Inspection on 20/07/09 for Belgarth Nursing Home

This inspection was carried out on 20th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Belgarth Nursing Home 26/06/07

Belgarth Nursing Home 15/05/06

Belgarth Nursing Home 21/11/05

Belgarth Nursing Home 21/06/05

Belgarth Nursing Home 08/03/05

Belgarth Nursing Home 26/07/04

Belgarth Nursing Home 03/02/04

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Chirnside House

Keer Sands Residential Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belgarth Nursing Home Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP     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: Marie Matthews     Date: 2 1 0 7 2 0 0 9 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. 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. 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 34 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Belgarth Nursing Home Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP 01282699077 01282619030 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bellgarth Care Home Limited care home 47 Number of places (if applicable): Under 65 Over 65 0 0 47 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 47 47 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, Dementia - Code DE, Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of people who can be accommodated is: 47. Date of last inspection Brief description of the care home Belgarth is an extended detached older building situated on the outskirts of Barrowford, approximately one and a half miles from Nelson centre. The home is registered to provide both nursing and personal care for twenty-two people who have physical and care needs and for twenty-five people with a dementia or a mental disorder. Facilities are on two floors with a passenger lift to access the first floor. Care Homes for Older People Page 4 of 34 Brief description of the care home The home has garden and patio areas for people to enjoy and provides a parking area for visitors. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £412.00 to £560.00. Items not included in the fee include newspapers, hairdressing, chiropody and escorted hospital visits. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection, including a visit to the home, took place on 20th and 21st July 2009. The last inspection on this service was completed on 26th June 2007 with an annual service review taking place on 10th June 2008. The inspection process included looking at records, a tour of the home, discussions with the deputy manager, five care staff, three visitors and six residents. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Information was also included from anonymous surveys completed by five residents and eight staff. The registered manager was on leave at the time of the inspection visit. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The medication procedures needed to be reviewed to reflect the current practices and Care Homes for Older People Page 8 of 34 to provide safe guidance for staff. Some medicine practices should be reviewed as they could result in medication errors being made and could place residents at risk. Activity records need to be more detailed as they did not always support that residents social needs were met or reflected the range of activities that had been introduced. There were concerns that some residents routines were determined by staffing numbers rather than choice. The home needs to ensure that some care practices were reviewed to ensure all residents were able to make choices and decisions about their lives. The adult protection procedures need to be reviewed to provide clear and accurate guidance for staff; this would ensure any incidents would be referred appropriately. The home needs to ensure that all incidents that affect residents well being and safety were referred to the appropriate agencies in accordance with safe guidance; this would prevent residents being placed at risk. There were concerns that a safe recruitment procedures had not been followed and that this could place residents at risk of being cared for by unsuitable people. Residents should be encouraged to participate in the annual survey and meetings should be arranged to allow residents and their relatives to regularly air their views and opinions about the service. Not all records were available during the key inspection as the registered manager was on leave; records should always be available for inspection to help us to monitor whether the home was being managed properly. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with information about the home that helped them to decide whether their needs would be met. Residents needs had been assessed prior to admission and staff had the skills and experience to look after people properly. Evidence: People were given clear information about services offered at Belgarth to help them to decide whether it was the right place for them to stay. The service user guide should include a copy of the most recent inspection summary to keep people up to date with the current situation in the home. Each resident had a signed copy of their contract or terms and conditions with the home; this would ensure residents and their relatives were aware of their rights and responsibilities whilst living at Belgarth. Care Homes for Older People Page 11 of 34 Evidence: Detailed information was collected from various sources about new residents before they were admitted to the home; this would help to determine whether their needs would be met. Residents and their relatives were involved in the assessment process; this would ensure all aspects of their needs were considered. The deputy manager confirmed that people would be invited to visit the home, view the facilities and meet with staff and other residents before making a decision to live there; this would help people to decide whether Belgarth was the right place for them. In the absence of a training matrix it was not clear what the current competies of staff were; however discussion with staff and other records confirmed that staff had a range of skills and experience to meet the needs of the residents in the home. It was noted that one new member of staff had received an introduction to the home but there was no formal record of this (see standard 30); records would support that new staff were familiar with the routines of the home and safe to practice. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans had improved and recorded how residents health and personal care needs were being met; residents and their relatives had been involved in decisions about their care. Some medication practices need to be improved and procedures did not always reflect current practices or provide staff with safe guidance which could place residents at risk. Evidence: Four care plans were looked at in detail. The care plans had been developed from assessment information and detailed the action to be taken by staff to meet residents needs. Residents and their relatives had been involved in the development and review of the content of the care plan; this showed that residents were involved in decisions about care. Care plans had been reviewed regularly but need to be reviewed at least every month to ensure the information is up to date and reflects any changes to care. The care plans included useful information about residents routines, preferences, likes and dislikes and residents said staff listened to them and acted on what they said; this Care Homes for Older People Page 13 of 34 Evidence: would help to ensure they received the care and support they both needed and wanted. Residents said they received the care and support they needed and were provided with a range of aids and adaptations to improve their comfort and safety and to help maintain their independence wherever possible. Any risks to residents had been assessed and appropriate action taken to keep them safe. Residents health had been monitored and appropriate advice and support sought as needed. Care staff were trained in health care matters which would help them to recognise and respond appropriately to any changes to residents health and well being. A system was in place to monitor the content of care plans although this was fairly informal; the deputy manager was advised how this could be improved. The medication procedures did not reflect the current practices within the home and must be reviewed to provide safe guidance for staff. Further additions were needed to support staff with administering as needed or PRN medicines (as recommended at the last key inspection visit), witnessing handwritten entries and supporting residents who wished to manage their own medicines. We found evidence that prescribed creams were being used for other residents and labels had been changed by staff; this practice must cease as prescribed creams were the property of whoever they were supplied for and changes to labels could put residents at risk of not receiving the correct treatment. The records were generally clear and showed that residents medicines were managed safely. However handwritten entries had not always been witnessed, codings had not always been used for medicines that were not administered and the application of external creams was not signed by the person who was responsible for this task; further advice was given to improve this practice. Storage was secure and appropriate. Care staff with responsibility for medicines were given training although records of training were not available at this inspection; staff advised that medicines could only be given by suitably competent staff and the provision of training in this area was confirmed by the registered provider following the inspection visit. Care Homes for Older People Page 14 of 34 Evidence: Advice was given to the deputy manager regarding the introduction of regular checks to ensure staff were managing residents medicines safely. Staff had received training to help them to maintain residents rights to privacy and to respect their privacy and dignity. Staff were observed responding to residents and visitors to the home in a friendly and respectful manner. One resident said she had been unwell and had been visited by her GP in the privacy of her bedroom. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of activities had improved although did not always meet residents needs and expectations. Some care practices did not allow residents to exercise control and choice over their lives. Residents received a healthy and nutritious diet that met their dietary needs and expectations. Evidence: An activities person had been employed to provide a range of activities to meet residents social needs and expectations; however records were incomplete and did not support that residents social needs were met or reflect the range of activities that had been introduced. Useful information regarding residents preferences, routines and interests had been collected as part of the care plan; this would help to plan suitable activities for individual residents. Residents indicated there were sometimes suitable activities available but said there could be more activities. Some residents enjoyed spending time alone either in their bedrooms or in the garden and this was respected; one resident enjoyed watching TV in the lounge but said the TV is not big enough for everyone to see. Two other residents said they had been able to go to the local shops or park but that this had been with support from their relatives. Care Homes for Older People Page 16 of 34 Evidence: Some residents were able to make choices and decisions and some said staff listened to them; other residents had to rely on staff to make the right decisions for them. Staff said routines were flexible and residents were able to make choices in a number of areas such as meals, routines and how they spent their day. However there were concerns that some residents routines were determined by staffing numbers rather than choice. Examples of this included some residents (on the dementia unit) were unable to go to their bedrooms throughout the day unless they were poorly and if residents wanted a sleep or a lie down they had to use recliner chairs on the unit. This concern had also been raised in the recent survey. There had been a complaint stating that residents, particularly on the dementia unit, were not given choices regarding times of rising and retiring and were being taken to bed as early as 7pm; staff confirmed that some residents were taken upstairs from 7.30pm onwards although they could choose whether to sit in the lounge or in their bedrooms. It was clear from looking at records and discussion with that residents preferred routines had not always been considered and staff had followed instructions determined by staffing numbers rather than choices. A previous recommendation had been made, following the complaint, that staffing levels were adjusted to ensure resident had choices and routines were flexible; rotas showed an extra staff member had been recruited but that this had not improved the flexibility of routines for all residents. The home needs to ensure that some care practices were reviewed to ensure all residents were able to make choices and decisions about their lives. Visitors were made to feel welcome and staff were friendly and respectful towards them. One resident said he was looking forward to going to visit his son and staff had helped to arrange this. One resident said they are good with families and make them comfortable and another said my visitors can come anytime. People were given information regarding visiting times and were advised to avoid visiting at mealtimes. Records showed that residents were offered a choice of appetising and nutritious meals; residents and staff confirmed they would also be offered alternatives to the menu. Comments included I like the food, I have always had a good appetite, I like the food well enough and I enjoy the food, there is always a choice. One resident said they enjoyed the weekly fish and chip supper from the local chip shop. One visitor said he was able to make his own drinks in the small kitchen area. There were hot and cold drinks and biscuits available for residents throughout the day. Since the last inspection there had been concerns raised that residents were unable to have any food after 7pm when the kitchen was closed. Staff confirmed that food was always available in the small kitchen after tea and the fridge was replenished on a daily basis; they confirmed that residents were always given something to eat before Care Homes for Older People Page 17 of 34 Evidence: bed and throughout the night if needed. Following the complaint we made a recommendation that records of food served were maintained to support the provision of suppers; however this had been disregarded. Dining rooms were clean although tablecloths were still not provided on the dementia unit as this had been assessed as a risk to residents; it was recommended that this was reconsidered. The lunchtime meal was hot, nutritious and well presented and residents said they enjoyed it. Staff gave residents unhurried assistance and support with their meals ensuring residents had time to enjoy their meals. Special diets were catered for and staff were aware of residents food preferences; this ensured residents received a diet that met their needs and preferences. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People knew who to speak to if they were unhappy and the complaints procedures were accessible to most people. People were protected from abuse and neglect by staff awareness although failure to follow safe procedures could place residents at risk. Evidence: There was a clear complaints procedure and records of any complaints or concerns raised. The procedure was issued to people with the service user guide at the time of admission which would inform people how the service would deal with any complaints or concerns. In the past twelve months there had been three complaints forwarded to the Care Quality Commission (formerly CSCI) and one directly to the home. The content and outcome of these complaints had been referred to under the relevant standard. Complaints and concerns were monitored each month by the regional manager and the information was used to improve the service. Information from surveys and discussion with residents and visitors supported that people knew who to speak to if they were unhappy with the service. Staff were aware of how to respond to complaints and concerns; this would ensure people would be listened to. There adult protection procedures provided useful information for staff and would help them to recognise and respond to any reports or suspicions of abuse or neglect. The Care Homes for Older People Page 19 of 34 Evidence: procedures needed amending to clarify that all incidents must be reported under safeguarding and must not be investigated by the person in charge; this would ensure that the procedures would be followed properly. Staff were aware of how to recognise and respond to abuse or neglect and had received training to support them with this. Safeguarding adults had been discussed with staff at recent meetings which would help keep them up to date with current guidance. In the past twelve months there had been five incidents that had been referred to the local authority under the safeguarding adults procedures; three of these were currently being investigated. Two of these incidents had not been referred in accordance with safe guidance; this indicates lack of awareness of the procedures and could place residents at risk. Following a review of records there were concerns that thorough recruitment checks were not in place prior to employment of new staff; this could place residents at risk of being cared for by unsuitable people. (See standard 29). There were procedures to support staff with reporting any poor practice within the organisation; staff who were spoken to understood their responsibilities and this would help to protect residents. There were procedures to support staff with dealing with aggression and the use of restraint measures. The use of bed rails had been assessed, discussed with residents and their relatives and kept under review; this would help to determine whether this form of restraint was appropriate. It was recommended that staff were provided with training in the Mental Capacity Act and Deprivation Of Liberty Safeguards; this would help them to understand how this related to residents in their care. There was still no procedure (as recommended at the last key inspection) to support staff with the management of residents finances; the procedure would support staff with safeguarding residents monies. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe, clean, comfortable and well maintained with evidence to support ongoing improvements. Evidence: During a tour of the home it was clear it was well maintained, safe, bright and comfortable with a development plan to support ongoing improvements; this would ensure residents were provided with a pleasant place to live. Grounds were safe and accessible and seating was available for residents and their visitors to enjoy the gardens in the warmer weather. The home complied with the requirements made at the last visits from the fire safety officer and environmental health officer. Comfortable communal areas and quiet seating areas were provided on both units; this gave residents and their visitors a choice of where to meet. The communal areas had been improved on the dementia unit creating more space for people to enjoy. Senior staff said improvements to the unit were being considered in line with good practice guidance; examples included memory boxes, appropriate colour co ordination, clearer signage and reminiscence items. Care Homes for Older People Page 21 of 34 Evidence: A number of bedrooms were equipped with en suite facilities however there were bathrooms and toilets located close to bed rooms and communal areas. The home was equipped with specialist equipment and adaptations to meet residents individual needs and maintain their comfort. Residents were happy with their rooms which were clean and bright; some had brought in personal items to enhance the homely feel. Bed room doors were fitted with suitable locks and each room had a secure drawer for storage of valuables; keys were available and this respected residents rights to privacy. The home was warm, clean and bright; residents said the home was fresh and clean. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were competent, supported and provided in sufficient numbers to meet the needs of the current residents. Failure to follow a safe recruitment procedure could place residents at risk of being cared for by unsuitable people. Evidence: In the past twelve months there had been a complaint regarding insufficient staff and the home had been asked to provide records to support the home was staffed appropriately. Staffing rotas were clear and showed there were sufficient staff to meet the needs of the current residents and shortfalls had been covered, where possible, by existing staff; this would ensure residents were looked after by staff who knew them. Staff said there were enough staff but they were sometimes let down by unreliable staff. Six residents and two visitors said there were usually enough staff, two residents said there could be more staff and another said staff response to buzzers could be better. One resident said some staff are more pleasant than others and there are enough staff, they work hard. Residents made positive comments about the staff including the staff are very nice, Im looked after, the staff are very pleasant and youll find nothing wrong here, the staff are fantastic. Care Homes for Older People Page 23 of 34 Evidence: Staff said there was a good team and residents were well looked after and everything is done as it should be. There were clear recruitment procedures although they needed minor amendment to reflect that new staff would be able to commence employment under supervision on receipt of a clear POVA First check. Three staff employment and training files were looked at in detail. There were concerns that safe recruitment procedures had not been followed and that this could place residents at risk of being cared for by unsuitable people. Examples included one file did not have a completed application form, none of the files included evidence of a POVA first check and only one file included a current criminal records bureau (CRB) check. Two of the files did not contain the required two references and one reference had arrived following employment, references had not been verified (as per procedure) and there was no record to support a fair interview and selection process had been followed. The reference forms needed minor review as they did not clearly indicate the details of the referee in relation to the application form. Staff had been given the company handbook and a contract of employment but not a job description; these records would make staff aware of their rights and responsibilities whilst employed at Belgarth. There should be a recent photograph maintained on staff files as a means of identification. Most of the staff had achieved a recognised qualification in care and other staff were working towards one; this would give them the skills and knowledge to meet peoples needs. There were records to support all staff were provided with ongoing training and support to give them the skills and knowledge to help them meet residents needs although a copy of the training matrix was unavailable at the time of the inspection visit. Staff confirmed they were given relevant training. One said I get the support, experience and knowledge I need and others confirmed they received induction and relevant training; this showed the organisation was committed to improving standards by providing competent staff. New staff received an introduction to the home and were initially supported by senior staff until they had the skills and confidence to work independently. One new member of staff said she had received her induction although the records to support this were not seen at the time of the inspection. See standard 4 and standard 37 for any requirements and recommendations made under the above staffing outcomes. Care Homes for Older People Page 24 of 34 Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe although systems to measure whether peoples needs and expectations were being met could be improved. Evidence: The registered manager is Mrs Lynne Markham; she has the required qualifications and experience to run the home. Mrs Markham is supported by a senior manager and her practice is monitored at regular intervals. She is able to meet and discuss any issues with other registered managers within the organisation and is kept up to date with changes to legislation and the organisations plans for the future. Relatives had participated in an annual survey and the results had been made available to visitors to the home; some of the issues raised in the survey were discussed following the key inspection. There was no evidence that residents had been involved in the survey or that meetings had been arranged to allow residents and their relatives to regularly air their views and opinions about the service. A recommendation Care Homes for Older People Page 26 of 34 Evidence: relating to this was made at the last key inspection visit. The home had achieved the Investors In People award; this is an quality assurance award accredited by an outside body and demonstrates a commitment to staff training and development. Policies and procedures had been reviewed and updated to provide staff with safe guidance; staff were also issued with company handbooks to support them with their work at Belgarth. The AQAA indicated that systems were in place to monitor all aspects of staff practice and whether residents needs were being met although records to support this were not seen. The deputy manager had introduced a system of informal care plan checks and advice was given to help develop this further and to include the monitoring of medication practices. Complaints and concerns were monitored by the regional manager and the information was used to improve the service. There were records to support regular visits from a senior person in the organisation; records supported that the management of the home was monitored. Financial records could not be accessed as both the administrator and registered manager were on leave. The deputy manager was able to discuss the financial procedure and practices within the home. Records were clear and residents or their relatives were invoiced for any additional charges such as hairdressing, chiropody and newspapers; although there was no procedure to support staff with safe practice (see standard 18). Records were stored safely. There were gaps in some records that had been referred to under individual standards; these included records relating to safe management of medicines, the provision of activities, records regarding food served, safe recruitment processes, management of residents finances and the provision of training. Not all records were available during the key inspection as the registered manager was on leave; records should always be available for inspection to help us to monitor whether the home was being managed properly. Recommendations and requirements relating to staffing and recruitment issues from standard 29 have been made under standard 37 - records. Good practice recommendations to help improve safety and outcomes for residents and relatives had been made following the last key inspection and in relation to a recent complaint; it was noted that some of these had not yet been responded to and Care Homes for Older People Page 27 of 34 Evidence: further recommendations were made. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the past twelve months and where further improvements were needed. Records supported that systems and equipment were safe and well maintained. Staff had been provided with regular training that would keep themselves and others safe. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication procedures must be reviewed to reflect safe and current practice in the home. This will ensure medicines are managed safely and residents are not placed at risk. 24/08/2009 2 12 12 Residents wishes, decisions and choices must be taken into consideration. This will ensure residents are able to exercise choice and control over their lives wherever possible. 24/08/2009 3 18 13 The safeguarding adults procedures must reflect that all incidents must be referred to the local authority for investigation and these procedures must be followed at all times. This will ensure any reports, suspicions or incidents of abuse or neglect are 24/08/2009 Care Homes for Older People Page 30 of 34 investigated in accordance with local guidance and residents are protected. 4 37 19 A safe and thorough recruitment procedure must be followed and staff must not be employed until satisfactory checks are in place. This will ensure residents are protected from unsuitable people 5 37 17 Records as listed in Schedule 3 must be available at all times for inspection purposes. This will help to determine whether the home is being managed properly. 24/08/2009 24/08/2009 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 1 The service user guide should include a summary of the most recent inspection report ; this will help to keep people up to date. An up to date training matrix and staff training records should be available for inspection; this would help to identify the current competencies of staff. All new staff should have a formal record of their introduction to the home as part of the induction process; this will ensure new staff have been made familiar with their role and are safe to practice. A review of the care plan should be undertaken at least monthly; this would ensure the information is up to date and reflects any changes to care. Handwritten entries on medication records should be witnessed to reduce the risk of error. Page 31 of 34 2 4 3 4 4 7 5 9 Care Homes for Older People 6 7 9 9 The application of external creams should be signed by the person who was responsible for this task. The practice of sharing prescribed creams with other residents and altering the names on the labels should be reviewed. Appropriate codes should be used for any medicines not administered. There should be procedures to support staff with administering as needed or PRN medicines, witnessing handwritten entries and supporting residents who wished to manage their own medicines. Consideration should be given to providing a larger TV in the main lounge; this would benefit all residents who enjoy watching TV. Records should reflect the range of activities that residents participate in. Records of food served throughout the night, should be maintained; this will support that residents nutritional needs and choices are met. Consideration should be given to providing tablecloths and condiments on the dementia unit; this will help to improve the dining experience. There should be a procedure to support staff with the management of residents finances; the procedure would support staff with safeguarding residents monies. It was recommended that staff were provided with training in the Mental Capacity Act and Deprivation Of Liberty Safeguards; this would help them to understand how this related to residents in their care. Systems should be in place to monitor whether staff were following policies and procedures and whether peoples needs were met. Residents should be able to express their views of the service and participate in the annual survey. Resident and relative meetings should be arranged to give people the opportunity to air their views about the service they receive. All applicants should complete an application form. Applicants should provide a recent photograph as a means of identification. References should be verified as part of the recruitment process to help identify whether they are authentic. 8 9 9 9 10 12 11 12 12 15 13 15 14 18 15 18 16 33 17 18 33 33 19 20 21 37 37 37 Care Homes for Older People Page 32 of 34 22 37 The reference form should reflect the designation of the referee and the company they are from; this would help to identify whether the reference has been given by an appropriate person. The recruitment procedures need minor amendment to reflect that new staff would be able to work under supervision on receipt of a clear POVA First check. A record of the interview and selection process should be maintained to support that a fair process has been followed. 23 37 24 37 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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