Inspection on 08/03/10 for Bentley Court Care Home

This inspection was carried out on 8th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Inspirations

Westmead

Hopwood Court

Coton Hill House

Doddington Lodge

Innage Grange

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: Bentley Court Care Home Bentley Court Care Home 29 Nordley Road Wednesfield Wolverhampton West Midlands WV11 1PX     The quality rating for this care home is:   zero star poor 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: Rosalind Dennis     Date: 1 0 0 3 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 30 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 30 Information about the care home Name of care home: Address: Bentley Court Care Home Bentley Court Care Home 29 Nordley Road Wednesfield Wolverhampton West Midlands WV11 1PX Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Debbie Rowley Type of registration: Number of places registered: care home 77 Priory Elderly Care Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 77 The registered person may provide the following category of service only: Care Home with Nursing, Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category/ies: Old Age, not falling within any other category, Code OP (36) Dementia, Code DE (41) Date of last inspection Brief description of the care home Bentley Court is a three storey purpose built building located along a residential road in the Wednesfield area of Wolverhampton. The home is close to local bus routes for Wolverhampton, Walsall, Cannock and Birmingham. It is also close to local community Care Homes for Older People Page 4 of 30 Over 65 41 36 41 0 Brief description of the care home facilities including shops and healthcare services. There is ample off road parking with specific spaces for people who have disabilities. There is a level access front entrance. It has a welcoming reception area and an assisted toilet facility for visitors. The majority of bedrooms have en-suite facilities consisting of a toilet and wash hand basin. A number of bedrooms have en-suite facilities that include a walk in shower. There are two spacious lounges and dining rooms on each floor. The main lounges and have an induction loop system, to support people who have hearing impairments. There is a choice of stairs or passenger lift to the first floor and there is level access to a patio and rear garden, which is fully enclosed. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. The guide did not contain information on the range of fees charged therefore the reader is advised to seek information direct from the service. Inspection reports produced by CQC can be obtained direct from Bentley Court or from CQCs website at www.CQC.org.uk. This is the first inspection of this service. Care Homes for Older People Page 5 of 30 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: zero star poor 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: This key unannounced inspection was carried out over two days in total. One inspector and CQC local area manager visited the home on the 8th March 2010. One inspector returned on the 10th March to continue the inspection. This is the first inspection of the home since the service was registered with us on the 7th July 2009. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. The purpose of this inspection was to assess all key standards - that is those areas of service delivery that are considered essential to the running of a care home. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the Care Homes for Older People Page 6 of 30 home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). The AQAA is a document that should provide information about the home and how they think it meets the needs of people living there. The AQAA, which had been completed by the manager provided us with a good level of information about the home, although our findings show that the information did not reflect what is actually happening in the home. We also looked at information which we had received from other agencies, including the local safeguarding adults team. We case tracked six of the people we met during the inspection. Case tracking involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The people we case tracked were not able to tell us about their day to day life at the home and the support they receive from staff. We also met other people during the day, including visitors to the home and spent time in different areas of the home observing staff in their work. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with some staff to establish their views of working at the home and to establish if anything needs to be improved. The manager was present on both days of our inspection as were company representatives, so we were able to provide feedback to them about our findings. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 Older People Page 8 of 30 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 9 of 30 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. People are at risk of not receiving the care they need because the home is not ensuring assessment processes are effective in looking at individual needs prior to and on admission to the home and how to meet those needs safely. Evidence: We looked at the care records for people who live in different parts of the home and found that people have not had full assessments of their needs undertaken before they were admitted to the home. Enough information should be obtained at the time of a persons admission so that staff know how people want and should have their care needs met. We found there was a lack of information to show that staff had looked at peoples likes, dislikes and preferences so that their care could be planned to take account of these. For example, one persons assessment states that they require assistance with their personal care but does not identify any details as to how this should be provided. We saw delays from when people have been admitted to when plans for their care have been written and assessments of risks to their health, safety Care Homes for Older People Page 10 of 30 Evidence: and welfare undertaken. This means it is unclear how staff have been able to know and provide safe and effective care people. We saw that the home has a Statement of Purpose and a Service User Guide available in the reception area for people to read, so that they know about the home and services offered. One relative we spoke with said that these documents had given them valuable information when they were considering the home. We looked at the service user guide which contains information about the home, although it does not include the fees charged which it should do, so that people know the range of fees. In December 2009, the local authority took the decision to suspend new placements at the home, following concerns raised through the local safeguarding adults process. This suspension remains in place at the time of our inspection. Care Homes for Older People Page 11 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because staff are not effective in ensuring care is provided according to the needs of the person or when risks to the health and welfare of that person are identified. Evidence: We spent time in different parts of the home, observing how people were being looked after by the staff working at the home. We saw that people appeared clean. Of significance to our inspection is those people who are unable to feedback their views, and are reliant on staff being aware of their needs and how to meet them. It is therefore important that care records are accurate and contain sufficient information so that staff have guidance to follow on how to meet individual needs and that any risks to the individual are clearly identified. We examined care records for six people, which shows that the home is not adhering to legislation or good practice guidance in how it assesses, plans and reviews peoples care. We saw that the home has used core care plans, in planning peoples care. Core care plans are documents which are already written and have spaces for staff to include Care Homes for Older People Page 12 of 30 Evidence: specific information about the person. The core care plans we saw in the care files of people whose care we looked at were poorly written and were not based on good practice guidance. For example, a core care plan about promoting tissue viability (skin care) included comments such as up in chair for one minute every two hours, expose skin to air and did not reflect the level of care and equipment needed to reduce the risk of pressure sores and sore skin occurring. A core care plan about washing and dressing did not include anything to show that peoples preferences had been looked at such as whether they prefer a bath or shower or which toiletries they prefer to use. The care plan included comments about promoting healthy skin by lubricating dry skin but did not say with what. A core care plan in one persons care records guided staff to assess the persons breathing rate every four hours, but there was no evidence to suggest this has been carried out and no reason to indicate why it would be needed as the care plan identifies that they do not have breathing difficulties. We found what had been written in core care plans for social and religious needs was inappropriate and showed a lack of understanding by staff about those needs. We found poor recording in respect of wound care and management, such as gaps in recording to show that wounds have been re-dressed, measured or monitored. One person had a care plan describing that they have a wound and bruising to their arm. Their plan informs staff that they need their wound dressing changed every other day, yet a wound assessment chart showed the wound had been re-dressed once after five days in January 2010. We could not find any further records to say whether the wound had healed. For another person we saw that a specialist in tissue viability had been involved in their care and had written specific advice and guidance to the home in January on the management and treatment of the persons wounds. When we looked at the persons care records, their care plans had not been updated to reflect this advice. The records also indicate that the treatment was not used until almost two months after it was advised. The deputy manager confirmed that the home obtained the treatment some time ago, yet our findings in the care records suggest the person has only recently started the treatment. We spoke with a nurse involved in the persons care who was able to tell us the treatment currently being used, which correspond to that advised by the tissue viability specialist. We saw that a person who had been assessed as being at very high risk of being malnourished was seen by a doctor when they lost some weight. Staff had written in the persons daily notes that they needed to monitor the persons food and fluid intake. We looked at these records but they were inconsistent and often gave insufficient information, giving comments such as breakfast, lunch and tea, which does not give a full account of dietary intake. We also looked at charts where staff had recorded the persons weight and found them difficult to follow and that they did not Care Homes for Older People Page 13 of 30 Evidence: confirm the same weight loss, which had triggered the doctors visit. We found that staff had assessed peoples moving and handling needs but the guidance to staff on how to move people safely was not adequate in that it did not contain enough information about the equipment and staff needed. We also saw that written information could be confusing to staff and thus place them and the person at risk of harm. For example we saw that staff had documented that a person uses a frame with two staff to help them mobilize, a week later staff had written no changes to moving and handling needs chairbound. Their care records showed that a social care professional involved in their care had requested a plan for the person to mobilize. However the care records indicated the person had only been supported to mobilize twice in over a month. Care records suggest a lack of understanding and awareness about caring and supporting people with dementia. One persons care plan stated make the person understand that changes are due to the disease and that they are getting irritable due to inability to recall events. The care plan does not promote positive person-centred care or include guidance to staff on the best ways to communicate with the person or the support needed to maximize their abilities. None of the care records for the people whose care we looked at indicated that the person or their representatives have been consulted with or involved in the writing or reviewing of their care plan. We saw that people who had bed rails on their beds had assessments in place to show that staff had assessed the risk of using bed rails. However there was nothing to suggest that staff had discussed the use with the persons representative. We looked at the Medication Administration Records for the people we case tracked which showed that these were up to date and properly recorded. Medication is stored in locked cupboards and trolleys so that people are not at risk of taking medication they are not prescribed. In the medication storage room on the dementia care unit, we found medicine which is injected to help control blood sugar was not being stored correctly, despite the label on the medicine giving clear instruction on how it should be stored. We also found in the fridge two tubes of eye ointment, which had dates written on them to indicate when they had been opened. The ointment had been opened for longer than 28 days. The nurse confirmed that the people for whom the eye ointment was for, no longer need it but could not explain why it had not been discarded and was still being stored in the fridge. The temperature of the medication fridge and storage room on the dementia care unit was satisfactory but on the nursing unit we found the temperature of the medication fridge to be too high. Care Homes for Older People Page 14 of 30 Evidence: The manager showed us documents which she is planning to introduce so staff involved in medicine administration, have an ongoing assessment of their competency. We were also shown, by the company representative, new care documentation which is to be implemented at the home, which should help to guide staff in assessing and planning the care people need. We discussed that it would also be good to incorporate guidance from the specialist consultant in dementia care who was visiting the home during the inspection, into the care planning process. Care Homes for Older People Page 15 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with sufficient opportunities to enhance their wellbeing and there is a lack of evidence to show that their likes, dislikes and preferences are taken into consideration when meeting their daily needs. Evidence: During our inspection we met with a consultant who specialises in dementia care and who has been enlisted by the company to support staff to develop and enrich the experiences of people living at the home who have dementia. This is positive as our observations at this inspection shows there is currently very little to involve, engage and stimulate people. We spent some time in one lounge on the dementia care unit and observed reactions from a group of people and observed interactions between them and staff. Music was playing loudly and continued to do so throughout the morning. None of the people seated in the lounge appeared to be listening or enjoying the music. At one point, the music stopped and two people began to engage in conversation. Within a few minutes a member of staff came and switched the music back on and the people stopped talking with each other. It was apparent from observing peoples reactions that they were disturbed by the music but the staff did not seem to notice. One staff member Care Homes for Older People Page 16 of 30 Evidence: was throwing a ball for people to catch and although they were encouraging people to join in, people did not seem to be enjoying the game or wanting to participate. Another staff member took over but had little effect with engaging people in the activity. This staff member also seemed unsure of how to guide a person away from sitting on a small table. We saw one person repeatedly opening their bedroom door and making comments, none of the care staff interacted with this person or used techniques to guide them away from what they were doing. A housekeeper walking by their bedroom was the only staff member seen interacting with this person and to engage in conversation with them. Of the people whose care we looked at throughout the home, we found that limited information was available about individual likes, dislikes and preferences. There was little to show that staff had explored peoples religious and cultural needs as well as looking at what was meaningful to the individual before their illness and what is important to them now. This was included in our feedback on the first day of our inspection. On the second day of our inspection we found a calmer atmosphere on the dementia care unit and the care staff on duty had improved techniques in engaging with people. We observed two care staff asking people about their previous life experiences with variable success and a nurse was seen asking a family for these details in a short period of time. We suggested to the manager that something which is so important as a persons life history should be written over time, involving the person and all those important to them, rather than rushing to obtain the information. Peoples past experiences, likes and dislikes will then help staff to know more about the person so that they can provide care and support which focuses on the person as an individual. We saw a copy of the homes activity programme in the main reception, but this was not an accurate reflection of what we saw on the unit where people with dementia live. The AQAA completed by the manager, describes how people have a good choice of activities, which does not support our findings from the inspection. The homes programme of activities is only accessible to people who are able to access the communal areas and records show that it is the same few people participating on a regular basis. A singer had recently attended the home to give a performance. Regular activities included exercise sessions, board games and craft activities. On the day of the inspection some people were making Easter bonnets. Records for people who spend most of their time in their own rooms show activities are very limited. For example one persons care records show that during the last two months they have had one activity each week and these have been limited to being read to and chatting. People told us and records showed that they have very little opportunity to go out into Care Homes for Older People Page 17 of 30 Evidence: the community unless their families take them. Staff told us that there are not enough staff for people to be taken out on a 1 to 1 basis. The manager informed us that a mini bus is on order which will enable more people to go out on trips and engage in activities outside the home. We observed staff giving meals out to people. It was difficult to know if meals reflected peoples preferences because there was limited information to show this had been explored with them. People appeared to be enjoying their meals and were engaging with other people at the dining table. Two care staff on the second day of our inspection discussed how they offer people choices of what they want to eat and drink and we saw this happening. This had not happened on the first day of our inspection as we had observed people being given drinks of tea without being asked first if that is what they wanted. We saw that the home has introduced protected mealtimes, so that disruptions during meals are kept to a minimum and the home is considering enhancing dining experiences by enabling people to serve their own meals. The main corridor on the ground floor has displayed on a notice board contact details for various advocacy groups so that people or their representatives know of organisations they can contact if they need someone to speak with or to act on their behalf. Care Homes for Older People Page 18 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safeguarding and protection processes in place at the home are not effective, which places people at risk of harm and of not being supported appropriately. Evidence: The complaints procedure was available in the home for relatives and people living in the home to read. We looked at the method used by the home to record and respond to complaints and saw that some complaints had been recorded in the homes complaints log and the outcomes were clear. Some concerns had been noted on peoples care files or in daily notes and there was no record of how these had been dealt with or what the outcome was for individual people. This means that people can not always be sure that their complaints will be listened to and dealt with appropriately. Some of the people who live at Bentley Court may show behaviours of concern at times. We found that care plans did not always provide plans to help staff manage or prevent this behaviour. This means that some people living in the home may not be properly supported or prevented from the risk of harm. There was evidence from the daily records that staff do not always recognise incidents which should be referred to the appropriate authority for further investigation. One persons notes referred to them being pushed to the floor, kicked and punched by another person living at the home. We found this had not been referred to the Care Homes for Older People Page 19 of 30 Evidence: manager by the nurse on duty and was documented as A small incident internally managed. There was a further entry in another persons care file which showed that a similar incident had also occurred with them. This incident had not been referred to the local safeguarding adults team. There were records to show that people living in the home had sustained bruises for which no cause could be found. Accident records showed that these had been referred to the GP but no outcome was recorded. Failure to refer such incidents described above, through the safeguarding procedures may lead to people suffering harm and not receiving the care and support they require. Three staff we spoke with could confirm their role in safeguarding adults who live at Bentley Court from the risk of harm or abuse and they told us they had received training in abuse awareness. They told us they would not hesitate to report poor practice. We saw notices up informing staff about the process which needs to be followed if they believe that measures need to be put in place to safeguard people, including for people who are not able to make their own decisions. We also saw notices informing staff of planned training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DOLS). The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow should peoples freedom need to be restricted. Two care staff we spoke with were aware of the Act and had an awareness of the Deprivation of Liberty Safeguards (DOLS). A senior member of staff told us they were aware of DOLS, but not the process to follow if they needed to make a referral to the appropriate professionals. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an environment which is homely, clean and meets their needs. Evidence: We looked at the bedrooms of the people whose care we looked at and found these to be very clean. We saw that some people had photos and pictures in their rooms of people who are important to them. We also saw photographs in a frame outside of one persons room and the deputy manager explained how they are intending to develop these for other people, so that it might help people to identify their room by seeing photographs of people and items of significance to them. The majority of bedrooms have en-suite facilities consisting of a toilet and wash hand basin. A number of bedrooms have en-suite facilities that include a walk in shower. Some of the bedrooms have a mix of carpet and non slip floor covering and the lighting in the bedrooms can be adjusted to provide a dimming effect and can also act as a nightlight. Each bedroom has low surface temperature radiators that can be adjusted for peoples comfort. On the first floor where people with dementia live, the corridor areas have pictures and memorabilia to reflect different themes. We saw work was in progress to further develop the unit with objects and pictures to prompt responses from the people who Care Homes for Older People Page 21 of 30 Evidence: live here. There are two spacious lounges and dining rooms on each floor. The main lounges and have an induction loop system, to support people who have hearing impairments. The main lounges have plenty of space for seating. Because the home is not full, people are only using one of the lounges on each floor. We saw that the home has equipment to help people to move safely and to get in and out of the baths. There are also showers which are accessible by people with mobility difficulties. There are toilets close to communal rooms. There is a choice of stairs or passenger lift to the first floor and there is level access to a patio and rear garden, which is fully enclosed. We were told that there are plans to develop the gardens. The second floor is where facilities such as the main home kitchen and laundry are located. We were informed that an audit was undertaken of the home by an infection control specialist from the local PCT, which identified that the home was nearly 100 effective in its infection control processes, so that people can be reassured they are provided with an environment and equipment which is clean. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not safeguarded from the risk of harm and abuse because staff do not have the skills to ensure all health and care needs are met and the homes recruitment process is not robust. Evidence: We spoke with staff, observed them working and discussed staffing levels with the manager which indicated that sufficient care and nursing staff were on duty on both days of our inspection to meet the needs of people currently living at home. We saw staff were supervising people when they walked around different areas of the home and staff told us that they always make sure a member of staff is present when people are seated in communal areas, which we also saw happening. Although we saw that sufficient care and nursing staff were on duty, including a Registered Mental Nurse on the unit for people with dementia, what was lacking was the skill and awareness of staff in meeting the needs of people with dementia. We had assurances from the manager and company that the competency and skill needs of staff will be addressed. The AQAA also notes plans for improvement to continue to research all areas of training relevant for staff to improve their knowledge and skills. We saw that staff are provided with a corporate induction programme, which includes moving and handling, fire safety, health and safety, infection control, basic food hygiene, equality and diversity and safeguarding adults. We were informed that Care Homes for Older People Page 23 of 30 Evidence: training about dementia is to be provided by a specialist consultant in dementia care. Two staff we spoke with viewed the induction they had when they first started working at the home as good, which prepared for them working at the home. We examined five staff personnel files to look at how the home recruits staff. We found the home has not ensured these staff had all the necessary pre-employment checks undertaken to ensure they are suitable to work with vulnerable people, which is a requirement of our regulations. Therefore information provided in the AQAA is not accurate as it describes the home as having a thorough recruitment policy in place. We saw that one member of staff had not had a reference obtained from their present employer and for another member of staff references had been obtained from staff they no longer worked with. We saw that the home had obtained Criminal Record Bureau Disclosure (CRB) for staff. On scrutiny of the CRBs and for other staff working at the home, we saw that the home had not requested additional checks called ISA/POVA First checks, which are checks against a national list of people considered not suitable to work with vulnerable adults. This means staff are working at the home without all the necessary pre-employment checks being completed. A representative for the company confirmed on the second day of our inspection that it will take action to ensure that recruitment processes at the home comply with our regulations and with their company policy. At the time of completing the AQAA, the manager informed us that just over 50 of care staff had achieved a recognised qualification in care (National Vocation Qualification), which should contribute to the staff team having an effective knowledge of social care. Care Homes for Older People Page 24 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been managed in the best interests of the people who live at Bentley Court , which means people cannot be confident that their needs will be met and their health, safety and welfare promoted. Evidence: The Registered Manager, Debbie Rowley is an experienced manager of care services and has the supportive qualifications to manage the home. It is not clear why the failings identified during our inspection and which have also been identified by other agencies, have occurred. However we had assurances during the inspection that the company will strive to improve the service and subsequent outcomes for people. We saw that a representative of the company monitors quality at regular intervals with monthly unannounced visits to the home and we observed the reports produced as a result of these visits. These visits show that the company had identified issues with staff recruitment and other deficits, although this had not triggered prompt action by the home to rectify the failings. We saw that relatives/representatives of people Care Homes for Older People Page 25 of 30 Evidence: living at the home have been provided with opportunities to comment on different aspects of the home through surveys. The collected results of surveys sent in February 2010, were on display by the main reception, as well as what the home is doing about any negative feedback it receives. The results showed that people who responded were generally satisfied with the service provided by the home, although the results also showed that people considered some improvements are needed to aspects of the service. Observation of maintenance and servicing records shows a well organised process to ensure all parts of the home are safe and equipment well-maintained. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 7 12 People must have care that is planned and provided according to individual needs and preferences. This is to ensure people receive the care they need and the monitoring that their conditions require. 21/05/2010 2 8 13 Any risks to the health, safety and well-being of people living at the home must be identified, recorded and managed according to the persons wishes and capabilities and on advice from professionals involved in their care. This is to ensure that unnecessary risks to the health and safety of people are identified and as far as possible eliminated. 21/05/2010 Care Homes for Older People Page 28 of 30 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 3 9 13 Medication must be stored within the temperature range recommended by the manufacturer. This is to ensure that medication does not loose its potency or become contaminated. 21/05/2010 4 29 19 Staff recruited by the home must have all required preemployment checks undertaken. This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 21/05/2010 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 7 People and their representatives should be involved in the assessment, planning and evaluating of their care. This is so that people are kept informed of their care needs and so that care is focused on their needs and wishes. People living at the home must be provided with a range of activities that are appropriate and meet their individual needs and capabilities. This is to promote well-being and ensure that the social needs of people living at the home are met. 2 12 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - 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. 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