Inspection on 27/11/08 for Arden Valley Christian Nursing Home

This inspection was carried out on 27th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arden Valley Christian Nursing... 03/06/08

Arden Valley Christian Nursing... 16/01/08

Arden Valley Christian Nursing... 01/11/07

Arden Valley Christian Nursing... 24/04/07

Arden Valley Christian Nursing... 23/06/06

Arden Valley Christian Nursing... 13/12/05

Arden Valley Christian Nursing... 26/04/05

Arden Valley Christian Nursing... 08/09/04

Arden Valley Christian Nursing... 13/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arden Valley Christian Nursing Home Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR     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: Julie McGarry     Date: 2 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. the things that people have said are important to them: They reflect 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 34 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Arden Valley Christian Nursing Home Bearley Cross Wootton Wawen Solihull West Midlands B95 6DR 01789731168 01789731883 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Petra Thompson Type of registration: Number of places registered: Trinity Care Limited care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age (DE(E)) 24 Old age, not falling within any other category (OP) 24 Date of last inspection Brief description of the care home Arden Valley is a purpose built home providing accommodation for 24 people with dementia and 24 people who are frail elderly. Accommodation is provided on the ground and first floor of the property. Residents from both units have access to a secluded garden at the rear of the building. Each unit provides a variety of communal living space with a light and airy conservatory area. The home is located in a rural Care Homes for Older People Page 4 of 34 Over 65 24 24 0 0 Brief description of the care home area, which is not easily accessible without a car. There was no written information available about the cost of living in this home. The manager said it is assessed on an individual basis and the fee is agreed before people move into the home. The fees do not include newspapers, toiletries, hairdressing or private telephones. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as information about: Care Homes for Older People Page 6 of 34 concerns, complaints or allegations; incidents; previous inspections and reports. Since the last Key inspection carried out in June 2008, a random inspection was undertaken in August 2008. This was carried out to determine if specific requirements from the Key inspection had been met and within required timescales. The requirements assessed related to assessments care planning and risk assessments, access to health care and staffing. We found that the home had met the requirements. The requirements relating to medication were not looked at during the random inspection and were assessed separately at this inspection by a Pharmacy inspector. At this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the dementia care unit lounge watching to see how residents were treated and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. Four people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Commission for Social Care Inspection will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the acting home manager and senior management. What the care home does well: What has improved since the last inspection? The previous manager and current acting manager have addressed all the requirements made at the last key inspection of June 2008. Some requirements were met at the random inspection in August 2008, the remaining medication related requirements have been met at this inspection. Areas of improvement include: The manager has started to introduce systems to review and improve the quality of the services offered by the home. Surveys have been carried out to determine the views of residents and their relatives. The information received can be used to help monitor and improve the services provided for people who use the service. Staff have attended a programme of training in 2008. The training covered topics related to mandatory training these include, fire awareness, manual handling, health and safety and food hygiene. Evidence that staff have attended training in the Protection of Vulnerable Adults is in place. Requirements made in relation to safe medication storage and administration have been met. Care Homes for Older People Page 8 of 34 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home, benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: Six people have moved to live at the home since the last inspection. The case files of two people recently admitted to the home, plus two others identified for case tracking were examined to assess the pre-admission process. Assessments provided details of their health and personal care needs, which include information on mobility, history of falls and health history, communication and wellbeing. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. There is evidence that people who move to this service are being seen by their GP within seven days of their arrival. The acting manager informs us that this is now standard practice at the home. Care Homes for Older People Page 11 of 34 Evidence: On records seen, there is sufficient information available so that the home could confirm they could meet each persons needs and develop care plans. For example, the assessment of one person with dementia identified previous aggression, can be feisty and swears, but not physically violent. A care plan is available in the persons file to give staff directions on communicating effectively with the resident, and what actions to take should this persons behaviour change. Another persons assessment states that they have a poor appetite and takes fortisips. There is a nutritional care plan in place that is being reviewed monthly, it shows evidence of input from the dietician and weekly weight records are being maintained. The Statement of Purpose and Service User Guide are available at the home. These documents help people to make an informed decision about whether they move into the home. The acting manager is reviewing these documents to update the information to show a recent change in manager. Care Homes for Older People Page 12 of 34 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 are treated respectfully and have greater protection from harm by safer management of medicines. Care plans are available for each of the identified needs of residents however, further work is needed on some files to ensure they reflect the current needs of people and are more accessible to staff. Evidence: We observed that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. We looked at the case files of people identified for case tracking. Each person had care plans, daily records and monitoring records. Care plans were based on information secured during the pre-admission assessment and supplemented by further assessment after admission. Care Homes for Older People Page 13 of 34 Evidence: Case files for each person are standardised, however they are not well organised or easy to follow. Some case files contained in excess of thirty care plans. This could mean that staff have difficulty accessing information about the needs of people living in the home, and impact upon the actions they need to take to meet those needs. For example, one nurse on duty was asked about the needs for two people who remained in their beds during the inspection. We were informed that both people needed to remain in their beds due to skin pressure care. When we looked through the care plans with the nurse and members of the management team, the information that both people should remain in their beds was not clear. There are pressure care plans and risk assessments plans in place; however, the information about the need for bed rest was not detailed. This could lead to staff being confused about the current care practices of both individuals. One member of staff spoken to commented Paperwork can be disorganised and difficult to find information quick. Additionally, one persons care plan details information about a pressure sore on their left ankle. The care plan in place states that a change in dressing is required every three to four days. Records of when the dressings are being changed are being maintained however, it shows that this is not happening every three to four days as directed. On one occasions it was nine days between a change in the dressings. On discussion with the operations manager, we were told that this has been reviewed in this persons notes and they no longer need such frequent dressing changes however, the care plan has not been updated to show this change. Clearer guidelines in this persons care plan are needed to ensure that staff provide consistent care that meets the needs of that individual. Another persons care plan states that there is a risk of choking and requires thick n easy to be added to drinks. More detailed information is needed to ensure the right amount of thick n easy is added to drinks to meet the needs of the individual and minimise the risk of choking. When we spoke to the deputy manager, she was unaware that any residents were assessed as needing thick n easy. All staff should be aware of peoples individual needs to ensure needs are met appropriately, and any risks identified minimised. Since the last inspection it is evident that care plan and risks assessment records have improved and provide more detail. The acting manager tells us that his predecessor has reviewed all thirty nine care files, and has made arrangements for three monthly and six monthly reviews. During the inspection we saw evidence that reviews are now taking place. During the second day of the inspection, the operations manager reviewed one persons care plan and was able to demonstrate to us how further development of Care Homes for Older People Page 14 of 34 Evidence: peoples care plans will make them more accessible staff. The care plan for a person with diabetes, documented that blood sugar should be monitored weekly. Records are available to confirm this is being done, which means staff are monitoring this persons medical condition which should promote their health. The service uses risk assessments for falls, bed rails, entrapment, nutrition, pressure sores, and changes in peoples behaviour which are reviewed monthly. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. For example, a care plan is available in one persons file to give staff directions on and what actions to take should this persons behaviour change, and the need for supervision at specific times of the day to minimise risk to themselves and others. This risk assessment plan has been implemented following three safeguarding referrals that relate to changes in this persons behaviour. Each persons case file contained a record of contact with or visits by Health Care Professionals. These included the GP, optician and dietician. People spoken to confirmed that professional support was available. We looked at the systems for management of medicines in the nursing unit and dementia care unit. The pharmacist inspection lasted three hours. Seven residents medication was looked at together with the medicine charts and care plans. Two nurses were spoken with and all feedback was given to the acting manager. Southern Cross has introduced a policy where all mealtimes are protected and so no medication is administered until after the meals have finished. This would have an impact on the time between medication rounds as some days breakfast does not finish until 10am and this would affect the time between medication rounds. There should be a break of at least four hours between medication rounds to prevent potential overdose of medication. The policy had not been adhered to on the day of inspection so the time between medication rounds was sufficient. The medication was stored in two dedicated rooms. One rooms temperature reached 26C as the air conditioning unit had not been switched on. The temperature must not exceed 25C. Above this the medication is not stored correctly which may compromise its stability and so not work as intended. Systems had been installed to check the prescription prior to dispensing and to check the dispensed medication received into the home. Care Homes for Older People Page 15 of 34 Evidence: Audits indicated that the majority of medicines had been administered as prescribed. A few discrepancies were seen. The acting manager checks 25 of all the medicines in the trolley on a monthly basis to confirm that they have been administered as prescribed. There were no protocols on the premise detailing the prescribed use of medicines use on a when required basis. This may have a serious impact on the health and well being of the residents. One nurse spoken with during the inspection did not know how or when to administer one medicine prescribed to treat an epileptic fit. There was no information about this medication in the care plans. The care plans lacked details of all the medication the residents were prescribed. It could not be demonstrated exactly why some residents had been prescribed some medicines. Without such information staff would not be able to fully support the clinical needs of the residents they look after. People living in the home were observed to be treated with respect and their dignity maintained for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice, it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind caring and attentive towards them. One person told us Staff are very nice, and work hard. Care Homes for Older People Page 16 of 34 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. The home has a planned programme of activities so that people in the home can maintain their enduring interests. People benefit from a nutritious and varied diet with a good menu choice. Evidence: The home employs a full time activities co-ordinator who is responsible for arranging individual or group activities for the benefit of the people who live there. The coordinator is employed to work 37.5 hours per week Monday to Friday from 10am to approximately six pm. The hours are flexible to meet the needs of the people who use the service. An activities schedule is in place which shows that there is an activity being provided each weekday. On the first day of the inspection the activities co-ordinator, made arrangements for group of people to go out on a trip in the homes minibus for tea and coffee. On the second day of the inspection, the activities co-ordinator spent the morning with individual residents in their rooms. In the afternoon, a large number of people from both the dementia unit and nursing unit came together to join in an arranged activity, this involved outside entertainers. The home hires entertainers on a regular basis and Care Homes for Older People Page 17 of 34 Evidence: on this occasion it was for an early celebration for St Andrews Day. The entertainers provided mainly music, although there was also some poetry reading. Current activities programmes were seen in peoples bedrooms. Several residents were unable to participate in group activities because of their physical frailty, the activities co-ordinator and staff said they spent one to one sessions with these people, but not on a daily basis as time would not always allow, especially when short staffed. Peoples religious and spiritual needs are considered. People are supported to meet with members of clergy from their faith, and receive Holy Communion should they wish to do so. Records for person however state that they expressed an interest to go to a service and receive Holy Communion, however due to this person behaviour needs, they were not able to do so and the record states as XX calls out, felt that this was not possible for Holy Communion, but will try at a more free and easy service, in a fortnight time. Clearer records should be maintained if a decision is made by staff to prevent someone from practising their faith. On the first day of the inspection, people who live at the home were supported to get up at different times through the morning. They were given the option of having breakfast in their own rooms or the dining room. Breakfast was served up to 11am. At breakfast a choice of a cooked meal is offered as well as cereals toast and drinks. Menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. Tables were well presented in preparation for lunch. People said that they were able to have their meal in the dining or their own room if they wish. One person spoken to commented the food is good, and I get enough to eat. The home has a kitchenette on each floor in addition to the main kitchen. Residents and families can use the kitchenette to make themselves a hot drink or have a snack. Evening tea is served at approximately 4:45pm. As this can be a long time until breakfast staff are now ensuring that the kitchenettes are well stocked with food and drinks to ensure people are able to have food and drinks in the evening. Kitchen staff spoken to confirmed that sandwiches are made each day and left in the fridge for people to have during the night and fruit and finger snack foods are left during the day. There are choices offered for each meal each day with the addition of a pureed diet alternative when necessary. The menu now offers a soft diet alternative, and the Care Homes for Older People Page 18 of 34 Evidence: kitchen staff have records to inform them of peoples diets. Kitchen staff also told us that staff are knowledgeable about peoples dietary needs, and help ensure people are receiving nutritious meals presented in a way that meets their individual needs. Care Homes for Older People Page 19 of 34 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. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: The home has a formal complaints policy. People are encouraged to raise their concerns with the staff on duty. Residents were observed to be familiar with the staff on duty and felt confident to make requests. This suggests that residents who are able to, would be confident in raising concerns with staff. There have been three complaints raised since the last inspection, two have been fully addressed, one dated June 2008 has no entry to state if the complaint has been resolved. The home has an adult protection policy to give staff direction in how to respond to suspicion allegations or incidences of abuse. When we asked staff about the homes policies and procedures on safeguarding and whistle blowing, they could not tell us where the policy documents are kept, but could discuss good practices and protocols around issues relating to the protection of vulnerable adults, however some staff would benefit from further training to ensure all staff respond in a consistent way to safeguarding matters. Staff training records were seen to demonstrate that most of the staff had received training in recognising and responding to signs of abuse. Recent staff meeting records show that the acting manager has discussed whistle blowing Care Homes for Older People Page 20 of 34 Evidence: procedures. Information about the homes policies and procedures on whistle blowing were also found in the staff room. Since the last inspection the home has liaised with us and the local safeguarding team in relation to a number of safeguarding matters. It is evident from these discussions that both the previous manager and current acting manager are both familiar with local Adult Safeguarding Procedures and have demonstrated their commitment to follow them. This demonstrates that the home has a consistent approach to safeguarding. The operations manager informed us at the inspection that the home has accepted offers of support in training staff from the Health Authority and where possible from the safeguarding team in the local authority. This demonstrates the commitment by the home to improve the quality of care it offers to the people who live there, and their commitment to develop staff training. Safeguarding concerns at the home largely relate to the management of medication. In two circumstances poor management of medication has lead to the suspension of staff, and the home is currently carrying out their internal investigations into these matters. Other safeguarding matters relate to incidents between residents. The home has liaised with the local authority in relation to these incidents, and action plans have been developed to look at how any repeat of these risks / incidents can be minimised. For example, one person with dementia has been identified as needing supervision between 4pm and 6pm. This is a time when their behaviour can change and put themselves and other people who live there at risk. This persons care plan and risk assessment plan have been updated to reflect this. However, on the first day of the inspection at 3:45pm we observed that this person was in a lounge with other residents who there have been previous incidents with, and there were no staff present. At this time two members of staff were observed chatting to residents in the second lounge. The management were made aware of this and responded by arranging for staff to be present in the lounge. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clean attractive well furnished and comfortable surroundings to live in and enjoy. Evidence: The home provides accommodation over two floors. People who have general nursing needs live on the ground floor and people with dementia care needs live on the first floor. Each floor has 24 single occupancy bedrooms with ensuite facilities. There is a dining room in the centre of each house and a lounge at either end. Decorating work is ongoing throughout the home and in the dementia care house an artist has created scenes on the walls of some of the corridors to provide a more stimulating environment for people living there. The quality of the furnishings and fittings in peoples rooms were generally good. Call systems in rooms are accessible to people. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. Equipment is available to assist residents and staff in the delivery of personal care which includes assisted baths profiling beds accessible showers and moving and Care Homes for Older People Page 22 of 34 Evidence: handling equipment including hoists. A range of pressure relieving equipment including specialised air mattresses are available. The home felt very warm throughout the inspection. The acting manager informs us that the large air conditioning unit on the first floor has been replaced to a quieter system. This action now addresses the concerns at the last inspection that that the constant noise could have a negative effect on peoples well being. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub were available and were used by staff when handling soiled linen and when supporting people with personal care. The home has a modern well organised laundry room with dedicated laundry staff. Residents clothing looked well laundered and ironed. The kitchen was clean and well organised. Records are kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The allocation of staff on duty does not always allow for ongoing observation of residents during peak times of activity. This could expose residents to the risk of harm. The majority of staff are qualified and have attended mandatory and other training related to the needs of people in their care. This will ensure that competent staff care for people living in the home. Staff recruitment procedures are not robust and consistent to ensure residents are protected from the risk of harm. Evidence: There are currently 39 people living at the home, 17 People upstairs and 22 people downstairs. All staff spoke to commented on their commitment to providing good quality care. The deputy manager is enthusiastic to help drive up care standards in the home. Comments from staff include : Carers do their job properly, but they are all rushing in work and can not take breaks. Have got some brilliant carers here, very attentive, which makes me want to stay I feel is a good nursing home, but problems in staff turnover and maintaining standards. foor example, recently alot of agency staff and they dont always document things in the diary. Care Homes for Older People Page 24 of 34 Evidence: Rapport and morale are not bad at the monent, staff get worn out staff feel more settled with Paul on board. The acting manager informs us that the home is currently recruiting a permanent manager and additional nursing and care staff. The staffing rotas show that the home currently employees 23 care assistants, 9 nurses, two of which are currently suspended pending investigation, a deputy manager and acting manager. The home is currently using bank and agency staff to help ensure the minimum levels of staff are being met at the home. On the afternoon of the second day of the inspection, we observed that there was one registered nurse and three carers working in the nursing unit. Staff spoken with felt that four staff are needed to meet more than the basic needs of the people who live there. During the inspection the home gave its commitment to ensure that there will be one registered nurse and four care staff on duty on the nursing unit during the 8am - 2pm, and 2pm to 8pm shifts. This staffing level should help ensure the needs of people with high dependency levels are being met. Staffing rotas tell us that the following levels of staff are available at the home: 8am to 2pm : One nurse and three care staff upstairs; one nurse and four care staff downstairs 2pm to 8pm :One nurse and three carers upstairs ; one nurse and four carers downstairs 8pm to 8am : one nurse upstairs an one nurse downstairs and 3 carers. There are occasions when staff prefer to work a long shift, this is from 8am to 8pm. Staff spoken to state that when they are short staffed it can be difficult to find time to take their entitled breaks. The acting manager needs to ensure that all staff are taking their entitled breaks, and arrangements are made should the home be short staffed. Consideration also needs to be given to effectiveness and standards of care provided when staff when working for twelve hours. The staffing rotas are difficult to read, staff surnames are not included and there is no key codes to determine what different letters or abbreviations on the rota refer to. As documented in the last inspection report, staffing levels impact on the amount of time staff can spend with people, resulting in only basic care needs being met. The quality of care observed was good and staff interactions were not rushed. However, there were long periods throughout the inspection where people were alone in their bedrooms or alone in lounges without staff being present is still evident within the Care Homes for Older People Page 25 of 34 Evidence: home. One relative spoken to commented on the staff support stating, the carers are very kind and caring. Another commented, I have no complaints about the care that XX receives, however I have nothing to compare the quality of care here to, if I wasnt happy, I would speak to the manager. Out of 19 care staff employed at the home, 8 have a National Vocational Qualification in Care (NVQ) at level two, which is below the National Minimum Standard for 50 of staff to be qualified. The training matrix includes POVA, Dementia Awareness, Moving and Handling, Infection Control, Nutrition, Control of Substances Hazardous to Health (COSHH) and Continence Medication. There continues to be a good training matrix in place, the records seen on the matrix and on individual files for three of the staff, does demonstrate that staff currently have the required skills to undertake their roles. There is evidence that mandatory training including first aid, infection control, food hygiene, health and safety, moving and handling and medication has been taking place. Staff have also been attended training in the Protection of Vulnerable Adults training as recommended at the last inspection. Four staff files were seen. Not all files had evidence that checks undertaken by the Criminal Record Bureau (CRB) have been received prior to starting employment, however records did show that the home had PoVA First checks in place. Files did demonstrate that references had been taken up prior to starting work, however, a reference for one person was verbal, and two references for another person where personal references, none from a previous employer. The management should record why it is acceptable to have two personal references and none from the last employer. Information about staff induction is limited. One persons record shows that that they have attended training in fire safety and health and safety. the acting manager informs us that this individual has an induction booklet and is in the process of completing this. Another person has also attended training in fire safety and health and safety. We are told that this person was able to shadowother staff for three days, however we could see no evidence of this. Again we were told that this person had an induction pack that they are currently completing, however this was not available for us to see. Minutes from a recent staff meeting state that staff feel that a more detailed induction program is needed for new staff. Care Homes for Older People Page 26 of 34 Evidence: On the day of the inspection the staff were noted to have a good manner with people and offered them care and support in a caring and compassionate way. Care Homes for Older People Page 27 of 34 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. A lack of continuity in the management of the home does not ensure the service is run in the best interests of people living in the home. The people who live their and their families are provided with opportunities to make their opinions of the service known and the organisation has systems in place to monitor quality performance. Evidence: There has a lack of continuity in the management of this home. The manager at the time of the last inspection has left and the home is now on their second acting manager since then. This means that the home continues to be without a full stable management team. The home has however recently employed a deputy manager. The acting manager informs us that interviews are currently being carried out to employ a permanent manager. Care Homes for Older People Page 28 of 34 Evidence: There is evidence that the home has improved in some areas of its quality of care, but there is evidence that the home would benefit from a manager that could spend time in the home to develop the service and the staff team. From discussions with staff, morale has improved since the last inspection, however, three staff members spoken with all felt that staffing levels needed to increase to enable staff to meet more than basic care needs of the people who live within the nursing unit. Systems for the safe keeping of monies to safeguard residents financial interests are good. The views and opinions of residents and relatives have been sought through questionnaires. A survey for relatives and people who live at the home was carried out in August 2008, the outcomes from these surveys were seen and read. The information received had been analysed and this was read. An action plan dated October 2008, is in place to address the outcomes of the surveys. Examples of the homes future plans include: addressing maintenance and decoration work, and increasing opportunities for trips. The statistics drawn from the surveys show that the majority of residents surveyed and relatives surveyed were Quite Satisfied in their responses. Comments from the surveys included: The home needs vast improvement. I have nothing positive to say about Arden Valley, relative comments. Although the home has seen an increase in quality in recent weeks months it still has a long way to go. Professional comment. I think there should be a lot more staff on duty, they dont have time to finish what Ive asked them to do, or want to see if I need anything else person who lives at the home. The home has arrangements in place for Regulation 26 visits to take place. These visits by a senior member of staff within the organisation take place to look at how the home is performing, and recommendations for development in the care at the home are made. Records of these visits were seen. Minutes from staff meetings were seen. A recent visit shows that the acting manager is addressing such issues as whistle blowing in the meetings. Care Homes for Older People Page 29 of 34 Evidence: The home has health and safety certificates of maintenance. Weekly fire testing is carried out and records are maintained to show this is happening. Care Homes for Older People Page 30 of 34 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 34 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 17 Each individual must have a detailed care plan to assist staff to meet all their needs. This is to ensure that staff have clear guidelines to provide consistent and appropriate care based on peoples individuals needs. 16/01/2009 2 9 13 All medication must be stored in compliance with their product licences. This is to ensure that their stability is maintained. 16/01/2009 3 29 19 Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. To include Two written references including where applicable a reference relating to the persons last period of employment. A full employment history together with a satisfactory 13/02/2009 Care Homes for Older People Page 32 of 34 written explanation of any gaps in employment. The outcome of a Criminal Record Bureau CRB disclosure and checks against the Protection of Vulnerable Adults register PoVA. This will ensure that the homes staff recruitment practices safeguard people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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). 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. 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