Inspection on 08/02/10 for Belmar Nursing Home

This inspection was carried out on 8th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Belmar Nursing Home 04/02/09

Belmar Nursing Home 06/02/08

Belmar Nursing Home 30/05/07

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

Barkerhouse Road (123)

Fernhaven

Thames House

Creative Support

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY     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: Lesley Plant     Date: 1 2 0 2 2 0 1 0 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 Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY 01253739534 01253796447 belmarnh@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Belmar Care Home Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only: Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 4), Mental disorder, excluding learning disability or dementia: Code MD. The maximum number of people who can be accommodated is: 44. Date of last inspection Brief description of the care home Belmar Nursing Home is situated in a residential area of Lytham St Annes. The home provides a number of lounge and dining rooms plus a conservatory, which is the designated smoking room. There are gardens to the front and side of the building plus a small area at the rear of the home where vegatables are grown. The home is currently registered to provide personal and nursing care to up to 44 Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 4 44 0 4 0 2 2 0 0 9 Brief description of the care home people, with 40 places for people with mental health problems and four places for people over 65 with dementia. Details of the fees can be obtained by contacting the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for people who use the service and involved gathering information about the Belmar from a wide range of sources over a period of time. The inspection was unannounced and was carried out over two days. At the time of the inspection visits there were 32 people living at the home. All of the key national minimum standards, plus the standard relating to staff supervision, were assessed. Time was spent talking to service users, staff and the manager of the home and staff were observed carrying out their duties. Records were viewed and a tour of the building took place. Care Quality Commission surveys were received from seven service users, two relatives, four members of staff and a social care professional with close links to the home. Information from these surveys is included within this report. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the Care Homes for Adults (18-65 years) Page 6 of 36 home, also provided some useful information. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? Staff appear to be taking better care of service users clothing. This is important as it can impact upon self esteem. A recorded handover sheet is now used to pass information when staff change shifts. The nursing staff on duty agreed that this was very helpful and along with the daily records, gives a good picture of how each person has been. There is a signing in and out book for service users, to ensure that staff know who is in the building. Although not always used, more service users are now complying with the request to use this book. The regular community meetings give good opportunities for individuals to air their views. Service users have been involved in devising new menus and meals are now served over a longer time period resulting in meal times being much calmer and more relaxed. A training matrix for the staff team is now in place showing what training has been undertaken by each member of staff. This helps to identify any gaps and shows which courses need to be arranged. The refurbishment of the home has continued, resulting in service users now having a better standard of accommodation than at the last key inspection. New boilers have been installed and a number of bathrooms and toilets have been totally upgraded. Some of the original bedrooms have been made bigger and some have been given en suite facilities. The managers office is now on the ground floor, meaning that the manager is more available to staff and can more easily spend time in the main areas of the home. Care Homes for Adults (18-65 years) Page 8 of 36 The general cleanliness of the home has much improved and along with the refurbishment, helps in providing a more pleasant environment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Assessments take place prior to people being admitted to the home, helping to ensure that their needs can be met. Evidence: The AQAA states that written information is available for prospective service users and any other interested parties. This gives information regarding the purpose of the home, the support provided by staff, the accommodation, contractual terms and details of the complaints procedure. There have been few admissions to the home since the last key inspection. At the time of this inspection there were 32 service users resident at the home. An individual who had been living at the home for three months was spoken to, assessment records were viewed and the process of this admission discussed with the manager of the home and the senior nurse who had conducted the assessment. Good information had been gathered prior to admission. The service user had visited the home as had the social worker and a relative. During these visits relevant Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: information was gathered from all three parties. This helps to ensure that all views are taken into account and that everyone concerned has opportunity to give their account of the support required. The assessment documentation viewed identifies all the main areas of need and from this information the care plans are developed. A detailed social work assessment was also available. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans and risk management plans are in place. However these lack detail, are not person centred and there are inconsistencies regarding how support is provided. Evidence: Written care plans are in place and documentation is signed to indicate that care plans are being reviewed. However a number of care plans viewed did not give clear directions regarding how the identified need was to be met. Care plans need to be more person centred and guide staff in how the support is to be provided. A care plan stating that an individual should be educated on the hygiene aspect of continence and the hygiene of their bedroom needs to give more precise guidance to staff regarding how this is to be done and by whom. Not all care plans are signed by the service user concerned. Where individuals are either unwilling or unable to sign in agreement, the reason should be recorded and agreement gained from the social worker or relative. This is particularly important when restrictions, considered to be in the best interests of the individual, have been Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: imposed. Specific care plans regarding restrictions, such as limiting alcohol were viewed on files. Generally the alcohol reduction programmes are working well and are resulting in healthier lifestyles for those concerned. However, if the service user is not in agreement this should be recorded and agreement gained from the social worker or representative. If necessary an application for authorisation regarding deprivation of liberty should be made to the local authority. Staff keep good daily records which give a picture of how each person has been each day. Incident recording is clear, showing what happened before hand, what the incident was and how it was dealt with. More use should be made of these records as it does not appear that this information informs the review of care plans. For one person an incident record showed that prior to the incident the individual had been complaining of being given one can of beer instead of two. There are two written care plans for this person, with one saying that they have one can of beer a day and another saying two cans a day. Four members of staff were spoken to, with three having differing views of the agreed amounts of alcohol for this service user. These conflicting views may have directly lead to the serious incident taking place. One person at the home has intensive support needs, regarding mobility, eating and continence. Care plans are being regularly reviewed, a moving and handling risk assessment is in place, records show that fluids are monitored and there is a risk assessment in place regarding using bed rails. This is good practice as bed rails do pose certain potential risks. Conflicting information was found regarding an individual who, like a number of service users, is reluctant to restrict his smoking to the designated smoking room and smokes in his bedroom. The manager explained that this had been risk assessed and a risk reduction plan was in place. This included staff checking the bedroom to ensure that a metal bin and ashtray were in place, that these were regularly emptied and that windows should be opened for ventilation. However, the nurse on duty stated that if he found this person smoking in their bedroom he would re direct him to the designated smoking room. This service user can become verbally and physically aggressive and it is important that the staff team apply a consistent approach. Some good risk management plans were viewed on files. For one person the plan clearly outlined the support required to attend a health appointment, stating the transport to be used, that two staff were needed and that staff should take a mobile phone with them. However, other risk management plans did not give clear directions as to what staff should actually do. Records for one person state that they can be attention seeking, argumentative and verbally aggressive, but the risk management Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: plan only gives general advice to staff and is not personalised. Risk management plans regarding behaviour need to give staff clear direction regarding what helps and what doesnt help. This is particularly important for agency staff who may not know the individual service user very well. Care planning and risk management need to be improved, with all staff having clear guidance regarding the support required. There still appears to be a lack of communication between different groups of staff and this needs to be addressed. At present these shortfalls are causing mixed messages for service users and are not helping to reduce the difficult behaviour displayed by some individuals. There needs to be a consistency of approach. A robust key worker system and strong management leadership would help in this area. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Activities are provided and people enjoy the meals at the home. Evidence: The people living at the Belmar have very different needs. Some people are able to arrange their own social life and others may have difficulty communicating their preferences. It is acknowledged that for many people with mental health problems, motivation may be low and for some people their medication may also have an effect on their levels of motivation. At the last key inspection there was an activities coordinator in post and individual care plans regarding activities were being put in place. Staff changes have been made and a new activities coordinator is soon to commence duty. The manager is keen to introduce rehabilitation activities and there are also plans to provide gym equipment in the outbuilding which used to house laundry equipment. The small ground floor Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: kitchen, where cookery sessions were held is now out of use due to the building of the new extension and the internal refurbishment of the home. There are plans to refurbish this kitchen for the use of service users, as the cookery sessions had proved popular in the past. During the two days of this inspection staff were observed playing dominoes and board games with individuals and giving the ladies a manicure. A valentine celebration was planned, with a buffet, decorations made by service users and a music therapy entertainer booked for the party. A singer comes to the home each month and a music therapy session also takes place each month. Records show that service users go for walks and occasional meals out. Some people have links with the local community mental health team and access activities at this base. One person enjoys gardening and grows vegetables in an area created for him at the rear of the home. Some service users are able to access the local area without staff support and have built up community links. One person explained that although he had decided to give up his part job in a bar, he may look for employment in the future and he felt that staff would provide support if necessary. Service users could be more involved in the daily routines of the home. Activity plans could be developed to promote more independence by supporting individuals to take part in daily household activities, such as doing their ironing or cleaning their bedroom. For one person a care plan was in place regarding the individual wanting to live more independently, stating that they had agreed to drawing up a list of activities which would help toward this goal. However this had not yet been done. The manager is keen to introduce rehabilitation activities, which will help people to develop skills and increase their independence. Staff record on the daily notes if anyone has had a visitor or contact with their family. Visitors are made welcome as seen during this inspection visit. Service users can meet with visitors in one of the large lounge areas, the conservatory, dining room or their own bedroom. Improvements have been made regarding the provision of meals at the home. Meal time periods have been extended, allowing for some people to take their meal earlier if they wish. Two dining rooms are in use and this along with the staggered meal times has helped meal times to become a calmer experience. A printed and laminated menu card is made available each day, showing that days meal options, which are also displayed on a menu board on the door of the main dining room. Service users were involved in devising the new menus and the meals served during both days of Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: the inspection were nicely presented and enjoyed by the inspector and service users. The main meal is now served at tea time, with lunch being a lighter snack meal. Breakfast consists of cereal and toast, with a cooked option which changes each day. Lunch is a choice from soup, sandwiches and a hot meal, with tea being a choice from three hot meal options, one of which is vegetarian. The cook explained that she is aware of individual preferences and special diets needed by some service users. There is a cook and a kitchen assistant on duty each day. Service users spoken to stated that they enjoy the meals at the home and there were also favourable comments about the food, on the CQC surveys completed by service users. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care needs are generally being met. Medication arrangements are not being monitored and a lack of good practice in this area could pose risks for service users. Evidence: The people living at the home require varying degrees of support with their personal care. Some people are reluctant to accept support from staff. Although care plans are in place regarding personal care, these could be more personalised with details of what helps and what doesnt help individuals to maintain an acceptable level of hygiene and change their clothing. A daily work allocation is written by the senior care staff on duty each morning. This gives details of which staff are responsible for certain tasks, such as supporting service users to go to the bathroom or helping certain individuals to get washed and dressed in the morning. This helps to ensure that service users are supported with their personal care. A handover sheet is now used to aid information sharing between the different staff shifts. The nursing staff spoken to stated that this was proving useful. Some individuals at the home are reluctant to accept assistance with personal care. One service user is more likely to accept support from male staff and the staff spoken Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: to were aware of this. This should be included within the care plan, as detail such as this will be particularly useful for agency staff. Generally service users were looking clean and tidy. The newly equipped laundry and having a designated laundry worker appear to be helping the care of clothing. Each service user has a hospital transfer form on their file, with useful details that can be taken with them if they were to be admitted to hospital. Blood sugar levels and weights are monitored as appropriate to the individual and records are maintained. Records are also kept of any health care appointments, allowing health issues and their treatment to be tracked. One of the senior care assistants explained that they check the diary each morning to ensure that no appointments are missed. It was noted that referrals to specialists such as dietitians are being made. Specialist input is also provided from the local community mental health team, who carry out reviews for individuals they are involved with. A CQC survey was completed by a social care professional with close links to the home who commented. The service is clearly trying to deliver improvements and have demonstrated changes to practices when issues have been raised by ourselves. Medication is safely stored in locked medication trolleys, which are kept in the nurses office. Medication is only handled by qualified nursing staff. Medication administration records for five service users was viewed and showed that staff sign the record when medication has been given. The dispensing pharmacist provides most medication in pre packaged cassettes. At the last key inspection it was noted that staff date any medication not provided in the cassettes, such as liquids when it is opened. This helps to ensure that medication is not given when it is past its use by date and also provides an audit trail, which can be monitored. This good practice is no longer being consistently carried out. Staff record on the medication administration record if medication has been refused by the service user. This is good practice but if a service user regularly refuses their medication this should be discussed with relevant professionals such as the GP and social worker and addressed within a care plan. Staff need to be proactive in supporting service users to comply with their medication regime and if necessary have individualised care plans in place. The last key inspection recommended that handwritten entries of prescribed medication should be checked and signed by two staff, to help avoid mistakes being made. It was also recommended that any medication prescribed to be given when required should have accompanying guidance directing staff as to when this should be given. This will help to ensure that this medication is being administered consistently Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: by all staff, including agency nurses, who may not know the individual service user. These recommendations have not been put into practice. A concern had been recently raised regarding individuals who drink alcohol and are taking prescribed medication. The inspector was informed that each persons GP was aware of this, yet there was no record of this being discussed with individual GPs or any recognition of any associated risks that might occur. This needs to be addressed formally with the appropriate GPs and clear records of any agreements or associated risks maintained on file. There is no formal system for auditing medication procedures. This should be put in place to ensure that staff are working to agreed good practice procedures. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for dealing with complaints are in place. Staff training helps to give staff an understanding of safeguarding issues. Evidence: A formal complaints procedure is in place and is available to those living at the home. The majority of service users who completed CQC surveys responded that they know how to make a complaint and all responded that they know who to speak to if they are unhappy about anything. The responses on staff surveys also confirmed that staff know what to do should anyone raise a complaint or concern. The manager has introduced monthly community meetings where those living at the home can air their opinions. Minutes of these meetings were viewed. These forums also provide opportunity for service users to raise any individual or collective concerns or ideas for improvement. Since the last key inspection most of the team have attended safeguarding training, provided by a local training group and the home also has a training pack which can be used with staff. Training regarding safeguarding and protection is seen as mandatory and includes the importance of staff reporting any bad practice that they may witness. The majority of care staff have completed NVQ (national vocational qualification) programmes which also address issues of protection and vulnerability. Some people living at the home are not able to manage their own money and have Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: some personal spending money held in safekeeping for them. The administrator keeps clear records of income and expenditure and where possible the individual will sign for any money received. These arrangements help to protect the finances of service users. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 is clean and most parts of the building available to service users have been refurbished, providing a reasonable standard of accommodation. Evidence: The refurbishment of the home has continued and has resulted in service users now having a better standard of accommodation than at the last key inspection. New boilers have been installed and a number of bathrooms and toilets have been totally upgraded. Some of the original bedrooms have been made bigger and some have been given en suite facilities. A new phone system has also been installed which means that staff working in different parts of the building can communicate with the nurses office and seek assistance if required. The managers office is now on the ground floor, meaning that the manager is more available to staff and can more easily spend time in the main areas of the home. The old managers office in the basement has been refurbished and is now used for meetings or staff training sessions. The service users spoken to were happy with their bedroom accommodation. Most individuals are now in upgraded rooms, with the rooms awaiting refurbishment, in the main being kept empty. The extension, which will house five en suite bedrooms is well under way. There are no plans as yet to increase the number of people accommodated as the overall aim is to provide better accommodation for service users within the Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: currently agreed numbers of people who can be accommodated. A CQC survey completed by a social care professional with links to the home acknowledged the recent improvements at the home. Comments included; Over the last year they have provided better facilities in terms of rooms and a meeting office to provide more privacy. There are plans to furnish the old laundry room with gym equipment, to use the small kitchen on the ground floor as a rehabilitation kitchen, to have a new conservatory built and a new lift installed. Improvements have been made to the laundry facilities at the home. The laundry, which used to be in a separate building at the rear of the home, has been re sited in the basement. New laundry equipment has been installed and there are dedicated laundry staff employed at the home. There is a team of cleaning staff working at the home. Improvements have been made since the last key inspection, with the parts of the home viewed all appearing clean. The conservatory, which is a designated smoking area, is now being cleaned more frequently as are other key areas of the home. The newly refurbished bathrooms are more easily cleanable and everywhere was smelling fresh, with no unpleasant odours. A relative who completed a CQC survey stated, Since the new management, the standard of cleanliness has improved. The rooms and beds are definitely cleaner. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Qualification training opportunities and recruitment practices are well managed. A well structured induction programme, a robust core training programme and regular supervisions for staff would help to improve the quality of the service. Evidence: At the time of this inspection visit there were 32 service users resident at the home. The manager aims to have six care staff plus a qualified nurse on duty each day. These staffing arrangements were in place on the first day of the inspection, however on the second day of the inspection there were four care staff on duty, with two of these being agency staff. During the night there are three staff on duty, including a qualified nurse. In addition to direct support staff there is an administrator, maintenance worker, laundry worker cleaning staff and kitchen staff. The good levels of ancillary staffing mean that nursing and care staff can focus on their support role and do not have to carry out other duties at the home. Seven of the ten care staff, including senior care staff, have achieved a NVQ (National Vocational Qualification) at level 2 or above. Two members of staff are working toward their level 2 award. The promotion of NVQ training is a strength of the service and shows that staff have had their work practice assessed and have been deemed competent in their role. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: There have been a number of staff changes since the last key inspection, with the manager of the home working toward building up a team of staff who have the right skills, knowledge and attitude to help to move the service forward. At present there are a number of vacancies and a recruitment drive has commenced. Interviews are planned for recruiting more nursing staff and there are also plans to appoint a deputy manager/lead nurse. Once the vacancies are filled, the need to use agency staff will reduce and a more stable staff team can be established. Records were viewed in relation to two care staff in post for seven months. Documentation included a copy of the interview assessment, two references, a health questionnaire, application form and a criminal records bureau disclosure, which included a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable adults. The manager is aware of the need to make a reasoned and considered judgement before appointing any person with a past conviction and that a record of this should be maintained. New staff receive a copy of the General Social Care Council code of practice and have a formal appraisal review after three months in post. The manager would then extend the probationary period if the staff members performance was not satisfactory. These recruitment procedures help to ensure that only appropriate staff are appointed and given a permanent contract. There is now a training matrix for the staff team, showing what training has been completed and the courses which are seen as mandatory. Since the last key inspection most of the team have completed fire safety training and training regarding safeguarding issues. Training regarding safeguarding and protection is seen as mandatory and includes the importance of staff reporting any bad practice that they may witness. Although the majority of staff have attended moving and handling training in the past, there is a need for refresher training in this area and it is important that more recently appointed staff also attend this programme. The senior nurse is planning a programme of essential training which will take place during the coming year. Skills for Care, the national training organisation for the social care sector have produced induction standards for new care workers and all new staff should work through this programme of induction. This addresses all basic health and safety topics, including moving and handling, first aid and infection control. Two members of staff who commenced at the Belmar last summer started to work through the Skills for Care induction standards, however the full programme was not completed. One of Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: these staff was spoken to and confirmed that he had worked alongside more senior staff during his first few weeks of employment. It is important that a structured induction programme, which meets agreed standards is put in place for all new staff and that regular refresher training in key health and safety topics is provided to existing staff. This will help to ensure that all staff are working in ways which promote the health and safety of service users. The manager has introduced a system of formal supervision for nursing and care staff and some records of these meetings were viewed. Supervision sessions are not yet happening on a regular basis and this should be addressed. Although regular staff meetings take place, regular supervision for staff will help to ensure that all are working to a good standard and and are following agreed procedures. A robust system of staff supervision is an essential element of quality monitoring. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Effective quality monitoring and quality assurance systems need to be put in place. This will help to ensure that improvements are made and sustained. Evidence: The manager, who commenced at the home in May 2009 is a qualified and experienced registered mental health nurse and is currently undertaking the level 4 Leadership and Management award, which is seen as the appropriate qualification for managing a social care service. The manager confirmed that an application to be registered has been submitted to the CQC. A new administrator has also commenced at the home. The previous manager still works at the home on a part time basis and is to focus on staff training for the foreseeable future. There are plans to recruit a deputy manager. Nursing staff and senior care assistants also carry out some management duties at the home. The on call system was discussed with the manager of the home, who confirmed that there is always a senior manager available for emergencies at weekends and during each night. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: A social care professional with close links to the home, completed a CQC survey and commented, The management is open to discussion and feedback. Surveys from staff also contained favourable comments about the manager including; The manager listens well and tries to take time for all staff and is approachable for any help or questions. The new manager is clearly keen to make improvements and during the inspection visit talked about the changes necessary and shared his ideas for providing an improved service. The manager has now had time to settle into their new role and should concentrate on putting plans into practice, which will result in more positive outcomes for those living at the Belmar. Quality assurance and quality monitoring will be a key factor in effecting change at the home. The managers office has been relocated from the basement to the ground floor of the home, meaning that the manager is more readily accessible to staff and can also, with an administrator in post and the change of office location, spend more time in the main part of the home. It is essential that both the manager and the nursing staff are able to spend time working alongside care staff, observing and directing work practice. During the two days of this inspection visit nursing staff tended to stay in the nurses office dealing with medication and doing paperwork. Although these are important tasks there is a need for these senior staff to demonstrate good practice and lead the staff team. There have been a number of staff changes since the last inspection and the manager is now focused on recruiting staff with the appropriate skills and abilities to work at the home. It is important that this recruitment drive continues and that the use of agency staff is kept to a minimum. The improvements to the building and the start of the new bedroom extension have also required management oversight. It is now essential that quality monitoring and quality assurance systems are established and embedded into the service. At present there are regular service user meetings and staff meetings, which provide good opportunities for people to air their views and for agreed ways of working to be discussed. There is however a need for more robust quality assurance at the home. There has been no auditing of medication practices, which has resulted in the recommendations made at the last inspection not being consistently carried out. The issues of communication and consistency regarding care planning and the delivery of support, as outlined in this report need to be addressed and monitored. Robust quality monitoring is essential if improvements are to be made and sustained. Regular formal recorded staff supervision sessions will help in this area, as would the strengthening of the key worker system. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The provider company has links with a health and safety consultancy firm who provide guidance in this area. The manager confirmed that recommendations made by the local fire and rescue service have either been addressed or are being worked toward. Action has been taken to minimise the risk of fire in relation to service users who smoke in their bedrooms. This needs to be kept under continual review. At the last environmental health agency visit it was advised that fly screens be fitted to the new windows in the kitchen and this has been done. Regular checks take place regarding fire equipment, emergency lighting, water temperatures and portable electrical equipment and the accompanying records were seen. Each bath has a bath thermometer attached and staff record the water temperature each time a bath is used. There is a signing in and out book for service users, to ensure that staff know who is in the building. Although not always used, more service users are now complying with the request to use this book. Kitchen staff take responsibility for health and safety in their area of work and monitor the temperature of the fridge and freezer to ensure that safe temperatures are maintained. The need for all staff to undergo training in health and safety related topics has been addressed within the staffing section of this report. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 24 Quality assurance and quality 30/05/2009 monitoring systems must be established. (Previous timescale not met.) Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There must be 31/03/2010 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. In order for service users health to be protected. 2 37 9 There must be a manager who is registered with the CQC. This will confirm that the manager is suitable to manage the home. 01/06/2010 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 6 Where restrictions have to be imposed, these should be agreed with the person concerned or their representative, social worker or relative. This will help to ensure that any restrictions are in the individuals best interests. Care Homes for Adults (18-65 years) Page 33 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 6 Where possible individuals should be fully involved in the drawing up of their care plan and sign to agree the content. This will help to ensure that people are getting the support that they want and need. Care plans should be person centered, clearly state how the support is to be provided and be communicated to all staff. Strengthening of the key worker role may help in this area. Risk management plans should be person centred, communicated to all staff and give clear directions regarding the agreed approach. This will promote consistency in the support provided and help to keep people safe. Individual activity plans which promote independence should be developed. Meaningful activities will help service users to develop skills and interests. Regular audits and checks should be carried out to ensure that medication is being handled and recorded appropriately. Care plans should be put in place for service users who regularly refuse to take prescribed medication. These should address any potential risks and detail how staff can promote compliance. Any medication prescribed to be given when required, should be supported by written guidance detailing the circumstances under which this is to be adminstered, promoting conistency. Where indviduals are known to be drinking alcohol, advice should be sought from the GP and this should be recorded. This will help in identifying and minimising any potential risks. Medication which is not supplied in the cassette system, such a liquids, should be dated when opened. This will help to ensure that out of date medication is not used and that medication can be properly audited. All handwritten entries on medication administration records should be checked and signed by two staff. This will help to prevent errors being made. The refurbishment plan for the home should continue. This will result in the home being an attractive, comfortable and Page 34 of 36 3 6 4 9 5 16 6 20 7 20 8 20 9 20 10 20 11 20 12 24 Care Homes for Adults (18-65 years) 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 homely place to live. 13 35 All staff should receive training regarding health and safety topics and refresher training in these areas is also important. Staff will then have the knowledge and skills necessary for their work. Staff should undergo a structured induction programme in line with nationally agreed standards. This will help to ensure that staff are equipped for the tasks they are to perform. All care and nursing staff should receive formal recorded supervision at least six times a year. Formal supervision can address work practice issues and training needs and help staff to work to agreed standards. 14 35 15 36 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!