Inspection on 07/07/10 for Berry Hill Care Home

This is the latest available inspection report for this service, carried out on 7th July 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Berry Hill Care Home 26/06/06

Berry Hill Care Home 24/11/05

Berry Hill Care Home 18/07/05

Berry Hill Care Home 15/11/04

Berry Hill Care Home 25/05/04

Berry Hill Care Home 07/01/04

Berry Hill Care Home 11/12/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Berry Hill Care Home Berry Hill Lane Mansfield Nottinghamshire NG18 4JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 0 8 0 7 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Berry Hill Care Home Berry Hill Lane Mansfield Nottinghamshire NG18 4JR 01623421211 01623428864 berryhill@ashbournesl.co.uk www.schealthcare.co.uk Southern Cross Care Homes No 2 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 66 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 66. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - code OP. Date of last inspection Brief description of the care home Berry Hill Park Care Centre is a sixty-three bedded care home providing nursing and residential care, owned by Southern Cross Healthcare. It is a two-storey building with the upper floor accessible by stairs and two passenger lifts. Berry Hill also has extensive grounds and a car park to the front. The building is Care Homes for Older People Page 4 of 32 Over 65 66 0 Brief description of the care home situated on a main road with access to public transport and a direct bus route to Mansfield, which is three miles away. The accommodation was originally divided into two wings but is now regarded as one whole unit. Accommodation consists of a total of 48 single rooms, which all have en suite facilities except one. There are eight double rooms, which are all currently used as single rooms and all of these have en suite facilities. The fees range from £379 to £744.62 depending on the type of room chosen and the dependency needs of the individual. Hairdressing, chiropody, outings and personal toiletries are not included in these fees. There are copies of the last inspection report, the Statement of Purpose and Service User Guide in reception. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We looked at all of the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. Most of the people living at the home are white, British but we asked staff about the needs of a person from a minority ethnic group to make sure their needs are being Care Homes for Older People Page 6 of 32 considered and provided for at the service. The staff team come from a wide variety of backgrounds and experiences. We spoke with three members of staff, three people living at the service and two relatives to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 32 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs fully assessed and they can be assured that these will be met at the service. Evidence: We looked at the care plan of the person who was most recently admitted to the service to check that their needs were fully assessed before admission to be sure these could be met at the service. We found that a social worker has assessed the person and there is clear evidence that the staff from the service went out to visit and assess the persons needs. Their needs are within the category of registration. Staff we spoke with told us, if a person needs nursing care, one of the nurses will go out to assess them, if they need residential one of the senior care staff will go. A Senior told us, we look at the paperwork, the medical history, if specialist beds, Care Homes for Older People Page 11 of 32 Evidence: mattresses and cushions are needed. If we visit people at home we look at the equipment they have. We dont accept people with Dementia as we are not registered for that. We get the social workers reports before people come in and we give all staff a verbal handover about peoples needs. They can read the reports and people are encouraged to do this. The people we spoke with who live at the service told us, I dont know how we decided on coming here, it just evolved really. I dont think we visited anywhere else, it was a fait accomplis as we wanted to stay local. Intermediate care is not provided at the service and this standard is not applicable. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met in a way which preserves their personal dignity. The arrangements for medication are not robust and people do not receive their medication as prescribed by their Doctor. Evidence: We case tracked three people who live at the service to make sure their needs can be met there. We looked at their care plans and found these to be up to date and regularly reviewed. The acting manager did note, however that often care staff are writing the same thing in peoples daily records for each shift and she will address this with them. However, we found there are some areas of recording which could be improved upon, for example behaviour plans could be more individualised and where there is a pattern of challenging behaviour there could be better monitoring of this. Where bed rails are needed there should be a capacity assessment in place to ensure people consent to these being used. In the absence of capacity it is best practice to have their use authorised by people who do not work at the service. There is no evidence that people Care Homes for Older People Page 13 of 32 Evidence: are routinely involved in writing their care plan, and as care plans indicate most people have capacity, this should be a priority. Staff we spoke with told us, the nurses write the nursing residents care plans and senior carers do the residential ones. We did try and get the care staff to write them, but they struggled so they write the daily and weekly diaries we use for reviews. They also fill in care charts when we use them. We spoke to staff about providing care to people who are from minority ethnic groups. It is clear from interviews that they know the persons religion, first language, and cultural and dietary preferences. They told us, we use non verbal communication a lot, we make sure (the person) has a special diet and snacks. (The person) has regular visitors and the family are very happy. People who live at the service told us, we have not seen a care plan, we have not been asked for our views. A relative told us, the quality of written work in the past has left something to be desired. The acting manager has introduced six monthly review meetings. We found clear evidence in the care plans that health care needs are identified, and referred where necessary for treatment. For example, peoples weight is closely monitored and there is evidence that staff inform their Doctor if they are losing weight. Nursing tools are used to assess risk and plans are in place to address these. Body maps are routinely used to record changes to skin integrity, bruising and tears. Staff we spoke with told us, We have good relationships with the Doctors and District Nurses, the Doctors will come out the same day if we request a visit. We have input from Speech and Language Therapists, the Physiotherapists, Dieticians, Tissue Viability Nurses, Psychiatrists and we have just referred someone to the Falls Prevention Team. We are very good at getting health care professionals in. If we have any nursing queries we can always ask the qualified staff and they will all help us. People we spoke with told us, We are pretty healthy, we see the Doctor, the optician, the chiropodist and the dentist if we need them. A relative we spoke with (who has previously raised concerns with us) said, the care is definitely improving. We looked at the arrangements for the storage of medication and found these to be safe, secure and medicines are stored in compliance with the manufacturers instructions. We checked the records, storage and balances of Controlled Drugs and found these to be acceptable. We found that the service are not doing capacity Care Homes for Older People Page 14 of 32 Evidence: assessments in respect of self medication and this would be good practice, especially as there are some people who are able to manage their own medicines. The manager did an internal audit in June which covered all areas of the administration of medication and this aspect of the service was rated as good. The homes pharmacist did an audit visit in April this year and no issues were raised. We looked at the staff training records and found that all of the senior care staff who administer medication have received training, two have just completed their advanced course. However, none of the qualified nurses are recorded as having done any medication training. When this was queried with the acting manager she said the nurses would have done medication training as part of their induction. The service use the Monitored Dosage System but also have some medication stored in boxes. We checked the balances of the boxed medication against the records of receipt and administration and found several discrepancies. We found staff have been signing to say they have given medication when they have not, they have not been recording the amount of medication given where the dose varies, they have not been carrying forward medication held in stock which makes auditing impossible and in two cases people were not given their prescribed medication as it was out of stock. In one case, painkilling medication was not given for five nights and in another a medication prescribed twice a day was not given for 15 days. In the latter case a safeguarding referral has been made. As a result of the evidence we gathered we made an immediate requirement to ensure the safety of people living at the service. The service took prompt action and we have since sent out a compliance letter. Staff we spoke with told us, since you inspected the medication, we have checked every medication and balanced it. I dont know what went wrong, I know I have given tablets as prescribed but we have slipped up with this. We have been working on it all day and we will be doing regular running totals to check we are right. I have just done my advanced medication training. We never share medication. People who live at the service told us, we take tablets and the staff look after these for us. They wait for us to take our tablets and they seem safe enough. A relative told us, medication seems ok now, they have improved it. I used to self medicate but I dont want to anymore. The staff gave us good examples of how they preserve peoples rights to privacy and Care Homes for Older People Page 15 of 32 Evidence: uphold their dignity. They said, We have signs for the door to make people knock and wait, but they keep going missing and some bedrooms dont have locks on the doors which is difficult. We make sure doors are shut and curtains are drawn and we ask visitors to step outside whilst we assist people. If we see staff who treat people disrespectfully we tell them, its often when they are new. A year ago we were all so down, we used to feel we were banging our head against a brick wall and trying to provide good care. No one would believe how bad it was. People who live at the service told us, the staff are good at making you feel comfortable when they help with personal care. I dont like needing help, its so undignified, but thats me not about them and how they help. I just dont like being in the position where I need help. A relative told us, the staff are nice, the overall ambiance is good. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live flexible lifestyles in accordance with their needs and preferences and they are supported to develop friendships and maintain contact with their loved ones. Evidence: We looked at the care plans and found there is an assessment of peoples interests and details of activities they enjoy. The activity co-ordinator records the activities she does with people and these include; listening to music, reading newspapers, colouring and art work, ball exercises and doing floor games. There is an activities area in one part of the ground floor lounge and the acting manager has plans to convert an upstairs lounge into a cinema room. We observed people listening to music, reading their newspapers and doing colouring during our visit. The staff taking time to do activities in the activity co-ordinators absence. Staff we spoke with told us, we do colouring, make cards for special occasions, we do loads at Christmas, make eggs for Easter. We also go out on the bus and we have been to Gunthorpe, Newark and out to visit garden centres. There is plenty for people to do if they want. We try and do things with them if the activity co-ordinator is off, Care Homes for Older People Page 17 of 32 Evidence: we paint their nails or do some singing. (The activity Co-ordinator) goes to peoples bedrooms in the afternoon to have a chat with those who cant or wont come down. People who live at the service told us, they dont do as many activities here now there are less people in, we do number games. The staff will take us shopping but we cant afford the same things we used to. We spend all our days together and we have a good friend who visits. I dont know what we would do without her. Joint resident/relative meetings are held at the service, we looked at the minutes of the last meeting and found these are very positive about the changes since the new acting manager took the role. We spoke with a relative who raised a number of concerns with us since we last visited to see if the service seems to be improving. The person told us, In comparison with the last few years, its improving and getting better. There is an element of trust coming back in. The garden is being done and when we raised this as a concern it was acted on straight away. We have resident/relative meetings but they are not well attended, it is difficult to motivate people as some people live a distance away. Staff we spoke with told us, relatives can come whenever they like and they are welcome whenever they come. We saw the acting manager inviting a relative to join his wife for lunch during our visit, and the small downstairs lounge has been made available to families for special events and parties. When we looked at the care plans we found there has been an assessment of each persons capacity but often not in relation to a particular decision. This is not necessary as the Mental Capacity Act starts with a presumption of capacity, it needs to be used mainly where there may be a doubt about capacity and choice is being made where a decision is needed. Similarly we noticed in some parts of the care plan there are key decisions such as end of life care, resuscitation issues and management of finances where there are issues of capacity and the decisions made are crucial and impact on fundamental rights. We have spoken with the manager about this issue to clarify things, but it is clear that they have tried to incorporate the new Act into their work with people. There have been referrals to the Deprivation of Liberty Safeguards team to see if authorisations are required and this shows the acting manager has a good understanding of her legal obligations. Staff we spoke with told us that routines at the service are flexible and take account of peoples choices and preferences. They told us, the odd ones get up early, but it is not the same people every day. Some people like a lie in and dont like to be up early. Care Homes for Older People Page 18 of 32 Evidence: People can go to bed in the afternoon for a lie down if they want. Some like to go to bed very, very early but we prefer they have their tea before going up at least. People we spoke with told us, I get up early, sometimes it does seem too early but my (relative) likes me to be up and I feel bad if I dont. Another person told us, I do make my own decisions about everything, but then I can manage with very little help. We have received a number of concerns about the quality of the food available since our last visit. We observed lunch and found the atmosphere to be relaxed, people chatted between themselves and the staff offered people help very discreetly. We received mixed views about the food. The staff told us, I think the food varies, some days are better than others but they do get a choice. We have talked about doing a menu for one particular person who is used to having her meal at night as most people would not want their main meal then. There is a soft diet option and they blend the food separately so it looks nicer. Sometimes people dont want what they have ordered. That happens a lot. A person who lives at the service told us, the food is terrible, bland, boring, not what we used to eat. I would like something more tasty and more varied. Im not sure what though. We spoke with the acting manager about these comments and she told us they are trying to liaise with the person to see what they could offer which may be more palatable. A relative told us, the food has really improved. My (relative) eats in (their) room by choice. Care Homes for Older People Page 19 of 32 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. People who live at the service have access to a robust complaints procedure and can be assured that their concerns will be acted upon. They are safeguarded at the service by trained staff who will protect them. Evidence: There have been four complaints made directly to us since we last visited the service. These concerned liaison with relatives following accidents, staff being unable to meet peoples needs, care plans not being up to date, new employees working together without supervision or training, staff failing to promote independence, staff failing to assist people with their meals, people not given adapted cutlery, items going missing, staff not checking on people in their rooms. Concerns were also raised about responses to buzzers, about the odour control and hygiene at the service and about the quality of the food. The service have taken many steps to address these concerns and a new acting manager and deputy manager were appointed several months ago. Since this time, two complaints have been made directly to the service, one concerning the response of staff to buzzers which was partially substantiated and another about a bed not being made which was substantiated. The concerns are documented, with evidence of investigation and action plans to address failings. People who complain have been told what the outcome is. Care Homes for Older People Page 20 of 32 Evidence: The staff we spoke with explained there were significant problems at the service before the new acting manager came into post and they feel this explains the number and nature of the complaints which were being made. They told us, we work as a team now, we didnt use to, it was them (the nurses) and us, they wouldnt help us. We feel so much happier, we had no one to turn to last year, and having new management has been a big weight lifted from us. We feel better, morale is better, we didnt want to come in to work, it was an awful feeling. They told us there have been hardly any complaints recently, we are all expected to report any complaints and I am sure (the acting manager) would deal with it fast. People who live at the service told us, we have never complained, Im not sure we would really, thats not the kind of people we are. Relatives told us, any comments we make are acted upon now. The staff used to smoke outside my (relatives room) and it came in the windows, this has been sorted now. We have been made aware of three safeguarding incidents since we last visited the service; one concerning a staff members conduct and two between people living at the service. All were reported under safeguarding and the local procedures have been followed. We have looked at all of the records concerning safeguarding incidents and one of these issues is still awaiting conclusion but the service have taken appropriate action. When we looked at the training records for the service, we found that most of the staff have attended safeguarding training. The staff we spoke with told us, I feel people are much safer here now and better cared for because we have back up and we have support, we are able to get on with doing our jobs. We have all had safeguarding training it reconfirmed for us what good practice is. I feel 100 confident that people are safe and get the care they need now. People who live at the service told us, we feel safe, the staff are not cruel people. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and well maintained home. Evidence: We did a partial tour of the accommodation to make sure it is safe, comfortable and clean and provides homely accommodation to people living there. As we have said (OP16) there have been a number of complaints since we last visited about the cleanliness of the service. The acting manager told us there has been a programme of refurbishment and redecoration to improve the standards. We found the home to be clean, comfortable and well maintained throughout. Care and consideration has been given as to how to make use of several areas to provide places for people to use. There are four lounges, three on the ground floor and one on the first floor which is being converted into a cinema room for people to use. Several of the double rooms are being converted into deluxe bed sitters to offer people more choice of accommodation. The bedrooms we saw are pleasant and personalised, though some do not have privacy locks fitted (See OP10.) The only area of concern was the lack of storage space for frames and wheelchairs. Care Homes for Older People Page 22 of 32 Evidence: These are being stored in a corridor at the moment, but they are blocking peoples bedroom doors and as such impact on escape routes and present a risk. Alternative arrangements need to be put in place. Staff we spoke with told us, the decoration which has been done alone makes the place look better. It smelled awful for a start and it desperately needed a lick of paint. They have done it gradually and have found new and better cleaning products to improve infection control. People who live at the service told us, the home is kept spotlessly clean and fresh, you cant fault the cleaning staff. We have two rooms and I am waiting for a new television aeriel which is on order. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring, well trained staff who are properly recruited and supervised, and in sufficient numbers to meet their needs. Evidence: We looked at the staffing arrangements for the service. There are usually 6 care staff on duty and 1 nurse until 19:30. The acting manager considers the dependency levels of people and also the layout of the building in determining what staffing level is needed at the service. This is good practice. Our observations provide evidence that people receive a lot of help support and reassurance from the staff who spend quality time with them and engage with them well. Staff we spoke with told us, I think there are enough staff on duty now. We have quite a lot of sickness and you cant help people not coming in, but we have a good staff team who will pick up extra shifts and help out. We are using hardly any agency staff. The people who live at the service told us, occasionally we have to wait for staff but they have a lot of people to care for and I am realistic. The night staff are good and they pretty much come straight away. The staff are very nice though. Care Homes for Older People Page 24 of 32 Evidence: A relative told us, the quality of staff is improving. They did kick against it a bit at first but the acting manager and her deputy are getting on top of it. The staff seem happier. We looked at the training records for the service and found they have already exceeded their target of 50 of care staff having National Vocational Qualification Level 2. A further 8 staff have already achieved their National Vocational Qualification Level 3, and one person is awaiting her National Vocational Qualification Level 4 certificate. This exceeds the National Minimum Standard. The acting manager told us that she has been focusing on training, and on making sure people have received the training they need to do their jobs. The staff have received training in fire safety, Food Hygiene, Control Of Substances Hazardous to Health, Moving and Handling, Safeguarding, Health and Safety, Infection Control, Nutrition, Safe Handling of Medicines, Medication Update, Pressure Care, Customer Care, Care Planning, Challenging Behaviour, Dementia awareness, and the safe use of Bed rails. Staff we spoke with told us, We have had as much training as possible since (the acting manager) came. We have done loads, all of the statutory training. We looked at the staff files of three people to make sure they contain the information and documents needed to make sure people are safe to work with vulnerable people. The files are well organised and contain all of the paperwork required by Law. Staff we spoke with have worked at the service for some time but they confirm they have had all of the necessary checks. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is improving but action needs to be taken to improve the management of medicines so that the service runs in the best interests of people living at the service. Evidence: A new acting manager and deputy have been appointed since our last visit, but the acting manager has not yet applied to become registered with us. She needs to ensure that the arrangements for medication improve (See OP9.) Staff told us, The acting manager and the deputy are brilliant really. You can talk to them and (the acting manager) will help you sort any problem. There have been significant improvements. People who live at the service told us, the home runs well, if they ask our opinion we give it. Relatives told us, the improvements are down to (the acting manager and her deputy), the discipline is coming back. It was all about poor management. The acting manager is doing a brilliant job and the two of them have made such a Care Homes for Older People Page 26 of 32 Evidence: difference. We looked at recent audits of the service, the acting manager has been proactive in this area and her audits incorporate the views of people using the service. However, the monthly visits on behalf of the provider are not taking place. The last record we could find was from February this year. Staff did not make any comments to us on this area. We were unable to access the financial records of people living at the service as the administrator was on leave. We will look at these records during our next visit. All health and safety tests are being conducted as required. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 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 7 12 Peoples capacity to decide 30/08/2010 whether they want bed rails to be used must be assessed To make sure people are given the opportunity to make informed decisions about their care. 2 7 15 There should be evidence 30/08/2010 that people have been involved in the development and review of their care plan unless there are valid, recorded reasons for this not to happen To ensure people are aware of and as far as possible have agreed the actions staff will take to meet their needs 3 7 14 Care plans on behaviour needs must give staff guidance about how to manage this. There must be records of incidents of challenging behaviour 30/08/2010 Care Homes for Older People Page 29 of 32 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 To enable staff to provide a consistent approach and look for things which work well with each individual. 4 9 12 Peoples capacity to self medicate must be assessed To make sure that people have their decisions respected and rights upheld. 5 9 24 There must be clear recording practice and regular audits of medication to ensure the systems are safe and that people are receiving their medication as prescribed wherever possible. 6 10 23 Bedrooms must be able to be secured To ensure the privacy, dignity and security of peoples belongings can be maintained. 7 14 12 Peoples capacity must be assessed under the Mental Capacity Act where a decision is needed which impacts on their rights. To make sure they are enabled to make choices wherever possible in 30/08/2010 08/10/2010 06/08/2010 30/08/2010 Care Homes for Older People Page 30 of 32 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 accordance with their legal rights. 8 20 23 More appropriate storage for 30/09/2010 frames and wheelchairs must be found To minimise risks to people living at the service 9 33 26 A representative of the provider must visit the service every month and produce a report about how the service is being conducted To ensure there is proper monitoring and there are improvements to the areas we have highlighted. 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 31/08/2010 1 7 Daily records should reflect what has happened on each shift to make sure there is accurate information available about peoples wellbeing. When people lack capacity to consent to the use of bed rails these should be authorised by people who are external to the service. Consider the current menu and catering in light of the comments made by staff and people living at the service to see if further improvements can be made. 2 7 3 15 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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