Inspection on 08/04/09 for Balmore Country House Care Home

This inspection was carried out on 8th April 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Balmore Country House Care Home 01/08/08

Balmore Country House Care Home 06/07/07

Balmore Country House Care Home 04/07/06

Balmore Country House Care Home 12/01/06

Balmore Country House Care Home 07/06/05

Balmore Country House Care Home 31/03/05

Balmore Country House Care Home 25/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report Care homes for older people Name: Address: Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY     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: Karmon Hawley     Date: 0 8 0 4 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 36 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 36 Information about the care home Name of care home: Address: Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY 01159213006 F/P01159213006 ruddhomes@talk21.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ruddington Nursing Homes Limited care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 46 The registered person may provide the following categories 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 Physical Disability - Code PD Dementia - Code DE Date of last inspection Brief description of the care home Balmore Country House Care Home provides nursing and personal care for up to 50 older people. Balmore is a converted and extended property set in pleasant and extensive grounds in Ruddington village, near Nottingham. There is a welcoming atmosphere for people using the service and relatives as well as professionals visiting the home. There are several sitting rooms and a private sun room offering sufficient Care Homes for Older People Page 4 of 36 46 0 46 Over 65 0 46 0 Brief description of the care home space for people using the service. There is a passenger lift providing access to the upper floor and there is access for wheelchairs throughout the home. The current fees for the home, which are made available on the point of enquiry range between £338 to £600 per week. These fees do not include chiropody or hairdressing fees. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting Care Homes for Older People Page 6 of 36 the care plans of 4 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The acting manager, members of staff and people who use the service were spoken with as part of this visit. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of people using the service. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Plans of care must be in place for all identified needs to ensure that these are met. When using the Mental Capacity Act justification for doing so must be assessed and documented to ensure that peoples rights are maintained. Plans of care must be in place for all identified needs and evaluated when significant Care Homes for Older People Page 8 of 36 events or changes occur in peoples needs. This will ensure that peoples needs are met and they receive continuity of care. Risk assessments and management plans must be specific for each individual and in place for all highlighted risks. This will ensure that people using the service are fully protected. Medication must be administered safely and medication that has not been taken must not left with people using the service. This will ensure that people are protected from taking medication that has not been prescribed for them. Staff practices that undermine peoples dignity must be addressed and poor staff practices in regard to answering peoples calls for help must be addressed to ensure that people are supported as needed and protected from harm. It must be ensured that staff carry out their duties as requested by management and do not disrespect people using the service. People that have dementia care needs must be provided with adequate structured stimulation, activities and purpose in their lives. All concerns must be logged in the complaints book to demonstrate that these have been fully investigated and resolved. Management must be aware of the safeguarding adults procedure in regard to alerting safeguarding incidents. This will ensure that people using the service are protected from abuse and any incidents are investigated appropriately. Evidence to demonstrate that registered nurses have an effective registration number to show that they are registered to practice must be available. Staffing levels and dependencies of people using the service must be assessed in regard to the amount of staff on duty. This will ensure that sufficient staff are available to meet peoples needs. Appropriate risk assessments and management plans must be in place in regard to windows that have no restrictors in place. This will ensure that people using the service are fully protected. The Fire Authority must be liaised with in regard to the necessity of staff undertaking fire drills and the testing of emergency lights. This will ensure that people using the service are protected from the risk of fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Care Homes for Older People Page 9 of 36 order line 0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and that staff are able to meet these before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The acting manager visits people in the community to carry out a preadmission assessment to make sure that staff are able to meet the persons needs before a decision to move into the care home is made. Within case files examined we saw evidence that these assessments are taking place as required. So that people can get a feel for what it would be like to live at the care home they can visit and spend time there before they make any decisions to move in. Staff spoken with tell us that they are informed of peoples needs before they move into the care home so that they are able to support them appropriately. Care Homes for Older People Page 12 of 36 Evidence: One person using the service told us, I am new here, and I have only been here for one day. My son looked around and liked it. I havent had the chance to unpack my stuff yet, I would like to get it done as it will make me feel more settled. The service does not offer intermediate care. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not fully met and they are not fully protected from risks. Medication practices do not always protected people using the service. Peoples dignity is not always maintained. Evidence: Some plans of care are person centred and cover peoples personal preferences and the way in which they wish their care to be delivered, whereas others remain task focussed and give standard statements instead of highlighting preferences to make sure that people receive care in their preferred way. To enhance peoples rights the Mental Capacity Act has been utilised within plans of care to assess peoples capacity to consent, however within one plan of care, there is no additional information in respect of how the persons mental health affects them to justify the use of this. Plans of care are in place for the majority of peoples needs such as personal care and nutrition, however within one case file examined where mental health care needs and Care Homes for Older People Page 14 of 36 Evidence: challenging behaviour is a presenting problem there is no plan of care in place to outline the necessary support that the person requires despite there being a risk assessment and evidence of challenging behaviour occurring with daily running records. Plans of care have not been evaluated to ensure continuity of care since February 2009 nor updated despite significant events occurring such as requiring emergency treatment due to a medical condition, nevertheless significant information and a record of staffs actions are recorded within the daily running records. Risk assessments are in place for the majority of peoples highlighted needs, however these are not always in place when an assessment such as infection control or pressure area care has identified a high level of risk to ensure that these are managed. Risk assessments in place are pre printed and of a generic nature, for example the risk of falls, states to use a reclining chair for people who have a tendency to lean forward in their chairs when this may not always be appropriate and could be considered as restraint. Staff spoken with are able to discuss the needs of people using the service and the support that they need to ensure that their needs are met. People using the service feel that their needs are generally met, however there are some concerns about the availability of staff and staff answering buzzers which is further covered in the staffing section. So that peoples health care needs are met people using the service are supported and enabled to access specialist services such as the doctor, dentist and district nurse as required. During the tour of the care home we saw that specialist equipment such as mattresses and cushions are available for people who need them. Staff spoken with said, There is enough manual handling equipment but there are so many people that need it that it does take us time to get around people, people can see the doctor, they come round once a week and as needed. Staff have undertaken updated training in manual handling to ensure that they maintain good practices. During the inspection we saw that staff supported people Care Homes for Older People Page 15 of 36 Evidence: with moving and the use of equipment in an appropriate manner. People using the service confirm that they can see the doctor if they need to and one said, the physio comes twice a week and I can see the doctor when I need to. Staff who administer medication have been trained to do so, however on observing staff practice we saw that medication was left on one persons side table. This was discussed with the acting manager, as there has been an incident that we were informed about when one person took another persons medication that had also been left on a table. Despite the acting manager putting up a notice stating not to leave medication with people due to the incident that occurred, as we saw this is still taking place. The acting manager discussed this with the registered nurse involved and is dealing with this issue. We sent an urgent action letter to the service following the inspection to ensure that this matter is dealt with urgently and people are protected by the medication practices employed by staff. Medication records examined show us that people receive their medication as prescribed and handwritten entries are signed by two members of staff to show that these have been checked as correct. On person using the service told us, the nurses look after my tablets for me, I am happy with this arrangement. Staff spoken with are able to discuss how they ensure that peoples privacy and dignity is maintained by knocking on doors before entering and covering people when offering support with personal care. People using the service told us that staff are kind and respectful at all times. During the visit we did observe that four ladies were sat in the lounge without tights or anything covering their legs and one gentleman sat without any socks. This was discussed with the acting manager to ascertain if this is through choice, however no explanation was given. A concern had been raised in regard to people not being washed when having their incontinence aids changed resulting in people becoming sore. This was discussed with two members of staff who held varying views, one said that they have never come across this occurring, whereas another said, when I was getting someone up this morning, it was obvious that they had not been washed when their pad had been changed, they smelt really bad, therefore I bathed them this afternoon. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people using the service are satisfied with the activities on offer and the life that they lead, however those people that are more dependent sometimes do not appear to receive much stimulation and purpose in their lives. People using the service are supported to maintain contacts with people that are important to them. Evidence: A full time activities coordinator supports people to participate in various activities such as baking, reminiscence, bingo and pamper sessions. Each person has individualised records that show that some people do more than others, however following discussions with staff and people using the service this is mainly through choice. Outside entertainers also visit the care home, such as people who provide music for health sessions. There is also evidence of people attending trips to the theatre and participating in celebrating events such as Valentines Day. People using the service offered the following comments about the activities on offer and life at the care home; I am happy here, there are some activities, there is enough to do, I occupy myself reading and chatting most of the time, but I do enjoy a game of bingo, I would like more exercise, but I do enjoy the activities, I like the Care Homes for Older People Page 17 of 36 Evidence: music to movement and reminiscence. We can have a laugh and remember how things used to be, there are activities on offer but I am not that interested in them, there is an activities lady and she does reminiscence. There was a church service today, I would have liked to have attended but no one told me that it was on, I like living here, I did some drawing and baking and I went to the Easter church service, and there is a lady who does activities; she has taken me out a couple of times. My son has also taken me out shopping. Staff spoken with told us, there is an activities coordinator and activities are on offer, they have a hard job though as a lot of people are not interested, therefore they are trying new things such as baking which people do like, and there is an activities person but there is possibly not enough for people to do, however not all of them want to get involved. After lunch we spent some time observing people sitting in the small lounge, this area is very quiet and people that spend their time there predominantly have dementia care needs. People sat aimlessly with tables in front of them, the television was on but most people were either sleeping, fidgeting or in a withdrawn state. A member of staff was in the room at the time, however they did not attempt to converse with people for some of the time and simply stood there, nevertheless when a person asked for a refreshing drink they did oblige straight away and was polite. On discussing this with the acting manager she stated it was mainly because the activities coordinator was not working on this day and people would normally be doing something. So that people are supported in maintaining contact with people that are important to them there are no restrictions on visiting and visitors may be received in private. Staff spoken with confirmed this and several visitors were seen to come and go throughout the day. People using the service told us, my family are made welcome when they come to visit, and we had a party for my birthday, my family came it was really nice. To enhance staff awareness of peoples rights the majority of staff have undertaken training in the Mental Capacity Act. Staff spoken with discussed how they ensure that these are maintained; people should be offered choices for example, if they can not talk, simply getting clothes out and asking people to point to what they want to wear can help this. We should ask permission when we are offering support and dont just assume, so that we make sure we do not force people to do things that they do not want to do, we must give them choices and time to make their own decisions, and it is important that people have someone that they can trust to look after them and treat them with respect so that they can come to us, we should make sure people feel Care Homes for Older People Page 18 of 36 Evidence: at home, safe and happy. People using the service said, I am happy and settled here, I can ask for anything, and I can do what I want to do. A varied and traditional style menu is on offer to people using the service and fresh fruit is available throughout the day. A concern about the availability of food was raised prior to our visit, however the manager, staff and people using the service told us that food is available at all times of the day, although the choice is more limited. This information is not highlighted on the menus, however the acting manager stated that this would be added so that everybody is aware that this service is available. People using the service offered the following comments about the food, The food is not to bad, I liked it when we had Spaghetti Bolognese. If I am hungry at night I am ok, as the staff give me sandwiches that I eat about 7:30 when I have a glass of wine. I wouldnt go short I would say something, and food is good; there are choices available at each meal. Staff spoken with said, we can access the kitchen at any time, the main food stores are locked, however food is available in the fridges, and kitchen staff put food in the fridge for people if they get hungry. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the service deals with complaints when they arise, minor concerns may not be fully investigated and resolved as these are not considered to be complaints. People using the service are not fully protected from abuse. Evidence: So that people using the service know how to make a complaint if they need to the complaints procedure is displayed in the main entrance. We received one complaint about the service since the last inspection in regard to standards of care and equipment; this was referred to the provider to investigate. Within the complaints folder we saw that this complaint had been dealt with satisfactorily and although the complainant not fully satisfied the issue resolved. We have also been in receipt of an anonymous concern about the service in regard to standards of care, staff practices and management. These areas are covered within the relevant section of the report. Within the complaints folder there are no other complaints logged, however when case tracking people using the service we saw that two concerns in regard to a persons missing glasses and a radiator not working had not been logged in the complaint file to evidence that these issues had been dealt with and resolved. Care Homes for Older People Page 20 of 36 Evidence: Staff spoken with are able to discuss how they would deal with a complaint should one be received to ensure that this was dealt with and resolved. One person using the service told us, if I was unhappy I would talk to the sister. Although policies and procedures are in place in regard to protecting people from abuse, these are out of date and do not contain all the necessary information. The acting manager stated that these are currently in the process of being updated at head office. A large number of staff have undertaken training in safeguarding adults and staff spoken with are able to discuss their roles and responsibilities in regard to ensuring that people are protected from abuse. if I did not feel that anything was being done to address issues I know that I can go above the acting manager if I need to. One safeguarding alert has been made to the Local Authority since the previous inspection in regard to an unexplained injury a person sustained. This was investigated by the Local Authority and an inconclusive outcome was found. Whilst case tracking people using the service we found that on two occasions there have been incidents where one person using the service has hit and caused injury to another. These incidents have not been alerted to the Local Authority or us so that these could be investigated as needed. On speaking with the acting manager, she stated that she was not aware that these incidents needed to be reported, however discussed how she was going to get addtional support from the mental health care team in regard to this issue. Staff spoken with are able to discuss how they deal with behaviour that may be challenging and the methods that they would employ to divert peoples attention to try to prevent incidents like the above occurring. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained environement, which is clean and comfortable. Evidence: There are various seating areas around the care home that people may access and spend their time in. The garden is also secure and offers sheltered seating areas. A maintenance person is employed who continues to carry out maintenance as required and all areas of the care home are satisfactorily maintained. A new hairdressing room and shower room are now in use for people using the service. We saw that peoples rooms are personalised with their own belongings and all areas are clean and tidy. One person using the service told us, I have a nice room. Care Homes for Older People Page 22 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staffing levels have been increased peoples needs are not fully met, which may be due to the deployment of staff and some staffs unwillingness to answer buzzers and support people when needed. People using the service are not fully protected by the recruitment policies and procedures in place. Evidence: The acting manager has increase staffing levels during the day in working towards ensuring that there are sufficient staff available to meet peoples needs. The duty rota examined confirms that this has taken place and these staffing levels are maintained unless a member of staff is off sick at short notice. Staff spoken with offered the following comments, I love working here, the staff levels are good and now we work as a team and we do manage, however we could do with more staff as we have a lot of people that are highly dependent and it is physically hard work, and the team works well most of the time, there has been some frictions but it is being sorted. The staff levels have just been put up to 6 it makes a big difference especially as a lot of people need to use the hoist; it is hard work physically and mentally. People using the service offered varying comments about the staffing levels employed Care Homes for Older People Page 23 of 36 Evidence: within the care home; I tried to get up this morning at 7:30am whilst the staff are not too busy, so I pressed the buzzer but a member of staff just came and cancelled it, I could see her from my bed. She did not even come to check to see if I was aright, I could have been having a heart attack or something. No one came so I just got myself up. It would have been nice if they could have just acknowledged me. Touch wood I can look after myself but it is worrying, it has disappointed me, it is not the personal care like I would have hoped for. I would like someone to come to me if I press the buzzer even If I do not want much, I had a bad stomach the other night but I didnt bother pressing the buzzer, as I knew that no one would come. There is not enough staff, I have complained about it twice and staff have told me it is because they are short staffed, and the staff are very nice, however they do not answer the buzzer in the night, I waited all night last night for help and they never came, I look after myself but the staff are here to help me if needed, the staff are very nice, I have been in hospitals where they have been very rude it is not like that here. We discussed the issues in regard to the answering of buzzers with the acting manager who stated that she would investigate these concerns. So that new staff are aware of their roles and responsibilities when they commence employment they undertake an induction, which covers all the compulsory training. On examining staff files we saw evidence of this taking place. Staff spoken with also confirm that all new staff have inductions when they first start working at the care home. Four members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring or people) level 2 and some have attained level 3. One member of staff members spoken with confirmed that they have undertaken level 2 and they are now working towards completing level 3. Staff files examined do not contain all the required documentation such as personal identification to make sure that people using the service are protected from unsuitable people being employed. All members of staff do however have a satisfactory Criminal Record Bureau check in place (a police check to see if a person has a criminal record or caution). One member of staff spoken with confirmed that they have a Criminal Record Bureau check in place. On checking staff files we saw that two registered nurses professional identification numbers are out of date and there is no evidence to show that these are effective and that that are registered to work. We left an immediate requirement letter as the acting manager must ensure that there is evidence to demonstrate that registered nurses Care Homes for Older People Page 24 of 36 Evidence: have an effective registration number so that people using the service are protected and receive nursing care from nurses that are registered to work. A training matrix examined shows us that additional compulsory training such as manual handling and dementia care has taken place since the previous inspection. Some other training however has not been updated for over four years; the acting manager was in the process of arranging additional training to rectify this on the day of the inspection. Two people working in the kitchen do not have up to date food hygiene certificates, the acting manager stated that the Environmental Health Officer had commented on this in November of last year yet this has still not been addressed. Staff spoken with said, I feel supported in training and development, I have done, manual handling, dementia care and safeguarding adults courses, plus many more, and I feel supported in my training and development, I have done the Mental Capacity Act and dementia care, I am aware of offering people choices, this training has helped me to look at the individual and put into perspective what they are going through. Care Homes for Older People Page 25 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has only been in post for a short while and is making efforts to improve the service, she still has a great deal to learn about the management of the service, however she is committed to doing so. People using the service are not fully protected from risks, due to the lack of window restrictors on some windows. Evidence: The acting manager has been working at the service for two years, initially as a registered nurse, then the deputy manager and now as the acting manager. At present she does not have hours where she is supernumerary so that time can be dedicated solely to the management of the home. She is currently working towards completing the National Vocational Qualification Registered Managers award (a nationally recognised work and theory based qualification designed to enhance management knowledge and skills.) Staff spoken with offered the following comments; there has been changes in the Care Homes for Older People Page 26 of 36 Evidence: management and it has been hard to adjust but things are fine now and it is starting to get better. Staff are communicating more now with each other and with the residents. I can see the manager if I have a problem, she listens to you, for example I was worried about a resident and she called the GP. Kate is trying really hard and is slowly improving things. There is enough discipline and respect from staff. The home is well run if there are enough staff. People using the service told us, Kate is quite marvellous, I like her and get on well with her, Kate is alright but there is not much discipline, she is happy go lucky and will do anything to help but needs to have more discipline with the staff as they tend to spend time talking over you about the job and their lives and not getting on with the job that they are supposed to be doing, and the manager is nice it is well run. People using the service are given the opportunity to have a say in regard to the service they receive by way of questionnaires and meetings. However there are no recent questionnaire results to look at, as these are not yet due to be sent. A residents and relatives meeting has taken place and issues such as activities, outings, entertainment, food and any issues of concern have been discussed. Staff meetings at all levels also take place, which staff state are useful; staff meetings take place and they are helpful, if there is a problem this can be brought up and resolved. The last meeting minutes examined show us that health and safety issues, the deprivation of liberty and person centred and quality of care have been discussed. Staff have also received a number of thank you cards and messages in regard to the care and attention that staff have given to people using the service. Staff at the care home are not responsible for peoples personal allowances, therefore if a cost such as hairdressing is incurred then relevant others that are responsible for the finances are invoice for this. On examining accident records, these contain all the required information and they show us that appropriate action has been taken. However we did see that accidents mainly occur in the evening and during the night shift, this was discussed with the manager, who stated that she is aware of this. The maintenance records show us that regular maintenance such as gas and electrics are taking place as required to make sure that these are in good working order. The fire logs examined show us that only 10 members of staff have undertaken recent Care Homes for Older People Page 27 of 36 Evidence: fire drills to make sure that people are protected in the event of a fire. Also the testing of the emergency lights have not taken place as required. During the tour of the building we saw that several windows in peoples bedroom do not have window restrictors in place to prevent these opening to far. We left an immediate requirement form so that the acting manager must assess the risk to people using the service and put in any preventative measures that are necessary to make sure that they remain safe. Care Homes for Older People Page 28 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 18 You must ensure that you have evidence to demonstrate that registered nurses have an effective registration number to show that they are registered to practice. This will ensure that people using the service receive nursing care from people that are registered to practice and they are protected from unsuitable or untrained staff. 09/04/2009 2 38 13 You must ensure that 09/03/2009 appropriate risk assessments and management plans are in place in regard to window that have no restrictors in place. This will ensure that people using the service are fully protected. 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 Plans of care must be evaluated when significant events or changes occur in peoples needs. 01/06/2009 Care Homes for Older People Page 30 of 36 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 This will ensure that peoples needs are met and they receive continuity of care. 2 7 13 Risk assessments and management plans must be specific for each indiviudal and in place for all highlighted risks. This will ensure that people using the service are fully protected. 3 7 15 Plans of care must be in place for peoples highlighted needs. This will ensure that peoples needs are fully met. 4 7 12 You must justify the use of the Mental Capacity Act in regard to peoples best interests. This will ensure that people do not experience deprivation of their liberty. 5 9 13 You must ensure that medication is administered safely and medication that has not been taken is not left with people using the service. 14/05/2009 01/06/2009 01/06/2009 01/06/2009 Care Homes for Older People Page 31 of 36 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 This will ensure that people are protected from taking medication that has not been prescribed for them. 6 10 12 You must ensure that that staff practices that undermine peoples dignity are addressed. This will ensure that peoples dignity is maintained at all times. 7 12 16 You must demonstrate that 26/06/2009 people that have dementia care needs are provided with adequate structured stimulation, activities and purpose in their lives. This will ensure that people are supported to lead an active and stimulating life as possible. 8 16 22 You must log all concerns in 01/06/2009 the complaints book to demonstrate that these have been fully investigated and resolved. This will ensure that any concerns are fully investigated and resolved to the persons satisfaction. 01/06/2009 Care Homes for Older People Page 32 of 36 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 9 18 13 Management must be aware of the safeguarding adults procedure in regard to alerting safeguarding incidents. This will ensure that people using the service are protected from abuse and any incidents are investigated appropriately. 15/05/2009 10 27 12 You must address poor staff practices in regard to answering peoples calls for help. This will ensure that people are supported as needed and protected from harm. 01/06/2009 11 27 18 You must assess the staffing 01/06/2009 levels, deployment of staff and dependencies of people using the service. This will ensure that sufficient staff are available to meet peoples needs. 12 30 23 You must consult with the 01/06/2009 Environmental Health Authority in regards to the arrangement of staff training who are preparing and handling food. This will ensure that people using the service are protected. Care Homes for Older People Page 33 of 36 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 13 31 12 You must ensure that staff 14/05/2009 carry out their duties as requested by management and do not disrespect people using the service. This will ensure that peoples needs are fully met and they are treated with respect. 14 38 23 Liaise with the Fire Authority 01/06/2009 in regard to the necessity of staff undertaking fire drills and the testing of emergency lights. This will ensure that people using the service are protected from the risk of fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Plans of care continue to develop to ensure that they are person centred to make sure that people using the service receive care in their preferred way. When staff are supervising lounges, they spend time conversing with people using the service. Ensure that up to date policies and procedures are available for staff to access at all times. The manager has supernumerary hours allocated on a regular basis so that time can be dedicated solely to the management of the service. Carry out an audit of accidents that are occurring so that preventative measures can be considered of there is a Page 34 of 36 2 3 4 12 18 31 5 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations pattern of events. Care Homes for Older People Page 35 of 36 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. 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