Inspection on 07/09/09 for Arncliffe Court Nursing Home

This inspection was carried out on 7th September 2009.

CQC 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

Arncliffe Court Nursing Home 06/07/07

Arncliffe Court Nursing Home 13/03/07

Arncliffe Court Nursing Home 31/05/06

Arncliffe Court Nursing Home 15/11/05

Arncliffe Court Nursing Home 24/05/05

Arncliffe Court Nursing Home 08/11/04

Arncliffe Court Nursing Home 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debbie Corcoran     Date: 2 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF 01514866628 01514481934 southark@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 150 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 60) Dementia: Code DE (maximum number of places: 90) The maximum number of service users who can be accommodated is: 150 Date of last inspection Brief description of the care home Arncliffe Court is registered to provide care for 150 individuals. The Home is situated in Halewood, Knowsley, Merseyside. Arncliffe Court is on a housing estate close to all local amenities and has good links with public transport. There are local shops nearby and a main shopping area can be reached by bus or car. Care Homes for Older People Page 4 of 33 90 0 Over 65 90 60 Brief description of the care home Arncliffe Court is divided into five units all of which are physically separate and operate on an individual basis. Each unit has access to a secure courtyard garden and all the units are situated in landscaped grounds. The Units all have names and vary in function: Gateacre House: nursing care for older people with mental health needs, Speke House: nursing care for older people, Childwall House: residential care (personal care only) for older people, Paisley House and Woolton House: residential care for older people with mental health needs. There is a smoking policy in operation across the site and residents who wish to smoke can do so in designated areas. A site manager is responsible for the management of the home with each unit being managed by a unit manager. The fees for residing at Arncliffe Court range from £513 to £697 per week. Care Homes for Older People Page 5 of 33 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 visit to the home was not announced beforehand. The inspection visit took place over a period of three days. The first day of the inspection included a pharmacy inspector who looked at medication practices on two of the five units and two regulation inspectors. The second day included two regulation inspectors. The third day was carried out the following week when the manager was available and this included the lead inspector only. The quality rating for this service is 1 star. This means that the people using this service experience adequate quality outcomes. During the visit the majority of the people living at the home were met and a number were spoken with either on a one to one basis or a small group basis. A number of relatives were also spoken with. Discussions took place with the manager of the service and number of staff including unit managers, care staff, domestic staff and catering staff. Care Homes for Older People Page 6 of 33 We also sent surveys to people using the service and to members of staff and we received a good return of these. Some of the information in these has been used to assist us in assessing the service and forming judgments about the quality of outcomes for people living at the home. A sample of records were looked at in relation to peoples care. We also looked at other records including medication administration records, staff files, staff training records and health and safety records. These help to show us how peoples health and wellbeing are being promoted and whether staff have the skills and training needed to support people appropriately. A tour of the home was carried out which included most areas and a sample of bedrooms. The manager returned a self assessment of the service prior to this visit. The self assessment enables the service provider to inform us of what they do well, where they have improved and where they can improve in the future. It also includes information on how they promote equality and diversity, how they seek the views of people living at the home and includes data on staffing and health and safety. The self assessment is referred to as an Annual Quality Assurance Assessment (AQAA). Some of the information in this has been used to inform the findings of the inspection and the reader can see information taken directly from this within the main body of the report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: There is room to improve the admissions procedure in relation to assessing a persons needs. When a new person is admitted to the home an assessment of their needs is carried out by a senior member of staff. However, we found that the quality of information in assessments varied greatly and some included minimal qualitative information. In addition we found that assessment information is not being attained from the agency referring the person. Each of the people living at the home has a care plan. We saw some good examples of care planning but we also found some care plans lacked important information about the care and support provided to the person. This was also the case with other documentation relating to the person. Not providing staff with accurate, up to date care plans and other relevant information can place people using the service at risk of not receiving the care and support they need. Overall, we found medication was being handled safely but a number of Care Homes for Older People Page 8 of 33 recommendations for good practice have been made following our findings. Some of the people living at the home have had minimal opportunity to be involved in activities. Activities records and discussions with members of staff showed us that there is less activity on some units than others. This should be addressed and every person living at the home should have equality of opportunity to a varied and stimulating range of activities. Overall the home environment was found to be maintained appropriately and it was reported that there has been a good deal of investment in the environment more recently. However, there were a number of areas for improvement which need to be addressed as identified in the main body of the report. The home has had a number of managers since the last key inspection. The manager at the time of the inspection visit was working her notice to leave. We were informed that a new manager had been appointed and it is imperative that this person makes an application with us for registration as manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. Some people are admitted to the home without a comprehensive assessment of their needs having been carried out and this may mean that staff do not have sufficiently detailed and information about the person. Evidence: We looked at the statement of purpose and service user guide for the home. These are documents which provide information on the services and facilities provided at Arncliffe Court. They include information on the philosophy of care, process for assessing peoples needs, care planning, staffing, meeting medical and nursing care needs, activities, terms and conditions of residency and fees. People who are thinking of moving into Arncliffe Court can use these in order to aid their decision. People are given the opportunity to visit the home and spend some time there before deciding if it is the right place for them. This was confirmed during discussions with people living at the home and with their relatives. Care Homes for Older People Page 11 of 33 Evidence: The manager has detailed in the providers self assessment of the service (AQAA) Comprehensive written information is provided to all prospective clients, outlining the ethos of Bupa Care Homes and the home, as well as vital information to help with the process of choosing a care home. The homes CSCI reports, the Service User Guide and Statement of Purpose are made available in reception. Prospective residents who are unsure are given the option of a trial in the home, to ensure their happiness and wellbeing. When a person is referred for a service an assessment of their needs is carried out by a senior member of staff from the home. This is done to ensure that the persons assessed needs can be met at the home. The homes assessment process includes carrying out a pre admissions assessment and then further assessments at various stages following the persons admission to the home. We case tracked eight people using the service. By this we mean that we looked in more detail at their needs, the type of support they were receiving and their care plans. The quality of information in the assessments for the people we case tracked was variable. We saw some examples where there was quite a good level of information to describe was the persons needs were. However, we also saw examples whereby the level of information was minimal. The actual assessment tool used allows for a comprehensive assessment of needs to be carried out. However, the assessments were not always completed in sufficient detail. This was in all areas of the assessments but a particular example was for people who were admitted with dementia care needs and there was little if any reference to the impact of this on their day to day life. Ensuring comprehensive assessments are carried out is fundamental to ensuring staff are provided with the information they need to know to meet the persons needs and to ensure good care planning based upon the persons assessed needs. We also noted examples whereby assessments had not been reviewed or updated even though there had been a clear change in the persons needs, based on our observations, discussions with staff and other records. We also saw that were assessments had been updated there was frequently no reference to when this had been carried out or by whom. The home has an admissions procedure and this was viewed. This does not include information with regards to attaining a copy of an assessment from the referring agency for a new person. We saw that care plans from the referring agency were on records but we did not see any assessment information for any of the eight people we Care Homes for Older People Page 12 of 33 Evidence: looked at in more detail. This should form part of the admissions procedure for the home. At the time of the visit the Local Authority has suspended contracting with one of the units of the home pending the findings of an adult safeguarding investigation. The home does not currently provide intermediate care and therefore standards in this area were not assessed. Care Homes for Older People Page 13 of 33 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. The needs of the people living at the home are not always clearly reflected in their care plan or other records and this may compromise their health and wellbeing. Evidence: Each of the people living at the home has a care plan. These were looked in some detail for eight people who we case tracked and for an additional two people for specific reasons. The care plans were found to be a substantial document which included sections for recording information on how to meet a persons needs in areas such as communication, lifestyle, maintaining safety, mental health and cognition, personal care, medication. There were some examples of care plans whereby a good detail of information had been recorded and it was easy to get an overall picture as to what the persons needs were and how they were being met and care plans were, on the whole, being reviewed on a monthly basis. However, there were also a number of examples whereby the information in care plans had not been updated and was therefore inaccurate and was process centred as opposed to person centred. For example, a Care Homes for Older People Page 14 of 33 Evidence: person may have lost weight and have been referred to a dietician and recommended to start taking a food supplement. The appropriate actions had been taken but this was not always reflected in the persons plan of care. Another person had seen a rapid deterioration to their health as a result of a health condition but there was a gap in their assessment, care planning and records and it was not possible to determine when or how their diagnosis was made or to follow through the changes in their care as their condition progressed. A further example, was that the care plans for people who have dementia care needs made little reference to the impact of this on their care and how to support the person with their psychological, emotional and behavioural needs. We could see some good examples of wound care we also saw some gaps in the recording and monitoring of wounds and we therefore could not fully see how the wound was being treated. Therefore there was a lack of consistency in the quality of care planning for wound care. Overall, evidence indicated that the needs of people with wounds or pressure areas were being met but the home must be able to demonstrate the effective monitoring and treatment of these. Without this information there is a risk that the person may not receive the care and support they require. At the time of the inspection visit a safeguarding investigation into the management of wound care was underway with regards to a person who lived at the home for a short period of time. This investigation has not yet been concluded but feedback to date indicates that BUPAs policies and procedures have not been followed by staff at the home. People living at the home and their relatives told us that they receive good care and felt well supported with their health needs. We spoke to staff about healthcare and we looked at records. There were some gaps in records but we asked staff questions where we found gaps and we found that people were being supported with their health and relevant healthcare professionals, eg Gp, district nurse, dietician, psychiatrist were being referred to on a regular basis. Again, this information was not always reflected in the persons care plan or record of appointments. This is an area which therefore needs to be improved. Without appropriately detailed care plans and supporting documentation it is not possible to establish whether or not a persons needs are being planned for and met there is a risk that there could be an oversight in meeting a persons needs. People living at the home were asked if they felt that their privacy and dignity was upheld when being supported with their personal care. All responses to this indicated that they did. During discussions with staff they were asked how they ensure they Care Homes for Older People Page 15 of 33 Evidence: maintain a persons privacy and dignity and staff gave appropriate answers to this. For example they talked about ensuring they talk to the person discreetly, talk through how they are going to support the person, ensure the use of towels and clothing to make sure the person is covered and ensure doors are closed. The manager told us in the self assessment of the service (AQAA) that they ensure equality and diversity is promoted accross the service by Rigorous recruitment policies and procedures. Care is more person centred. Diversity training on request. The Menu Manager programme provides help with developing meals for different dietary needs. Staff are supported where residents make inappropriate remarks. They also reported that they are planning to make further changes by Ongoing traininng. Regular reviews of policies and procedures. Personal Plans being regularly monitored with a specific view to equality and diversity. We looked at how medication is being managed on two of the five units (Speke House and Woolton House). Medication is administered by senior members of staff who have been provided with training in this. The home has medication policies and procedures to guide staff in their practice. Overall we found that medication is being attained, stored, administered and disposed of appropriately. However, we noted that there were some practices in managing medication which need to improve as we found the following; Medication administration records were unnecessarily complicated, although it was noted that staff were working with these to good effect. The medication administration on Speke House took approximately two hours to complete and this means that the next time for administration of some medications may be due close to the previous medication having been administered. We found there was no guidance for staff on how to administer some as required medications. Staff were not always double signing hand written entries on medication administration records and there was some use of sticky labels being used on medication administration records. A small number of administration or stock errors were also noted. We recommend a review of current practices and the implementation of systems which will address the above issues. Care plans have a section which is used to describe the medication needs of the person. However, these were found to contain information on the process of administering medication rather that what this means to the person. This is an area which could be improved. Staff could use this to record why a person requires medication, whether or not they are able to administer some or all of their own medication, signs and symptoms to look out for in relation to the effects of their medication and the reasons for as required medication. Care Homes for Older People Page 16 of 33 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. People living at the home do not have equality of opportunity to be involved in activities. This results in some people having had little or no inclusion in activities. Evidence: In order to assess the level and variety of activities available to people we spoke with people living at the home, their relatives, two activities co-ordinators and we viewed records which contain details of what activities had taken place over the past six months. Arncliffe Court has five separate units and each of these have up to thirty residents. The service has four activity co-ordinators but only three were working at the time of the visit as one person was on long term absence. The three co-ordinators were each working on a specified unit during the morning and this allows for them to carry out some one to one activities with people. In the afternoons all of the activities co-ordinators work together to provide an activity on one unit which people from other units are invited to join. This means that people move around the site for activities. This may suite some people but would not suite all people particularly those with dementia care needs as this may impact on their orientation. Feedback from staff in surveys was that activities need improvement particularly on the units for people who have dementia care needs. Records showed that on some units the level of activities over the course of a month was very limited and the current arrangements for Care Homes for Older People Page 17 of 33 Evidence: activities may leave some people excluded from being involved in an activity for a long period of time. The manager should review the level of opportunity for activities and ensure both equality of access to all people living at the home and regular opportunities for people to be included in an activity. During discussions with people living at the home they were asked about the choice and control they have over their daily lives. People confirmed that they choose their own daily routine as to when to get up, choice of meals throughout the day, support with personal care such as bathing. People can have a phone in their own room and people are given their post directly or this may be given directly to family depending on the needs of the person. People were observed to be spending time in their room, in the lounge or in the garden and some people were observed to be involved in activities. There has been one residents meeting so far this year. The manager reported that another meeting has been scheduled for the near future. Residents should be given the opportunity to meet on a regular basis in order to give them a forum to discuss their experiences of the service and for them to feed in to decision making about the home. People living at the home gave good feedback with regards to the meals and food provided. People have the option of a cooked breakfast everyday. There are three hot meals per day and people have a choice of each of these. All meals are prepared in the main kitchen and this was found to be clean and well organised. In addition to a choice of meals there is also an alternatives menu which people can choose from and it was observed that people are provided with alternatives to the main menu. All menus are passed by menu managers who are employed by BUPA and determine if a menu is nutritionally balanced. The chef reported that himself or a member of the catering team will talk to people living at the home on a daily basis and attain feedback on the meals through this and will alter the menu accordingly. A month long cruise theme was recently used and this is a means by which the meals will relate to particular countries. This was reported to have been particularly successful and enjoyed by the people living at the home. Whilst it was noted that people have a good choice of food this wasnt the case for people who require a blended diet as there were no options available for them. Once this was brought to the attention of the chef he said that he would introduce a menu for people requiring a blended diet with immediate effect. The chef also agreed to look at how menus are advertised as they are currently written in small writing on A4 paper and kept up on a notice board and therefore arent accessible to many of the people living at the home. Protected mealtimes has been introduced and this means that mealtimes are uninterrupted and focused on people being provided with the attention and support Care Homes for Older People Page 18 of 33 Evidence: they require to have an enjoyable and relaxing mealtime. We observed how people were being supported with their meal on two of the five units. On one of the units people were appropriately supported. On another unit it was evident that staff were not observing people appropriately. The mealtime was not well organised or orchestrated and as a result one person who was on a food monitoring chart had given part of their lunch to another person but staff were unaware of this and staff were unaware as to whether another person had been given their main course. Mealtimes can be the highlight of a persons day and it is important that staff pay due care and attention to ensuring people receive their food and enjoy this time of the day. Staff are not provided with information on the dietary needs of the people they support either through care planning (even though there is a section on diet) or through the provision of a menu which details particular foods being for example for a person who has diabetes. This is an area to improve practice. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and practices are in place to safeguard the health, safety and wellbeing of people living at the home. Evidence: The home has a complaints policy and procedure which is time scaled appropriately and includes contact details for the Commission. People living at the home told us during discussions and in surveys that they would let staff know if they were not happy about something and that staff would then address their concerns and that they knew how to make a formal complaint. Information on how to make a complaint is provided to people in the service user guide. A log of complaints is maintained. This was looked at and showed that complaints have been well documented, investigated and responded to. An adult protection policy and procedure is in place. This outlines responsibilities for responding to an allegation of abuse and any subsequent investigations. Staff recruitment procedures include a check against the Protection of Vulnerable Adults register and attaining a criminal records bureau check for new members off staff. Most staff have been provided with adult protection training. During discussions with staff they were able to explain what course of action they would take in the event of an allegation of abuse. The manager and senior staff were clear in their responsibilities to report safeguarding. Safeguarding information was looked at and it was evident that the manager has documented safeguarding referrals and outcomes to these well. Care Homes for Older People Page 20 of 33 Evidence: We have been informed by the home of a number of safeguarding referrals made to Social Services over the past twelve months. The majority of these have involved incidents between people living at the home. When this has been the case the home have taken action to reduce the risk of reoccurrence of incidents. We have been informed of two incidents were staff have been alleged to have been verbally aggressive towards a person living at the home. Additionally, there has been one adult protection investigation carried out by Social Services and at the time of the inspection visit another safeguarding investigation was underway. This was in relation to the care provided to a person who had lived at the home for a short period of time. The outcome of this investigation had not been concluded at the time of writing this report. The manager has detailed in the providers self assessment of the service (AQAA)All new staff attend training in adult protection as part of their induction. All regular staff receive ongoing training in adult protection and deprivation of liberty. All residents have undergone an assessment to meet the requirements of the deprivation of liberty guidelines. All unit managers have attended the Liverpool and Knowsley training days for the protection of adults and deprivation of liberty. All complaints and incidents are reported promptly to the relevant departments and accurate records are maintained. A sample of accident forms were looked at. Accidents are monitored through the homes quality assurance process. We noted that there was one accident form not available for one of the people who we had case tracked. Accident records must be completed as appropriate at all times so as to safeguard the health and wellbeing of people living at the home and in line with Health and Safety practices. We are regularly notified of incidents at the home and this is good practice. As discussed with the manager we require more detail in these notifications as to which area of the service they relate to and what action has been taken in response to the issue. Care Homes for Older People Page 21 of 33 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 living at the home are provided with a clean, safe and comfortable home environment. Evidence: The home was purpose built and it therefore meets required standards in relation to size, facilities, and accessibility. It is a one storey building situated in accessible grounds. Overall the home is furnished and presented to a good standard though there are differences in this across the five units as some have been refurbished more recently than others. One of the units in particular which would benefit from refurbishment is Gateacre House. This unit lacked warmth and was not welcoming or homely in appearance. Woolton House was found to have a strong malodorous odour and this was reported to be linked to carpeting in the hallway / corridor. This had been the subject of two complaints to the home. The manager reported that new flooring had been ordered and would be fitted as a matter of priority. The manager has reported that the flooring has been replaced since the inspection visit. The home was presented as clean with the exception of some of the carpeting in Woolton House (corridor and lounge) and some of the seating in the lounge in Woolton House and some areas of carpeting in Gateacre House were dirty. We also noted an Care Homes for Older People Page 22 of 33 Evidence: example whereby infection control practices were not observed appropriately. The details of this were discussed during feedback. The home is divided into five separate areas or units. These are referred to as Speke House, Woolton House, Gateacre House, Childwall House and Paisley House. Each of the units accommodates up to thirty people. Speke House provides residential care with nursing. Paisley House provides nursing care for people with dementia. Woolton House and Paisley provide residential care for people who have dementia and Childwall House provides residential care. There was little indication that attention had been paid to the needs of people with dementia on those units were people with dementia care needs were accommodated. There was no signposting to assist people in differentiating different parts of the home or to indicate for example which was their room. This was discussed with the manager of the service who reported that staff are in the process of attending training in dementia care and it is anticipated that this will create a more person centered approach to their work and to the environment. The manager has detailed in the providers self assessment of the service (AQAA) The home has recently undergone an extensive refurbishment, which included the following; Installation of new wet rooms on all units/ two new mira baths. New floor coverings/ soft furnishings to all communal areas and residents bedrooms. New lounge and dining furniture to all units and the majority of bedrooms. All areas of the home have been redecorated during the past six months. New garden furniture for all units. Cooler units installed in all five treatment rooms. Refurbishment of the main reception areas. Purchase of major equipment in the kitchen, including cooking range. There is a main kitchen which provides all meals to each of the units and each unit has a satellite kitchen for drinks and snacks to be prepared. The kitchen was found to be clean and a recent Environmental health visit concluded this to be the case. There is a central laundry which provides laundering for each of the units. A sample of bedrooms were looked at and were seen to be furnished and presented to a good standard. Many of the bedrooms were seen to be personalised with the persons own belongings. The home is fitted with aids and adaptations such as hoists, handrails and bath chairs so as to assist people to move and transfer safely. Records showed that these are Care Homes for Older People Page 23 of 33 Evidence: regularly serviced. The safety and maintenance of the home is checked on a regular basis as part of the quality assurance process. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by well trained and qualified staff. People feel staff are stretched but strive to provide good care and support. Evidence: There is an overall manager for the service and each of the five units has a manager. There is a manager and or senior staff on duty at all times. Staff roles and lines of accountability are clear. This means that staff know their responsibilities and know when to refer to a senior person for advice or support. We looked at how many staff were on duty when we arrived at the home and we checked staff rosters to confirm what usual staffing levels are. Each unit has up to thirty residents and there was one senior or unit manager on duty and four members of care staff. The same staffing levels were noted on each unit. Staff were observed to interact with residents with warmth and familiarity. People living at the home gave us good feedback about staff . One person commented theyre good staff and another person said the staff give good care. Relatives also gave good feedback about the staff. However, relatives and a small number of residents (during discussion and in surveys) commented that they felt staff were busy all of the time. One person commented there arent enough staff on duty and theyre rushed off their feet. Another comment was staff on the whole are helpful when Care Homes for Older People Page 25 of 33 Evidence: around and there are not enough staff on to help with a persons needs kept for long time before being changed which sometimes leads to the nursing home resident becoming sore. On one unit we found that people were still in bed late morning because there were only one senior and three members of care staff on duty. However, this was corrected as the member of bank staff who had been brought in to cover the shift had gone to another unit by mistake and had been working there. We looked at staff rosters and were gaps had been identified we saw that temporary / bank staff had been brought in to cover the absences. We have been advised of staff shortages by the home on a number of occasions over the past twelve months. This was discussed with the manager who stated that all efforts are made to cover staff who go off duty at short notice but there have been odd occasions when this has not been possible despite efforts to do so. Staff were observed to be busy at all times and staff were not seen to spend any time with the people living at the home unless involved in a task to support them. Based on the findings of our observations and feedback from people living at the home and their relatives we recommend a review of staffing levels is carried out so as to ensure staff are provided in sufficient numbers to effectively meet the needs of the people living at the home. We looked at a sample of staff files to assess recruitment and selection practices and ensure these were in line with protecting people. This showed that all relevant pre employment checks, for example, attaining references and carrying out a criminal records check, had been made prior to starting new members of staff. These practices aim to safeguard people living at the home. The manager provided us with a copy of the staff training matrix which identifies what training staff have been provided with. We also looked at a sample of training records. These showed us that care staff have been provided with training in topics such as fire safety, moving and handling, health and safety, food hygiene, dementia care awareness and adult protection. This level of training tells us that the staff team should be able to promote and safeguard the wellbeing of people living at the home. The manager reported in the providers self assessment of the service (AQAA) that fifty seven out of the seventy care staff have attained a relevant National Vocational Qualification (N.V.Q) in Health and Social Care. The minimum ratio of 50 percent trained staff has therefore been achieved and exceeded. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is managed effectively and their health, safety and welfare is promoted and protected. Evidence: The manager of the home has been in post since February 2009. However, at the time of the visit the manager was working her notice to leave the post and a new manager had been appointed. The home has had a number of changes of manager since the last key inspection visit and a number of staff reported that this has had an impact on the service in terms of staff moral. The home has one overall manager and each of the five units has a manager who is responsible for leading the staff team, staff rosters, staff supervisions, and identifying staff training amongst other duties. In relation to Speke House the unit manager is also the registered nurse. The staff roster showed that the person is regularly the only Care Homes for Older People Page 27 of 33 Evidence: qualified nurse on the unit and is also the person responsible for managing the unit. This means that they can be responsible for managing the unit, providing the clinical nursing support and administering medication. Medication administration can take up to two hours in one medication round. This was discussed with the manager. The manager stated that she felt this was appropriate as there is also a clinical services manager in post to support the nursing staff. We recommend this is reviewed in line with a review of staffing levels in general. BUPA has a clear quality assurance process which includes audits of the service and further audits of the auditing process. These audits cover all aspects of the service provided from care planning and medication to maintaining a safe environment and safe working practices. The auditing of care plans needs to be looked at as it is clear from our findings when looking at care plans that there are some inconsistencies in the level of information and accuracy of information being documented. The process for supporting people using the service with managing their personal monies was looked at for a sample of people. This was presented as a straight forward and accountable process which includes regular audits. Staff are provided with supervisions on a regular basis, although there was some difference in the frequency across different units. Team meetings take place throughout the year for different staff teams. These tend to take place for senior staff on a more regular basis than care staff. Supervisions and team meetings provide an opportunity for staff to communicate important information about the service, about the people using the service and to explore their development as workers. Health and safety policies, procedures and practice are in place to safeguard the well being of people living at the home, staff and visitors. A sample of fire safety and health and safety checks were looked at. These were found to be up to date. Safety certificates were viewed and those seen were up to date. Safe working practice risk assessments are in place and are reviewed on a regular basis. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must include sufficiently detailed information on how to meet the needs of the person in all aspects of their health and wellbeing. To promote the persons health and wellbeing and ensure staff are aware of what actions they need to take to meet the persons needs. 24/12/2009 2 8 17 Records relating to a persons support with health care must be maintained appropriately and accuratley. To ensure the health and wellbeing of people living at the home is promoted. 24/12/2009 3 12 16 People living at the home 24/12/2009 should have greater opportunity to be involved in social and recreational Care Homes for Older People Page 30 of 33 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 activities and past times as per their individual needs. To promote peoples health and wellbeing. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The admissions procedure should be reviewed, and improvements made, so as to ensure a level of consistency in the quality of assessment of needs. Medication practices should be improved as identified in the main body of the report. This includes improvements to stock control and medication administration records. The menu should be developed to include a choice of meals for people who require a special diet. Records relating to the people living at the home should include a greater level of informaton on the persons dietary needs and preferences. The menu should be made available in formats which are accessible to people living at the home. Accidents records should be made on all occassions as appropriate to Health and Safety requirements. Consideration should be given to improving the home environment to meet the needs of people who have dementia care needs. Infection control practices should be appropriatley maintained at all times. A number of areas of carpeting and upholstery should to be cleaned so as to ensure good standards of hygiene and presentation. A review of staffing levels should be carried out. This is to ensure staffing levels are maintained to a level to ensure 2 9 3 4 14 15 5 6 7 15 18 19 8 9 26 26 10 27 Care Homes for Older People Page 31 of 33 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 the needs of the people living at the home at effectively met all times. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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