Inspection on 02/06/09 for Bearwood Nursing Home

This inspection was carried out on 2nd June 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bearwood Nursing Home 12/02/10

Bearwood Nursing Home 29/09/09

Bearwood Nursing Home 25/07/07

Bearwood Nursing Home 06/11/06

Bearwood Nursing Home 16/01/06

Bearwood Nursing Home 22/08/05

Bearwood Nursing Home 28/09/04

Bearwood Nursing Home 19/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Bearwood Nursing Home 86 Bearwood Road Smethwick West Midlands B66 4HN     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: Karen Thompson     Date: 0 2 0 6 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 34 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 34 Information about the care home Name of care home: Address: Bearwood Nursing Home 86 Bearwood Road Smethwick West Midlands B66 4HN 01215588509 01215555182 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bearwood Nursing Home Ltd care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 74 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 74, Old age, not falling within any other category (OP) 74 Date of last inspection Brief description of the care home Bearwood Nursing Home provides nursing care for up to 74 elderly people. The home is a two-storey building with the second floor accessed by a passenger shaft lift. Bedrooms are on both floors with a mixture of double and single bedrooms some of which have ensuite facilities. There is a large lounge and dining room on the ground floor and two lounges/ dining rooms on the first floor. The home also has laundry and kitchen facilities. There is a large car park at the front of the home and patio/gardens to the rear. The home is close to local shops and amenities and is on a local bus route. Care Homes for Older People Page 4 of 34 74 0 Over 65 0 74 Brief description of the care home The fees at the home range from between 475 and 575 per week and are dependent on the needs of the residents and the room that they occupy. Hairdressing, toiletries, newspapers, Non National Health Service chiropody and physiotherapy are not included in the fee but are available at the home for an additional charge. Top up fees apply to Social Service funded EMI nursing residents. For up to date fee information the public are advised to contact the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality of this service is one star. This means the people who use this service have adequate quality outcomes. The focus of this inspection undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of servcie provision that need further developement. Prior to the fieldwork visit taking place a range of information was collected to plan the inspection, which included notifications received from the home. Three inspectors undertook this fieldwork visit carried out over one day. One of the owners was available for the duration of the inspection. The home did not know we were coming. Care Homes for Older People Page 6 of 34 At the time of the inspection sixty nine people were living in the home and information was gathered from speaking to and observing people who lived at the home. Four people were case tracked and this involved discovering their experiences of living at the home by meeting and observing them, looking at medication adminstration and care files and reviewing areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us to understand the experience of people who use the service. The home sent us its Annual Quality Assurance Assessment (AQAA) three days after the inspection. This is a questionaire the home is required to fill in annually to tell us about the home,staff and people who live there, along with improvements they have made and intend to make. We have incorporated some of the information from the AQAA into the report. Staff training records and health and safety files were looked at. At the time of the inspection three people who lived in the home and four members of staff were spoken to in order to gain their views and comments. Following the inspection we sent an immediate requirement letter to the provider about medication management. The provider has advised us that they are taking these concerns seriously. We will continue to monitor the home to determine the progress in meeting peoples needs and take appropriate action where necessary. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Management systems need auditing to identify those that are failing and the appropriate structures put in place to rectify these. Medication management systems must be reviewed and action taken to ensure that everyone recieves the medication they are prescribed. Manual handling practices should be monitored and staff provided with the equipment to ensure the correct procedure is followed to ensure the safety and wellbeing of people living in the home and those of staff. All concerns, complaints and safeguardings should be recorded and records should indicate the investigation, findings and outcomes and any follow up to reduce the risk of similar occurrences in the future, so there is continuous development in the home. The management team need to refamilairize themselves with the local safeguarding procedures to ensure that people living at the home have their rights protected and promoted fully. All staff in the home will need to be familiar with the Mental Capacity Act so they are aware of their responsibiliities and how to promote the rights of people living in the home. There needs to be a review of how information is collected and analysed for the quality Care Homes for Older People Page 8 of 34 assurance system so that issues and concerns can be identified and dealt with swiftly. Care practice needs to be reviewed in relation to catheter and mouth care, to ensure that practice in the home meets the required standard. Documentation and record keeping needs to be reviewed in a number of areas. Care plans need to be more person centred. Pre-populated charts and care plans need to be revisited by the home to ensure that all the information required is recorded. Bedrail risk assessments need to be reviewed to ensure they assess robustly the needs of people who may require such an aid. There was a variety of food available at all meals. The home should review the combination of some meals types and whether it meets the preferences of people living in the home. There is a high turnover of staff which affects the consistency of the service provided, exit interviews should be conducted to see if there are any reasons for this and whether this can be put right. Activities hours need to be reviewed to ensure they meet all the needs of people living in the home. 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available so they can make an informed decision about moving into the home. Peoples needs are assessed before they move in, so they can be confident their needs will be met upon moving into the home. Recommendations Evidence: The home provides nursing care for people with long term or respite care needs which may include dementia care. Admissions are not made to the home until an assessment of needs is carried out. We looked at four care files during our visit and found that the pre-admission assessment met the standard. These assessments were detailed and covered a number of areas, so that staff could identify peoples needs to determine if they could be met following admission to the home. We were given a copy of the Statement of Purpose and Service Users Guide which both meet the standard meaning people are provided with sufficient information to Care Homes for Older People Page 11 of 34 Evidence: make an informed choice. The service does not provide intermediate care so we did not assess this standard. The home reflects the cultural diversities of the local community by the people who live in the home, staff and facilities that are on offer and meets their needs. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and medicine needs are not being met in a consistent manner placing them at risk of harm. Evidence: All the files of people living at the home we examined contained care plans and risk assessments. These included needs, preferences and choice and gave staff instructions onhow their needs should be met. Information however from the pre admission assessment was not always being transferred into the care plan. For example a person identified as having a high risk of constipation pre-admission had no plan of care in place to demonstrate that staff at the home were aware of this risk, would be monitoring the conditionor the action they would need to take if necessary. The care plans all contain a plan of care for medication this was a pre populated care plan. The care plans stated assistance with but this doesnt identify the type of assistance required. Staff had not altered the pre populated care plan for someone that required administeration of medication via medically assisted route (PEG). Medication is not licenced to go via this route and records could not demonstrate staff were aware of safe procedures to administer medication via this route. Care Homes for Older People Page 13 of 34 Evidence: The care plans did contain individualized information. This was not however comprehensive but is evidence that the home is trying to develop person centred care. The owner informed us that carers and trained staff work together in drawing up the care plans. This is good practice. We found evidence that relatives had been asked to review and look at the care plan in some of the care plans demonstrating involvement in the meeting of needs process. There was evidence that risk assessments had been completed in respect of for example manual handling, tissue viability, fall, bedrails and nutrition. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. The bedrail risk assessment needs to be reviewed by the home as the risk assessment in use is not assessing the risk to the individual of using bedrails, but is an equipment safety check list. This was discussed with the home at the time of the visit. Appropriate pressure relieving equipment was observed to be in place for those people we case tracked. We were informed by the manager that on the previous day pressure relieving equipment was serviced. The tissue viability nurse was seen visiting the home on the day of our visit. Staff complete a turn chart that is pre populated with times. We observe people being turned throughout the day, but not on the times stated on the chart. If some one is required to be turned two hourly, they may be turned at 10:00hrs but not turned again till 13:30hrs, but the 12md box will be initialled using this system. Good practices would require that actual times of turning should be recorded. Staff were found to be turning people with pressure area damage on cotton sheets. Slide sheets are needed to turn people in bed, so as to reduce the friction from being turn which can damage to the skin and also help in the moving of the person therefore reducing risk to staff. Ideally every person requiring a slide sheet should have one, we were unable to establish the exact number of slide sheets in the home at the time of the inspection, but this was certainly less than three. Catheter care, one person was observed to be lying in bed horizonally with the catheter bag in the bed with them. The bag collecting the urine was also small in capacity. This type of bag is ideal for people who are up and about, but when someone is lying in bed they should have larger bag to collect the urine and this bag should be attached to a catheter stand to ensure that the urine can flow downwards and be monitored. This particular person was having their catheter renewed every four weeks, which may be normal for them but poor catheter care practice may be contributing to the need to change the tubing more frequently. Care Homes for Older People Page 14 of 34 Evidence: People living in the home who could not receive any fluids or nutrition via mouth, did not have any mouth care trays, in the bedrooms. We were informed that the home usually uses glycerine mouth swabs but these had run out. The home did not have any other mouth cleaning products in the home except for sponge swabs. Good practice would indicate that a mouthcare tray be in the persons room and available for use. There were no records to demonstrate mouth care was taking place. People with dementia did not have care plans in place that were detailed enough therefore staff did not have the information on how to support these people appropriately. Records demonstrated a variety of health professionals were visiting the home professionals such as G.Ps, opticians, dieticians and tissue viability nurse. The home liases with six G.P practices to meet the health needs of people living in the home. People moving into the home can retain their previous G.P if they are able and willing to keep them on. During the inspection health professionals from the PCT were carrying out reviews for people living in the home. There are medication rooms on both floors of the home. The home has one controlled drugs cabinet and this is stored in a medication room. Medication no longer required was not being stored in a locked cupboard in the medication room although all other medication in this room was in a locked facility. Medication no longer required needs to be kept in a locked cupboard. We looked at medication practice on both floors of the home, which led to us issuing of an immediate requirement letter following the inspection. We found that the medication administration record did not demonstrate all medication received into the home and therefore we could not audit the medication in a number of instances. We also found that medication from the previous months cycle was not being carried over to the current medication administration chart and again we could not audit the medication. Medication was being administred that was not on the medication administration chart, demonstrating staff were not following administration procedures as required by their professional body. The medication room was too hot for the storage of drugs and compromised the stability of the medication. The controlled drug cabinet did not comply with current legislation. Controlled drug medication which was no longer prescribed had not been disposed or returned to the pharmacist. We also found two examples of people living at the home who had not received their medication as prescribed. Staff had not actively sought medication for one perons and this had led to them going without medication for ten days. Staff spoken to demonstrated an awareness of equality, diversity and dignity. Staff interaction with people living at the home was observed to be good however we did Care Homes for Older People Page 15 of 34 Evidence: observe at lunchtime staff speaking in their mother tongue which was not the mother tongue of the majority of people sitting in the dining room. Whilst it is a positive that staff can speak several languages and this will be of benefit to those whose first language is not english, care has to be taken that other people living at the home do not feel shut out from conversations they can not understand. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home were flexible, so people are able to maintain important relationships. The activities co-ordinator time at the home needs to be reviewed to ensure that everyone has an opportunity to take part in an activity that promotes and enhances their social aspect of life. Menu arrangements need to be reviewed to ensure that everyone has a meal that is appetising. Evidence: There was no evidence of any rigid rules or routines in the home and people who live there can go outside on their own or with friends and family as they choose, depending on abilities. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. The company employs an activities co-ordinator who works across all four homes in the group. If a co-ordinator is working across four homes this equates to 10 hours dedicated activity time for the people living in the home. Whilst there was evidence that activities were taking place and staff did inform us they do help out with activities in the afternoon if they are able to, this is not alot of time considering the complex Care Homes for Older People Page 17 of 34 Evidence: needs of people living in the home. Painting and craft work that people have completed has been put on the walls in the lounge on the first floor. The home provides the opportunity for people to follow their own religion and ensuring their religious needs are met. Staff informed us that various faith groups had visited the home. There is a rotating four week menu, consisting of traditional English and traditional Indian food. Staff told us theres lots of choice, there is a good menu. One of the inspectors had lunch with people in the dining room of the ground floor of the home. The English option on the day of inspection did not match that stated on the menu. It consisted of a boiled egg, bread and butter and spagetti, which is an unusual combination. The boiled egg we were informed was boiled for 30 minutes and the colour and texture would indicate this. The Indian meal which was also sampled by the inspector was found to be nice. Staff were observed to be assisting discreetly and sensitively. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for dealing with complaints and concerns. Records and auditing systems for concerns, complaints and safeguarding needs to be more robust to demonstrate concerns are taken seriously and people have confidence in the system. Evidence: The home has an appropriate complaints procedure. The AQAA stated they had received 10 complaints in the past 12 months of which 2 were upheld and but we found only 6 complaints in the complaint log during our visit for this period. We found in a written concern in the home complaint log, which was discussed with the organisations management team at the time of the inspection as it was of a safeguarding nature. There was no other written evidence to suggest that this had been referred under safeguarding procedures and the management team at the time of discussion did not offer any explaination as to why it had not been referred. The organisations management were advised that we would have to refer these concerns on to Adults and Communities under safeguarding procedures. We were contacted the next day and informed by the owner that these concerns had been referred to adults and communities under safeguarding procedures at the time they were raised. The explaination offered for the management team not being aware of this was that it had been done by a trained nurse. It is concerning that something as serious as this was not communicated to the management team or picked up by the management team as the written record was accessible to them. It demonstrates that they are not Care Homes for Older People Page 19 of 34 Evidence: auditing the complaints log as part of their quality assurance system, and therefore it could not be demonstrated that peoples concerns are being taken seriously and followed up appropriately. Records indicated that the majority of the staff had undertaken training in respect of safeguarding and discussions with care staff revealed that they had a good knowledge of the procedure and confirmed they had received the training. Training in respect of the Mental Capacity Act and Deprivation of Liberty had not been undertaken. Systems will need to be put in place to ensure all staff have knowledge of the Mental Capacity Act and the Deprivation of Libery Safeguards, communensurate with their position in the home,to ensure people who lack capacity are supported appropriately and they have up to date knowledge of legislation. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some re-decoration is required to enhance the environment. Communal areas should not be used as general storage areas as this distracts from the home providing homely environment. Evidence: Bearwood Nursing home is a large converted two-storey building. Lounge and dining rooms are provided on both the ground and the first floor. There is a choice of double or single occupancy rooms with some having ensuite facilities on both floors. A number of bedrooms were visited and these meet the standards of space,furniture, heating and lighting. The lounge area on the ground floor contained a number of new chairs stacked in the corner of the room. These chairs need either to be redistributed as part of the replacement programme or stored in a more appropriate setting. There is a large car park at the front of the home and patio/gardens to the rear. The exterior patio area have patio furniture but would be more attractive with the addition of plants and flowers in patio pots. The homes decor was looking tired/worn and a number of areas were in need of redecoration. The organisation needs to review the number of slide sheets available as Care Homes for Older People Page 21 of 34 Evidence: discussed under health and personal care. A number of bedrails were found to be dirty and the cleaning of these should be reviewed. The laudry was visited and found to be clean and well organised. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust but the high turnover of staff means consisteney in meeting needs is compromised. Mandatory training is taking place and providing core skills to staff to meet needs but specialist training is needed in a number of areas to ensure staff have the skills to meet individual needs. Evidence: We sampled three staff files and found they met the standard in relation to recruitment. If the home employs someone before a Criminal Records Bureau check has been completed, they must ensure they have the results of a POVA first and carry out a risk assessment. The home notifies us this has occured and sends the risk assessment to us. There are fifty nine nursing and care staff working in the home. In the last twelve months sixteen members of staff left the home according to the print out given to us at the inspection and nineteen members of staff had been recruited. However the AQAA states fourteen members of staff have left. This means however approximately a thirty percent turnover in staff in one year whichever figures are used. This cannot be good for the consistency of care being provided to people living in the home. The home needs to review its recruitment and selection procedures and carry out exit interviews to ascertain why staff are leaving. This will help them ascertain whether anything can be put in place to reduce the number of people leaving the home. Care Homes for Older People Page 23 of 34 Evidence: The manager aims to have eight care staff and two nurses on duty during the morning, six care staff and two nurses during the evening and five care staff and one trained nurse of a night time. AQAA stated that no agency staff had been used in the past three months at the home. In addition to nursing and care staff there are domestic, catering, maintenance and administration staff. Following their employment new staff confirmed that they had undertaken the homes induction training. There is a rolling programme of staff training that includes fire safety, manual handling, safeguarding, first aid, health and safety, food hygiene and dementia. Training has occured in specific care need issues, but this has not occured for the majority of staff. Records indicate that four of the nine trained staff undertook medication training in 2007. Due to the problems identified in the health and personal care section, it is recommended that this is revisited for all trained staff. The training matrix showed that twelve of the thirty one carers had completed National Vocational Qualification (NVQ) level 2 or equivalent in care. Training ensures that staff have the appropriate skills and knowledge to care for people living in the home. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in the home sometimes work and sometimes dont therefore potentially placing people at risk. Evidence: The organisation has four homes. We were not informed prior to the inspection that the owners had decided to move the managers from the homes they were registered for to other homes in their group. This could be seen as good practice in the developement of managers however the registered person is required to give written notice to us as soon as practicable when a person other than the registered person manages the home. A sample of peoples money held by the home was audited. Records were checked and the systems appeared to be of a good standard with receipts for expenditure. On discussion with staff they stated they enjoyed working in the home. Staff told us they received regular supervision. Care Homes for Older People Page 25 of 34 Evidence: The home has a quality assurance system in place. The quality assurance system is based on the National Minimum Standards. Issues identified by ourselves during this inspection are not being picked up by people using this system. The home has surveyed relatives and people about the care and the majority of people had no complaints about the care or the service. However a high proportion of people who repsonded to the homes survey said that they didnt know how to make a complaint. Record keeping in relation to complaints was problematic as it was difficult to retrieve information. The lack of management awareness of safeguarding referrals that had taken place in the home was concerning and potentially places people at risk. The inspection occurred three days prior to the home being required to return their Annual Quality Assurance Assessment (AQAA) to us. The document was returned to us and gave some information about the home, staff, people who live there and the improvements over the past year and plans for the future fo the home. However it lacked detail and under the National Minimum Standards the sections on what we could do better was not completed. Records indicated that regular maintenace checks and servicing of equipment was taking place. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 There must be sufficient 31/07/2009 slide sheets in the home to ensure people can be turned appropriately in bed. This will reduce the possibility of skin intergrity being compromised by friction on turning and placing the person at risk of pressure damage. 2 8 13 Before bedrails are put into place there must be undertaken a risk assessment of the persons suitability for such equipment and the home must ensure systems are in place for monitoring and maintaining bedrails This will ensure that no ones rights are restricted and their safety is also promoted and maintained 24/07/2009 3 9 13 A quality assurance system must be installed to assess 24/07/2009 Care Homes for Older People Page 28 of 34 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 staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This will ensure that all medicines are administered to people living in the home as prescribed and this can be demonstrated. 4 9 13 Appropriate systems must be in place to demonstrate the suitability of medication administered via PEG feeding tube. To promote and ensure the safety and well being of people receiving medication via this route. 5 9 13 The medicine chart must 24/07/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the persons medicines and be signed directly after the transaction and accurately record of what has occured. To ensure that people living at the home get their medication as prescribed. 24/07/2009 Care Homes for Older People Page 29 of 34 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 6 9 13 The quantity of any balances 24/07/2009 carried over from previous cycles must be recorded to enable audits to take place to demonstrate medications are administered as prescribed. To ensure the health and well being of people receiving medication 7 9 13 A system must be installed 24/07/2009 to check the prescription prior to dispensing and to check the dispensed medication and the medicine chart against the prescription for accuracy. All discrepancies must be addressed with the health care professional. To ensure that people living in the home receive their medication as prescribed. 8 9 13 All medicaton must be stored in compliance with their product licences and not in a room that exceeds 25c in temperature This will ensure the stability of the medication. 24/07/2009 9 9 13 The current controlled drugs 24/07/2009 cabinet must be upgraded to comply with the changes in legisaltion Care Homes for Older People Page 30 of 34 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 controlled drug medication is stored securely and safely 10 9 13 Medication no longer 24/07/2009 required must be stored in a locked cupboard whilst awaiting disposal This will ensure that all medication held in the home is stored securely. 11 9 13 All stafff must be trained to adhere to the medication policies and procedures and also the indications and side effects of the medication they handle. This will promote the health and well being of people receiving medication from trained staff in the home. 12 18 13 The management team must 24/07/2009 demonstrate they have received updated training in their local safeguarding policies and procedures. This will ensure that people living at the home have their right protected and promoted. 13 31 39 The Registered person shall give written notice to the Commission as soon as it is practicable to do so iif a 31/07/2009 24/07/2009 Care Homes for Older People Page 31 of 34 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 person osther than the registered person carries on or manages the care home This will ensure that the Commission is aware of the management arrangements of the home and people living at the home have their well being promoted. 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 2 7 7 Medication care plans need to be taylored to the persons needs, to demonstrate they are person centred. Catheter care practice must be reviewed in the home to ensure it meets best practice and does not place people at risk of harm Care plans should be based on a thorough assessment of needs, this should contain detailed information of how to meet these needs in an individual manner. All trained staff working at the hme should re-familarise themselves with NMC Record Keeping document to promote and protect the well being of people living in the home. Mouth care practice needs to be reviewed, to ensure equipment is readily available and the home can demonstrate people have received mouth care. All trained staff working at the hme should re-familarise themselves with NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. It is recommended that all unwanted medicines are removed from the premises to reduce the risk of maladministration of medicines 3 7 4 7 5 7 6 9 7 9 Care Homes for Older People Page 32 of 34 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 8 12 The hours allocated for activities should be reviewed to enable the service to broaden the range of activity provision and opportunities for people living at the home. (recommendation made July 2007 not implemented) The english meals menu needed to be reviewed to ensure they meet cultural expectations and taste. The management team need to review their complaints log and ensure that information is easily retrievable and available for auditing. It is reccommended that the home obtains a copy of the Department of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training so they are aware of their responsibilities and peoples rights are protected. A refurishment programme should be drawn up to act as a guide and demonstrate when redecoration and refurishment is to take place. New chairs stored in the communal areas should be moved to a more suitable area, to allow people living at the home to enjoy the lounge environment. The home should ensure that number of care staff with NVQ2 or above is 50 percent or more, to ensure and demonstrate a basis level of care knowledge has been acheived and can be delivered to people living in the home. The management team should carry out exit interviews for staff who are leaving to see if there are any patterns or trends that could account for the high turnover of staff. From this they may be able to put systems in place to reduce the number of staff leaving the home. A review of raining provided in specialist areas needs to be carried out to ensure that their are suffiecient staff with the knowledge and skills to meet individual requirments. The quality assurance system in place should be reviewed to ensure that it is robust enough to pick up any issues or concerns so these can be put right quickly. 9 10 15 16 11 18 12 19 13 19 14 28 15 29 16 30 17 33 Care Homes for Older People Page 33 of 34 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. 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