Inspection on 02/04/09 for Abbey Park

This inspection was carried out on 2nd April 2009.

CQC 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.

Other inspections for this house

Abbey Park 08/04/08

Abbey Park 27/04/07

Abbey Park 11/05/06

Abbey Park 06/10/05

Abbey Park 27/04/05

Abbey Park 27/09/04

Abbey Park 06/04/04

Abbey Park 02/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Park 49-51 Park Road Moseley Birmingham West Midlands B13 8AH     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: Brenda ONeill     Date: 0 2 0 4 2 0 0 9 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 32 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 32 Information about the care home Name of care home: Address: Abbey Park 49-51 Park Road Moseley Birmingham West Midlands B13 8AH 01214424376 01214491300 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) : Mr M Salim,Mr M Mughal care home 28 Number of places (if applicable): Under 65 Over 65 6 28 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 28 Dementia - over 65 years of age (DE(E)) 6 Date of last inspection Brief description of the care home Abbey Park is a home registered for 28 older people and has both single and shared bedroom accommodation. It is situated in the Moseley area of Birmingham in a residential street within a ten-minute walk of Cannon Hill Park. Within walking distance there is access to bus services that will take you to the centre of Birmingham or to Acocks Green or, on another route to Birmingham and to Druids Heath. Care Homes for Older People Page 4 of 32 Brief description of the care home The home is an adapted building over three floors. The third floor is accessed by a stair lift and there is a passenger lift to the second floor. The home has three lounges and two dining areas. One of the dining areas is reserved for service users that smoke. There is an assisted bathing facility on the ground floor and an assisted shower on the first floor. The home has a large accessible enclosed garden to the rear of the property. The home has a ramped access at the front of the house but this is not the main access to the building and there is ramped access at the rear of the building. A small amount of car parking is available at the side of the home. The range of fees charged at the home was not included in the service user guide. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on April 8th 2008. This inspection was carried out over one day. The home did not know we were going to visit. The focus of 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, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included 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, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information Care Homes for Older People Page 6 of 32 about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent 10 Have your Say surveys to people who use the service, 8 to staff and 4 to health care professionals. We received six back from staff and all of them from the people living in the home and these views have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Tissue viability assessments needed to be completed properly and management plans put in place where a risk was identified to ensure people were fully safeguarded. All the people living in the home should have care plans in place that detail their social care needs and how these are to be met by staff. This will ensure people receive person centred care on an ongoing basis. Care Homes for Older People Page 8 of 32 Staff should receive training in adult protection issues to ensure the people living in the home are fully safeguarded. The home should have a system in place for monitoring the quality of the service offered based on seeking the views of the people living in the home with a view to continuous improvement. This will ensure the service offered in the home is kept to an acceptable standard for the people living there. The responsible individual for the home should visit the home unannounced at least monthly and prepare a report about the conduct of the home. These reports must be made available for inspection. This will ensure people living in the home know someone is overseeing the management of the home. The gap under the kitchen door must be addressed and the fire alarm checked weekly. This will ensure the people living in the home and the staff are not put at risk should there be a fire. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for people wanting to live in the home to help them decide if the home could meet their needs. The assessment process for the people wanting to live in the home ensured their needs were known to staff before admission. Evidence: The service user guide for the home had been updated with some hand written amendments. As the document was dated 2003 it was strongly recommended that it was fully reviewed and reprinted and that the range of fees charged at the home was included. This would ensure that anyone wanting to move into the home had all the necessary information to help them decide if the home could meet their needs. The pre admission assessment procedure for two people admitted to the home since the last inspection was checked. The home had obtained copies of the social workers assessments prior to the people being admitted to the home. These included some Care Homes for Older People Page 11 of 32 Evidence: good detail about the individuals needs, their family history and why they required residential care. The manager had also undertaken an assessment which covered all the required areas including, hygiene and dressing, communication, mobility and memory impairment. As at the last inspection it was recommended that the manager included the date and venue of the assessment so that it could be determined if they had been undertaken prior to admission. This was of particular importance for anyone admitted to the home who was a private payer and there was no social work involvement. This would evidence that a full assessment had been undertaken prior to admission so that an informed decision could be made as to whether the home could meet the persons needs. Both of the files sampled had copies of contacts in place that detailed the terms and conditions of residence at the home including the fees and the number of the room to be occupied. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were receiving their care in a way that suited their needs. This needed to be reflected in care plans to ensure staff could deliver this care on an ongoing basis. Strategies for managing risks were not always clear which could potentially put people at risk. The medication system was well managed and ensured people received their medication as prescribed. Evidence: The manager of the home and the staff we spoke with were able to tell us very clearly what the needs of the people living in the home were and how people liked their care delivered. The levels of care people were seen to receive, what was recorded in their daily notes and what they told us they were receiving was not reflected in their care plans. We sampled three care plans and there was little detail of individual needs, to what extent people could care for themselves, likes and dislikes or cultural needs. Care plans included statements such as needs assistance with activities of daily living and Care Homes for Older People Page 13 of 32 Evidence: one carer to give X all personal and oral hygiene. Where people had dementia it was not clearly detailed in the care plans how this affected their every day lives. One care plan did include a mention that the person may repeat themselves. There were some details of peoples continence needs, for example, whether they wore aids or not and what sizes but another care plan included a plan for continence and the person had no needs in this area. One of the people living in the home had hair, skin and dietary needs in relation to their culture. The manager was able to tell us how she had discussed these with the person and their relatives and about the concerns she had about the persons hair care and giving them gentle shampoo. The person had some cream with her and showed this to us and there were some treatments in her room. Staff were able to tell us about the need for creams and so on and how the family had brought them into the home quite recently. The person told us she gets creamed so skin is good and have some cream for my hair. None of these details were in the persons care plan. People living in the home were receiving some very good person centred care. The manager needed to ensure this was detailed in the care plans rather than the generic plans that were in place in many cases. This would ensure the staff always had a point of reference if they were unsure of how to care for any of the people living in the home. All the files sampled included risk assessments for manual handling, nutrition and tissue viability. The tissue viability assessments had not been completed properly and the age of the people concerned had not been taken into account. This would have put all of them at risk of developing pressure sores. The manager was advised she must review these forms and then ensure there were management plans in place detailing how staff were to minimise the risk of people developing pressure sores. One of the manual handling risk assessments stated the person used a zimmer frame. There had been a recent change for this person and the hoist was being used for all transfers as they were not able to stand. This needed to be updated on the assessment. Staff were seen to use the hoist and all those spoken with were able to tell us the person was not able to stand and that they used the hoist. There were some general risk assessments in place that were generally adequate for issues such as falling and smoking. One of the people whose care was being tracked had some ongoing health concerns. Some of these were very well documented in the care plan with details of how staff were to manage these. For example, the person was allowed only a certain amount of fluids daily and went to the hospital three days a week for some treatment. Another health concern for this person was not so well detailed. However the staff and the manager were able to tell us exactly how this Care Homes for Older People Page 14 of 32 Evidence: illness was monitored, what the person was allowed to eat and when and how they would know if the condition was deteriorating. The recordings for this person also showed that staff knew when this condition deteriorated and that they did what they should and then if there was no improvement they called for medical help. Again a written management plan needed to be in place for this so that staff could refer to it whenever necessary. The assessment for one of the people living in the home stated they could be verbally aggressive to other people. There was a management plan in place for staff to follow should this happen. This detailed what may lead to the behaviour and what staff were to do about it to avoid it escalating. This ensured the person did not become distressed and other people living in the home were not exposed to any verbal abuse. Visits by health care professionals were recorded on separate sheets so they were easy to track and they did cross reference to the daily records. The records indicated that when staff identified any health care issues these were then followed up and monitored. There was evidence of visits from G.Ps, district nurses, people being admitted to hospital when necessary and check ups by dentists and opticians. It was recommended that all general hospital appointments were recorded on these sheets also so that they can also be easily tracked. All the letters for these were kept and appointments were in the diary however staff needed to know from the records when people had been to hospital and what the outcome of the visits were. This would ensure staff were kept up to date with any health issues they needed to monitor to ensure peoples well being. A doctor visited the home on the day of the inspection and made very positive comments about the home. He stated he knew that if they rang a visit was needed and they were never called out needlessly. He felt that he had a very good working relationship with the staff at the home. The system in place for administering medication was well managed and ensured people received their medication as prescribed. A random audit of the medication in the home was undertaken and no discrepancies were found. Only senior staff administered medication and all had received training. All medication was acknowledged when received into the home and signed for when administered. There was some controlled medication in the home which was administered by the district nurse. The controlled drug register was being signed by the nurse and a member of staff. Two relatively minor issues were raised during this visit. Eye drops needed to be dated when opened as they have to be discarded after 28 days. Unless dated staff would not know when this was. The medication fridge needed to have the temperatures checked daily to ensure the fridge was working effectively and that Care Homes for Older People Page 15 of 32 Evidence: medication was being stored in line with manufacturers instructions. The people living in the home had their rights to privacy and dignity upheld. Staff addressed them appropriately and by the name of their choice. Staff were extremely polite and courteous to the people living in the home and treated them with great respect. They were seen to meet the needs of the people living in the home discreetly and sensitively throughout the day. It was very pleasing to see staff talking to the people living in the home all the time. When they were assisting people they told them what they were going to do and why and continually enquired as to their well being to ensure their assistance was appropriate. The people living in the home could spend time privately in their rooms if they wished without being disturbed. Bedroom doors were lockable and people were able to have keys if they wished and all double rooms had adequate screening. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were no rigid rules or routines in the home. There were some activities available for people to take part in if they wished but it could not be shown that these met the needs of all the people living in the home. The arrangements for visiting the home enabled visitors to come at any reasonable hour. The catering arrangements at the home met the needs of the people living there. Evidence: The home had a very relaxed atmosphere throughout the course of the inspection and we were made very welcome. The interactions between the staff and the people living in the home were very friendly and there was a lot of laughter. Staff were commended for how polite, courteous and respectful they were to the people living in the home. There were no rigid rules or routines in the home. People were seen to wander freely around the home, spend time in the smoking room, in their bedrooms and in the lounges. All the people living in the home that were seen and those spoken with seemed very content and satisfied with the service they were receiving. There were no care plans in place for meeting the social care needs of the people living in the home. It was therefore difficult to assess if individuals social needs were being Care Homes for Older People Page 17 of 32 Evidence: met particularly for those who were unable to say what they liked doing. This issue was also raised at the last inspection. There was an activities programme in the home that detailed such things as puzzles, skittles, drawing, reminiscence and sing songs. Staff told us they facilitated activities every day including chair aerobics, games, jigsaws and music and dancing. Three individual activity records for the people living in the home were sampled. One of these included several entries which indicated the person received some mental stimulation virtually every day. The other two detailed very little, for example, one had nine entries since January and six of these were when the person went out to ongoing hospital appointments. The manager needed to ensure that the interests of the people living in the home were discussed with individuals or their relatives/representatives. Care plans needed to be in place to show how individual social care needs were to be met by staff. The abilities of the individuals living in the home varied considerably and this would have a direct bearing on what they were able to do. Some were able to initiate their own activities others were totally reliant on staff for any stimulation. There did not appear to be any restrictions on visiting within reasonable hours. There was evidence on the daily records and activity records of frequent visitors to the home. There was no indication on the records seen that staff took individuals out. People were seen to exercise some choice and control over their lives in respect of what time they went to bed and got up, what they wore, how they spent their time and what they ate. They had been encouraged to personalise their bedrooms to their liking and personal effects were evident in most of the bedrooms seen. The manager spoke to us about asking relatives to bring in personal effects for bedrooms to try and help people feel more at home in their rooms. The people living in the home were seen to be asked what they would like for their lunch from the choices available. People appeared very satisfied with the food being served in the home. One person said could not be hungry here lots of food another indicated their cultural needs were being met saying food is good get bananas, potato, sweet potatoes. We joined the people living in the home for lunch. People appeared to generally enjoy their food. One person did refuse his lunch and staff offered an alternative which was also declined. We felt parts of the meal were a little bland, for example, the potatoes were quite watery. The people living in the home did not appear to agree with this. Staff were seen to offer assistance where needed. One care assistant sat very patiently feeding one person and talking to her to try and encourage her to eat. Staff were clearly aware of any special diets, likes and dislikes of the people living in the home. When the sweet trolley arrived these preferences and diets had been catered for but staff still asked people what they wanted. Care Homes for Older People Page 18 of 32 Evidence: Records of the food being served to the people living in the home were being kept and these showed that there was a good variety of meals on offer. Not all foods were detailed and it would not be possible to evidence people had received a nutritional diet at all times from the records. For example, the records said such things as sausage meal, chicken meal and lamb and pudding. Staff needed to record what was included in meals, such as vegetables and puddings. This will evidence people are getting a good variety of nutritious food on an ongoing basis. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate complaints procedure for the home and the people living there were listened to and their views acted on. All staff working at the home should receive training in adult protection issues to ensure the people living there are fully safeguarded. Evidence: There had not been any complaints lodged with us or at the home since the last inspection. Surveys received from the people living in the home indicated that they knew how to make a complaint and that staff listen to them and act on what they say. People were comfortable in the presence of the staff and the manager which would give them the confidence to raise any issues. People were seen approaching the manager throughout the day with a variety of requests, for example, wanting cigarettes and wanting to see a doctor. These requests were responded to positively. Staff surveys also indicated they would know what to do should anyone raise concerns with them. Comments received included If someone is concerned about the home I would advise them to contact my manager as well as informing my manager in person, If there are any concerns I would listen to what is said and I would ask them to speak to the manager and I can always go to the manager about any concerns I Care Homes for Older People Page 20 of 32 Evidence: have for service users. There were policies and procedures on site for adult protection. Part of the homes procedure included a checklist for staff to follow if abuse was suspected and this stated investigate in a robust manner, which is contradictory to the multi agency guidelines, which needed to be followed in the suspicion of abuse. This checklist needed to be removed from the policies. This remains outstanding from previous inspections. The manager has demonstrated in the past her awareness of what to do about any suspicion or event of abuse and has reported incidents appropriately. The manager told us she had not been able to find a trainer to deliver training for staff in adult protection issues. She had obtained a computer based training session that had an accompanying work sheet for staff to complete. This training was just starting in the home. The manager should ensure all staff undertake this and that the topic is added to the training matrix. This will ensure staff are fully aware of the reporting procedures for adult protection issues and that people are fully safeguarded. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was generally well maintained and safe and provided the people living there with a comfortable and homely environment in which to live. Evidence: A tour of the home was undertaken and some bedrooms were seen. The home was generally well maintained, safe and comfortable. The people living in the home appeared very comfortable and indicated on the surveys returned to us that the home was always fresh and clean. There had been some improvements made since the last inspection including a lot of redecoration, some new carpets in bedrooms, new flooring in the laundry and a new washing machine. Redecoration is an ongoing task in the home to try and maintain it to an acceptable standard. There had been no changes to the layout of the home which was suited to the needs of the people there. Communal space was ample with three lounges and one dining room. One of the lounges was a designated smoking area. The dining room was quite small but some of the people living at the home chose to eat in the lounges. It was noted that there were Care Homes for Older People Page 22 of 32 Evidence: some water damaged tiles on the ceiling of the dining room however the manager stated there were some new ones in the home so these were to be replaced. There were adequate numbers of toilet, bathing and shower facilities throughout the home. One of the bathrooms had a hoist and the shower was floor level, both of these rooms allowed for assistance from staff. Some of the bedrooms also had en-suite facilities. Bedrooms in the home were a mix of singles and doubles, varied in size and some had en-suite facilities. Privacy screening was available in the double rooms. Bedrooms had been personalised to the occupants choosing. It was noted that some of the vanity units in the bedrooms were showing signs of wear and tear. These should be replaced in order of priority to ensure the home is kept to an acceptable standard for the people living there. There was a large, well maintained garden to the rear of the home for the use of the people living in the home in the warmer weather. The kitchen was clean and tidy and the home had received a very positive report recently from the environmental health officer. This showed food hygiene practices were very good. It was noted there was a very large gap under the kitchen door which would not give the required protection should there be a fire in the home. The manager was to get this repaired. During the tour of the home it was noted that staff had put aprons that had been used when assisting with personal care in the bin with general waste. These should be disposed of in the appropriate bins to ensure good infection control in the home. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate staffing levels were maintained by a competent staff team that enabled the needs of the people living at the home to be met. Recruitment procedures were robust and protected the people living in the home. Evidence: There had been some staff turnover at the home but some of the staff had worked there for a considerable amount of time. This was good for the continuity of care of the people living in the home. Staffing levels ensured the needs of the people living in the home could be met. People living in the home were very happy with the staff team and described them as wonderful and very good. The interactions between the staff and the people living in the home were very good, friendly but professional. Staff were able to tell us what the needs of the people living in the home were and how they liked to be cared for. They were well aware of their likes, dislikes and preferences and were able to ensure people received person centred care. Staff told us they worked well as a team and that if they had any problems the manager was very approachable. Care Homes for Older People Page 24 of 32 Evidence: The recruitment files for three new staff were checked. These showed that all the appropraite checks were undertaken prior to people commencing work at the home including POVA first and CRB checks. It was noted that the references for one staff member were missing. The manager stated these had been received but they could not be found at the time. Induction training for two of the new staff was a checklist. For the other there was a Skills for Care booklet that had been completed showing quite an extensive induction. The manager needed to ensure there was more detail of what was included during induction training when using the checklist. Staff told us they had extensive induction training which included time spent with the manager and a considerable amount of time spent shadowing senior staff to ensure they were able to complete tasks appropriately and be confident in their roles. Records should be kept of what has been covered when staff are shadowing. Staff were very positive about their training in general. They told us they had had training in topics such as manual handling, medication, fire, food hygiene and first aid. The training matrix for the home indicated which staff still required training and when people were due for updates. Training was ongoing in the home. The manager was advised to extend the training matrix to include topic such as dementia care training and adult protection as staff were having or had training in these topics and they were not reflected on the training matrix. Over fifty percent of the staff were qualified to NVQ level 2 or the equivalent , some to level 3 and others were undertaking their level 3. Observing staff throughout the day and speaking to them showed that they were confident in their roles and that they had the knowledge and skills to care for the people living in the home safely. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensured the home was run in a competent manner and in the best interests of the people living there. Evidence: The manager of the home had been in post for a considerable amount of time. She demonstrated throughout the inspection that she has a very good knowledge of the needs of the people living in the home and how they liked to be cared for. She had a very good relationship with the proprietor and stated he was very supportive and a regular visitor to the home. Staff were very positive in their comments about the manager saying she was very approachable and they could talk to her at any time. The people living in the home were clearly also very comfortable with the manager and approached her about a variety of things during the day. Care Homes for Older People Page 26 of 32 Evidence: It was evident throughout the day that the people living in the home received a very good standard of individualised care. This was not always reflected in the records kept in the home such as the care plans and risk assessments and some improvements were needed. The home still did not have a formal quality assurance system in the home. The people living in the home were issued with satisfaction surveys every few months and there were staff meetings. The manager also undertook audits within the home, for example, medication audits and health and safety audits. However there was no way of analysing the information gathered and drawing up a yearly development plan for the home with the aim of continually improving the service. The manager discussed with us how best to move forward on this issue which has been ongoing for some time. Although the provider was a frequent visitor to the home there was little evidence that he was making any unannounced visits to the home to oversee the management/conduct of the home. Reports of his unannounced visits to the home should be available in the home for inspection. There had been no changes to the system in place for managing money on behalf of the people living in the home where necessary. A specific account had been set up by the proprietor for some personal allowances to be paid into where there was no other option. The proprietor then drew the money and passed it over to the manager. All these people had individual books where this was recorded. Other people living in the home also had some personal allowance managed by the home which was deposited with the manager by their relatives. The records kept were sampled and found to be appropriate. All income and expenditure were detailed and receipts were available for expenditure. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices. The AQAA returned to us indicated the equipment in the home is serviced as required. We sampled the in house checks on the fire system and these were generally up to date. However the weekly fire alarm check did lapse occasionally. The manager continued to ensure we were notified of any accidents or incidents in the home so that we were assured they were managed in the best interests of the people living in the home. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Tissue viability assessments must be fully completed and management plans put in place where a risk is identified. This will ensure the risk of developing pressure sores is reduced as much as possible. 14/05/2009 2 19 23 The gap under the kitchen door must be addressed. This will ensure the people living in the home and the staff are not put at risk should there be a fire. 07/05/2009 3 38 13 The fire alarm must be checked weekly. This will ensure the people living in the home are not exposed to any unnecessary risks. 07/05/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 29 of 32 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that the service user guide is reviewed and updated and the range of fees is included. This will ensure people have all the relevant information to help them decide if the home can meet their needs. The homes pre admission assessment should include details of where and when the assessment was completed to evidence that it was undertaken prior to the individual being admitted to the home. Care plans should detail all the individual needs of the people living in the home and how these are to be met by staff. This will ensure people receive person centred care on an ongoing basis. The outcome of general hospital appointmnets should be recorded on professional visit sheets. This will ensure staff have all the information they need to ensure the well being of the people living in the home. Management plans for any identified risks should be updated when the needs of the people living in the home change. This will ensure people are not exposed to any unnecessary risks. All eye drops should be dated on opening so staff know when they are to be discarded. The temperatures of the medication fridge should be monitored to ensure medication is kept at the correct temperatures. All the people living in the home should have care plans in place that detail their social care needs and how these are to be met by staff. This will ensure people receive person centred care. Records of the food served to the people living in the home should include sufficient detail to show people are receiving a varied and nutritious diet on an ongoing basis. The adult protection procedures in the home should be amended to ensure they comply with the multi agency guidelines. This will ensure people living at the home are fully safeguarded. Staff should receive training in adult protection issues to ensure the people living in the home are fully safeguarded. The vanity units in the bedrooms should be replaced in order of priority. This will ensure bedrooms are kept to an acceptable standard for the people living in the home. Page 30 of 32 2 3 3 7 4 8 5 8 6 7 9 9 8 12 9 15 10 18 11 12 18 24 Care Homes for Older People 13 26 Staff should ensure protective clothing is disposed of in the appropraite bins. This will ensure good infection control in the home. The responsible individual for the home should visit the home unannounced at least monthly and prepare a report about the conduct of the home. These reports must be made available for inspection. This will ensure people living in the home know someone is overseeing the management of the home. The home should have a system in place for monitoring the quality of the service offered based on seeking the views of the people living in the home with a view to continuous improvement. This will ensure the service offered in the home is kept to an acceptable standard for the people living there. 14 33 15 33 Care Homes for Older People Page 31 of 32 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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