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Inspection on 17/11/08 for Abbey Court Nursing Home

Also see our care home review for Abbey Court Nursing Home for more information

This inspection was carried out on 17th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yvonne Allen     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 36 Information about the care home Name of care home: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD 01543277358 01543277876 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Restful Homes (Cannock) Limited care home 117 Number of places (if applicable): Under 65 Over 65 0 25 80 35 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: DE Minimum age 60 years MD Minimum age 50 years PD Minimum age 55 years Date of last inspection Brief description of the care home 59 10 0 58 Abbey Court is a purpose-built care home, providing nursing and residential care, located within a residential area on the outskirts of Cannock. The home can accommodate up to 117 service users in the following categories; Dementia care (59), Mental disorder, excluding learning disability or dementia (10), Mental disorder, excluding learning disability or dementia- over 65 years of age (25), Old age not falling Care Homes for Older People Page 4 of 36 Brief description of the care home in any other category (80), Physical disability (58), Physical disability over 65years of age (35). Current scale of charges range from 290 - 575 pounds per week. The home is on two floors and all areas have access via the stairs and/or passenger lift. Within the home there are a total of 13 lounges available, including a specific smoking lounge. There are four dining rooms and ample facilities in the home including two hairdressing salons. The home has an enclosed garden with a suitable patio area. The registered care manager (RGN) is in charge of the home. First level nurses (both RGN and RMN), and teams of care assistants, provide care. Local GP practices and a pharmacist service the home. Community nurses, health service professionals, and NHS facilities are accessed as and when required. Several local GP practices and a pharmacist service the home. Activities, hobbies and entertainment take place with transport provided as required. Care Homes for Older People Page 5 of 36 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 ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. This unannounced Key Inspection visit was carried out by two inspectors over two days. We brought our planned inspection forward as a result of information given to us by purchasers of care, namely Social Services and the Primary Care Trust (PCT). This information contained a significant number of concerns, complaints and Safeguarding referrals about the home. In light of the above information, the purchasers of care had decided to carry out a Large Scale Investigation (LSI) which involved an in depth case review of all the people living in the home whom they funded. This LSI was planned to run for several weeks as there was a large number of people to review. Care Homes for Older People Page 6 of 36 Because we had not planned this inspection beforehand we did not have an Annual Quality Assurance Assessment (AQAA) from the Providers prior to the visit. We did, however, talk to a number of people who live in the home, visitors and staff during our inspection visit. Their comments have been included in this report. Although this inspection visit was carried out on the seventeenth and eighteenth of November 2008, the inspection process continued for several weeks after this date until we had received information and feedback from the reviewers involved in the LSI. At the same time of receiving this information we were also given a plan of action from the Providers. This plan of action is thorough and comprehensive and tells us how the Providers and managers propose to address each concern raised prior to and during the reviews. This includes proposals on how they will improve outcomes for the people who live in the home. Throughout both the inspection and large scale investigation processes the Providers of Abbey Court have cooperated fully and have worked with us to help ensure that outcomes are improved for the people who live at the home. This work is still on going as they continue to implement their action plan. During our inspection visit we assessed all the Key Minimum Standards. For each outcome we also included information from the reviews held by the purchasers of care. We have made a judgment for each outcome based on the evidence we found and also the information found during the reviews. As a result of the evidence gathered during this process we have made some requirements for improvement based on the evidence we found at the time of the inspection visit. The Providers must address these within the given timescales. We have also made some good practice recommendations. The Providers should consider addressing these in order to help improve outcomes for people living in the home. The ways we gathered our evidence are as follows We spoke with people who live in the home and visitors who were present during the inspection. We held discussions with the Providers and Manager of the home. We spoke with some of the staff who work at the home. We walked around the home. We looked at relevant records and documentation. We observed staff interaction with people and looked at care practices. We received information from other professionals who visit the home. The providers are also required to supply us with an improvement plan outlining how they aim to improve outcomes for people who live at the home. Care Homes for Older People Page 8 of 36 What the care home does well: What has improved since the last inspection? There was only one area for improvement highlighted at the last inspection and this was to review and amend the Statement Of Purpose. The Provider has addressed this within the timescale given. Care Homes for Older People Page 9 of 36 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 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 receive an assessment of their needs prior to being offered a place at the home. Evidence: People are admitted to the home following an initial assessment of their needs. We spoke with some of the people who live at the home and their visiting relatives and they told us that they had been involved in the admission process. Some people told us that the manager had been out to assess their relative prior to offering a place at the home. Yes the manager came out to assess mum before she came into the home. Some of the people who live at the home were unable to remember the admission process and one lady told us I cant remember - my daughter dealt with everything. Care Homes for Older People Page 12 of 36 Evidence: Another person remembered coming to visit for a look around the home after looking at other homes. We looked at a number of care plans from both units and these all contained a record of the pre-admission assessment of needs which had been carried out by one of the unit managers or the registered manager. Some of these care plans contained preadmission assessments from funding bodies such as Social Services. People had signed in agreement with their assessment and plan of care on admission to the home. Care Homes for Older People Page 13 of 36 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 who live in the home are generally happy with the care and services provided to them. The documentation, planning and delivery of care is not consistent and it cannot always be guaranteed that peoples assessed needs will be fully met. The Providers have produced a plan of action in order to help improve this outcome for the people who live at the home. Evidence: We visited both of the units and spoke to people who live at the home. We also spoke with a number of visiting relatives and staff who work at the home. We looked at a random selection of individual care plans. The standard of care planning is inconsistent. This means that some of the care plans are good and effective and up to date with their evaluations whilst others are not, lacking information, some Care Homes for Older People Page 14 of 36 Evidence: information being out of date and/or not covering all areas/problems. Some of the care plans we looked at contained good evidence of visits by health care professionals including the Tissue Viability Nurse Spcialist, General Practitioners, Chiropodist, Epileptic Nurse Specialist, Community Psychiatric Nurse (CPN) and Optician. We also noted that people had been referred for checks on their health and well being where indicated. The information contained in the care plans we saw is generally satisfactory but there are some areas where information is lacking or incorrect and health care monitoring has not always been followed through. We noted that two nutritional risk assessments scored high and this indicated refer to dietitian - but there was no evidence that this had been done. A Waterlow risk assessment - which assesses as persons risk of developing pressure ulcers, was seen as a high score - but there was no care plan in place for this. Some of the codes used to assess the moving and handling of a person did not correspond with the same persons patient handling codes and did not make sense. This was seen for two of the care plans we looked at. Generally care plans contained little evidence of reviews and evaluations with people and/or their representatives involved. Some monthly evaluations of plans was late and some information contained in plans was out of date or no longer applicable. There were some problems documented for which a care plan had not been developed. An example of this was a person had Rheumatoid Arthritis and there was no plan of care in place for this. Another example was no care plan in place for a person with a hearing impairment and use of a hearing aid. Some plans were not clear in specifying what action should be taken by staff to address a particular problem and most of the action documented was actually the problem itself and not a solution. An example of this was for a person who had challenging behaviour and was aggressive. Since the last Key inspection there have been some improvements to the assessment and planning of mental health care needs. However there is still room for improvement in this area. Plans do not always identify and incorporate specific mental health needs. We noted that the home have a new document being introduced to care plans. This document identifies personal choices and preferences and incorporates these into the activities of daily living in the home. We spoke with a care assistant who was working Care Homes for Older People Page 15 of 36 Evidence: on the second floor unit and she explained the use of the new forms. She also said we know the residents on a one to one basis and know what they need and there is a lot of teamwork on this unit. We spoke with a number of people who live at the home and their representatives and everybody we spoke to was complimentary about the home and happy with the care and attention provided to them. The following comments were received Oh they are very good here and My mom looks better than she did when she came in and I am very well cared for here - the staff are wonderful. Its lovely here - they look after me very well. They work as a team. I cant fault this place at all - very good here. My own standards have not been lowered at all. Carers are very good bye and large. They do encourage Independence. Some staff go the extra mile. Care plan is reviewed with me. No areas for improvement. We asked people if they felt that the staff treated them with dignity and respect and they told us that they did. We observed care practices during the two days and saw that staff were attentive to needs and appeared to have a good rapport with people who live in the home. People looked comfortable and well cared for and were given drinks and left with jugs of water and juice to drink throughout the day. Documentation relating to daily care, including fluid intake charts, had been completed as plan. Bedrooms had been adapted to meet individual needs and items were left within easy reach for people, including the call bell, should this be needed. Equipment was provided for people for help with moving and handling, mobilizing and pressure Care Homes for Older People Page 16 of 36 Evidence: relieving equipment had been provided following an assessment. We looked at the arrangements for the receipt, storage, administration and disposal of medication in the home. We were told that most of the people who live in the home have their medication administered to them by the nurses, but that people who wish to self medicate could do so following a suitable risk assessment. We observed the lunchtime medication round on the first floor unit on one day and the ground floor unit the next day. Medication Administration Record (MAR) charts had been signed and completed as required. A bottle of liquid Sulperide in use was out of date and should have been used 1 month after opening. This was discarded at the time by the unit manager. The Homely remedies list was seen in place. Photographs were attached to MAR charts in order to identify people. Allergies to medication are clearly identified on the MAR charts. It is a recommendation that these be highlighted in red to help safeguard people. It was noted that the manager has recently sent letters to the pharmacist documenting medications to which a person has been identified as allergic. This is a good way of safeguarding against mal-administration of medication. The concerns and issues found during the reviews carried out by the purchasers of care are outlined below Some people who live at the home are potentially at risk nutritionally, evidenced by weight loss. As a result of the reviews the home seek dietician advice. Outcomes of professional visits are not always clear. A person with a specific infection did not have appropriate infection control equipment in place in her room. People and their relatives do not always feel involved in the planning of care. Care plans are not always kept up to date with the latest information. Care plan evaluation entries are repetitive. Care plans are missed for some additional conditions and problems. There is some incorrect and/or missing diagnoses on file. People are left unsupervised in lounge areas. Following one of these reviews we were shown some documentation, by reviewers, Care Homes for Older People Page 17 of 36 Evidence: from the care plan of a person living in the home. The care plan is with reference to behavioral problems. The comments written down by the manager of the home and the care assistant (keyworker) are somewhat cynical and quite presumptuous and lead the reader to believe that this lady acts the way that she does deliberately. Staff should be mindful of the words they use on documents when writing about people, and behavioural assessments should be undertaken by specialist health care professionals wherever possible. Care Homes for Older People Page 18 of 36 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. Daily life in the home is quite flexible and varied and the Providers try to promote personal choices, preferences and autonomy. It cannot be guarenteed, however, that the social and therapeutic needs of each person is met at the home. This would be further improved by training the people delivering the activities to help ensure that these are tailor made to meet individual needs. Evidence: There is a planned programme of activity and entertainment within the home. This is planned and overseen by the two activity co-ordinators who are employed there. We met with them and discussed the above programme. Activities included manicures, hand massage, arts and crafts, shopping, home baking, reminiscence and board games. The co-ordinators are based one on each unit and organize group activities and some one to one sessions but these would benefit and be improved by being more individual and adapted to personal abilities and preferences. Care Homes for Older People Page 19 of 36 Evidence: They also informed us that they are raising money to purchase a minibus. This will help to provide transport for more outings for people who live in the home. The activities co-ordinators had not received training specific to therapeutic activities and it is recommended that this be sought. This will help them understand the social and therapeutic needs of particular client groups, including people with dementia. People told us that Church services are held once a month in the home and that spiritual needs are catered for. We noted that one lady is a Hindu and her needs are catered for. This is mainly with her dietary needs. The Cook explained to us how she meets this ladys vegetarian needs and spicy food preferences and we saw some of the dishes she had prepared for her. We also noted that the dietary preferences and any special diets are listed in the kitchen. The Cook is well aware of these. We asked people what they thought about the meals served in the home and they were generally complimentary about these. We observed the lunches being served. These appeared nutritious and there is a choice of main menu. One lady (with mental health needs) was not eating the lunch which had been placed in front of her so the carer asked for some sandwiches to be sent up and these arrived promptly. The carer was well aware of this ladys eating habits and preferences and explained to me about these. In order to help people with mental health needs and little or no communication skills to be able to make a choice about their meals, it is recommended that a differrent approach to meus is adopted. A pictorial menu could be introduced. People will then be able to pick out the pictures of meals they prefer. Providers are starting to look at the promotion of autonomy, choices and preferences on all the units throughout the home. The introduction of the choices and preference document to care plans will help to ensure that these are carried through for the activities of daily life in the home. Reviewers found that activities provided are not to all residents tastes and some people felt that there isnt enough activities provided to stimulate them. Care Homes for Older People Page 20 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It cannot always be guaranteed that people will be listened to and that their complaints will be taken seriously and acted upon. People may be at risk of harm if safeguarding procedures are not followed accordingly. The action plan adopted by the providers should help to ensure that this outcome is improved. Evidence: We, the commission have received two complaints about the home since the last Key inspection. These were both referred to the Provider to investigate. One of these was referred back to us recently as the complainant was dissatisfied with the Provider investigation by the registered manager and felt that she was not being listened to. This complaint has now been referred to the Operations Manager as investigation of complaints falls under her job role. The Operations Manager accepted the referral from us and stated that she would fully investigate the complaint and liaise with the complainant. We have been made aware of a number of complaints about this home which have been referred to Social Services over the past 12 months. These complaints have Care Homes for Older People Page 21 of 36 Evidence: mainly come from representatives of people who live at the home. Also people have told Social Services that they feel unable to complain due to fear of repercussions. The issues and trends of these concerns are across the spectrum of services provided by the home, but mainly focus on health and care needs. Also there have been a number of safeguarding referrals made over the last 12 months. It is concerning to note that some safeguarding referrals have been made by representatives of people who live in the home, and not by the manager. It is also concerning to note that the manager has failed to adhere to the Safeguarding procedures in respect of suspending staff when allegations have been made against them. We discussed the above with Sarah Edwards (Registered Manager), Mr Cawley (Registered Provider) and the Operations Manager during the inspection. Mr Cawley and Sarah Edwards maintain that they have an open culture where people are actively encouraged to make their concerns known. We go out of our way to encourage people to raise any concerns they might have. We walked around the ground floor unit with the Providers and observed that interaction with people was good. People knew who they were and chatted with ease to them. One person told us I think its really good how they come around to talk to us regularly - you dont get that in every home you know! We asked some of the people if they had any concerns would they feel comfortable raising these and they all said that they would do. The introduction and employment of the Operations Manager has had a beneficial result in providing support and guidance for the manager of the home. She told us that part of her job role is to investigate complaints of a serious nature. She confirmed that concerns will be dealt with on a daily one-to-one basis and she will continue to give support to the manager Sarah. The people we spoke with at the time of the inspection visit told us that they knew who to go to should they have any concerns. We spoke with several members of staff about their knowledge of Safeguarding and the procedure surrounding this. They explained this to us and were aware of their duties and responsibilities in such cases. They also told us that they had received training in abuse. We looked at their training records which confirmed this. The people involved in the reviews for the purchasers of care found Care Homes for Older People Page 22 of 36 Evidence: That over the last twelve months they have received a total of twelve complaints about this home six of which have been Vulnerable Adults referrals. During their investigations they have found that Incidents involving people who live at the home are not always deemed as a Safeguarding Adults event. Safeguarding events are not always reported immediately. Some people do not feel comfortable to make a complaint. Care Homes for Older People Page 23 of 36 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. The home provides a clean and comfortable purpose built environment which has been adapted to meet individual needs. Evidence: We walked around the home and looked at a random selection of bedrooms, all the communal areas, the kitchen and laundry room. The home is clean, comfortable, warm and well presented. There are no mal odours present and people tell us You never get any smells here - it is always clean. The bed sheets are changed very regularly. My mothers bathroom is cleaned then cleaned again later that day. Bedrooms had been adapted to suit individual needs and are supplied with the necessary aids, adaptations and equipment to help them with mobility and Independence. Care Homes for Older People Page 24 of 36 Evidence: Pressure relieving equipment was evident with provision of specialist mattresses and cushions. The number of lounges provided helps to promote small groups of people to socialize. On the mental health unit there are murals being painted along the corridor area. These are attractive and pleasing to the eye. This is helping to make the environment more stimulating for people who live on this unit. There is a programme of redecoration and refurbishment in place at the home. Since the last Key inspection this has been on going with bedrooms and bathrooms being redecorated. The painter was noted painting the corridor area at the time of the inspection visit. The kitchen was clean and well presented. The last visit from Environmental Health had given the rating of 3 stars with a few recommendations, which have since been addressed. In the wash up area one of the freezer doors would not close and it is a recommendation that this be made good or replaced. The laundry was found to be clean and tidy. Each person has a separate basket in which their personal laundry is kept and returned to their bedroom. We noted that the laundry is quite small for the size of the care home and has only two washers and driers. We were informed that the laundry is managed well and that laundry hours supplied exceed those normally required. Some people have raised concerns about the effectiveness of the laundry system. Care Homes for Older People Page 25 of 36 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 cared for by a staff team that have been carefully selected to work at the home. There is a commitment to staff training and development although it is recommended to review the induction and supervision policies in order to help ensure that new staff receive the appropriate support. Evidence: At the time of the inspection visit there appeared to be sufficient numbers of staff on duty to meet the needs of the people accommodated in the home. There was management support consisting of the Registered Manager, Operations Manager and the Provider. There is also a deputy manager in post to support the manager. There was also two administrators on duty, a full time maintenance person and two activity co-ordinators. There was a trained nurse in charge of each unit supported by a team of care staff. There was a Cook and team of kitchen assistants, a housekeeper working with a team Care Homes for Older People Page 26 of 36 Evidence: of domestic assistants and a laundry assistant. The home also employs a full time decorator who was also on duty at the time of the inspection visit. We looked at the record of staff rotas for the two weeks prior to and the two weeks following the inspection visit. From these rotas there does appear to be a satisfactory number of staff provided for the number of people accommodated in the home at the time. However it is the responsibility of the manager to ensure that staff numbers are sufficient to meet the dependency needs of the people living in the home and to provide supervision to help keep people safe. Therefore staff provision should be regularly reviewed. The manager confirmed that she does this daily. There is a staff training and development programme in place at the home and this includes National Vocational Qualification (NVQ) training. The home has met the national minimum standard for 50 per cent of care staff to be trained to NVQ level 2 and above and this training is on going. There is a robust recruitment procedure in place. We looked at staff files and they contained all the required information. We saw that new staff had completed induction training. We spoke to these staff members and they all confirmed that they receive mandatory training and other training relevant training sessions as they arise. Staff working on the mental health unit had received dementia awareness training. We saw certificates of training sessions documented in staff files. A nurse we spoke to told us that, in her opinion, induction for new staff starting at the home is not long enough and there is inadequate supervision for new starters. It is therfore recommended that staff induction and supervision be discussed and reviewed by the manager and staff team. The nurse also told us that the routine in the morning at the home is poor and is based around the needs of the staff not those of the people living in the home. When we asked if she had discussed this at staff meetings she said that these meetings are not held often enough. Care Homes for Older People Page 27 of 36 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 home is well run but has not always been managed in the best interests of the people who live there. The action plan produced by the Providers should help improve the overall management of the home. Evidence: We Spoke at length to the Registered Manager, to the Operations Manager, and to the Provider. These people were present during the course of the two day inspection. Some of the concerns raised by people who live in the home, since the last inspection, to Social Services indicate that management of concerns and communication with people has not always been effective. Some people have felt that their concerns have not always been listened to. Care Homes for Older People Page 28 of 36 Evidence: Also, it has been of concern to us that the manager of the home does not always follow the safeguarding procedures as set out and this has been highlighted and discussed with the manager over the last few months. We spoke about this to the managers and providers during the inspection visit and have made requirements for this to be improved under standard 16 of this report. All the concerns raised throughout this inspection process indicate that management of the home has not been as effective as it should be. It was identified, however, that management support has improved somewhat over the last few months with the introduction of an Operations Manager. This should help the Registered Manager with overall management, including quality assurance and complaints management within the home. Also the Providers regularly visit the home and offer support and advice. The manager attends regular mandatory training sessions and other training applicable to her needs and job role. When we carried out our inspection visit we received very complimentary comments about the manager and the Providers. I would go to Sarah if I had any concerns and Sarah is very supportive of our training needs and they always come round to chat to us and to see if we are alright. The following comments had been left by a visitor on Fifteenth November 2008 -Just a few words to say that our friend could not wish to be in a better place. She loves it in here. There is a Quality Assurance system in place at the home which audits all areas and services provided. We saw records relating to these audits and the Operations Manager will be helping to develop these further. People or their representatives are encouraged to handle and manage their own finances wherever possible. If they do wish for the home to keep personal allowances In a secure place then this is available to them. We looked at the system for the maintenance of personal allowances. The administrator oversees this and keeps a safe, transparent system where an audit trail can be carried out at any time easily. People can access their monies whenever they wish to. There is very good documentation relating to general Health and Safety of the home. The Maintenance Person is responsible for this and keeps these records in very good order. He oversees the servicing and testing of all the equipment used in the home, including fire safety equipment. Outside contractors are brought in for specialist servicing of equipment. There are good records of all the required fire safety checks, Care Homes for Older People Page 29 of 36 Evidence: staff fire drills and fire training. The maintenance person should be congratulated on his excellent record keeping. Care Homes for Older People Page 30 of 36 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 31 of 36 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 15 15(1) The Registered Person 26/02/2009 shall....prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. A plan of care should be developed for each identified need. This is to help ensure that all assessed needs are met. 2 7 15 15(2) The Registered Person 26/02/2009 shall....(a) make the service users plan available to them and (b) keep the plan under review and (c)after consultation with the service user or his representative, revise the plan. This is so that the care documented in the plan is accurate, up to date, and reflects the current needs of the individual person. Care plan reviews and evaluations should be updated with the Care Homes for Older People Page 32 of 36 individual service user or their representative wherever possible. 3 8 12 12(1)(a) The Registered Person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. Where people are identified as having a risk of developing pressure ulcers then a specific care plan must be developed to help ensure adequate prevention and treatment is in place. 4 8 12 12(1)(a) The Registered Person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. Care Plans must be developed for people with mental health care needs and must identify and show how these specific problems will be met. 5 8 12 12(1)(a) The Registered Person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. Where indicated people must be weighed regularly and where required, referred to a dietician. Care plans must be developed to help 26/02/2009 26/02/2009 26/02/2009 Care Homes for Older People Page 33 of 36 ensure that nutritional needs are monitored and met. 6 16 22 22(3) The Registered provider shall ensure that any complaint made under the complaints procedure is fully investigated. The Provider and manager will need to ensure that people feel able to raise concerns and that their concerns will be dealt with promptly and in accordance with their complaints procedure. 7 18 13 13 (6) The Registered 26/02/2009 Person shall make arrangements, by training staff...to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. Local Safeguarding procedures must be adhered to in order to protect people who live in the home. 26/02/2009 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 Staff should be mindful of the words they use on documents when writing about people, and behavioural assessments should be undertaken by specialist health care professionals wherever possible. It is recommended that peoples allergies to medication be highlighted in red on the MAR chart so as to help ensure that people are safeguarded from mal-administration of medication. 2 9 Care Homes for Older People Page 34 of 36 3 12 It is recommended that the activities co-ordinators receive training specific to social and therapeutic activities. This will help the co-ordinators understand the social and therapeutic needs of particular client groups, including people with dementia, and help ensure that these needs are met. It is recommended that a differrent approach to menus be adopted on the mental health unit. This will help to ensure that people are given meals which they would choose to have. It is recommended that deployment of staff during the mornings be reviewed in order to ensure that this is geared around meeting the needs of the people living at the home. It is recommended that staff induction and supervision be discussed and reviewed by the manager and staff team in order to help ensure that new staff receive appropriate support. 4 15 5 27 6 30 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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