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Inspection on 09/09/09 for Beech Court Nursing Home

Also see our care home review for Beech Court Nursing Home for more information

This inspection was carried out on 9th September 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prospective service users and their relatives/representatives are encouraged to visit the home before making a decision to move into the home for a trial period. The healthcare needs of service users are fully met by a local GP practice. Service users and their relatives are confident that any concerns or complaints would be listened to and acted upon. The housekeeping staff work hard to ensuring that the home is clean, homely and free from unpleasant odours. " All the care workers at Beech Court are concerned and are totally committed to their patients. Their well being is their first priority at all times. My X appears to be very content in Beech Court so that in turn makes me a very happy individual".

What has improved since the last inspection?

The four requirements made at the last inspection have been complied with, these related to staff receiving safeguarding training, the registration of nurses being regularly checked, full work history with gaps in employment being explored as part of the recruitment process and that the risks to peoples health and well being should be routinely assessed and action taken to minimise them. A programme of refurbishment and redecoration has taken place. An additional hoist has been purchased and individual hoist slings. A new sluice disinfector has been installed. Quality assurance systems have been developed and good practice recommendations made at the last inspection have been implemented.

What the care home could do better:

Care plans need to be further developed to include the social and emotional needs of service users and detail how these are to be met. The home`s statement of purpose and service user guide need to be updated to reflect the home`s registration category. The range of activities provided to service users, including community involvement needs to be reviewed together with the provision of adequate staffing resources. That a named member/s of staff are allocated each day to undertake activities to service users, including the needs of service users requiring 1-1 interactions. Activities undertaken should be recorded in daily records and reflect information recorded in the emotional/social care needs care plan. The service user with care needs associated with meal times, should be actioned and form part of the care plan. The manager/chef should seek the views of the service users about how to improve the evening meal choices. The home`s complaints procedure needs updating. The home`s staffing structure, staffing levels and recruitment of permanent staff needs to be reviewed to ensure that the care needs of service users are met and that service users benefit from continuity of care. Training opportunities should be extended to bank staff. Recruitment procedures need to be more robust. The role of the registered manager needs to be reviewed.

Key inspection report Care homes for older people Name: Address: Beech Court Nursing Home 37 Newland Street Eynsham Oxfordshire OX29 4LB     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: Marie Carvell     Date: 0 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Beech Court Nursing Home 37 Newland Street Eynsham Oxfordshire OX29 4LB 01865883611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): beechcourt@talk21.com Dr Brian Cheung Name of registered manager (if applicable) Glynis Lynette Dunbar Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26 The registered person may provide the following category of service: Care home with nursing ( N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beech Court is a large listed building of architectural and historical note. It is situated in Eynsham, a village five miles west of Oxford and is close to shops, Post Office and 3 churches. Beech Court is home to 26 older people who are frail and require nursing care 24 hours a day. The home offers convalescence, holiday breaks, long, and short stay care. The accommodation is provided in single and shared rooms on 2 floors and there is a passenger lift to provide access to all areas. The communal rooms are Care Homes for Older People Page 4 of 31 Over 65 26 0 2 2 1 0 2 0 0 8 Brief description of the care home spacious and large picture windows afford a good view of the delightful garden. There are spacious, well kept grounds on both sides of the house, to which the service users have access. The home is not registered to accept service users with a primary diagnosis of dementia or mental disorder, this would require additional registration categories being registered. The fees range from 564.00 pounds per week to 930.00 pounds per week. Additional costs are incurred for chiropody, hairdressing, physiotherapy, occupational therapy and personal items. Care Homes for Older People Page 5 of 31 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 last key inspection of this service was completed in October 2008. This inspection was an unannounced key inspection. We( the commission) arrived at the service at 10.15am and we were in the service until 5.30pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Glynis Dunbar in July 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent with service users, relatives, a visiting healthcare professional, the manager, provider and all staff on duty. We checked the four requirements made at the last inspection for compliance, toured the premises, examined a sample of records required to be kept in the home including service user and staff records. We observed how care was being delivered to service users and joined service users for the midday meal. Care Homes for Older People Page 6 of 31 Surveys were received from service users, relatives and members of staff. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be further developed to include the social and emotional needs of service users and detail how these are to be met. The homes statement of purpose and service user guide need to be updated to reflect the homes registration category. The range of activities provided to service users, including community involvement needs to be reviewed together with the provision of adequate staffing resources. That a named member/s of staff are allocated each day to undertake activities to service users, including the needs of service users requiring 1-1 interactions. Activities undertaken should be recorded in daily records and reflect information recorded in the emotional/social care needs care plan. The service user with care needs associated with meal times, should be actioned and form part of the care plan. Care Homes for Older People Page 8 of 31 The manager/chef should seek the views of the service users about how to improve the evening meal choices. The homes complaints procedure needs updating. The homes staffing structure, staffing levels and recruitment of permanent staff needs to be reviewed to ensure that the care needs of service users are met and that service users benefit from continuity of care. Training opportunities should be extended to bank staff. Recruitment procedures need to be more robust. The role of the registered manager needs to be reviewed. 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 31 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 31 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. Service users are assessed prior to admission to ensure that the home is able to meet their assessed needs. This is well documented in service user files. All service users are able to move into the home for a trial period, before making a decision to stay permanently. Evidence: All prospective service users and their representatives are provided with information about the home and are encouraged to visit, before deciding whether to move into the home for a trial period, this was confirmed by service users and relatives, spoken to or who returned surveys. The information recorded in the statement of purpose and service guide needs to be updated as the information recorded does not accurately reflect the homes registration category, this was discussed with the provider and manager, who agreed to update these documents. The home currently has twenty one service users, seventeen of the placements are funded by the local authority. Several service users said that they or their relatives had been able to visit the home to look Care Homes for Older People Page 11 of 31 Evidence: at the premises and facilities available. The manager carries out all pre-admission assessments to ensure that the home is able to meet the assessed needs of service users. This is well documented in service user files. Care Homes for Older People Page 12 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs are identified and met. Care plans need to be developed to include the social and emotional care needs of service users and how these are to be met. The health care needs of service users are fully met. Service users feel that they are treated with dignity and respect. Evidence: Care plans are well documented and gave information about the service users physical care needs and what action needed to be taken by staff to meet these. However, these need to be developed to include the social and emotional needs of service users and detail how these are to be met. One survey received from a service user commented that they Sometimes received the care and support they needed and another survey commented that they Usually received the care and support needed. Two surveys from relatives felt that the home Always meet the needs of their relative. Care Homes for Older People Page 13 of 31 Evidence: Service users were observed to be appropriately dressed and attention had been given to ensuring service users were wearing appropriate footwear. A hairdresser visits the home regularly and this is appreciated by service users. The healthcare needs of service users are met by a local GP practice. Healthcare professionals visit the home as required. Five of the current service users employ a physiotherapist privately for thirty minutes to one hour each week. Ten service users employ an occupational therapist privately for two hours each week, to provide activities. From discussion with the manager, staff and from examination of service user records the health care needs of service users are fully met. From information recorded on surveys, one service user felt that the home Always made sure that they receive the medical care needed and one service user felt that Usually the home made sure that they received the medical care needed. Medication storage, medication administration records and evidence of disposal of medication were seen to be satisfactory. It was observed that two containers of a cream, prescribed to a service user no longer living in the home, was being used by another service user, this was addressed during the inspection. The manager expressed her satisfaction of the service provided by the community pharmacist. Staff were observed to interact with service users in a kind, respectful and friendly manner. We gained the impression that there a good rapport between staff, visiting relatives and service users. Staff were observed to address service users by their preferred name and service users able to give an opinion felt that they were always treated with dignity and respect. Comments made by relatives and service users during the inspection or stated in surveys included All the care workers at Beech Court are concerned and totally committed to their patients. Their well being is their first priority at all times, My X appears to be very content in Beech Court so that in turn makes me a very happy individual. From discussion with the manager, we consider that the home would be able to meet the needs of individual service users of various religious, racial or cultural needs. Care Homes for Older People Page 14 of 31 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. The range of activities provided to service users and the staff resources need to be reviewed and developed. Service users are provided with a varied, wholesome and nutritious diet. Evidence: The home does not employ an activity organiser. However, one of the care assistants has completed a reminiscence course. On the day of this visit there was no activities planned as the care assistant who usually provides an exercise session was off duty. The activities programme was displayed in the largest of the three lounges and planned daily activities are the same each week. A church service is provided each Monday by the Baptist Church, the chef organises a reminiscence session each Tuesday and bingo each Saturday afternoon and a volunteer provides some activities each Thursday. Several service users said that other than the television there was very little to do and staff confirmed that activities were dependent on staff time. Service users confirmed that there are no planned outings, due to shortages of staff. Although service user records detailed life history, hobbies and interests this is not reflected in care plans or social events in the home. The activities programme refers to the GP visit and chiropody as activities, this was discussed with the provider and Care Homes for Older People Page 15 of 31 Evidence: manager as we do not consider these to be social activities, in addition the activity programme refers to occupational therapy and physiotherapy. However, these are provided only to those service users who are able to pay privately, this disadvantages those service users who are unable or unwilling to pay. This was discussed with the provider and manager who agreed to develop the range of activities provided to service users. Comments made on surveys stated that the home Sometimes arranges activities that service users can take part in. It is a good practice recommendation of this report that a named member/s of staff are allocated each day to provide activities to service users, including the needs of service users requiring 1-1 interactions, this should be recorded in daily records. Service user/ relative meetings do not take place, but service users and relatives said that the manager always made herself available to discuss any concerns. Relatives were observed to be made welcome and in discussion this was confirmed. We joined service users for the midday meal. The menus was displayed and service users said that although there isnt a choice the chef would always prepare an alternative if asked. The meal served was tasty, attractively served and hot. Service users said that the food was generally good, but there was little variation from the sandwiches and soup, served for the evening meal. It is a good practice recommendation of this report, that the views of the service users should be sought about how to improve the evening meal choices. Surveys received from service users commented that they Usually liked the meals served at the home. Many of the service users need assistance with eating their meals and care staff were observed assisting service users in a relaxed and discrete manner. One service user eats very slowly, resulting in his/her food getting cold. This was refered to in the last inspection report and the concern had not yet been resolved. It was suggested to the manager and relative that the service user is given a small portion of food at a time to ensure that the food remains hot and for the home to purchase a heated dish. The manager confirmed that she had not considered serving smaller, more frequent portions. This should be included in the care planning documentation. Care Homes for Older People Page 16 of 31 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. The homes complaints procedure needs to be updated to include the commissions name, address and telephone number. Service users and their relatives are confident that any concerns or complaints would be listened to and acted upon by the manager. Safeguarding vulnerable adult training has recently been undertaken by the manager and staff team. Training needs to be arranged for the two newly recruited care assistants, housekeeper, chef, provider and bank nurses and care assistants. Evidence: The homes complaints procedure is displayed in the entrance hall, this needs to be updated as the name of the commission, address and telephone number is out of date. This was discussed with the manager and provider, who agreed to update this information. The home has recorded one complaint in the last twelve months, this was recorded appropriately with action taken and outcome. The manager confirmed that she would record any verbal complaints received. Service users and relatives, either spoken to or had returned surveys confirmed that they knew how to make a formal complaint, several comments that if they had concerns or complaints then they would speak to the manager and were confident that their complaint would be listened to and acted upon. Service users funded by a local authority can also access the local authority complaints procedure. At the last inspection a requirement was made that all staff must have safeguarding Care Homes for Older People Page 17 of 31 Evidence: training to ensure that they are fully aware as to what constitutes a safeguarding issue.The manager completed safeguarding vulnerable adults from abuse training for registered nurses in June 2009, safeguarding adults training level one in September 2009 and is booked to attend a level two training course in November 2009. In early September 2009, one registered nurse and six care assistants completed safeguarding training at level one and a registered nurse undertook training at level two. We were advised that training is being arranged for the two new care assistants recently recruited, housekeeper, chef and provider. It was not evidenced that all bank staff have attended up to date safeguarding training. It is a good practice recommendation of this report that this is provided as soon as possible. Staff on duty said that they had enjoyed the safeguarding training, were clear about safeguarding procedures and the homes whistle blowing procedures. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the protection of vulnerable adults list of staff unsuitable to work with vulnerable adults ( POVA). Care Homes for Older People Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comfortable, homely accommodation to service users. Appropriate aids and adaptations are in place to assist service users with independence. Since the last inspection a new sluice disinfector has been installed. The housekeeping staff work hard to ensuring that the home is clean and free from unpleasant smells. Good infection control measures are in place and housekeeping staff undertake COSHH and infection control training. Evidence: The home is a listed building and has been adapted to its present role as a care home. Since the last inspection a programme of refurbishment and redecoration has taken place, including the damage caused by a road traffic accident to the front of the home. Communal areas of the home consist of a large lounge/dining room, used by the majority of service users, the entrance hall is used as a lounge/dining area and the room previously used as a bedroom was being used as a lounge area on the day of this visit. The largest of the lounge/dining rooms, has limited space for service users to move around comfortably. Staff confirmed that lack of space is a problem when using a hoist to move service users from armchair to wheelchair. The dining facilities Care Homes for Older People Page 19 of 31 Evidence: are insufficient for all service users to sit at a dining room table for their meals. Currently eight service users use the dining table to eat in the larger lounge and four service users in the second lounge, the remaining service users eat their meals from their armchairs. We were advised that this was the service users preference. The home was seen to be well maintained and service users expressed their satisfaction of the facilities available. The gardens are well maintained, but service users said that they rarely had the opportunity to sit outside in the warmer weather. Bathrooms and toilets have been refurbished and all have appropriate aids and adaptations to assist with service user independence. Additional hoists have been purchased and individual hoist slings are provided. Bedrooms were seen to be comfortable and personalised by their occupants. Bedrooms vary in size, some are compact and are not suitable for service users, who require hoisting from bed to chair/wheelchair. Five of the bedrooms are for shared occupancy, privacy screens are provided and staff on duty described how the privacy and dignity of service users was maintained when providing personal care. Service users are encouraged to bring in items of furniture and other personal possessions. Service users expressed their satisfaction of being able to personalise their bedrooms. Since the last inspection a new sluice disinfector has been installed on the ground floor of the home and the provider confirmed that a new sluice disinfector will be installed on the first floor in due course. The call bell system is due to be replaced within the next few months. All radiators are covered, window restrictors are in place and hot water outlets are maintained at the recommended safe hot water temperatures. The home was seen to be clean, pleasant and hygienic. The housekeeping staff work hard to ensuring that the home is clean and free from unpleasant odours. Good infection control measures were in place including liquid soap dispensers and paper towels. Protective clothing and alcohol hand rub was available throughout the home. Housekeeping staff undertake COSHH and infection control training. During the inspection it was noted that the majority of bedrooms doors did not have the name of the rooms occupant. This was discussed with the manager and provider as potentially this could cause a delay in the case of an emergency evacuation or when staff unfamiliar with the service users are on duty. The manager confirmed that there wasnt a list of service users and where accommodated in the home for use in Care Homes for Older People Page 20 of 31 Evidence: an emergency. This was addressed by the provider during the inspection. It was noted that the key to the cellar door was kept in a prominent place by the door frame. The door was locked, but poised a significant risk to service users, who could open the door to a steep stone staircase. This was discussed with the manager and provider and addressed during the inspection. The provider considered this to be a minimal risk as it was thought that very few service users would have the mental and physical dexterity and interest to overcome the previous arrangement. The provider is planning to develop the home further and following the inspection we received a summary of the extension plan, this would include twelve new single bedrooms with en-suite facilities, adding en-suite facilities to three existing bedrooms, conversion of two shared bedrooms to single and at least three new communal areas, some with small catering areas. This is subject to further revision, planning permission and economic conditions. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing structure, staffing levels and the recruitment of permanent staff needs to to be reviewed to ensure that the care needs of service users are met and that service users benefit from continuity of care. Training opportunities need to be extended to all staff, including the ten members of bank staff. Recruitment procedures need to be further developed. Evidence: From discussion with the manager, staff on duty, comments made on surveys and examination of duty rosters it is not evidenced that there is consistently sufficient staff on duty to meet the needs of service users. At the time of this inspection the manager was on duty from 8am until 6.30pm, providing nursing cover, assisted by three care assistants, one of whom had been in post for a few weeks, working from 8am until 2pm and a second who said was her first day back at work from long term leave. An housekeeper was on duty from 8am until 12.30pm and a care assistant was working as the relief cook from 8am until 1.30pm. From 2pm a bank registered nurse ( RN) was rostered to work until 8pm, assisted by Care Homes for Older People Page 22 of 31 Evidence: two care assistants who had worked the morning shift, one working 2pm until 8pm and the second working 5pm until 8pm. At 6pm a bank RN came on duty and was rostered to work until 8am the following morning and assisted by a care assistant working from 8pm until 8am. The home does not employ a laundry assistant as this task is undertaken by all staff on duty. The manager confirmed that the home does not have any staff vacancies. The homes staffing structure consists of two permanent RNs to cover day and night duty, five bank RNs, six permanent care assistants to cover day and night duty and five bank care assistants. In addition to care and nursing staff there is a team of ancillary staff. The manager confirmed that all bank RNs have other employment. The home is not running at full occupancy at the time of this inspection and the manager confirmed that she would discuss with the provider the need to increase staffing levels as the provider manages the duty rosters. At the last inspection it was noted that the duty roster does not include a formal handover at the beginning of each shift to discuss the most up to date information about the service users. This was discussed with the manager, as we would expect the roster to evidence an overlap between staff going off duty and staff coming on duty to discuss and share pertinent information. The manager agreed to address this and acknowledged that this was important as from the duty rosters, individual bank RNs may not be on shift for many days at a time. Four surveys completed by staff stated that there was usually enough staff on duty to meet the individual needs of service users, two surveys stated that there was always enough staff on duty. Comments made by service user, staff and relatives either during the inspection or recorded on surveys included There is always someone on duty. Sometimes under pressure, Staff are always very busy, Staff are not always available when I need them, They need to employ more staff, Need more activities for the residents, Need to employ more permanent staff rather than bank staff, which would improve service and loyalty. To this end less pressure to permanent staff to cover shifts and They seem to be short staffed, so a few more care workers would probadly be a good idea. The staffing levels, especially the need for the manager to undertake the role as the sole RN on duty and the recruitment of permanent staff was discussed with the manager and provider.This would benefit continuity of care, assist with delegation of care tasks and give the manager the opportunity to introduce a named nurse/key worker system. The provider agreed to consider improving the staffing structure, staffing levels and the recruitment of permanent staff. Care Homes for Older People Page 23 of 31 Evidence: Care staff are encouraged to undertake national vocational training (NVQ). All permanent care staff have achieved NVQ at level II, one care assistant has completed level III and three care assistants have completed the assessors award. It was not evidenced whether the five bank care assistants have undertaken NVQ training, as any bank/agency staff working in the home should be included in the 50 per cent ratio of NVQ trained care staff. The standard of training within the home is good and staff who completed surveys made the following comments Good in-house training, Fully supports staff with NVQ or further educationand There are plenty of opportunities to go on study days. It is not evidenced that training opportunities or study days are extended to bank staff. There is a a staff training and development plan, this would benefit from being developed further and advise was given to the manager and provider about the organising of training records. Comments made on one staff survey to the question, what could the home do better included Everyone would benefit from regular updating and education on mental health issues in care of the elderly. At the last inspection two requirements were made, that the professional status of the RNs should be checked to ensure that it is current at the time of employment and that the full work history with any gaps in employment explained to ensure that effective robust procedures are in place. These requirements have been satisfactorily addressed. Since the last inspection two care assistants have been recruited to permanent posts. The manager was unable to confirm the date of their appointments as she said that the provider undertakes all staff selection and recruitment. Both staff files were examined, files contained a completed application form with inserts detailing employment history and a separate CV. The files contained copies of identification and a job description, the provider was able to evidence that a criminal record bureau checks had been completed via Oxfordshire county council. References had been obtained from previous employers or colleagues. The provider confirmed that he had taken up verbal references for one of the applicants and these were on file, the provider was aware that all references must be requested in writing. Although the provider had requested references in writing these had not been returned and he had not kept copies of the reference requests. Neither personnel file contained evidence of the interview process, start date or photograph. The provider stated that the date the care staff commenced employment was recorded on their contracts of employment, these were not available as the members of staff had not returned the documents. Following the inspection we received an action plan from the provider, detailing how he would be developing the staff application form to include all the Care Homes for Older People Page 24 of 31 Evidence: information required rather than the current practice of including inserts, he confirmed that all reference and CRB forms will dated and copies of correspondence kept on file, this was also ageed in discussion during the inspection. The provider also confirmed that the manager was to increase her input into the application process whenever practicable to ensure equal opportunities and that all staff files will include a staff photograph. Neither staff files contained evidence of any induction having taken place. The manager confirmed that one of the care assistants who had commenced ( working in the home) in the last few weeks had not yet started induction training as this was planned for the day of the inspection. All staff who completed a survey confirmed that appropriate checks had been completed before they started work and that staff induction covered everything very well that they needed to know to do the job. Staff meetings take place appropriately twice per year, the minutes of the last meeting held in April 2009 were seen. It was noted that only permanent staff attended and it is a good practice recommendation of this report that bank staff, as part of the staff team, should be encouraged to attend staff meetings. Care Homes for Older People Page 25 of 31 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 registered manager is an experienced manager and registered nurse. Although she is the homes registered manager, her role within the home is the day to day care of service users, no management time is allocated. The provider has agreed to review this. Quality assurance systems have been further developed since the last inspection. The requirement made at the last inspection regarding risk assessments has been addressed. Evidence: The manager Glynis Dunbar is an experienced manager and registered nurse. She has updated her skills and knowledge this year by attending several mandatory and specialist training courses, including a module at Brookes University to assess and facilitate nursing students on placement in the home. Although she is the homes registered manager, her role within the home is the day to day care of service users. Care Homes for Older People Page 26 of 31 Evidence: From discussion with the manager and examination of the duty rosters it is evidenced that the manager and the one permanent RN, who works day duty, cover the majority of day time shifts. During a two week roster, no management time was allocated. This was discussed with the manager and provider as we would expect the registered manager to be responsible for the day to day management of the home and staff team rather than covering care duties. The provider commented that the manager could work some additional hours, if she wished to complete any paperwork. The provider was asked to review the managers role within the home as currently the provider, who has an office in the home, undertakes the majority of the home administration, including all staffing issues. The manager does not have an office and service user daily records are kept the compact nurses station. The manager confirmed that she does not have access to a computer and would benefit from computer training. Throughout the inspection, records required to be kept in the home and requested had to be obtained from the providers office, the manager does not have access to the providers office, in his absence. There is a quality assurance system in place and this has been further developed in the last twelve months. A survey of service users and their relatives views about the care provided has been undertaken, the information analysed and a development plan agreed. Comments made by service users, staff and relatives, spoken to or who completed surveys said that they felt the home was run in the best interests of the service users. Several comments were made that the manager was approachable, caring and always available, Always prepared to listen and Works very hard. Comments were also made that although the provider is in the home regularly, he is rarely seen, although staff felt that they could speak to him with concerns or worries if the manager was not available. Procedures are in place for dealing with service users monies and valuables.The procedures have not changes since the last inspection and the manager said that the provider invoices service users or their relatives for any expenditure incurred. Service users are provided with a lockable space in their bedrooms, should they wish to keep any small valuables safely. Service users are advised to take out their own contents insurance. At the last inspection a requirement was made that the risks to peoples health and well being should be routinely assessed and suitable action taken to minimise risks. This has been addressed. Policies regarding the risk assessments of bed guards and a fire risk assessment have been completed. There is a Deprivation of Liberties policy in Care Homes for Older People Page 27 of 31 Evidence: place regarding the use of restraint. Regular audits are completed and include care planning, medication, infection control and the homes environment. The completion of the audits are shared between the manager and provider. Comments made on one survey received to the question, what the home could do better included Health and safety regarding the use of foot pieces on wheelchairs and staff awareness. Need more glide sheets for safe moving and handling. A sample of records relating to health, safety and welfare were examined and found to be well maintained and up to date. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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