Inspection on 10/12/09 for Beech House

This is the latest available inspection report for this service, carried out on 10th December 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech House 22/02/06

Beech House 29/03/05

Beech House 24/01/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Beech House 11 Prowse Close Thornbury South Glos BS35 1EG     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: Vanessa Carter     Date: 1 0 1 2 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 29 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 29 Information about the care home Name of care home: Address: Beech House 11 Prowse Close Thornbury South Glos BS35 1EG 01454412266 01454412200 beechhousecare@aol.com www.bristolcarehomes.co.uk Beechcare (Thornbury) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Manager must be a RN on parts 1 or 12 of the NMC register May accommodate up to 55 persons aged 50 years and over who are receiving nursing care Staffing Notice dated 15.2.02 applies Date of last inspection Brief description of the care home Beech House is a purpose built nursing home, situated at the head of a private housing development, close to the centre of Thornbury in South Gloucestershire. Thornbury is a market town with a wide range of shops. It is easily accessible to both the M5 and M4 Motorways. Beech House has been trading since January 2001 and is one of three homes run by this independent care provider. The other homes are in Almondsbury (Glebe House) and Horfield in Bristol (Field House). Beech House has been built to the highest standards and is tastefully decorated throughout. Furnishings offer a high level Care Homes for Older People Page 4 of 29 0 Over 65 55 Brief description of the care home of comfort. Care is provided for 55 service users in 49 single rooms and 3 double rooms, all with en-suite facilities. There is a large conservatory on the ground floor, with two other lounges and dining rooms. The home has two lifts therefore the home is fully accessible. The gardens are to the rear and to one side of the property. There are two paved areas plus a gazebo and garden furniture that provides space to sit outside in good weather. Care Homes for Older People Page 5 of 29 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: We completed an unannounced inspection of Beech House Nursing Home in one day and spent a total of 7 hours in the home. The last inspection of this service was undertaken in January 2007 and our overall judgement about the quality of the service provided for the people who live in the home was that they received an excellent service. After that inspection we planned to visit again within three years. We last completed a service review on the 15 July 2008 and again in April 2009 were still of the opinion that people received an excellent service. There has recently been a change in the management arrangements and a new home manager has just been appointed. Prior to this inspection we asked the care provider to complete the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment was not due back in time to be Care Homes for Older People Page 6 of 29 included as part of the pre-inspection planning process and had still not been submitted by the time the report was completed. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to those staff on duty and the deputy manager. The newly appointed manager was not available for the inspection visit. We observed the interactions between staff and the people who live in the home. We also spoke to some of the people who live there and visiting relatives. At the time of this report the fees for placement in the home range between 725 and 775 pounds per week. Additonal charges may be made for other services and these are detailed in the homes brochure. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We have made four requirements and five recommendations following this inspection. Recruitment procedures must be more robust and CRB checks must be completed for all staff including those under the age of 18 years old. This is so people will be protected from being looked after by unsuitable workers. The newly appointed home manager will need to make application to the Care Quality Commission for registration. This is a legal requirement. The registered provider must ensure that in future, the Annual Quality Assurance Assessment (AQAA) is submitted within the timescale set. Despite extending the deadline for submission on this occasion, the AQAA has not been submitted. All staff working in the home must be regularly supervised. On a formal basis this should be at least six times a year. Recommendations of good practice have been made in respect of information made available about the home needing updating, risk assessment processes being Care Homes for Older People Page 8 of 29 expanded, end of life care planning being properly documented and fire drills being recorded. 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 29 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 29 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. The information that is available about the home provides clear details of the service and its facilities but does need some updating. Placement in the home is only offered after a robust pre-admission assessment has been completed. Evidence: Both the Statement of Purpose and Service Users Guide (called the Residents Guide to our Service) are informative and provide a very clear picture about the home and what services and facilities it has to offer. Both documents need updating to reflect the changes in management and the Care Quality Commission information. A copy of the homes brochure is given to people who enquire about the home and who have been assessed as appropriate for placement. A copy of the service user guide is placed in each bedroom and will be given to new people as they are admitted into the home. This means that people will have the necessary information to make an informed choice that the home is the right place for them. People will know what to expect when they choose to live at Beech House. We spoke to one person who had recently Care Homes for Older People Page 11 of 29 Evidence: moved in to the home. They told us that family members had arranged the placement but written information was available in the room when they moved in. Each person will be provided with a contract or a set of terms and conditions of stay. For those people who are part funded by the local authority, or funded by the primary care trust, a schedule of payments will be set up with the funding authority. Prior to any placement being offered, a pre-admission assessment will be completed by either the home manager or the deputy. We looked at the documentation completed for two people who had recently moved in to the home. We could see that they had been assessed prior to the admission date. Where a person is returning to the home for a period of respite care, a re-assessment will always be completed to ensure that any changes in need are identified and accommodated. The pre-admission process will ensure that the home has the necessary facilities (nursing equipment) and the staff team have the necessary skills to meet peoples specific care needs. The assessment is recorded upon a comprehensive Resident Assessment document and this covers all aspects of personal, health, mobility, mental health status and social care needs. This assessment is then used as a basis of the care planning documentation. New placements are always arranged on an initial trial basis with a review of how things have gone being completed at the end of this time. This review will be undertaken with the funding authority where appropriate, the person if possible, any family or representatives, and home staff. This trial period can be extended if necessary. Care Homes for Older People Page 12 of 29 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 planning processes ensure that peoples individual care and support needs will be identified and met in the way that they want. The monitoring of peoples health is good and medical care is arranged as necessary. Medication procedures are safe and follow good practice guidelines. Evidence: Each person will have a plan of care prepared that details their specific care and support needs and the actions that need to be taken by the care staff to meet those needs. We looked at a sample of three plans, one person with highly complex needs, a second person with wound care needs, and the other, randomly selected. We found that each of the support plans had been well prepared. Very specific information was recorded in one persons plan about how their needs had to be met and evidenced that there had been consultation in the drawing of the plan with the person and their carer. The wound care planning documentation prepared for one person was clear and detailed the medical products to be used and the frequency that dressings needed attending to. An evaluation was recorded each time the dressing was changed. Care Homes for Older People Page 13 of 29 Evidence: Care planning documentation includes a number of risk assessments, and we saw those in respect of moving and handling tasks and the likelihood of developing pressure sores (waterlow), and use of bed rails to maintain a persons safety. The mobility risk assessment result in a handling plan being devised - those seen needed to record more detail about the specific equipment to be used. When people need to be moved using a hoist, the sling size must be recorded. When the likelihood of developing a pressure sore is identified, appropriate equipment is provided. We noted that nutritional risk assessments and falls screening were not routinely undertaken for everybody and we discussed this with the deputy manager and the home manager. New nutritional assessment documentation is to be introduced as part of the care planning process, and this was already a planned improvement. Falls risk assessments will only be completed if this presents as a problem, and then a management strategy will be devised to reduce or eliminate any risks. All plans and risk assessments are reviewed on a monthly basis. A communication report is completed on a daily basis and those we looked at provided a good account of care given. Carers and nursing staff will complete these records. Most of the people are registered with one GP practice and records are kept of all contacts with GPs and other healthcare professionals. People are able to retain their preferred GP upon admission as long as the GP is able to undertake domiciliary visits to the home when necessary. Examples of other healthcare professional who may visit the home include chirpodists, dieticians, physiotherapists, opticians and dentists. We spoke with the deputy manager about recent flu vaccinations and were advised that she is suitably qualified to administer these. There are processes in place to monitor peoples health care status - this may include body weight,diabetes management, fluid or dietary intake. Medications systems are unchanged and are safe. There are procedures in place for the ordering, receipt, administration and disposal of medications. Signage is in place where oxygen cylinders are stored and in use. Records evidenced that controlled drugs are auditted on a weekly basis on top of being checked each occasion they are used. We were told that some carers are receiving additional training in order to be able to assist the qualified nurses with the medication rounds. This measure has been taken to ensure that people receive their medications at the time they are prescribed, and not late in the morning. During the time we spent in the home we observed the staff team interacting with the people they were looking after and visitors, in a kind, thoughtful and professional manner. Staff were courteous and polite, but there was a lot of friendly banter, and fun being had. People told us that they were well looked after - nothing is too much Care Homes for Older People Page 14 of 29 Evidence: trouble, this is like a first class hotel and all the girls are so friendly and helpful. As part of the care planning process, end of life care needs are discussed where appropriate. We saw that in some cases the decisions about the persons care was being made by the next of kin and it was not obvious whether the person themselves had been consulted. The resuscitation assessment states that where decisions could not be discussed with the person, an explanation should be recorded. In this assessment there is space to record GP consultation and relatives or advocates involved. The home also has explanatory information leaflet about what resuscitation means. We discussed with the deputy during the inspection and later with the manager, about the importance of these records being completed properly. We expect to see a clear record of who was involved in the discussions and signatures from the person where possible, family, member of staff from the home and the GP who is agreeing the clinical decision. Care Homes for Older People Page 15 of 29 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. There are opportunities for the people who live in Beech House to participate in a range of social activities. The support of family and friends is encouraged and welcomed. The standard of catering is high and people will be provided with a well balanced and nutritious diet. Evidence: The home employs dedicated activity organisers who arrange a variety of different activities throughout the week. Gentle keep fit and sherry sessions are arranged each morning. There are also arts and crafts sessions, musical entertainers, church services, interactive TV games, films and bingo arranged. We were told that the home had a Summer Fete and the money raised was used to purchase a large flat screen television for the lounge. There is a piano in one of the lounges. A hairdresser visits the home on a regular basis. A copy of the weekly Activity Calender and menu is provided to each person each week. In the main reception area there is a notice board displaying details about future events. The following week there is a carol service being arranged. The home previously had a large minibus which was rarely used for group outings. This has been replaced with a smaller vehicle that can accommodate one wheelchair user or two people, plus driver and a carer. This vehicle is well used and people are taken out individually or in pairs, to places of their own choice. A Care Homes for Older People Page 16 of 29 Evidence: trolley shop is taken around each week and people are able to purchase toilettries and sweets. One person we spoke with during the inspection said I am told about what is happening but I like to stay in my room. I have my newspaper and attempt the crossword. People are able to have visits from family and friends at any reasonable times. One visitor told us that they were regular visitors to the home, that they always found the staff very friendly and were offered refreshments. Our overall opinion because of observations made during the inspection visit and comments received were that people are encouraged to make their own decisions where possible. People are asked about where they want to spend their time, what they would like to eat and what time they would like to get up and retire to bed. The home has a rolling six week menu plan and offers a choice of two main midday meals. The meals being served on the day of the inspection was roast pork or a cheese pasta dish. A range of red meats, chicken, fish and vegetarian meals are served throughout the week. Alternative meals are provided if both choices on a particular day are not to a persons taste. People spoken with about the meals said that they were very good - the food is always lovely, I look forward to my lunch every day and I have not lived here very long but I must say the catering is first class. In the afternoons, hot or cold drinks are served with cakes and in the early evening, soup and sandwiches, or snack meals are provided. The kitchens were awarded the top five star rating when they were last visited by an environmental health officer. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure and any complaints people may have will be listened to and acted upon. Staff awareness of safeguarding issues will ensure that people are protected from being harmed. Evidence: The homes Complaints Procedure is included in the Statement of Purpose and Residents Guide and is also displayed in the main reception area of the home. The information needs to be expanded to ensure that any complainant is fully aware of how their complaint will be handled and what timescales will be adhered to. Also details about the Commission need to be updated. Those people spoken with during the inspection said they would feel happy about raising any concerns. Everyone is so helpful, they deal with any requests I may have, I have nothing to complain about and my relative has raised some issues with the staff and they have been sorted out. We looked at the homes Complaints Log. The manager has received seven complaints in the last year and the records evidenced the actions taken and the outcomes of all but the last two complaints (these have only recently been received). One of the other complaints was dealt with under safeguarding procedures and led to a strategy plan of action being put in place to prevent a similar event. The issues raised in this complaint were in respect of communication, care planning and healthcare monitoring. The strategy plan is being reviewed again in February 2010 records evidence that the home has worked well with the local authority in putting things right. We are assured that the management of any complaints or safeguarding Care Homes for Older People Page 18 of 29 Evidence: issues is now satisfactory , that people will be listened to and any necessary actions will be taken. The home has a protection of vulnerable adults (POVA) policy. Those staff spoken with during the course of the inspection demonstrated good awareness of safeguarding issues and of their responsibilities in protecting the people who live in the home. Staff will receive safeguarding training as part of the induction training programme for new staff but also on a regular update basis. A new internal trainer has been appointed who will provide this training for the staff team. Care Homes for Older People Page 19 of 29 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. Beech House Nursing Home is a comfortable and well equipped care home. It is kept clean and fresh. Each bedroom has en-suite facilities and all communal areas are well furnished. Evidence: Beech House Nursing Home is a purpose built two storey care home, located in amongst a private housing development. It is well maintained and provides private and communal facilities on both floors. Car parking for visitors is limited but spaces are available to both sides of the property. There is level access into the home and visitors are able to wait in a lobby area until the locked door is opened. The entrance is secured with a key padded lock and during office hours, visitors are welcomed to the home by the administrator. CCTV cameras are installed in the main entrance to alert the administrator to peoples arrival. Access to the upper floor is via passenger lifts or via staircases, making the whole home fully accessible for people who have impaired mobility. All areas of the home are well decorated and appropriately furnished. There is access out in to the gardens and the patio from the conservatory room. Some of the bedrooms have french doors that open out on to the gardens. There is a gazebo that provides shelter during the summer months. There are two lounges and a dining room on each floor. The dining rooms are set out hotel style and the lounges are furnished with comfortable armchairs and elegant Care Homes for Older People Page 20 of 29 Evidence: fixtures and fittings. There is a kitchenette on each floor where visitors and able people can make themselves refreshments. Each floor has a nursing station, and there are three sluice rooms (two on the upper floor and one on the ground floor). The corridors are wide and have grab rails on both sides. There are several places in the corridors where people can sit and watch the world go by. There are sufficient numbers of communal bathrooms located throughout the home fitted with either an assisted bath, or a level access shower facility. One of the bathrooms has recently been fitted out with a new specialist bath. All bedrooms have ensuite faciltities of a toilet and wash handbasins. Toilets are also located near the lounges and dining rooms. There is a plentiful supply of hoists, stand aids and other types of equipment to assist with moving and handling tasks. There is a selection of different types of beds with some being specialist profiling nursing beds, some hospital type beds and a few remaining ordinary divan beds. There is rolling programme of replacement of these divan beds. Specific items of equipment will be obtained for people with particular care needs as and when required. The home has a number of different mattresses and alternating air mattresses and people are provided with the one that meets their specific needs. A nurse call bell system is installed throughout the home, and in each of the bedrooms there are two call points, one by the bed and one by the armchairs. There are 49 bedrooms for single occupancy, and three shared rooms. Privacy screening is available for the shared rooms. Each bedroom is fully furnished, with ensuite facilities, and there is a rolling programme of furniture replacement. Most of the bedrooms were seen during the inspection - people are encouraged to personalise their rooms and to bring in any small items of furniture and other items. The home was nice and warm on the day of inspection and well lit. The home was clean throughout and fresh smelling. An air purification system ensures that the home always remains free of any unpleasant odours. One person told us the home is always being cleaned, it is spotlessly clean. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Beech House will be cared for by staff who are skilled and competent and able to meet their specific care needs. Recruitment of all new staff has not always been in line with safe procedures, which means that unsuitable staff could have been employed to work in the home. Evidence: Many of the staff who work in the home have done so for a number of years. There is a well established team of registered nurses and care staff. The deputy manager has worked at Beech House for five years and a new home manager has just been appointed. Staffing levels are based upon the collective dependency needs of all people in residence and adjustments are made to the numbers of staff on duty when people develop higher dependency levels. We were told that currently for the day shift there are three registered nurses plus 11 carers, and overnight two nurses and three carers. Those staff spoken with said that although shifts are always busy, the staffing levels were correct. A team of housekeeping, laundry and catering, administrative staff, maintenance and activities staff, are also employed in sufficient numbers to provide support in meeting peoples daily living needs. All care staff have either already achieved at least a National Vocational Qualification (NVQ)Level 2 in Care or will be expected to start working towards the award in the near future. All new recruits are expected to undertake NVQ training after they have Care Homes for Older People Page 22 of 29 Evidence: completed their initial training and probationary period. One senior member of staff is an NVQ Assessor and will support staff in completing the award. In addition, a number of staff have an NVQ at Level 3. We looked at six recuitment files to check the procedures that are followed before new staff are employed to work in the home. We found that the correct procedures were not always being followed as some staff (those under the age of 18) were being employed without a CRB or POVAfirst check having been completed. This is extremely unsafe practice and has the potential to mean that unsuitable staff may be employed to work in the home. Immediate actions were taken by the administration manager to complete the documentation necessary for these checks, however those people holding a registered position (responsible individual or registered home manager), must ensure that the necessary pre-employment checks are always completed before any staff member begins work in the home. A personal training log is kept for each staff member and we looked at some of these. A Training Manager has just been appointed to oversee and arrange the training for both registered nurses and care staff who work in this home and the other two homes in the group - a training session was taking place in the home on the day of inspection and staff were doing manual handling and fire awareness training. All new recruits will complete an induction training programme and this consists of manual handling, fire safety, infection control, safeguarding of vulnerable adults (SOVA), home procedures and policies. These mandatory training sessions will then be repeated on a regular basis to ensure that the staff work within the homes policies. We were told that the training manager will be preparing an overview for each home that shows what training each individual staff member has received and is due to attend. The home operates a modular training package as well as the mandatory training programme that all staff have to complete - this includes diet and nutrition, mental capacity act, care and administration of medications, risk assessment and basic first aid. Care Homes for Older People Page 23 of 29 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. This home is well managed and run in the best interests of the people who live there. Their views will be sought to ensure that people receive the care and support that meets their expectations. Peoples health and safety will be promoted because of safe working practices. Evidence: The new home manager was only appointed in November 2009, having moved from a sister home in the same organisation, where she held a deputy manager post for a number of years. We were notified of this appointment. This manager will need to make application to the Care Quality Commission to be the registered manager for the service . She is registered nurse and will complete further Leadership and Management training once settled in to the role. She is supported in the management of the home by a deputy manager, administration staff and a team of registered nurses. Regular meetings are to be re-introduced by the home manager, with staff teams, Care Homes for Older People Page 24 of 29 Evidence: people who live in the home, and with relatives. There has been a recent period where these meetings have not happened whilst management changes occured but previous records evidence that the opinions of others are sought and acted upon where possible. Regulation 26 visits are undertaken by managers from the other homes or by the owners, and a report of the visit made. We looked at those that had been completed for the last year and in general they had been completed on a monthly basis. Prior to this inspection we asked the manager/responsible person to complete the annual quality assurance assessment (AQAA). We have had to remind them to submit the document but this has still not been received by the time this report was completed. It is a legal requirement that the AQAA be completed on a yearly basis. Whilst we are aware that there have been changes in the management of this home, the proprietor is required to ensure that the AQAA is submitted on time. We could consider taking enforcement action if this situation happens again. The home does not look after personal monies for people. A lockable drawer is available in each bedroom. Some services, such as hairdressing, newspapers and chiropody will be invoiced. There was very minimal records to evidence that staff receive formal supervision on a regular basis and we were told that this task has recently fallen by the wayside. We were told this by staff we spoke with during the inspection and the deputy manager. The home manager will need to re-introduce a programme of supervision for each staff member to ensure they monitor work performance and identify any training and development needs. Staff should be formally supervised regularly, and this should be done at least six times a year. Records must be available for inspection. Safe working practices ensure the safety of both the people who live in the home and the staff team. We would suggest that some of the safe systems of work devised from manual handling risk assessments are revisited and fuller details recorded about specific moving and handling equipment needed. All the necessary environment and equipment checks are completed regularly by the maintenance man, the fire log evidenced that the alarm system and fire fighting equipment is tested regularly and water temeratures are monitored. The home is well maintained throughout and no health and safety concerns have been raised as a result of this inspection. More detailed records could be kept when the fire alarm system has been accidentally activated, to demonstrate that staff have acted as if it was a fire drill. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 The registered person must ensure that a POVA check and CRB diclosure is obtained for all new staff before employment starts (this includes all workers under the age of 18 years). This is so that you are satisfied that the worker is suitable to look after vulnerable people. 15/01/2010 2 31 9 The newly appointed manager will need to make application for registration This is because it is a legal requirement. 10/03/2010 3 33 24 The registered provider 15/01/2010 must ensure that the Annual Quality Assurance Assessment is submitted when it is due. This year it is late but next year it must be submitted on time. Care Homes for Older People Page 27 of 29 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 This is because it is a legal requirement. 4 36 18 All staff working at the home 10/03/2010 must be appropriately supervised on a regular basis. This is so that their work performance can be monitored 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 1 The statement of purpose and service user guide needs updating with new manager details and also correct details regarding the Care Quality Commission. Standard risk assessments undertaken for each person should also include falls screening and nutritional screening, so that any needs can be highlighted and a preventative care plan be devised. Documents kept in respect of end of life care planning and resuscitation wishes must be completed in detail and evidence the persons involvement or reasons why this is not possible. Record fuller details on manual handling risk assessments about the equipment that is to be used. Record fuller details when the fire alarm system has been activated to evidence that the staff acted as if it was a fire drill. 2 7 3 11 4 5 38 38 Care Homes for Older People Page 28 of 29 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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