Inspection on 01/07/09 for St Giles Private Nursing Home

This is the latest available inspection report for this service, carried out on 1st July 2009.

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

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

Other inspections for this house

St Giles Private Nursing Home 06/09/06

St Giles Private Nursing Home 27/01/06

St Giles Private Nursing Home 13/07/05

St Giles Private Nursing Home 08/02/05

St Giles Private Nursing Home 16/07/04

St Giles Private Nursing Home 16/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: St Giles Private Nursing Home 122 Tile Cross Road Garretts Green Birmingham West Midlands B33 0LT     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: Amanda Lyndon     Date: 0 1 0 7 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: St Giles Private Nursing Home 122 Tile Cross Road Garretts Green Birmingham West Midlands B33 0LT 01217708531 01217708146 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Restful Homes Group Ltd care home 48 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: 48 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 48 Date of last inspection Brief description of the care home St Giles provides general nursing care and accommodation for up to forty eight older people. The home is located in a residential area close to shops, pubs, and other amenities with good public transport links. There is ample off road car parking to the front of the building and there is a secure garden that is accessible to all people living at the home. The home is purpose built and the accommodation is spread over two floors. Upper floors are accessed via a passenger lift or stairway. Forty four bedrooms offer single accommodation and there are two twin bedded rooms. All bedrooms have en suite Care Homes for Older People Page 4 of 30 Over 65 48 0 Brief description of the care home bathroom facilities with a toilet and washbasin. In addition, assisted baths and level access showers are available on both floors of the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists and pressure relieving equipment to meet the assessed needs of people living there. The home offers communal dining and lounge areas. A separate room is allocated as a hairdressing salon. Kitchen and laundry facilities are based on site. The home is a nonsmoking environment and a shelter is provided outside for people wishing to smoke. St Giles employs an activities coordinator and the opportunity to take part in a wide range of activities is offered to people who live in the home. In the reception area there is information that may be of interest along with dates of forthcoming events. A copy of our last inspection report, statement of purpose and service user guide are displayed so that people can read them if they choose. Details of fees charged to live at the home are included in the service user guide, and are available from the home on request. Items excluded from the accommodation fee include private phone installation and calls, hairdressing and newspapers. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The focus of our inspections is upon outcomes for people who live in the home, and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. The date of the last key inspection at this home was 25th April 2008. Prior to the visit taking place, we looked at all of the information we had received, or asked for. This included any complaints made or notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We received an Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. It also gives us some numerical information about staff and people living at the home. Care Homes for Older People Page 6 of 30 We sent out random surveys to ten people who live at the home, ten relatives, and ten staff members, in order to obtain their views about the service provided. Eight people who live at the home, and five relatives returned surveys to us, and their comments are included in this report. The visit to the home was undertaken by one inspector over one day. We, the Care Quality Commission were assisted throughout by the home manager, home director and the staff team on duty that day. The home did not know that we were visiting. There were forty six people living at the home on the day of our visit. Three people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to staff about the care they provided to these people. In addition we spent time speaking with four other people living at the home, six relatives, five staff members, and one health care professional. We sampled care, staffing, and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean, and comfortable for them. Care Homes for Older People Page 7 of 30 What the care home does well: The statement of purpose and service user guides provides people with all the information that they need when considering whether St Giles is the right place for them to live. Peoples needs are assessed before they move into the home, so they can be confident that their needs will be met there. People are supported by the right number of staff who have a good understanding of their specific care needs. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. People are encouraged to lead fulfilling lives that meet their needs, interests and expectations. People living at the home are offered a variety of healthy meals that meet any special dietary requirements. There are good procedures to listen to people so they have the opportunity to influence how the home is run. People are confident that actions will be taken to address any concerns that they may raise. There is a robust system for checking that peoples money is held at the home in a safe manner. People told us: The manager was very helpful when she came to see me. She brought me a brochure and told me about the home. Dad seems to be very well cared for. Were notified immediately of any changes in medication. I prefer a bath and thats what they give me. We like to sit outside for a long while when its warm. Us three are friends. I love to be with people here. There are no restrictions here we get on well. There are not any rules here. People get to choose what they eat. If its not on the menu we cook them what they would like instead. The manager, secretary and nursing staff are always around to answer queries or concerns and are never too busy to give us their time. Nothing is too much trouble for the staff here. Carers, Cleaners and laundry persons are very pleasant to us and Dad, making a nice Care Homes for Older People Page 8 of 30 environment. 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 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission processes are thorough, and people living there can be confident that their care needs will be met. Evidence: The statement of purpose and service user guides had been updated recently and these included information about the services and facilities provided at the home, and the fees charged to live there. We saw that copies produced in Braille, audio and large print formats were available at the home, so that more people can access this information. We saw that they had been distributed to people living at the home. We sampled the pre admission assessments of three people who had recently come to live at the home. We saw that senior staff undertake comprehensive assessments in order to determine whether peoples assessed care needs could be met whilst living at the home. In addition, people are invited to view and spend time at the home in order to sample what life would be like to live there. During our visit one person who had Care Homes for Older People Page 11 of 30 Evidence: recently come to live at the home said One of the staff came to meet me at my last home, and my family came here to view the home for me. One person who completed a survey prior to our visit said The manager was very helpful when she came to see me. She brought me a brochure and told me about the home. People come to live at the home for an initial trial period of between four and six weeks. We saw that after this time a care review is arranged involving the person, people important to them, their social worker and the home staff. This provides all present with the opportunity to discuss whether the persons care needs are being met at the home, and whether they wish to stay there. Intermediate care is not provided at St Giles. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place ensuring that the health and personal care needs of people living at the home are met. Evidence: Comprehensive assessments of peoples individual physical, emotional and social care needs are undertaken on admission to the home, and care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves and in what areas they require support. Since our last visit, a new care planning system had been introduced and we sampled three of these. We found that they had been personalised and included clear instructions about the specific support required by staff, so that people should receive care and support in the ways they prefer. These included comprehensive care plans that had been written for people that required nursing tasks to be undertaken as part of their care. We saw that the vast majority of information recorded in the care plans reflected the actual care provided. Risk assessments, for example regarding moving and handling, had been undertaken and these included details of the specialist equipment that people required in order to be transferred in a Care Homes for Older People Page 13 of 30 Evidence: safe manner. Care records identified that people living at the home and their representatives are invited to care reviews with the homes staff and social workers in order to discuss their care and put forward any suggestions for improvements. One relative who completed a survey prior to our visit said Dad seems to be very well cared for. Were notified immediately of any changes in medication. Another relative said I was called once due to Dad falling. I was notified straight away and was made aware of whether or not it was serious and if we needed to be there. From discussions with people living at the home, staff, relatives, and from our observations on the day, we identified that people were receiving the appropriate care and support in order to meet their personal care needs. One person met during the visit said I prefer a bath and thats what they give me. The home told us that within the last twelve months, two people had developed pressure sores (sore skin) since coming to live at the home, and one person had developed pressure sores during a hospital stay. We discussed this with the home manager who stated the reasons for this and that the appropriate actions had been taken in conjunction with specialist wound care nurses. In addition, we saw that their ongoing advice and support was being provided for people currently living at the home who had sore skin. From care records sampled we were unable to determine that care had been provided to one person case tracked, as requested by the wound care nurse. We discussed this with the care staff and we saw that alternative methods of recording this information were being used however we were told by the nursing staff that these did not accurately reflect the care provided. We brought this to the attention of the management team and we saw that the appropriate recording charts had been implemented by the end of our visit. We saw that during a care review a request was made by a health care professional visiting the home that a bed cradle be used for one person who had sore skin, in order to prevent the pressure of bed clothes on their skin. Despite attempts made by the nursing staff we saw that a bed cradle had not been provided for this person on the day of our visit, some five days after the request was made. After discussion with the home manager this was rectified before the end of our visit. People can retain their own doctor on admission to the home, if the doctor is in agreement. Advice can be sought as needed from a range of other health and social care professionals. We spoke with a health care professional who was visiting the home and positive comments were made by this person about the service provided Care Homes for Older People Page 14 of 30 Evidence: there. Since our last visit, the home have employed a physiotherapist who delivers care on both a one to one and group basis. This is important for people who require this service in order to regain their independence. We looked at the system in place for the management of medication, and saw that medication administration charts were well maintained. Stock balances of medication sampled during the visit were correct, however we saw that a person had not received one of their tablets for four days at the start of the current twenty eight day drug order cycle, as this had not been dispensed by the pharmacy. This was discussed with the home manager who told us that she had since had a meeting with the head pharmacist to discuss the homes concerns about the service provided to them. This should mean that all medicines are available to be given as prescribed. It was of concern that during the early afternoon on the day of the visit the room temperature recorded in both drug storage rooms exceeded thirty degrees Celsius. It was an exceptionally hot day, however written records identified that the temperature in these rooms had also exceeded twenty five degrees Celsius on other days prior to this. In response to us previously raising this as a concern, portable cooling systems had been purchased for these rooms, however these were not working effectively. This was brought to the attention of the homes director, and by the end of our visit actions had been taken to successfully reduce the room temperatures to within safe medication storage limits. We observed staff assisting people in a respectful manner, and this maintains their dignity. Peoples preferred names were recorded within their care plans and we heard staff greeting them by these names. A number of people choose to have a key to their bedrooms so that they have independence and privacy in this area. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live at the home receive good support to make choices and decisions about their day to day lives so that they lead lifestyles that meet their needs and expectations. Evidence: A new activity co ordinator had recently began working at the home and as she had previously worked at the home as a care assistant, she had a good understanding of peoples individual abilities and interests. From our observations during the visit and sampling of records, we identified that there is a range of activities provided for people to participate in, if they choose to do so. Forthcoming activities and entertainments were on display in the home so that people were aware that they had been arranged. People told us that special occasions are celebrated and that they enjoyed the coffee mornings and gardening club. One person met during the visit said The activity lady comes and sees us when there is singing on. We like that although none of us can dance well. People living at the home also told us that they are involved in choosing the entertainment provided at the home. They told us that there were links with the local community, and people from the local church college and school visit the home. Care Homes for Older People Page 16 of 30 Evidence: Since our last visit, the home has introduced a newsletter about life at St Giles and forthcoming activities and events. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so that people can follow their religious beliefs if they wish. We were told that there is an open visiting policy, and relatives met during the visit told us that they are made to feel welcome at the home. People told us that they can meet with their visitors in private if they wish, and we saw that some people choose to go outside of the home with their friends and family. From discussions with people living at the home, relatives, staff, and sampling of records, we evidenced that people have choices and are encouraged to make their own decisions about their daily lives. This includes the time they get up and how they spend their day. One person met during the visit said The staff get me up at 6.30am its the best part of the day. Another person said We like to sit outside for a long while when its warm. Us three are friends. I love to be with people here. There are no restrictions here we get on well. People told us that they have a choice of where they are served their meals, and menus identified a variety of nutritious meals. These were produced in a large print format for ease of reading. A choice of meals is always available and in addition people have the option of choosing snacks at other times. Special diets are prepared for reasons of health, culture, and religion, and care staff met during the visit had a good understanding of this. The menu choices available on the day of the visit were part of the Culinary Cruise, sampling dishes from around the world. Alternative meals were also available if people chose not to participate in this. Dining tables were laid attractively, drinks were served and seating was arranged to promote social interactions between people living there. One person met during the visit said I liked my lunch it was a bit too much though. Another person who had chosen an Italian meal said Id rather have had my baked potato. We saw that staff asked this person if they would like them to prepare an alternative meal for them. One staff member said There are not any rules here. People get to choose what they eat. If its not on the menu we cook them what they would like instead. An environmental health inspection had recently been undertaken and the home was awarded four stars. This should mean that food is prepared in a hygienic manner. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of people living at the home are listened to and they are safeguarded from harm. Evidence: The complaints procedure was on display in the home, and was included within the service user guide. It was produced in a large print format making it easy to read, and included easy to understand information. In addition there were feedback and comment cards available for people to complete. The home manager told us that she had produced a new comment card to include minor concerns. We saw that actions had been taken in response to suggestions made by people living at the home, in order to improve the quality of their lives. A Weekly Matrons Forum was advertised in the home. This gives people the opportunity to discuss any concerns that they may have with the management team. It was evident however that senior staff are available at any time for people to speak to if they wish, and we saw that a good rapport had built up between the homes staff senior, management team, people living at the home, and people important to them. One relative who completed a survey prior to our visit said The manager, secretary, and nursing staff are always around to answer queries or concerns, and are never too busy to give us their time. Since our last visit, we have been aware of four complaints in relation to St Giles. The Care Homes for Older People Page 18 of 30 Evidence: majority of issues raised involved poor hygiene practices at the home. We saw that the home manager had investigated the concerns raised in an appropriate and timely manner, and the outcomes were that the issues raised were unfounded. Prior to our visit, positive comments were received about the cleanliness of the home. On the day of our visit, we saw that the home was clean and fresh throughout, and the majority of staff have recently completed comprehensive training in this area. We did, howeve, speak with the family of one person living at the home who said that on occasions whilst visiting they had found that bedroom furniture had been in need of cleaning. We brought this information to the attention of the home manager for action. We looked at the complaint register held at the home and this included details of the complaints that we were already aware of, and an additional one regarding admission procedures, on one occasion. This was investigated by the home manager and the outcome of this was not upheld. Since our last visit, we have been aware of two safeguarding referrals, one of which is currently ongoing. We saw that staff are currently undertaking a twelve week course on all issues surrounding safeguarding. The external assessor for this was visiting the home on the day of our visit, and staff met had a good understanding of their roles and responsibilities regarding this. In addition to this, the home manager told us that she had recently received training about deprivation of liberty safeguarding, and this information would be cascaded to the rest of the staff team. This should mean that they have the necessary knowledge about the actions to be taken should the need for this arise. One health care professional visiting the home during our visit said that the home manager and director respond appropriately to any issues raised and actions are taken. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a comfortable place to live, which meets their assessed needs. Evidence: St Giles is situated in a residential area of Garretts Green. There are a range of shops, pubs and public transport links nearby. There is a rolling programme of redecoration and upgrading of facilities in place, so that people are provided with a clean and homely place to live. Bedrooms are located on both floors of the home and the upper floor is accessed via a passenger lift or stairway. Forty four bedrooms offer single accommodation and there are two twin bedded rooms for people who choose to share. All bedrooms have an ensuite facility consisting of toilet and wash basin, and we saw that bedrooms had been personalised to reflect the age, gender, and interests of the people living there. Staff met during the visit told us that specialist equipment provided including profile beds, showering and bathing facilities, and hoisting equipment met the assessed needs of the people living there. There is a lounge and separate dining room on both floors, and we found that these were spacious and homely in appearance. People living at the home told us that they Care Homes for Older People Page 20 of 30 Evidence: can choose which of these they wish to spend their time in. There is an enclosed rear garden that is accessible and suitable for all people living at the home. Since our last visit, additional garden furniture has been purchased for people to use in this area. The home has a no smoking policy within the building, however there is an outside shelter for people to use should they choose to smoke. We saw that details of this are included in the statement of purpose and service user guide, so that people are aware of this prior to deciding whether to live at the home. One person who completed a survey prior to our visit said The cleaners work hard to keep the home clean and tidy and are always chatting to you while they work. Another person said The home is always beautiful, including the bedsheets. Rooms are always nicely cleaned and the laundry is always done. We found that the home was clean and fresh during our visit and one person living at the home met during the visit told us They keep your room tidy and the cleaners come and clean and dry your carpet. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place ensuring that people are supported by the right number of staff who are deemed to be suitably qualified to provide a good standard of care. Recruitment checks on new workers do not always protect people living at the home. Evidence: From discussions with staff and sampling of staffing rotas, we identified that there are two nurses and seven care assistants on duty during day time hours, and two nurses and three care assistants on duty overnight. Administration, activity, maintenance, cleaning, laundry and catering staff are also employed, so that people are supported in all areas of their lives. Staff met during the visit said that due to the dependencies of people living at the home, the workload was greater on the first floor of the home, and at times an additional member of staff was required in order to meet peoples care needs in a timely manner. During lunchtime we saw that the management team help the care staff to assist people with their meals so that people do not have to wait for a long time for assistance. During our visit call bells were answered in a timely fashion. One person who lives at the home said Sometimes the staff are busy you know but I have never had anyone tell me that they have had to wait too long for staff. Nothing is too much trouble for the staff here. A relative said All of the staff here have been brilliant. The home manager told us that there were currently no staff vacancies at the home. Care Homes for Older People Page 22 of 30 Evidence: We saw that staff turnover is low and agency staff is not used so that people are supported by staff who are familiar with their individual care needs. Staff met during the visit confirmed that the homes own staff cover periods of staff holidays and sickness so that staffing levels are not reduced. The gender mix of staff reflected that of the people living at the home so that support should be provided in an understanding manner. One relative who completed a survey prior to our visit said Carers, Cleaners and laundry persons are very pleasant to us and Dad, making a nice environment. Staff recruitment files sampled for new workers contained the vast majority of information required in order to safeguard people living at the home. Records held at the home did not always identify reasons for prospective workers gaps in employment history, however the home manager was able to provide this information to us verbally. We saw that two references had been obtained for a new worker however one of these was not deemed to be suitable. This was discussed with the home manager who stated that she would obtain an additional suitable reference without delay. New workers complete a four week induction training programme covering health and safety and care practices. This means that staff should have the necessary skills and knowledge to provide a good standard of care. We spoke with one care worker who had recently come to work at the home and she said I have had training in how to use the hoist and the best way to help people at mealtimes etc. I am happy that my induction told me everything. There is a rolling programme of training so that staff have access to regular sessions and updates to assist them to care for the people who live at the home. The training matrix identified that staff had undertaken recent training in key areas including basic first aid, infection control, dementia care and food hygiene. Dates for manual handling refresher training were arranged and plans were in place for staff to receive training about the Mental Capacity Act. Records identified that fire drills are arranged regularly at different times so that all of the staff team have the opportunity to participate in these. The supervision records of one staff member identified that she was in need of refresher training in a number of statutory areas. We saw that this had been achieved by the time of her next supervision. There are currently over 50 of staff who have completed a National Vocational Qualification NVQ 2 in care so that they should have the necessary skills and knowledge to provide a good standard of care. One staff member met during the visit told us that she is looking forward to starting Care Homes for Older People Page 23 of 30 Evidence: the NVQ 2 training in the following week. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there. Evidence: The home manager is a registered nurse and has been registered with us since July 2007. She told us that she has nearly completed the registered managers award so that she has the skills and knowledge to lead the staff team. The home manager works extra to the rota and this means that she has dedicated management time. Positive comments were received about her management style and during our visit it was apparent that people living at the home, visitors, and staff members were at ease when talking to her. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This included comprehensive details about the home, staff, and people who live there, and what the service hoped to achieve for the benefit of the people living there. Care Homes for Older People Page 25 of 30 Evidence: There are systems in place to capture the views of people living at the home so that they have a say in how the home is run. A Residents Forum is up and running and we met with the Chairperson of the Forum and her family during our visit. She told us that she valued her role of providing a voice for other people living at the home who may be unable to speak up for themselves. Regular group meetings are arranged for people living at the home, so that they have the opportunity to discuss the services provided at the home. We saw that details of forthcoming meetings are on display in the home, so that people can attend the meetings if they choose to do so. We saw that themed service satisfaction questionnaires are regularly distributed to people living at the home people important to them and visiting health and social care professionals. We saw that reports are produced based on the findings of these so that people know how well the home is performing. Quality monitoring visits are undertaken by an external senior manager and there was evidence that people living at the home are involved in these visits. We saw that suggestions made by people using the service during these visits were acted upon. The home do not manage the money of people living at the home, however we saw that there is a robust system in place for the safekeeping of small amounts of peoples money. Accident records were well maintained and regularly audited so that any trends or patterns in accidents occurring can be identified, and measures put in place to reduce the risk of further accidents of a similar nature. The majority of health and safety and maintenance records sampled were up to date, in order to promote the health and safety of people within the home. An exception to this was that the hot water temperature in one persons bedroom had been recorded above safe limits on two occasions, and there was no evidence that actions had been taken to reduce this to within safe limits. We tested the water temperature ourselves and a temperature of forty nine degrees Celsius was recorded posing a scalding risk to people using the wash basin in this room. This was brought to the attention of the homes director who immediately arranged for the hot water valve to be adjusted to within a safe limit before the end of our visit. Shortly after our visit, the home manager told us that all hot water outlet temperatures were within safe limits and systems were in place to closely monitor these. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 New workers must not commence employment at the home without two suitable references being obtained for that person. This is in order to safeguard people living at the home. 10/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Systems should be in place to ensure that accurate records are kept in order to assess the effectiveness of care provided to people living at the home. Arrangements should be made so that medication continues to be stored within manufacturers guidelines. A system should be introduced to ensure that any gaps in prospective workers employment history be explored and documented prior to working at the home in order to safeguard people living there. Arrangements should be made so that the temperature of hot water in all areas of the home that people living there have access to, continue to be within safe limits in order to prevent scalding injuries. Page 28 of 30 2 3 9 29 4 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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