the home. We spoke to two people admitted within the past six months and saw their care records. They were happy in the home and one persons condition has improved. One persons family Care Homes for Older People Page 11 of 30 Evidence: chose the home and the person agreed with their choice after visiting. One person moved out to supported living, which shows us that the home promotes independence and recovery. The home does not offer intermediate care services. The manager is clear on challenges staff are trained to meet and ensures that equipment and health arrangements are in place in advance of admission. Some people have settled in the home for longer than other placements, and people told us that they preferred Bank House to others they have tried. One person has lived in the home for 19 years. We saw excellent pre-admission assessments setting out relevant medical and social care histories and further information to be gathered. This was followed up with health and social care professionals, people and families. Admissions are planned and sensitive to reduce anxiety about the change in peoples lives. Further assessment makes use of all this information in care plans. After 28 days, trial periods are reviewed. Eight surveys told us that people had enough information and a contract to make decisions about the homes suitability. People and relatives told us that they are involved in care planning and care plans we saw were signed to confirm this. We did not examine contracts at this visit. There were five people funding their own care and the home told us they all have contracts. Care Homes for Older People Page 12 of 30 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. People have support the way they want and need for their independence, wellbeing and to preserve dignity. There is good access to health services so people have aids and specialist advice, and medication is given as prescribed. Systems could be more robust to safeguard people at risk of falling out of bed, and to store and account for medication. Evidence: During our visit staff updated each other about people and room changes - we sat in on a shift handover and a shift leader phoned in for a briefing. Care plans had detailed guidance so that staff have clear instructions about nutrition, continence, catheter and renal care, stimulation and depression, mobilizing, sensory aids, personal safety and medication. Preferences about personal routines, bathing, sleeping habits and even the number of pillows are recorded. People have choice about the gender of the staff who support them with personal care, privacy and dignity was maintained. Some people manage personal hygiene independently with minimal support. We complimented the way that staff safely and sensitively used a handling belt and Care Homes for Older People Page 13 of 30 Evidence: stand- aid to assist people to transfer on our visit. Risk of falling while mobilizing is well assessed but risk of falling out of bed also needs identification and review in a timely way if there are falls. The manager will be reviewing with one person and staff concerns we raised from the homes records about recent falls with no injuries, hoist instructions and room layout. Skin, oral and foot care is appropriately met, any pressure relieving mattress is provided but need for pressure cushions was not noted we saw sufficient cushions and were told they are routinely used. Healthy living is promoted and informed risk taking is monitored, for instance about smoking and dietary choices. A relative said that the manager has given Dad confidence and a feeling of security...guides my father in dealing with his medical needs as well as emotional ones. Best practice screening assesses risk of malnutrition as well as obesity. Dietary needs and preferences are known and catered for, and no one was prescribed nutritional supplements. Body Mass Index measurement, regular weighing and records about food intake are used to monitor health and wellbeing and changes are acted upon at early points, including short term illness. There are a variety of professionals involved with people, including physiotherapy, speech and language therapy, doctors and mental health services. Staff support people with individual exercise regimes for stroke recovery. A GP reviews everyone in the home monthly and good records are kept about this showing us that medication is regularly reviewed. Only one hospital admission took place during the year. We spoke to two relatives in the home who praised the care. One said, during my mothers 4 years at Bank House she was very well looked after and it was such a comfort that her last days were spent in her home she loved dearly. End of life care was carefully and sensitively planned. District Nurses who visited daily until recently told us in surveys that staff keep clear records, are informative and monitor people well. They seek and act upon professional advice. There is a separate medication administration record (MAR) for a stock of homely remedies and skin creams provided by the home to individuals, for instance to prevent skin breakdown or for minor pain relief. Staff collect and dispose of medication and have a two week monitored dose Nomad system which is safe and ensures medication does not run out. No one was self managing medication by choice. There is a list of authorized staff who had accredited training to handle medication. We confirmed with staff that they use reference books and care plan guidance, and that their practice is observed by the manager. This is not currently recorded so that recurrent errors can be addressed. We were told that errors are rare and are followed up. The MAR were generally good. Two gaps were missed in a recent internal audit but Care Homes for Older People Page 14 of 30 Evidence: we were able to confirm that the person had medication as prescribed. We had no concerns about peoples health or wellbeing, but we found areas for improvement and have confidence that the manager will address this in a timely way as agreed. The manager agreed that neither of us could account for as required medication stocks we tried to check, under the current recording system. The MAR should be the main record to account for all medication - supplies carried forward, administered and disposed of. A better system for storing disposals will prevent disposals being missed and staff will know where to store medication contaminated by error. The manager will dispose of a liquid medication opened in error but not dated by staff as its shelf life could not be determined. Currently no one is prescribed controlled drugs. A Schedule 2 drug is recorded in the controlled drugs register and MAR, which is a good practice, however there is no controlled drugs cabinet and the manager was not up to date on regulations about this and was signposted to the Commissions guidance. Medication is secured but there are no current checks of temperature to ensure it is stored in accordance with manufacturer instructions to remain effective health treatment. One cabinet above a radiator was warm and the drug fridge thermometer wasnt working. Ambiguous labeling of as required guidance by the pharmacist will be queried so that this is clear for staff. Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead the life they choose each day, and have support to keep in contact with friends and relatives. There is mental stimulation and exercise in the home and in the community which people can take part in. Dietary needs are met by excellent catering. Evidence: People have good opportunities to take part in worship, activities and entertainment provided in the home for mental stimulation and exercise, and these match their recorded interests and preferences. This is regularly reviewed by staff and in resident meetings. One survey suggested there should be more exercise sessions so we checked. The home arranges monthly sessions from an external provider supplemented by the activities organiser who has just returned from a period of illness. There are outings and themed events at the home such as strawberry tea, and attendance at a local day centre who provide day trips. Most people were lively and keen to take part in activities and the TV was only on in one communal room and people chose what they watched. We complimented staff who took time to converse with people who did not want to join activities. People told us that they make friends and particularly liked bingo, dominoes, card games and celebrations. The home was preparing for a 102nd birthday party. Care Homes for Older People Page 16 of 30 Evidence: TVs are not routinely on in the lounge, and people read and shared a newspaper. They had personal radios, TV, books and periodicals in their rooms and can lock their door for privacy. A public pay telephone in reception does not afford privacy. Some people have their own phones installed. Relatives said they are kept well informed and are always warmly welcomed, which was echoed by health professionals. There are facilities for people and visitors to make their own drinks. There are flexible routines to meet individual lifestyles, so people get up and go to bed when they want, eat where and when they like. For breakfast some have trays in their rooms. There are two sittings for meals so that people who need support have a calm atmosphere. This is best practice so that people eat well and are not distracted. People described the second sitting as a real social occasion. Food is home cooked and was highly praised by people on our visit, confirming surveys. There is a balanced diet and choice at each meal. One person checked their dietary choice was appropriate with staff on our visit. People are regularly consulted about menus by the cook, who is aware of their varied dietary needs. We found thoughtful catering arrangements so that people with diabetes have the same choice as other people, but sugar-free. Dishes are prepared which are suitable for soft diets. Care Homes for Older People Page 17 of 30 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. Complaints and consent are taken seriously but are not always logged so we could not confirm peoples rights were met, and a request about minor pain relief did not have timely response. Financial interests are protected. Staff have robust recruitment checks, understanding of abuse and know how to respond to safeguard people however incident analysis and prevention could improve protection. Evidence: The complaints procedure is in the service user guide, but families need accurate details about the Commission to report a concern outside of the home, if preferred. The homes records confirm there have been no recorded complaints for many years and no safeguarding referrals or concerns. However matters such as missing laundry were acted upon and discussed in staff meetings which should have been recorded as complaints to protect peoples rights and ensure timescales and satisfaction are met. In contrast, there is good incident recording even where there has been no injury, but incidents were not always followed up to investigate root causes, prevent recurrence or when procedures did not appear to be followed. The home keeps us well informed of events that seriously affect people. Peoples rights to manage their own financial affairs and mail are respected, as well as their rights to make daily decisions and take risks in accordance with the Mental Capacity Act. However personal inventories are not recorded - we are not aware of items going missing. We queried why a family signed care plans for a person with Care Homes for Older People Page 18 of 30 Evidence: mental capacity. Consent forms to share or limit information to representatives people nominate and professionals were not signed in one care record, as per the code of practice. The manager is aware of new legal duties in respect of Deprivation of Liberty Safeguards, has national and local forms and briefed staff. No authorisations have been necessary. We saw that people have freedom of movement, and care plans identify people who need escorts outside of the home. External doors were not locked but there are security measures to prevent intruders. Staff meetings discuss professional issues, for example sedatives as a last resort to changes in sleeping habits, which is good practice. During our observation in the lounge while activities took place elsewhere, there was a brief altercation between people which we discussed and will be followed up by the manager. Staff pop into the lounge every few minutes so that people have some supervision. Help with minor discomfort requested was not responded to in a timely way and the person was not kept informed about delay. This could exacerbate altercations. We saw one care plan with guidance on ways staff should respond to inappropriate comments, which are reducing in frequency showing us that the plan was sensitively agreed with the person and effectively used. Care Homes for Older People Page 19 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bank House is homely and well maintained. Rooms are individual, provide privacy and most people have the equipment they need to promote independence and safety. There are high standards of cleanliness and good measures to prevent and control infection. Evidence: People bring their own furniture and belongings. Privacy screens were in shared rooms, and rooms have lockable facilities. People have the equipment they need to promote their independence which is regularly reviewed. The manager arranged for a number of people to have new aids to promote confident mobility in response to physical and sensory needs. Care plans promote their use, care of spectacles and hearing aids. One person uses a wheelchair indoors, and one person was nursed in bed on our visit and there is appropriate and sufficient pressure relieving equipment. Some people have grab aids to help themselves out of bed, and commodes. One survey received after our visit suggested the home needs another toilet. We found that the home has sufficient toilet and assisted bathing facilities for its size and layout, and most rooms have en-suite toilets. The decoration and layout of bedrooms, furniture, facilities and storage is planned with people. We queried a risk of one person banging their head when in bed but were told that the person changed the room layout and did not want a cabinet moved. Care Homes for Older People Page 20 of 30 Evidence: Incident records showed that staff had difficulty using a hoist in one room; the manager will be reviewing this in response to our query. There are slings in two sizes for the hoist, currently not used daily with anyone. Care records have general hoist instructions but individual sling sizes are not assessed. Staff need sufficient instructions matching individual safety needs, which the manager intends to remedy. There are systems to regularly check the safety of the water supply to prevent bacteria, legionella and scalding water in the bath but did not include wash hand basins. We tested a number in various parts of the home with the manager and found water temperatures of 33 to 44 degrees, which is just within the safe range but could improve comfort. The manager planned to act on this and add this to regular checks. The home has good control measures to prevent and control infection and achieved 91 compliance with a Primary Care Trust audit in November 2009, and the home has the national best practice guidance. Anti-bacterial gel dispensers are in hallways and swine flu prevention information was on display. Liquid soap and paper towels are in communal rooms and measures for staff hand washing in peoples en-suites are progressing. However we drew the managers attention to cracked sealant and bath enamel, a taped commode and a cracked toilet seat where infection can harbour, and a damaged bath panel posing risk of injury. There are high standards of cleanliness and a housekeeping team. Cleaning schedules were introduced. The manager agreed there was no reason why bath towels were being stored in the laundry and in a bathroom, along with communal bubble bath as there is alternative storage and sufficient for individual supplies to prevent crosscontamination. Improved storage facilities for mops and staff belongings are planned. Care Homes for Older People Page 21 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Qualified and consistent staff have a team approach and good training to understand and meet peoples needs with skill and sensitively. Robust staff recruitment checks, high staffing levels and good staff handover systems ensure needs are flexibly met day and night. Evidence: People and relatives on our visit confirmed 15 surveys we received, including two health professionals, telling us that suitably experienced and knowledgeable staff are usually available to meet their needs. There is a low turnover of staff and some have worked in the home for up to 20 years. The staff group covers staff absence so that there is consistency of care, and temporary staff have not been necessary. Four staff left during the past year and one has returned after gaining wider care experience. There are two waking night staff and three care staff on each day shift, 8am to 3pm, and 3pm to 10pm. We saw enough staff at peak times to support people individually to eat, and confirmed by rotas that high staffing levels have been maintained. There are shift leaders, and team leaders supervise staff. In addition to care staff there is an activities organiser, housekeeping and catering staff, and an administrator one day per week. We noted that staff are efficient and committed and ensured the smooth running of the home despite snowy weather conditions on our visit. Care Homes for Older People Page 22 of 30 Evidence: We sat in on a shift handover and spoke to ten staff during our visit. There is a strong team approach to providing individualized care, food and cleanliness and we complimented staff skills and pride they take in their roles. Good communication systems were evident so that staff are informed of changes about people and matters affecting the home. People and relatives told us that they have good relationships with staff. Staff told us that they are happy in their jobs, get on well together and feel well supported. Staff outings are particularly appreciated and good training opportunities. We saw three staff files to confirm that there are robust recruitment checks on staff which protects people. There was however some ambiguity in two staff files which was explained to our satisfaction and the manager intends to amend records to reflect our discussion. Almost all care staff have NVQ Level 2 or 3 qualifications. Most mandatory training is undertaken and refreshed. Training is provided in-house and knowledge is externally certified. External training providers are used for accredited manual handling and medication training, for instance. We discussed certifying in-house training in infection control. A variety of staff meetings are held quarterly, and we saw from minutes that the manager keeps staff up to date about best practice and new laws. Staff also told us that they use reference material, for instance about medicines and peoples conditions. Staff have additional training about nutrition and dementia. There are Skills For Care inductions and competencies are signed off. Annual appraisals of performance include staff development and training needs, which are used to form a staff development plan. The manager said they intend to amend the format to include medication competence. Care Homes for Older People Page 23 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run by an experienced registered manager and there are safe working practices. The views of people and stakeholders are taken into account in refurbishment and service development plans. Fire safety and environmental health and safety could improve for peoples benefit. Evidence: The manager is an experienced and qualified general nurse who is registered by the Commission and has the appropriate management qualifications. Relatives particularly commented about how the manager has helped people to manage their health conditions with confidence. The manager played an active role with people and relatives on our visit. They readily approached him and he was responsive to their requests. We complimented leadership skills, clear delegation and accountable oversight. Bank House promotes individualized care, independence, choice, comfort and wellbeing. Staff impressed us with their skills and knowledge of the homes procedures and systems, their efficiency and professionalism. Care Homes for Older People Page 24 of 30 Evidence: The quality of AQAAs are excellent with self-analysis and understanding of individualized care, equality, diversity and value for money using local comparisons. There are clear development plans which they consult people about. Business plans respond to best practice suggestions of regulators and the Primary Care Trust for continued improvement. The home is well run with generally safe working practices and most record keeping up to date to protect people and securely kept for confidentiality. We complimented the quality of care records, most maintenance records and premises risk assessments. The fire risk assessment needs to review all the loose papers in the management office and haphazard storage in the room next door. Also, the manager said that there has only been one fire drill in the past year and confirmed that legally required records about this are not kept. There is a phased fire evacuation plan and we confirmed that fire equipment is checked and alarms are regularly tested. Re-decoration was taking place during our visit and minor damage had been caused but interim measures to prevent accidents were not taken, which we discussed. Repairs and refurbishment have a clear plan but need to prioritise timely infection controls, health and safety. Policies and procedures are regularly reviewed and make use of new laws about peoples rights and national best practice. The manager keeps staff up to date. Staff recruitment is planned in advance, for example seeking replacement for anticipated maternity leave in several months time. Annual appraisal of staff performance includes learning needs, which are used to drive a staff development plan. The manager intends to amend the appraisal format to include medication competence. New staff have an induction that includes the code of conduct and safeguarding policies. Staff do not benefit from wills or get involved in peoples financial affairs. We sampled the homes records of small amounts of peoples monies which tallied and were checked/signed by representatives regularly. There is a float so that peoples needs can be met if funds run out, which is thoughtful. There are policies about safekeeping of valuables and the home provides insurance cover for personal possessions. The homes liability insurance certificate was on display but the registration certificate was taken down during redecoration and will be replaced. Since the last inspection, formal quality assurance changed. The service user guide is not accurate and the Investors in People Award is no longer in place. Surveys are not used to obtain the views of people and other stakeholders. Views are sought in other ways discussed in this report, and at least annually at resident meetings. Staff meetings record discussion about minor concerns raised by people and families. Care Homes for Older People Page 25 of 30 Evidence: More formalized systems are needed and periodic analysis to identify any patterns that can be acted upon or learned from peoples experience through the homes systems - complaints, incidents, quality monitoring of health and safety for peoples benefit. We advised that the Commissions guidance on complaints, medication, destruction of police checks, registered provider visits and upcoming new registration process and regulations should be consulted when policies and systems are reviewed. Care Homes for Older People Page 26 of 30 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 27 of 30 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 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 The risk of people falling out of bed should be assessed and appropriate measures agreed with people to minimise risk of injury. Once opened, staff need to label medication with the date so that its shelf life can be checked. An appropriate controlled drugs cabinet should be purchased and installed in accordance with the Misuse of Drugs Act 1973. The purchase of a maximum, minimum thermometer is advised and daily checks wherever medication is stored to ensure compliance with product licenses to remain effective health treatment. The MAR should account for all medication in stock, disposed of and administered to prevent error and medication going missing. Safekeeping of medicines for disposal should be reviewed. The Commissions guidance on what constitutes a complaint and concern should be consulted to update and use the homes procedure to promote peoples rights. 2 3 9 9 4 9 5 9 6 16 Care Homes for Older People Page 28 of 30 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 7 17 Consent forms should be signed and reviewed with people about sharing information with self-chosen representatives and professionals in accordance with the Mental Capacity Act code of practice. Personal inventories should be kept up to date to promote peoples rights. People need timely response to minor discomfort and explanation of any delay. Care plans should identify individual sling size to prevent avoidable accidents if the hoist is necessary. Regular tests of hot water in wash hand-basins should be undertaken to make timely adjustments, protect people from scalds, and forewarn when thermostatic valves may need replacement, in accordance with Environmental Health advice on health and safety. Towels and toiletries should be stored so as to prevent cross-contamination. Periodic analysis should identify any patterns from complaints, incidents and the views of people and stakeholders so they can be acted upon, learned from or taken into account in the homes development plans. Regular appraisal of staff performance should include their competence and knowledge in safe handling of medication and following procedures to protect peoples health. The fire risk assessment should be reviewed in consultation with the West Midlands Fire Service so that precautions and systems meet fire regulations. Infection controls, health and safety should be prioritised and timely in the homes refurbishment, repair and maintenance plans. 8 9 10 11 17 18 19 25 12 13 26 33 14 36 15 38 16 38 Care Homes for Older People Page 29 of 30 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. 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. 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