Inspection on 04/11/08 for Beauvale Care Home

This inspection was carried out on 4th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beauvale Care Home 03/10/06

Beauvale Care Home 15/02/06

Beauvale Care Home 15/08/05

Beauvale Care Home 10/03/05

Beauvale Care Home 13/10/04

Beauvale Care Home 16/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beauvale Care Home Moor Lane Bingham Nottingham NG13 8AS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Beauvale Care Home Moor Lane Bingham Nottingham NG13 8AS 01949831263 01949831355 beauvale@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Tipping Type of registration: Number of places registered: Southern Cross Care Homes No 2 Ltd care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Southern Cross Care Homes No 2 Limited may provide the following categories of service only: Care Home with Nursing (N). The maximum number of places is 35. To service users of the following gender whose primary care needs on admission to the Beauvale Care Home are within the following categories:- Old age, not falling with any other category (OP) 35, Dementia over the age of 65 years (DE(E)) 35, Physical Disability over the age of 55 years (PD) maximum of places 3. Within the three physicial disability places, one named individual can be accommodated who under the age of 55 years. Ref. 20070203, Registration Report, S40350 C53. Date of last inspection Care Homes for Older People Page 4 of 36 Over 65 35 0 0 0 3 3 Brief description of the care home Beauvale is a purpose built care home situation close to the centre of the busy market town of Bingham with its range of shops, restaurants, public houses and places of worship. There are good public transport links from the centre and the service has its own car park at the front of the building. The service is registered to accept up to 35 older people or people with Dementia. Up to three places may be offered for people who are over 55 and who have physical disabilities. The service provides nursing care. Accommodation is provided over two floors with a vertical lift which offers access to people with mobility difficulties. There are 33 single bedrooms and there is one double bedroom which has an en suite facility. There are two lounges and a dining room at the home. The last inspection report is available in the reception area as is the service user guide, the statement of purpose and other information people may find helpful. The current fees range from £367 to £655, this fee does not include hairdressing and chiropody services. 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 Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live 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. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people Care Homes for Older People Page 6 of 36 who live there and how they can and intend to improve their service. We received this back from the manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out surveys to people living at the home and to staff to get their views on the service being provided. We received two back from people living at the service, and four back from staff. The surveys gave us a conflicting picture of the service and these comments are incorporated into the full report. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at Beauvale. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining room, during the lunchtime period. English is the first language of all of the people living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke with three members of staff and one relative to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence a continued breach of regulations concerning the staffing levels at the home, and we issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take written evidence with a view to assessing the findings in relation to enforcement action. What the care home does well: What has improved since the last inspection? The person we identified in our last report has had their needs reviewed to be sure that these can be met at the service. The risk assessments are very thorough and cover all of the identified areas of risk. They have improved in the past year by redecorating the reception area, by replacing the lounge chairs, new dining furniture has been purchased and the garden has been Care Homes for Older People Page 8 of 36 improved. The staff have had training on the Mental Capacity Act and they have appointed Dignity Champions to make sure that peoples rights and dignity are being respected. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 who want to live at the service have their needs assessed before admission to make sure these can be met. They receive enough information to make an informed decision about care. Evidence: The manager told us in her Annual Quality Assurance Assessment form that she sends a brochure, a copy of the statement of purpose and service user guide in a pack to the person who wants to live at the home. She told us that people have a comprehensive needs assessment before being admitted to the service. This is usually carried out by the Manager or a suitably qualified member of staff in the persons home, hospital or wherever they are living. She said that people are encouraged to participate as fully as possible in the assessment process. If this is not possible, relatives, carers, hospital staff will be consulted. Care Homes for Older People Page 11 of 36 Evidence: When we toured the accommodation we found that there is a copy of the service user guide in every bedroom, and there is also a copy of the document and the statement of purpose in the reception area. We looked at these documents and found them to be comprehensive and clear documents. We looked at the care plan of the last person to be admitted to the service and although the plan was not fully completed, it gave clear information about the persons needs and how these should be met. There was evidence that the District Nurse has been asked to visit the person to check on a particular area of need and specialist equipment is already in place. A relative we spoke with told us that, the social worker assessed (my relative) before (the person) came to live here, and I wrote down everything (my relative) needed, before the person came to live at the service, they said, I am pretty careful about checking up. The staff we spoke with told us they are not involved in the assessment process, but they said, the manager would assess people before admission, we read the Social Workers assessment and in an emergency we would give staff a constant verbal update. I think we could do with some training on the illness (a particular person) has because in some situations we are not sure if there are signs of the progression of the illness or because of something else. We passed these comment on to the manager who said she would look into this. Intermediate care is not provided at the service and this standard is not applicable. Care Homes for Older People Page 12 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. People have their personal and healthcare needs assessed and met at the service, but not always in a which shows respect for their privacy and dignity. The way medication is being administered could compromise the health of people living at the service. Evidence: The manager told us in her Annual Quality Assurance Assessment form that care plans are individualised and kept under review and that the staff know the people living at the service really well. She told us that the staff have monitored and recorded peoples likes and dislikes on a Personal Preference Plan found in each care file and that ongoing training is in place to encourage and nurture personalised care. We looked at the care plans and found them to be well written, person centred and they reflect the personal preferences of individuals. We found they cover issues of privacy, dignity, peoples capacity and their best interests well and recognise the importance of maintaining and promoting individuality. We found evidence that peoples relatives have signed their care plans to confirm that they agree with them. Care Homes for Older People Page 13 of 36 Evidence: There is clear evidence that they are kept under review. It is difficult to say from our observations whether the individual plans are being put into practice as there were so few staff interactions with the people we were observing. That said, when the staff do engage with the people living at the service they do so (in the main) in a caring and discreet manner. A health care professional commented to us that the strength of the service is that they treat everyone as individuals, they are patient and empathic with the residents. A relative said, the staff care for all of their physical needs, but there is no time for stimulation. Staff we spoke with told us, We try and personalise the plans as much as possible. If two people use the standaid, they will use it in a different way, personal preferences matter. If people can do things for themselves you have to give them that opportunity. We have a personal preference plan and a social history which we ask family or friends to write. I think the staff are good at considering needs, but if we are short staffed it is hard to do as much as we would like to. Other staff commented to us in surveys, I believe the service meets the different needs of each individual using the service at all times ensuring good care and support is given to them, the service provides outstanding care to all service users, we provide excellent care to the best of our ability. Our service users are cared for we feel, as we would like our own family to be cared for. The manager told us in her Annual Quality Assurance Assessment form that people have access to a full range of Hospital and community based services and the service has a good relationship with local primary care teams. We found that the plans on peoples health needs are well written and offer clear guidance to staff. There is evidence that referrals for assessment and treatment are made to District Nurses, Community Psychiatric Nurse and Specialist Nurses. The care plans provide evidence that equipment to prevent the development of pressure areas is in place. The service considers the Mental Capacity Act in its work and plans and one person has an advance directive. We found that the use of bed rails has not been signed by the relative in one plan and this is good practice. Our observation of staff shows that they move and handle people safely using the correct equipment. A health care professional commented to us, they are very thorough with residents Care Homes for Older People Page 14 of 36 Evidence: health - they always seek my advice even for minor problems, they attempt to plan for palliative care as much as possible. We visit from the surgery once a week and we have good communication between the surgery and the home. A relative we spoke with told us, the health side is looked after, the nursing staff are always available. Anything I ask for they do, unless it would be harmful (to my relative) the Doctor is called in if needed. Staff we spoke with commented, I think we are very good at looking after peoples health care needs, we pick up things like urine infections and we observe how people are, if they are not as they usually are we try and look at what may be wrong. If there is something serious we always make a referral. Staff told us that various pressure relieving equipment is in use, some people have Speech and Language Therapists and psychiatrists who visit. The manager told us in her Annual Quality Assurance Assessment form that medication is administered by nursing staff, although people can self medicate if they wish. We observed the nurse giving out medication, and although the checks before administering medication were thorough, we observed the person popping the tablets into their hand and then using their fingers to put the tablets into peoples mouths. Care and time was taken to go at the persons pace and to check that the tablets had been taken, but we then observed the nurse giving medication in the same way to another person without washing their hands between. Although the manager told us there are no people with transmissible infections living at the service, this is poor practice in terms of infection control. The staff we spoke with told us, Only nurses give out medication, although sometimes they will pop it out and give it to a senior to give out. I think medication is given out safely, we stay with the person until they have taken it. If they needed help I would put it on a spoon for them, I normally hold tablets on my hand so they can try and pick them up on their own. What is being described here is secondary dispensing, which is not best practice as the nurse is signing the Medication Record to show that to the best of their knowledge the medication has been taken. We looked at the Medication Administration Records and found that these are generally well kept, the records tally with the tablets remaining in boxed medication. The Controlled Drugs are appropriately recorded and the countdowns tally with the tablets remaining. Care Homes for Older People Page 15 of 36 Evidence: We observed five people who have Dementia over two hours during our visit to look at the quality of the care and interactions they receive. During this time we saw only one poor interaction between staff and the people we observed. This was when a person was moved without any explanation or warning, which startled them. We did, however observe some staff asking a person if they wanted to use the toilet very loudly which compromises the dignity of this person living at the service. This behaviour should be strongly discouraged. That said, the majority of the staff we saw spoke kindly, discreetly and gently to the people living at the service. We also saw them laughing and joking with people and giving them reassurance. Relatives told us, The staff in the main are quite pleasant and patient, but I cant say I have ever noticed staff being unpleasant to people. The staff we spoke with understand the need to promote and respect peoples privacy and dignity and they gave us examples of how they do this in their day to day work. One told us, as a senior, I try and listen out and if I hear anything inappropriate I would approach the staff member and ask them to work differently. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service are able to make choices about their life style, and these are respected and supported by staff. Social, educational, cultural and recreational activities do not meet individuals needs and expectations. Evidence: The manager told us in her Annual Quality Assurance Assessment that the two activities co-ordinators follow a religious and cultural calendar and involve people who live at the service in celebrating diverse events. Peoples birthdays are celebrated by staff and other people who live at the service. She told us that the service has, in response to requests provided a chinese meal which was a new experience for several people and most enjoyed it. They have also had picnics, and people who live at the service go out into town on market day; the fruit and vegetables used at the service are bought from the local market. During our observation we saw people having a musical quiz and singalong. The person who led the activity was very good at engaging with people who live at the service, but this was an activity that was mainly enjoyed by people who could remember the songs and join in. None of the people who have Dementia that we Care Homes for Older People Page 17 of 36 Evidence: observed were spoken with about the songs or encouraged to join in. We also noted that the activity was more suited to the older people who live at the service rather than the younger people. When the activity finished the people who sat in the lounge were left for an hour and twenty minutes without anything to stimulate or interest them. The television was off, there was no music and there were no staff sitting in the room to observe or speak with people who live at the home. People who were sitting in the lounge very rarely spoke to one another, and sat in silence for the majority of the time. In the afternoon the activity organiser did some baking with the people who live at the service, but we did not directly observe this activity. We looked at the record of activities and found that two people are employed to work with people living at the service, one in the morning and one in the afternoon. During November activities included massage, bonfire night, a vintage band, celebrating birthdays and a sponsored walk. A relative we spoke with told us, I take (my relative) to the pub for a meal, I think there is no stimulation for (my relative). I notice that people come into the home and are quite sprightly, but within a short while they sink within themselves. There are limited activities, dominoes, BINGO, but only for people who can join in. Two people commented to us in surveys about the activities, one said, this section is no longer applicable to (my relative) who prefers the solitude of (their) own room now, another said there are always activities which they can take part in. Staff we spoke with told us, the activity organisers take people shopping, they do quizzes, listen to music, they did baking this afternoon, they play dominoes and BINGO. I think they try and consider the people with Dementia, (the activities organiser) does a one to one morning. (A younger person) goes to college on a Monday and to a day service two days a week and we do try and play lots of different kinds of music. Another staff member told us, you are constantly trying to provide more to people with severe Dementia, you need to give them more mental care. We havent enough staff to give them more one to one time, even for just 10 minutes each. It is not disputed that providing activities which are appropriate to the diverse range of people and their particular needs is a challenge, but there must be appropriate activities and engagement for all of the people who live at the service. Relatives are welcomed into the home and the people we spoke with and who Care Homes for Older People Page 18 of 36 Evidence: commented in surveys said they can raise issues with the staff. Staff members told us, Relatives are welcome whenever they like. We all chat to relatives and answer any queries they have. The manager told us in her Annual Quality Assurance Assessment that people can have a flexible routine and personalise their rooms, being consulted about the colour when rooms are due for redecoration. Residents meetings have started and items in the minutes are actioned. We looked at the minutes of the residents meetings and found that these are properly recorded, we could not find the minutes for the last three meetings, so the last ones we saw were from June this year. The care plans we looked at had very clear details of the likes, dislikes and preferences of the people who live at the service (see OP7) and this is good practice. During our observation we saw that when staff do interact with the people living at the service they show respect for their choices and decisions. We saw the staff ask people if they had finished their drinks, whether they wanted to take their tablets by themselves, whether they would like a drink or a biscuit. They demonstrated a good understanding of people living at the home and a genuine concern for their wellbeing. A relative we spoke with told us, (my relative) is not forced to do anything, in the morning if (my relative) is asleep they leave (my relative) to lie in, and (my relative) likes to go to bed late, this is respected. Two people who completed surveys also confirmed that staff always listen to them and act on what they say. The staff we spoke with told us, people only get up early if they insist and that is their choice, their getting up times are not set in stone, it depends how they are feeling each day. I think the residents would indicate to us through their behaviour if they didnt want to do something. Another confirmed, we ask people what they want all the time, if people dont want to get up they dont have to. The manager told us in her Annual Quality Assurance Assessment that individual preferences for meals such as cultural and religious preferences are catered for. She told us that dietary preferences are also part of the kitchen records. There are drinks and snack tables available for people to help themselves, they state that meal times are unhurried and that people receive support to eat if they need this. We looked at the menu. There are two choices available every day, but the menus were not very varied, with a predominance of stews and casseroles. The daily menu is written on a board every day to help people remember what is available. Care Homes for Older People Page 19 of 36 Evidence: A relative we spoke with told us, the kitchen is a bit reliant on frozen food, I wish there was more fresh food used and teas could be better, I wouldnt like them myself. The two people who completed surveys told us they usually like the food. Staff told us, I think the cooks do a very good job with the budget they are given, I think they struggle sometimes, but in the main people can have what they want. Another told us, There are too many cutbacks on food, there is not a very wide choice of meals and there are too many casseroles. I think the food is mundane, it must drive them mad, they cant have extras like mint sauce. They do have fruit every day though. We observed lunch and found the staff help in a discreet and caring way, though from our observation it is clear that more staff would be helpful as some people were still waiting to be given their lunch after sitting at the table for 25 minutes. One member of staff referred to people who need assistance to eat as feeders, and this is unacceptable and dehumanising terminology which must be addressed. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service have access to an effective and robust complaints procedure. They are safeguarded at the service by well trained and supportive staff. Evidence: The manager told us in her Annual Quality Assurance Assessment that complaints are dealt with sympathetically and promptly and responded to within 28 days. The service also has a comments box for relatives and visitors as well as people living at the service to make suggestions for improvements. During our tour of the building we saw the complaints procedure on display in the reception area. We looked at the record of complaints and found these are managed well. There have been 8 complaints since our last Annual Service Review, these are all recorded, there are records of the investigation and the outcome of each complaint. A relative we spoke with told us, I make my views known, I can talk to any of the staff. Two people commented in surveys that they know who to speak to if they are unhappy and they know how to complain. A health care professional also commented that the service always responds appropriately if any concerns are raised. Staff we spoke with told us, Relatives have sometimes come to me with concerns, I document these and raise the issue with the manager. Care Homes for Older People Page 21 of 36 Evidence: The manager told us in her Annual Quality Assurance Assessment that staff have ongoing training in safeguarding and whistleblowing. She told us they have improved their service by identifying two dignity champions. We have been notified of an allegation of physical abuse since our last Annual Service Review. The service has taken prompt and appropriate action in response to this, and the person concerned no longer works at the service. There has been an appropriate notification to the Protection of Vulnerable Adults List. We found that the policy of the company on safeguarding is very confusing, and appears to be directing managers to make referrals to the Protection of Vulnerable Adults list rather than making safeguarding referrals to the Local Authority. We also found that clearer guidance to staff on their duty to disclose, on writing statements and preserving evidence would be helpful and avoid compromising investigations. There also needs to be clear guidance to managers (in line with the Independent Safeguarding Authority guidance) about making referrals to the Protection of Vulnerable Adults list. These issues must be resolved to ensure that people who live at the service are properly protected. A relative we spoke with told us, I think (my relative) is safe here, I cant say I have ever noticed staff being unpleasant. The staff we spoke with told us, I had safeguarding training about three months ago, all staff have had this within the last six months. If someone told me about a safeguarding situation I would report it to the manager or the nurse, if I felt that it hadnt been dealt with I would refer it higher, but I am sure the manager would deal with it. If I saw poor practice I would approach the staff member myself. Another told us, if I saw anything concerning I would report it. A couple of staff have done this before. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is not well maintained and it does not provide safe and comfortable accommodation for the people who live there. Evidence: The manager told us in her Annual Quality Assurance Assessment that the home is clean and comfortable and that the service employs a maintenance man to do small repairs. She told us the bedrooms are clean and refreshed and people can personalise them. She feels they could improve the location of the laundry and they could upgrade the bedroom furniture. They have improved in the past year by redecorating the reception area, by replacing the lounge chairs, new dining furniture has been purchased and the garden has been improved. In the coming year they will resite the laundry and the managers office and upgrade the bedroom furnishings. We did a partial tour of the accommodation including all communal areas and a sample of bedrooms. We found that the main lounge and the dining room look fresh and pleasant and consideration has been given to the layout of seating and dining furniture to provide smaller group living. However, we found that there are many areas of the home which need repairs or maintenance. Care Homes for Older People Page 23 of 36 Evidence: One bathroom is not operational, but there is no date set for the repairs to be made. This means the service is operating with insufficient bathing facilities as problems developed with the water pressure in the shower room during our visit. There is no operational bathing facility for people on the ground floor of the home, although a number of people have bedrooms on that floor. We found that a number of people do not have extension cords (which would make activating the call alarm system easier for them to use when they are in bed.) When we discussed this with the manager she told us these are on order, but there is no date for delivery. We found that there is a very strong odour in the double bedroom, which is not acceptable for the person who has to share the room. It is clear in discussion with staff and the manager that the staff have tried to eliminate the odour but for a variety of reasons this has not been successful. Further steps must be taken to eliminate odour in the room so that the person sharing can live in a comfortable, clean and pleasant environment. The manager should also consider whether it is appropriate for the named person to be sharing a room given their needs. During our observation we noticed how dim the lighting in the lounge is. This is concerning because a number of people living at the service have been identified on the Annual Quality Assurance Assessment as having visual problems and several people at the service have been identified as being at risk of falling. The quality of the lighting throughout the home should be reviewed. We also noticed that neither the lounge nor the dining room had any curtains at the window to promote privacy and enable draught exclusion. We found some areas of the home to be cold (especially the small lounge on the first floor) and if people have health needs or they are not mobile they will feel the cold more. A relative we spoke with told us, they are very slow at doing repairs, the lift was broken for a week and the shower was broken for months, I have complained about this. People who returned surveys to us said the home is usually or always kept clean and fresh. Staff we spoke with told us, we have only one standaid at the moment, at least half of the people who live here need to use it to move. People have to wait for help, we explain to them and we ask them to wait, but we really need two. I dont know when we will get the second one, we have been told it is on order. One of the bathrooms is out of order. I think broadly speaking repairs are done quite quickly, the lift didnt get seen to very quickly but in fairness it was a Bank Holiday. One room has a strong Care Homes for Older People Page 24 of 36 Evidence: odour. However, other staff members commented, we have to push for things to be done, whether it is the manager or Head Office to blame, I cant say. There is a lot that needs doing in the building, some nights the rooms feel cold and draughty, the shower has just gone, the water pressure, but our second standaid has just arrived. I would like equipment to be provided when it breaks down instead of waiting months for replacements. Staff cannot do the job to the best of their ability without the proper equipment, E.g. standaids and hoists which work properly within the Regulations. The replacement standaid arrived whilst we were at the service, but the long delays for repairs and essential maintenance has the potential for very negative outcomes for the people who live in this service, placing them at risk of injury, ill health and discomfort. Care Homes for Older People Page 25 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. People are supported by caring, well trained and safely recruited staff but there are insufficient staff on duty to meet the needs of the people who use the service. Evidence: We looked at the staff rota and found that there is a qualified nurse on every shift and between three and four care staff. On the day of our visit there were only four staff on duty until 11:30 in the morning. During our observation it was clear that there are not enough staff on duty to meet peoples needs. The lounge was not supervised by staff for an hour and twenty minutes (see OP12) although staff did pop in occasionally to check on people. We also found that the people with Dementia who we observed received minimal attention from the staff. Out of 100 five minute time frames there were 87 in which the people we were observing had no interaction with the staff at all. We only observed staff interacting with the five people we chose to observe a total of 18 times in a two hour period. The impact of this was that the people we observed spent most of their time in a passive mood state. The lack of human interaction is not positive for any person, but when they have Dementia and may not be able to initiate conversations the impact is more significant. When the staff did engage with people we observed them (in the main) to be caring, kind, supportive and discreet. Care Homes for Older People Page 26 of 36 Evidence: Relatives told us, the staff are stretched all of the time. The lack of staff is consistent, all the time, they work so hard but they always have jobs to do. There is no time for stimulation. Another person told us, any problems that occur in connection with care and support appear to be caused by insufficient staffing levels. The staff we spoke with told us, we tend to run on 5 staff in the morning, 3 in the afternoon and 3 overnight. Recently we have been short of staff, a lot of us have been working long hours. The manager has been in touch with an agency but they havent been able to cover. This morning we only had 4 staff on until 11:30 and we have just had a new person admitted who has very high needs. Others commented, sometimes I feel like I am a machine, not getting around all of my residents. There are sometimes 4 staff on in a morning and 3 in an afternoon and its really hard work. We do try and the staff really care but we desperately need more staff, the only time we interact properly with residents is at lunchtime as we sit with them and get that time. Other staff commented to us in surveys, the staffing has been cut back, the staff feel unable to cope and exhausted trying to cover sickness and annual leave. We are unable to spend as much time as we would like with the service users. We need more staff to meet the needs of each individual. We interviewed the manager of the service about the staffing levels and she told us, When we get to 35 residents we get an extra carer on nights. We need six staff on duty. She told us the service has been running with four or five staff on daytime shifts. She told us that a number of staff have left in quick succession and they have been trying to manage by staff doing extra hours. She told us, I have advertised and I have one person waiting for their Criminal Records Bureau check, and one waiting for references and I have sent out more applications. As this is an unmet requirement, we served a Code B notice under The Police and Criminal Evidence Act 1984 and seized copies of the staff rota. We will look at this evidence and decide whether we need to take any further enforcement action to secure compliance and the safety of people living at the home. The manager told us in her Annual Quality Assurance Assessment that the service has achieved its target, and has 50 of the care staff who have achieved their National Vocational Qualification Level 2. She told us that the staff are well trained and regularly supervised. She told us the service has improved by having an in house trainer and two trainers in moving and handling. We found the service is very good at providing training to its staff. This is one of the main strengths of the service. We looked at the training matrix and found that staff Care Homes for Older People Page 27 of 36 Evidence: have undertaken training on Fire safety, Basic Food Hygiene, Moving and Handling, Control of Substances Hazardous to Health, Health and Safety, Safeguarding, Infection Control, Nutrition, Medication, Pressure care, Customer Care, Care Planning, Supporting People with Challenging Behaviour, the safe use of bed rails and National Vocational Qualifications. A relative we spoke with told us, the staff are very well trained, they know what they are doing. I like the fact that there is good camaraderie between the staff. I could talk to any of them. Staff we spoke with told us, I have done my National Vocational Qualification Levels 2 and 3, and have done training on fire safety, health and safety, food safety, safeguarding, infection control, continence, the Mental Capacity Act 2005, and Yesterday, Today, Tomorrow. I am one of the Dignity Champions. The manager told us in her Annual Quality Assurance Assessment that staff are safely recruited. We looked at three staff files and found that they contain all of the information and documentation required by Law to make sure that staff are suitable to work with vulnerable people. The staff we spoke with confirmed that they have had full pre employment checks. Care Homes for Older People Page 28 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 management is not robust enough to ensure that the service is being run in the best interests of the people who live there. Evidence: The staff we spoke with told us, I think (the manager) is very good, she is very supportive and was when I was going forward as a dignity champion, she made time available. She is very fair, if she is unhappy with your performance she will discuss it with you, I think the manager is a fantastic person but we sometimes have to push her for things. One person commented in a survey, Supervision is not done as often as it should be, staff often feel that management does not care about any problems they may have. We found that although there are strengths about the service, there are also areas of weakness which indicate that these areas are not being appropriately overseen and managed, (OP9, OP10, OP12, OP19 - 26, OP27.) These areas must improve as they Care Homes for Older People Page 29 of 36 Evidence: directly impact on the people who live at the service. We did not have time to inspect the standard about Quality Assurance on this occasion and this will be looked at during our next inspection. There is a corporate approach to looking after money on behalf of people who live at the service. Their Personal Allowance is paid into a residents account, which attracts interest. There is a full record of receipt and withdrawal, and receipts are kept for any expenditure. Statements are sent out to relatives, or the person concerned if they are managing their own affairs. The arrangements are safe and protect the financial interests of the people living at the home. The staff we spoke with said they do not have any involvement with finances. A relative commented to us, I look after (my relatives) affairs but I would have no worries about depositing money at the home, they are very good. All of the health and safety tests and servicing has been done at the required intervals, (see OP22 about equipment). Staff we spoke with told us, I feel my health and safety is well looked after. Care Homes for Older People Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18(1)(a) Demonstrate that sufficient 22/12/2008 staff are provided at all times to meet the holistic needs of service users. To ensure the holistic needs of people living at the service are met. This requirement is outstanding from the last inspection. Timescale of 14/11/06 has not been met. Due to exceptional circumstances we will repeat this requirement a final time with a short timescale for compliance and this must be met to avoid further action being taken. Care Homes for Older People Page 31 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 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 9 13 The practice of secondary dispensing of medication must cease. To ensure that there is a clear audit trail which will show whether people have taken their medication as prescribed by their Doctor. 15/12/2008 2 9 13 Staff must not pop medication out into their hands or use their fingers to put tablets into peoples mouths. To prevent infection spreading between staff and people who use the service 15/12/2008 3 10 18 Staff must receive supervision, training and guidance To ensure that they treat people who live at the service with dignity and respect. 05/12/2008 Care Homes for Older People Page 32 of 36 4 12 18 The people in the lounge must be supervised appropriately To ensure their safety and promote their emotional wellbeing. 15/12/2008 5 12 16 The provision of activities 31/12/2008 must be reviewed in consultation with the people living at the service (or their relatives) To make sure that appropriate activities are provided for all age ranges and levels of ability. 6 19 23 Repairs and maintenance of 15/12/2008 essential equipment must be completed without undue delay. To ensure the safety and wellbeing of people who live at the service and the staff who support them. 7 19 23 There must be sufficient working bathing facilities to meet the needs of people who live at the service. To maintain their health and hygiene. 31/12/2008 8 20 16 Suitable curtains or other window coverings must be provided in the lounge and dining areas. To ensure the privacy and comfort of people living at the service is maintained. 31/12/2008 9 20 23 1. There must be adequate lighting in areas of the 22/12/2008 Care Homes for Older People Page 33 of 36 service used by people living there 2. There must be evidence that all areas of the home which are used by people living there are maintained at a comfortable temperature at all times To ensure their health, safety, comfort and wellbeing. 10 22 23 1. There must be enough 15/12/2008 moving and handling equipment available at all times to meet the needs of people who use the service 2. There must be an adequate supply of extension cords to call alarm systems to meet the needs of the people living at the service To ensure their needs can be met in a safe and timely manner 11 26 16 The odour in the identified bedroom must be eradicated. To provide a clean and comfortable environment for the person to live in. 12 31 10 There must be an 31/01/2009 improvement in the management of the areas we have raised in this report To ensure the health, safety, comfort and wellbeing of the people living at the service. 15/12/2008 Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Staff should be given information or training on the more specialised illnesses and conditions the people who live at the service have so that they can support them properly and effectively. If bed rails are used, the person, their next of kin or main carer should sign the risk assessment to indicate they have had the risks explained to them, and that they accept the need to use them. There should be stimulation and staff should interact socially with the people living at the service to support and maintain their social skills and meet their emotional needs. The menus should be reviewed with the people living at the service to make sure there is more variety and that their preferences are catered for. The safeguarding policy needs reviewing to make sure the correct terminology is used, and to offer clear guidance to staff and managers so they know what they must do if allegations are made to protect people living at the service. The appropriateness of the two identified people sharing a bedroom should be reviewed to ensure that they live in a clean and comfortable environment which meets their needs. 2 8 3 12 4 15 5 18 6 26 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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