Inspection on 28/04/10 for Belvoir Care Home

This inspection was carried out on 28th April 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Belvoir Care Home 01/07/10

Belvoir Care Home 27/07/07

Belvoir Care Home 16/05/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Belvoir Care Home 632 Halifax Road Rochdale Lancashire OL16 2SQ     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: Pat White     Date: 2 8 0 4 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 Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Belvoir Care Home 632 Halifax Road Rochdale Lancashire OL16 2SQ 01706377925 F/P01706377925 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Belvoire Care Home Limited Name of registered manager (if applicable) Mrs Mandy Pepper Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only to service users 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 The maximum number of service users who can be accomodated is: 24 Room 15 to be used only to accommodate the respite stay. Date of last inspection Brief description of the care home The home provides personal care and accommodation for 24 older people, including one respite stay bed. There are 14 single and five double bedrooms, with five of the bedrooms having the provision of en-suite toilets. A passenger lift to the first floor is provided. The home was originally two semi-detached houses, which were converted to provide one large home to which an extension was added at the rear of the building. There is a Care Homes for Older People Page 4 of 33 Over 65 24 0 Brief description of the care home small garden and patio area to the rear and car parking is also available. The home is located on the main road between Rochdale and Littleborough, close to shops and other local amenities. A bus route to/from Rochdale passes the home regularly. The weekly fees are between 372. 64 pounds and 388. 98 pounds. Additional charges are made for private chiropody, dentistry, hairdressing, specialist equipment and dry cleaning. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the most recent Inspection report is available within the home. Care Homes for Older People Page 5 of 33 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 inspection visit to Belvoir care home was carried out on the 22nd April 2010. This visit was part of a key inspection to determine an overall assessment on the quality of the services provided by the home. It included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People. At the last main inspection in 2007 the home was rated as a good service, so there were no serious concerns at that time that required checking at this visit. This key inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents care records and other documents and discussion with the manager and other staff. Four residents who were spoken with gave their views about the home and some of their views are included in this report. Other residents were spoken to but were unable to give their views about the home. Two relatives visiting the home at the time of the site visit were also spoken with and some of their comments are referred to in the report. In addition survey questionnaires from Care Homes for Older People Page 6 of 33 the commission were sent to some residents and staff for distribution. At the time of writing this report 10 residents and 9 members of staff had returned completed questionnaires, and their views expressed are also included in the report. In addition we have used and included information that the home provided, as required under the Care Homes Regulations, prior to the site. This includes information about the care, the premises, facilities and staffing matters, and their own views of the quality of the service provided in the home. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The way people are admitted to the home must be improved. Many recent admissions had been as an unplanned emergency, initially for respite care, and without thorough assessments to determine whether or not the home was suitable for them. One person did not have any written information about their needs at all, so there was no evidence that the home was a suitable place for them to live. Also people must not be admitted to Belvoir if they do not fit into the remit of the home, which is to provide care for frail older people, and without an assessment that shows their needs fall within that category. The written information in the care plans about what, and how, staff have to do to look after people properly must be improved. Some residents did not have a care plan at all, and others had care plans that did not include sufficient information on all matters relating to health and personal care, such as about falls, pressure areas, diet and leisure activities. Detailed written information about the care that people need is necessary to guide staff and ensure the correct care is given. Also the risks associated with everyday life should be properly assessed in such a way as to identify the risk, the Care Homes for Older People Page 8 of 33 level of risk and what staff need to do to reduce or eliminate the risk. This includes the risk of falling, pressure areas, and the risks associated with people administering their own medicines. This is necessary to help ensure people are looked after safely. The way medication is managed and organised in the home must be improved. The systems for recording the medication coming into the home and tracking that medication should be improved so that checks can be made on whether people are taking the correct medication. Also when people are managing their own medication there should be a proper risk assessment (see above) and support plan, that shows how people can do this safely, and explains the support needed from staff. Staff should also have written guidance about how, when and why to administer when required medication, including pain relief, so that residents receive this medication correctly and consistently according to their needs. The activities provided in the home should be improved and developed so that residents have interesting and fulfilling things to do. These activities should be developed according to individuals interests and preferences. Residents should also be consulted about the food served so that meals are provided that suit most peoples tastes. The training and procedures available to staff to guide them in what to do in the event of a suspicion or allegation of abuse or neglect should be improved. This is so that staff take the correct action and protect people as much as possible. The premises must be improved to provide a more pleasant and comfortable place for people to live in. A number of areas in the home were in need of repair and refurbishment, including the replacement of some furniture and carpets, the repair of toilet seats and a bath. Some of these matters were outstanding from the previous inspection 3 years ago. The training that is offered to staff should be improved. Even though most of the staff had completed the relevant National Vocational Qualifications staff had not undertaken suitable training in dementia and the protection of vulnerable adults (see above). Also most of the training was carried out in house through DVDs and staff would benefit from external training which is interesting, motivating and keeps people more up to date. The staff recruitment procedures could be more thorough to help ensure that unsuitable people are not employed in the home. All the necessary checks should be completed before people start work and their employment history should be fully explained so that management have information about past work experience and reasons for leaving jobs. The overall management of the home should be improved to ensure the home develops and improves in accordance with the Care Homes Regulations. and in accordance with the views of the residents. The owner was not monitoring the systems and services in the home satisfactorily as should be the case under the Care Homes Regulations, and had not taken action to address the requirements identified at our last inspection. The homes own systems of assessing the quality of the services in the home were not working properly, and the residents views were not being regularly or frequently sought. Care Homes for Older People Page 9 of 33 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 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 11 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures did not always assist staff to determine whether or not the home was suitable for people and could meet their needs. Evidence: There was written information about the home (the service user guide and the statement of purpose) to inform people of the services and facilities at Belvoir. However the copy of the service user guide kept in peoples room was not the most up to date so people living in the home may not have up to date and accurate details about the services and facilities. Also the updated version of the Statement of Purpose that was available in the hallway was not accurate as it stated that there was a bathroom suite on the first floor. However this was not in use due to a broken assisted bath, and the manager said there were no plans for having it repaired (see Environment). 10 residents, some assisted by relatives, who completed questionnaires from the Care Homes for Older People Page 12 of 33 Evidence: commission, all said that they had enough information to help them make a decision about whether or not the home was a suitable place for them to live. The most recent admissions to the home were described by the manager as emergency admissions for respite care. For one resident a senior member of staff had undertaken an assessment of their needs on the same day as the admission. Although this person had been in the home for a number of months there were parts of the assessment that had not been completed properly, such as the sections about, the residents previous life and interests and hobbies, footcare, food likes and dislikes and about falls. Another resident whose records were viewed, had been admitted as an emergency without an assessment. This person was younger whose needs were not described as those of an an older person, and was admitted primarily because there was no where else for this person to go at that time. No attempt had been made by the home to ensure that more suitable accommodation be found. There was no evidence, either in the records or information from the manager that this person was suitably placed. Thorough written assessments developed through well planned admissions are necessary so that staff understand peoples needs, and to help ensure that these needs can be met in the home and that the type of home is suitable for them. However in spite of the high numbers of recent unplanned admissions the people who completed the questionnaires, and those who were spoken with, indicated that in general they felt well cared for and that the physical needs were being met in the home. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all residents had written care plans that helped staff understand what care to provide, and some care plans did not include sufficient information on all matters of health and personal care. Medication systems and procedures would not ensure that all people received their medication correctly. Evidence: Not all residents had care plans detailing what and how care and support should be provided. Those residents referred to in the previous section and who had lived in the home for several months did not have a care plan. The manager stated that this was because they were not yet permanent. However both these residents urgently required written information about the care and support needed. We also looked at the records of another resident who had been in the home for a number of years. This person did have a care plan which was easy to follow and had some useful information to guide staff. There was also evidence that the care of this person was being reviewed and the care plan updated as necessary. However some parts of the care plan were not completed in sufficient detail. There were no instructions to staff about how to look after the catheter, the dietary section was not completed and there was Care Homes for Older People Page 14 of 33 Evidence: insufficient information about daily life and social activities. In addition there was no information on the care plan about what measures were in place to prevent pressure areas developing, and from which the resident was assessed as high risk. Records and talking to the manager showed that residents received the medical care they needed, including visits to the hospital as necessary and contact with the services for dementia. District nurses were involved as required and the chiropodist visited the home regularly. However not all residents had a call lead in their bedroom to enable them to summon help in an emergency and one resident had an unsatisfactory system in place to protect them from banging themselves against the wall whilst in bed. Both these matters were discussed with the manager and we were told that call bell leads had been ordered, and that she would ensure a more suitable way of protecting the identified resident whilst in bed. There were satisfactory written policies and procedures covering most aspects of medicines handling and that should provide useful guidance to staff. There were also some good practices. The prescriptions were checked by staff in the home before being sent to the chemist for dispensing and all staff who administered medication were seniors and who had received training from the community pharmacist. However through looking at the medication of the 3 residents whose records were viewed we identified a number of concerns and a confusing system in place. Some medicines had been dispensed both in boxes and in bubble packs. There was no guidance to staff about which to use and staff were using both in an ad hoc way. This made it difficult to audit and check that the right medication was being given. This problem was exacerbated because medication received into the home was not always being recorded and when there was surplus medicines the total number of the tablets was not recorded or carried forward into the next month. Also when boxes were being used the opening date was not always recorded. These oversights meant that there was no easy way of checking against the stocks remaining whether or not the right quantity of medicines had been given over a period of time. The manager said that the confusion in the systems and the surplus stock was partly due to dispensing errors by the community pharmacist. However she had failed to resolve this satisfactorily or set up a procedures to compensate and to direct staff in the best way of dealing with this. One person who was living in the home was administering their own medication. The risk assessment was unsatisfactory and did not include an assessment of any risks associated with this or how staff should monitor and ensure the medicines were taken. The manager was unsure whether or not this resident was taking the medicines correctly and whether they were re ordering them. She agreed to look into this, and had spoken to the person concerned before the end of the site visit. Care Homes for Older People Page 15 of 33 Evidence: There were concerns that one resident was not receiving when required and variable dose pain relief correctly as there was no written guidance to staff about what the pain relief was for, how much to give and when. As a result different staff were giving this according to different criteria, and at times none was given, even though the manager felt it should be given. This could result in the resident not having sufficient pain relief. More clarification was needed from the doctor and guidance about this should then be written down for staff to follow. We also found that controlled drugs were not being stored according to the Care Homes Regulations. Some morphine sulphate was stored with other medicines and had not been used for some time. This should have returned to the chemist to prevent mishandling of this drug. A referral was made for an inspection of medication by the commissions pharmacist inspector. There was evidence through the responses on the commissions questionnaires, observation on the site visit and talking to people that peoples rights to privacy and dignity were respected. People said that staff treated them properly, that they were well looked after and that staff carried out personal care in the right way. Care Homes for Older People Page 16 of 33 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. There were insufficient varied and stimulating activities but the food served was wholesome and varied and suited most residents tastes and preferences. Evidence: We were told that since the previous inspection, in spite of a recommendation, there had been little development in the provision of social activities and entertainment for people living in the home. We were also told that there were no organised trips out for people though they were encouraged to go out with visitors. There was not a designated activities coordinator and staff were expected to organise activities if and when they had time. Residents and staff spoken with felt that there was not much going on. However those who answered the commissions questionnaires indicated that there were usually suitable activities, so their perception of this was different to the view given at the site visit. We were also told that a 90th birthday party had been enjoyed recently and there was the general feeling that staff were doing their best under constraints of time. On the records viewed there was insufficient information about peoples previous interests and hobbies so this did not assist staff to provided stimulating activities that suited peoples interests and preferences. There were also told that local church ministers visited the home, but there was little information on the care plans about peoples spiritual needs, so it was not clear whether or not Care Homes for Older People Page 17 of 33 Evidence: peoples spiritual needs were being met. Daily routines were sufficiently flexible to suit individuals, and residents said they could get up and go to bed when they wanted and spend time in their rooms. Residents in general were satisfied with the level of choice they had. Two visitors to the home were spoken with at the time of the site visit. They told us that they were felt welcome in the home, could visit at any reasonable time, and that staff were friendly and approachable. They also said that communication between the staff and themselves was good and that they were kept informed of health matters and changes in peoples condition. To assess the food served we spoke to residents, looked at the menus and observed 2 meals served. People also commented on this in the commissions questionnaires. The comments made by residents spoken with ranged from the food was very good to it could be better. People who completed the questionnaires were generally positive about the food served. Menus showed that each day there was a choice of 2 hot meals at lunch time and choices of a lighter meal at tea time. The main hot meals served on the day of the site visit appeared tasty and wholesome. The menus viewed showed a good variation of traditional dishes. The lunch time meal observed was relaxed and unhurried and staff assisted people appropriately. The cook ensured that blended food was served in an appetizing way for individuals. Some comments that residents made about the food were discussed with the manager and she explained that she was already taking action. However it was unclear how residents views were taken into account when the menus were developed as there was not a specific system in place that involved them. Care Homes for Older People Page 18 of 33 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 what to do if they were not happy with something in the home and felt that their concerns would be taken seriously. However the procedures and the training available for the Protection of Vulnerable Adults would not help staff take the right course of action to protect people living in the home. Evidence: The home had a complaints procedure that appeared to be accessible to people, as all those who completed the commissions questionnaires stated that they knew what to do if they were not happy about anything. There was a copy of this available in the hallway and in the service user guides. Residents spoken with said that they would speak to the manager or another member of staff about matters of concern, and at the time of the site visit we observed a resident raising a matter with the manager who said she would deal with it. However the complaints procedure needed updating with respect to the commissions contact details and did not give any information about the Social Services and their role in the investigations of complaints. The information provided by the home prior to the site visit stated that two complaints had been made to the home in the last 12 months. None had been made directly to the commission. The records we looked at indicated that the complaints referred to were Safeguarding of Vulnerable Adults incidents (see below). These had been correctly reported to Social Services and there was some records kept that explained the incidents and the background. However there were no records of the action taken Care Homes for Older People Page 19 of 33 Evidence: by Social Services, the investigations made, and of the outcome of the investigations. So it was not clear how these matters had been concluded. The home had the local authority safeguarding information and procedures, but the homes step by step procedures and guidance to staff was not available at the time of the site visit. The manager said there were appropriate procedures but that a member of staff may borrowed them. Suitable step by step procedures must be available in the home for staff to follow at all times so that staff know what to do in the event or suspicion of abuse. In addition according to the records available to us at the site visit only a small proportion of staff had undertaken training in the Protection of Adults from Abuse, and this had been done through a DVD watched in the home. There was no external training that would help keep staff up to date with the correct government and local procedures. Therefore a recommendation made at the last inspection 3 years ago had not been met. There was evidence that staff needed to undertake this training in order to help protect people as a member of staff spoken with did not know the correct action to take. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided clean and safe accommodation for the residents. However not all parts of the home were well decorated and furnished and these areas of the home did not provide a pleasant environment for people. Evidence: A tour of the premises was undertaken which showed that a number of improvements needed to be made and that were outstanding from the previous inspection 3 years ago . Although some improvements had been made, such as some lighting had been changed to make areas lighter and brighter, and some rooms, including bedrooms, had been decorated, there were still parts of the home in need of urgent repair and refurbishments. These included decorating in the communal areas, replacement of some furniture, repairs to music playing appliances, and some new beds and carpets. Some doors and skirting boards would also benefit from restoration. In particular one small corridor near the dining room needed decorating and a storage heater there needed covering, one bedroom carpet with a deep hole and unsightly stains needed replacing, toilet lids needed replacing and a broken bath on the first floor either needed decommissioning or repairing. The manager was not sure if this bath was needed as people either used the shower on this floor or the bath on the ground floor. She agreed that there should be consultation with the residents about this. The fire equipment in the home had been serviced within the last 12 months and the Care Homes for Older People Page 21 of 33 Evidence: homes other safety measure were satisfactory. Most of the storage heaters were covered (see above) and the first floor windows had window restrictors. The hot water supply at outlets tested at random was of a safe temperature. All areas of the home viewed were of a satisfactory standard of cleanliness and there were no unpleasant odours. Staff had undertaken suitable training in infection control to help ensure satisfactory standards of hygiene and cleanliness. Care Homes for Older People Page 22 of 33 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 appeared to be on duty in sufficient numbers and with the right skills and experience to meet the physical needs of the residents, but the training offered to staff could be improved. The staff recruitment procedures were adequate, though could be more rigorous to help ensure unsuitable staff will not be employed in the home. Evidence: There appeared to be sufficient members of staff on duty at the time of the site visit to ensure that the physical needs of the residents were being met, and that staff continuity was good as most staff had worked in the home for a number of years. But we were told that there were insufficient staff on duty to organise regular and consistent activities based on individual needs. Some staff who completed the questionnaires for the commission did not feel there was always enough staff on duty. We were also told that there had been recent changes in staffing numbers and arrangements, including a reduction in administration hours, and that that further changes were planned including a reduction in management hours (see next section). There were concerns amongst staff about the impact on the home if these changes were implemented. A cook and cleaner were working in the home and this helped to ensure that good standards of food and cleanliness were maintained. Care Homes for Older People Page 23 of 33 Evidence: A high number of care staff had gained National Vocational Qualifications in care. We were informed that 16 out of 17 staff were qualified to at least NVQ level two. Records and discussion with the manager showed staff mainly took additional training in the core areas of moving and handling, fire safety, food hygiene, infection control and first aid. However most of this training was mainly in house through training package DVDs, though some staff had undertaken training from outside trainers in moving and handling, fire safety and infection control. Relying on mainly in house training packages could mean that staff do not have the benefit of new ideas taught in a stimulating environment. Also there was no evidence that staff completed training in dementia even though there were a significant proportion of residents with varying degrees of confusion and memory loss. As stated in a previous section only a small proportion of staff have undertaken appropriate training in the safeguarding of vulnerable adults. However those staff who completed the questionnaires did not perceive any shortfalls in the training they received so it was unclear what the impact of the gaps in the training were on staff and residents. The programme of induction for new members of staff was being developed in accordance with the current government guidance on this, and which should help to ensure that any new members of staff employed in the future have the necessary skills and knowledge to commence work. With respect to staff recruitment we were told that only two members of staff had been recruited since the last inspection (see above) and that these were not recent appointments. The records of these two members of staff were viewed. For one member of staff the recruitment procedures were sufficiently thorough and all the necessary checks, including the criminal records bureau check and references, were carried out before she began work in the home. However the other member of staff had commenced work in the home a few weeks prior to the Criminal Records Bureau check being obtained and there was no evidence that the Protection of Vulnerable Adults check was in place during this interim period. Also the employment history on the application form was incomplete and no written explanation of any gaps in employment. Not following thorough recruitment procedures for everyone may allow unsuitable people to be employed. Care Homes for Older People Page 24 of 33 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 is managed by a qualified and experienced manager, who is registered with the commission. However the overall management of the home needs to be improved in the best interests of residents and staff. Evidence: The manager had been in post for about 10 years, was registered with the commission and had all the necessary qualifications for someone managing a care home. However there were concerns that the management hours were gradually being reduced and that the manager was having to spend more time on admin and caring duties. It was also unclear as to what support the owner gave to the manager and to the home, as there was no evidence of the monthly monitoring visits that the owner is required to make or delegate under the Care Homes Regulations. We were told that the visits were taking place but that the records of these visits were kept at head office. However it was clear that such visits had not identified the matters of concern highlighted at this inspection, or led to the improvements that are needed. In addition the homes own written assessment of its services and facilities that it is required to Care Homes for Older People Page 25 of 33 Evidence: annually send to the commission was not well completed. It was short in detail and did not present a realistic view of the home. Few of the matters identified at this inspection for improvement were mentioned in their assessment, and we were not told about how the management felt the home could be improved. We were told that the homes own quality monitoring systems included the use of resident and relative questionnaires. However a questionnaire survey not been carried out since 2007 and residents meetings were not being held on a regular basis. Staff meetings were also not being held as frequently as the manager would wish. Therefore there was no evidence that the home was being developed according to the views of residents, relatives and staff. Residents finances appeared to be managed safely. The records kept for the fees paid were clear, well kept and up to date. Spot checks on 2 residents spending money that was kept in the home showed that the cash remaining balanced with the amount shown in the records. The records were clear and up to date and receipts for items purchased were kept. The home appeared to be generally a safe place for people to live and work. The information provided by the home referred to above, stated that all the appliances and installations had been serviced and maintained appropriately. Staff had undertaken health and safety related training, such as moving and handling and fire safety. The fire precautions were viewed and were satisfactory. Records showed the equipment was tested, and fire drills were held, with sufficient frequency. However the fire risk assessment had not been developed with the involvement of an expert in this field, and therefore it was not clear whether or not it was a suitable basis for the fire precautions. Care Homes for Older People Page 26 of 33 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 33 26 (5)(b) The provider needs to demonstrate to CSCI that Regulation 26 visits are undertaken so that we can be sure that he is fulfilling his responsibility in accordance with the law. 31/08/2007 Care Homes for Older People Page 27 of 33 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 3 14 People must not be admitted 28/05/2010 to the home without a thorough written assessment of peoples needs to help determine whether or not the home can meet their needs So that staff have written information to help them understand peoples needs and how to provide the right support. 2 4 14 People must not be admitted 28/05/2010 to the home unless it is determined that the home is suitable, and that their needs are best met in a care home for older people. So that people live in the right place where staff have the right training, background and experience to support them correctly. 3 7 15 All residents must have a written care plan that 28/05/2010 Care Homes for Older People Page 28 of 33 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 instructs staff on what care and support people need and how this should be provided So that staff know how to support people and so that people are given the right care and support. 4 8 13 A suitable system must be 28/05/2010 implemented to prevent the resident identified from injuring themselves whilst in bed. So that residents are safe from injury whilst in bed. 5 9 13 When people manage their own medication there must be an assessment of any risks involved, what needs to be done to minimise the risk and what monitoring staff must do to ensure the medication is taken So that people take the correct medication and remain as healthy as possible. 6 9 13 There must be a clear and 28/05/2010 accurate systems for recording and administration of medication that includes how to manage medicines that are dispensed in 28/05/2010 Care Homes for Older People Page 29 of 33 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 different ways and when there is a surplus. So that medicines can be checked to ensure that they are being given correctly. 7 18 13 There must be step by step procedures in the home at all times for staff to follow and suitable training in the Safeguarding of Vulnerable Adults. So that staff know what to do to protect people living in the home from abuse or neglect 8 19 23 All areas of the home must be well maintained, furnished and decorated, including carpets and furniture. So that residents live in a pleasant comfortable environment. 9 25 13 Residents must be protected 28/05/2010 from heaters that are too hot. So that residents are not at risk from burns from hot heaters 10 31 26 Regulation 26 visits must demonstrate that areas of improvement are identified and acted upon and these 28/05/2010 30/06/2010 30/06/2010 Care Homes for Older People Page 30 of 33 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 must be made available for the commission to inspect at any time. To ensure efficient management and development of the home. 11 33 24 Effective quality assurance systems need to be developed to demonstrate thorough internal auditing is undertaken and involves those people living at the home ensuring a quality service is provided. 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 30/06/2010 1 2 1 9 People should be given accurate and up to date information about the home There should be sufficient written guidance to staff on how to administer when required and variable dose mediciation so that the correct dose is given at the right time There should be stimulating and varied activities based on individual needs and interests that are fully recorded in peoples care plans. People should be properly consulted about the food served in the home and any individuals concerns and preferences raised should be addressed. The complaints procedure should be updated with respect to the commission and social services. 3 12 4 15 5 16 Care Homes for Older People Page 31 of 33 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 6 18 Full and accurate records should be kept of all complaints and Safeguarding incidents that include the action taken by all the different parties involved, the investigations and the outcome of the investigations. There should be a review, involving the residents, on the use of the upstairs bath and a decision based on this whether the assisted bath is to be repaired or decommissioned. There should be sufficient staff on duty, or the staff organised in such a way, to ensure suitable activities are organised for the residents. Staff recruitment procedures should always be in accordance with the Regulations, and people should not commence work before all the necessary checks have been completed and the employment histories have been fully explored and explained. Staff training should be extended to include dementia and other specific subjects and more outside training courses should be made available to staff. 7 21 8 27 9 29 10 30 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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