Inspection on 12/08/09 for Birkdale Park

This inspection was carried out on 12th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birkdale Park 24/06/09

Birkdale Park 03/08/07

Birkdale Park 16/02/07

Birkdale Park 09/02/06

Birkdale Park 09/08/05

Birkdale Park 09/02/05

Birkdale Park 10/08/04

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 25/11/2009.

Key inspection report Care homes for older people Name: Address: Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT     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: Margaret VanSchaick     Date: 1 2 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT 01704566055 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Carol Patricia Cunningham care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users to include up to 25 OP Date of last inspection Brief description of the care home Birkdale Park provides nursing care for 25 older people. It is owned by Mrs C Cunningham and the acting manager is Mrs A Nabilisi. The home has been converted from a large house to a care home and is situated in a residential area of Southport. It is on the main bus route to town and is close to Birkdale village. Recreational areas comprise of a lounge to the front of the building and a conservatory overlooking the garden. This room is also used as a dining room. The home has single and double bedrooms but all rooms are currently used to provide single accommodation. There is lift access to both floors and the mezzanine level (floor not serviced by a lift) has 2 bedrooms. These bedrooms are accessed by a short flight of stairs and a chair lift has been fitted. The home has 2 bathrooms with adapted baths to assist those who are less independent and a call system with an alarm facility. Gardens are landscaped to the front and rear; the rear garden is spacious and enclosed. The home has ample car parking space and a minibus is available for hospital appointments and trips out. Care Homes for Older People Page 4 of 36 Over 65 25 0 Brief description of the care home The weekly fees are £510. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home 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: A site visit took place as part of the unannounced key inspection. It was conducted over one day by one regulatory inspector and one pharmacy inspector and lasted approximately 8.5 hours. 17 residents were accommodated at this time. As part of the inspection process most areas of the service were viewed including residents bedrooms. Care records and other documentation was viewed. Discussion took place with residents, their families, staff and visitors to the service. The inspection was conducted with the acting manager Ann Nabilisi and Mrs Cunningham registered provider. During the inspection two residents were case tracked (their files looked at and their views of the service obtained). Two other residents care files were looked at too. All of the medication records and storage were looked at. All of the key standards for older people were inspected. Previous requirements and recommendations made at the last key inspection in 2007 have generally been addressed. Care Homes for Older People Page 6 of 36 Satisfaction forms Have your say about.... were distributed to staff, residents, relatives and health professionals prior to the inspection. A number of comments included in this report are taken from the surveys and interviews. An AQAA (Annual Quality Assurance Assessment) has been completed. The AQAA consists of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? Any resident who needs wound care now has wound mapping in place and clear instructions with regard to treatment with good records kept. Care Homes for Older People Page 8 of 36 Double rooms have a screen to ensure privacy although none of the residents share at present. The service has provided every resident with their own telephone, which enables them to maintain contact with their families and friends. 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. Care Homes for Older People Page 9 of 36 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 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to admission to Birkdale Park therefore this ensures care needs are identified. Evidence: Prospective residents are invited to the service prior to admission to see the accommodation on offer and to meet with staff and residents. Documentation evidenced that one of the residents admitted for respite was able to view the service prior to admission. Another resident was assessed in the hospital prior to admission as documented. A relative interviewed stated, Mum came in straight from hospital, someone came from here to see her. Information with regard to personal details including health professional contacts were in evidence on the admission/assessment forms viewed. The care documentation evidences residents previous health history, prescribed Care Homes for Older People Page 12 of 36 Evidence: medications and care needs. Care needs looked at include mobility, allergies, continence issues, religion, hobbies, sight, hearing, mental health, nutrition, pressure areas and wound care information. One residents file had a copy of the nursing assessment carried out by health professionals at the hospital. Care Homes for Older People Page 13 of 36 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. Residents care may be compromised because care plans are not in place on the day of admission to the service. Evidence: Both residents case tracked had no care plan on admission to the service. One resident had a care plan that was commenced the day following admission and another resident had one commenced three days later. The acting manager was advised that all new residents must have a care plan in place on entry to the service so that the resident can agree the care planned and staff are informed on how to manage any new residents care from the day they are received into the service. Residents and relatives were complimentary about the care provided. Residents interviewed stated, It is very good nursing care, I am very happy with the care, staff bring me my medication on time every morning after breakfast. I see the Dr and the chiropodist visits me and They look after me very well. Relatives interviewed stated, They provide good care, I have no worries, she has the Care Homes for Older People Page 14 of 36 Evidence: chiropodist and Dr when required and her health has improved. One of the residents who had no care plan in place was identified as at risk of falls from the assessment documentation yet there was no care plan or risk assessment in place. There was no other care documentation in place for this resident with regard to manual handling, nutrition or Waterloo scores (tool to assess risk of developing pressure sores). Another care plan viewed showed that all assessed needs had been followed up with the care planned relating to the individual needs of the resident. Some of the residents interviewed about their care plans were unsure that they had discussed them, residents interviewed stated, I must have done in the beginning and They never showed me that. Relatives interviewed about the care plan confirmed they were aware of the planned care and stated, I have read the care plan when Mum came in and since and I have a copy of the care plan. Two residents were noted to be nutritionally compromised yet not enough information is recorded on the care plans to identify their individual needs in this area. The care plans were generic and not specific. One of the residents had not had their weight recorded for several months and in this time had lost several kilograms. Both residents had been prescribed supplementary drinks yet medication records do not always identify that these are given. The acting manager was advised to seek further advice from the dietitian as to how to improve the management of the nutritional intake of both residents. One of the residents has wound care and all wound care treatment is recorded in detail with body mapping in place. During the visit it was noted that many pieces of equipment were is use for residents who needed them including, pressure relieving mattresses, cushions, bed rails and protectors. Residents also have access to other health professionals including, Gps, chiropodists, opticians and physiotherapists. Care documentation evidences the professional visits. As part of this visit the Pharmacist Inspector looked at the homes medication arrangements. We found that although some weaknesses remained, action was being taken to address concerns raised at our previous visit. We looked at medicines administration and saw that records were now referred to and completed at the time of administration, reducing the risk of mistakes. But, we were concerned that the time left between administering peoples breakfast medicines and their lunchtime medicines was very short. The times that medicines are administered needs to be monitored to help ensure enough time is left between doses of the same medicine. Care Homes for Older People Page 15 of 36 Evidence: The actual time should be recorded where medicines are given outside the normal medicines rounds. Since our previous visit the manager had sought advice from the community pharmacist about the different containers and devices available to support safe self-administration. A suitable device had been selected and was filled by the pharmacist, but the persons care plan had not been updated to reflect these changes nor did it clearly detail any concerns or how safe self-administration was supported and monitored. We saw that arrangements were in place to ensure that courses of new medicines were promptly started and records of doctors visits and advice were generally clearly recorded. Where nurses are asked to administer medicines purchased by residents checks are made to help to ensure it is safe and suitable for that person. We looked at medicines record keeping. Separate Cream Charts had been introduced to record the application of prescribed creams but some were missing. And, it was of concern that a pot of cream dispensed for one resident was being used for someone else and that the pharmacy label had been removed from a pot of cream in use for a second person. Similarly, records showing the administration of prescribed nutritional supplements were poorly completed so, it was not possible to tell whether they had been given. Procedures for handling nutritional supplements and prescribed creams need to be reviewed to help ensure they are safely administered as prescribed. As previously seen, most medication administration records were pre-printed by the pharmacy but where handwritten entries were made by nursing staff these were not checked and countersigned to reduce the risk of mistakes. Also, where medicines were not administered we found the reason for non-administration was not recorded. This is important as where medicines are regularly not taken as prescribed, advice should be sought from the doctor. We again found that there was sometimes a lack of information about the administration of medicines prescribed when required. The nurse-in-charge had continued to complete checks of medicines stock control and administration records but consideration should be given to completing a wider audit to help ensure that should any weaknesses arise they are promptly identified and addressed. A health professional canvassed for their views commented, They provide a caring environment and ask for assistance with medication queries in order to get the best care for their residents. Residents privacy and dignity is promoted. All of the residents were observed to be well groomed and dressed appropriately. Double rooms have a screen to ensure privacy although none of the residents share at present. Residents who wish to, remain in their own rooms. Residents who wish to mix with Care Homes for Older People Page 16 of 36 Evidence: others are able to and supported by staff, choose where they wish to go to. Staff were observed to be respectful and kind in their approach to all residents. Residents see other health professionals in their own room. Visitors are encouraged so that residents can maintain contact with their families. All of the residents have their own telephones. Local clergy were canvassed for their views and one commented, The service cares for peoples needs in a caring and professional way. Care Homes for Older People Page 17 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents make choices about how they wish to live their lives with staff support where needed. Evidence: Residents are encouraged to maintain contact with their families and friends with visitors able to visit daily. Some visitors were observed to call in at various times during the day we visited. Residents also have the use of their own telephone line, which enables them to maintain contact with friends and family. Residents interviewed confirmed visitors were free to come and visit when they wish to and stated, Yes I have friends in the area and they come and visit when they want within reason and My visitors are made very welcome, they are offered a cup of tea. Relatives interviewed stated, I come in every day. Im made to feel welcome and Im always offered a drink and I visit twice a day. There are no restrictions, none whatsoever, they are always pleased to see me and Im offered cups of tea. Residents are asked about their interests and hobbies on admission to the service. Some of the residents are able to follow their interests such as reading, receiving visitors and watching tv. Although activities have been organised by staff many of the residents are too frail to join in. Staff canvassed for their views commented, We could Care Homes for Older People Page 18 of 36 Evidence: do better by providing more occupational therapy and entertainment for the residents, which is not that easy because the majority do not want to join in. Activities listed include, pamper days, exercise class, board games, movies, crafts and reminiscence. One resident interviewed about activities stated, No, I havent seen any music or excercise classes, not to my knowledge I just rest and watch tv. A relative interviewed stated, I sometimes go into the conservatory and they have a sing a long, my wife joins in. Daily routines are discussed with residents and preferences are recorded. One relative interviewed stated, My mother prefers to have female staff and yes she does have female staff to care for her. Residents religious needs are addressed through regular visits from local clergy. Information with regard to local churches is posted on the residents notice board for their use. Residents handle their own financial affairs or with help from their families. Residents rooms showed that many were able to bring their own possessions as many were personalised. The menu on display evidences a good nutritious diet with choices available for residents and specialist diets catered for. Residents can eat their meals in their own rooms or the conservatory dining room. Chairs and tables provide comfortable seating arrangements. Specialist cutlery was observed for one resident therefore promoting their independence. Residents were generally happy about their food and stated, Oh yes, I like the meals, they seem to know what I like and what I dont like, The food is very good, plain straight forward and good, no choice of food and The food is great. Relatives interviewed stated, My wife always clears her plate, she is happy with the food, she can have a choice, there is always a choice available and Lunchtime dinners are good. Breakfast and tea time meals have much to be desired, there has never been a change in menu, members of the family bring food in as a change. Care Homes for Older People Page 19 of 36 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. Adult protection training needs to be provided to all staff so that they understand local procedures. We cannot be sure that residents are safe as up to date police checks have not been carried out for staff. Evidence: A complaints procedure is in place and available to residents and their families. A copy of which was posted on the residents notice board. A complaints log was in place and evidenced that complaints are investigated and outcomes recorded. Relatives interviewed stated, I have no complaints, Im aware of what to do, I read the information on the notice board and Everything has been okay I have no complaints, Im happy with the care my wife is getting. Im not really aware of the complaints procedure but the details are up on the notice board. Residents interviewed stated, I dont think I need to complain, I have no concerns, I have no problems speaking to senior staff and I love it, I have no problems, if I did I feel happy to approach A...(acting manager). There has been an incident of alleged theft in the service and the registered provider dealt with it internally and notified the Police and Commission of their findings. The outcome for the resident was that the service reimbursed them for their loss. The service has a copy of the adult protection procedure but some staff dont seem to be familiar with it. Some of the staff have not attended adult protection training. This Care Homes for Older People Page 20 of 36 Evidence: needs to be addressed to ensure that all staff are familiar in this area and therefore be able to promote and provide additional protection for residents in their care and follow the local procedure. The service may be putting residents at risk through not carrying out police checks on new staff employed in the home. Staff files were examined and some staff who have been in employment for several months have no up to date police checks. We cannot be sure that residents are safe. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a comfortable, clean and well maintained environment for residents. Evidence: A tour of the service took place and this showed that the building is maintained to a good standard. All of the residents bedrooms and public areas were decorated to a good standard. Residents rooms were clean and tidy and evidenced that many had their own belongings, which personalised their rooms. Bedrooms and public areas were furnished with comfortable armchairs and looked very homely. One resident interviewed was happy with their bedroom and stated, My bedroom is very nice, it is always clean. The service has supplied individual telephone lines to each bedroom so that residents can keep in touch with their families and friends. One of the residents interviewed was very complimentary about having her own phone and told us that at her request the phone had been moved to make it easier for her to use it. The conservatory has been fitted with new drapes, which blocks out the suns strong rays in the hot weather therefore ensuring a comfortable temperature for residents who use this facility for most of the day. The AQAA stated that a new home cinema is now in place in the conservatory to make it easier for residents to see and hear Care Homes for Older People Page 22 of 36 Evidence: entertainment. The service has a maintenance programme and employ a maintenance person to carry out the routine checks as recorded and planned maintenance. Gardens and grounds are easily accessed by residents of all abilities. Garden furniture for residents and their visitors use was in place. Access to fire escapes was clear and fire doors checked were easily opened. A call bell system is fitted throughout the service and was in use during the visit. The laundry provides a good service for residents personal clothing and had sufficient equipment in place including a foul laundry facility. Residents canvassed for their views commented, They provide well laundered clothes and They always have clean washing ready for me. The service has a sluice on each floor. The service employ a laundress to care for residents clothes. Surfaces are easily cleaned and hand washing facilities were in place for staff. Laundry staff told us they had sufficient equipment in place including protective clothing. The kitchen was run well and all areas were clean and organised during the visit. Care Homes for Older People Page 23 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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. Residents are not being protected because full pre employment checks are not carried out on all new staff. Evidence: The staff rota was viewed and evidences sufficient staff were on duty during the visit including the acting manager. Although staff canvassed for their views commented, We would like to give more time to each individual. This is not always possible and is dependent on the amount of staff on duty and There are good staff at the home but they are pressured to carry out the care on high dependency residents and staffing is allocated to the number of residents and not the level of care required. Staffing levels need to be monitored to ensure residents care is not compromised. Staff did confirm through interviews during the visit that residents care was not compromised. One registered nurse and one carer work on night duty. Three care staff cover day duty shifts and also the housekeeping team provide staff for the kitchen, domestic and laundry cover. One of the care staff starts their day shift at 7am helping to cover a busy time in the morning. The maintenance person was also on duty. Staff employed in the service told us they they were happy in their employment. Staff interviewed stated, I love it, its a nice home and a nice atmosphere, residents get good care, Residents get well looked after and I like it a lot here, it is a nice home Care Homes for Older People Page 24 of 36 Evidence: to work in, I find all the staff get on here. Residents and relatives asked for their views about how the service is run were complimentary. Residents interviewed stated, Staff are very nice, very pleasant and they always answer my buzzer and help me and Staff are nice. Relatives interviewed stated, Staff seem to be fine and Staff are great, they are always smiling, nothing is too much trouble. Another visitor to the service stated, Its very nice, very relaxed, staff are very friendly and approachable and residents look well cared for. The AQAA stated that seven care staff have an NVQ qualification in care. Some of the staff interviewed confirmed they had this qualification. Staff interviewed stated, I have the NVQ Level 3 in care and I have just started to do my Level 3 NVQ. The AQAA stated that new staff commence an induction programme on commencement of employment. One staff interviewed stated,My induction lasted half a shift, which included a handover medication round, policies and procedures, the routine of the home, introduction to residents and staff and a tour of the building and fire drill. The staff files looked at did not evidence staff induction. Some of the staff canvassed for their views gave mixed views about their induction therefore this needs to be looked at to ensure all new staff have an induction that is suited to their needs. The AQAA stated that all staff who started work in the service in the last twelve months had satisfactory pre employment checks. This is not the case as confirmed through viewing seven staff files. Five staff including registered nurses did not have a new police check carried out prior to commencing employment. The acting manager told us that she was not aware that police checks had to be in place prior to employment of registered nurses. We cannot be sure that residents are being protected. One registered nurse file had no up to date evidence to confirm that they could continue to practise as a registered nurse. All registered nurses working in nursing services must have evidence from The Nursing and Midwifery Council that their personal identification number (PIN) is up to date and therefore legally entitled to practise as a registered nurse. The acting manager told us that she had seen the nurses new PIN mumber but there was no documented evidence on file. The evidence on file showed that the PIN number had expired in March 2009. Some of the staff files evidenced very little work history and not all application forms were completed. One registered nurse file had no application form. Not all of the staff had two written references even although most of them have been employed in the Care Homes for Older People Page 25 of 36 Evidence: last year by the service. References in place with regard to the registered nurses in some cases, referred to them working as carers or support workers and not as registered nurses. Start dates of employees were not in evidence. The staff training matrix was viewed and evidenced the planned training for the year to include, manual handling, fire, basic food hygiene, infection control, first aid and equal opportunities. Some staff have already attended medication training, health and safety and risk assessment this year. Equality and Diversity training was not planned for this year. Staff interviewed about the training they had attended since commencement of employment stated, I have done fire, manual handling and first aid, it was all well delivered and each lasted 2-3 hours and I have done my mandatory training and fire, first aid and manual handling. Care Homes for Older People Page 26 of 36 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. We have concerns about how the service is managed because serious issues have been discovered with regard to recruitment of staff. Evidence: The service has been without a registered manager for approximately 15 months. This needs to be addressed to ensure that a registered manager application is formally applied for to the Commission. This was discussed with Mrs Cunningham (registered provider) during the visit. The acting manager has been in post since September 2008. The manager has many years experience as a nurse and has been employed as an acting manager with a previous employer. She has attended training in manual handling, fire, medication, infection control, deprivation of liberty and palliative care in recent months. The registered provider visits the service regularly to provide support. We have concerns as to how the service is being run as new staff have not had police Care Homes for Older People Page 27 of 36 Evidence: checks carried out prior to employment. Staff files do not evidence that all pre employment checks have been carried out prior to commencement of work. This places residents at risk and we cannot be sure that residents are safe. Relatives interviewed were happy about how the service was run and felt confident in approaching senior staff if there were any concerns. One relative interviewed stated, Everything is going smoothly, I can approach senior staff, no problems, we are on first name terms like old friends, we are kept informed. The service has an external quality assurance award, which was viewed during the visit. Staff meetings are held regularly throughout the year with minutes published and minutes of all meetings held this year were viewed. Residents views are canvassed regularly and the most recent questionnaires from March this year were posted on the residents notice board for those who wished to read them. All were positive in their responses about the service provided at Birkdale Park. One relative interviewed confirmed that families were asked for their views and stated, I have filled in a questionnaire and a gentleman came and asked probing questions. The registered provider carries out monthly visits and these are recorded in a report format and were viewed during the visit. Audits are carried out throughout the year and the following areas catering and food safety, care plans, grounds, housekeeping (cleaning schedules, kitchen daily and weekly tasks) and laundry, training, health and safety and activities were viewed. This showed monthly audits of these areas in the past few months of this year. Policies and procedures have been reviewed this year with one or two needing updating since the Care Quality Commission commenced in April this year. Some of the residents financial records were viewed and these were found to contain evidence of all financial transactions. All equipment used in the service have had annual checks and some of these certificates including fire, electrical, gas and lifts were viewed and found to be up to date. The maintenance person also carries out regular checks throughout the year, some weekly including fire logs and drills with records kept also. Care Homes for Older People Page 28 of 36 Evidence: A first aid box was located in the kitchen. Accident records are in place and the acting manager understands the reporting of accidents. Care Homes for Older People Page 29 of 36 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 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered provider 18/09/2009 must ensure that all new residents have a care plan in place on admission to the service. This will ensure that new residents can agree the care plan and staff will know how to manage the planned care of the new resident. 2 8 13 The registered provider must ensure that all new residents have a manual handling assessment in place on admission in particular where it is identified that they are at risk of falls. This will ensure that residents at risk of falls are managed from admission. 18/09/2009 3 8 12 The registered provider must ensure that all residents who are nutritionally compromised 18/09/2009 Care Homes for Older People Page 31 of 36 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 have early specialist intervention when sustaining weight loss. This will ensure that the resident will have specialist intervention early that may prevent further weight loss. 4 9 13 Prescribed creams must be administered from each persons own labeled supply And, Complete, clear, accurate and up-to-date records of all medication administered; including prescribed creams and nutritional supplements, must be maintained to support and evidence the safe administration of medication. 5 18 18 The registered provider must ensure that all staff attend adult protection training. This will ensure that staff are aware of local procedures. 6 18 19 The registered person must ensure that all staff have an up to date police check in place before commencing employment. 18/09/2009 01/12/2009 18/09/2009 Care Homes for Older People Page 32 of 36 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 This will ensure residents are safe. 7 29 18 The registered provider must ensure that all registered nurses have an up to date PIN number whilst they are employed as a registered nurse. This will ensure the registered nurse is legally able to practise as a registered nurse. 8 29 19 The registered provider 18/09/2009 must ensure that full pre employment checks must be in place for all staff prior to commencing work in the service. This includes, two written references, police checks and employment history. This will ensure that residents are protected. 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 18/09/2009 1 8 It is strongly recommended that any resident who is identified as nutritionally compromised should be weighed on a much more regular basis such as weekly as this will ensure staff become aware of weight loss at an early stage. It is strongly recommended that all residents who are Page 33 of 36 2 8 Care Homes for Older People 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 nutritionally compromised should have a care plan that is specific to their individual needs. 3 9 Where medicines are prescribed when required there should be written individual guidance about when they may be needed and how this need is made known. Handwritten entries on the medicines administration records should be signed, checked and countersigned to help reduce the risk of mistakes. Consideration should be given to carrying out wider audits of medicines handling to help ensure any areas for improvement are identified and quickly addressed. Where people self-administer medication there should be more written information about how this is supported and monitored to help ensure people receive any support they may need to do so safely. 4 12 It is recommended that further action should be taken to ensure all residents have their social needs assessed to ensure the activities that are in place are suited to their individual needs. It is recommended that the menu provided for residents should be reviewed to ensure all residents are provided with choices to suit their individual needs in particular for the breakfast meal and evening meals. It is strongly recommended that all staff should complete an application form and evidence previous employment history including dates prior to commencement of employment. This will ensure the service can view the previous experience of any employee and make a decision as to their suitability. It is strongly recommended that any staff who commences work should have the start date of their employment registered on their staff file. This will ensure authenticity. It is strongly recommended that all staff being employed as registered nurses in the service should have references relating to their work as a registered nurse. In the case of newly qualified registered nurses references from their training school will be acceptable. It is strongly recommended that staff files should show the induction staff undertake at commencement of employment Page 34 of 36 5 15 6 28 7 29 8 29 9 30 Care Homes for Older People 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 so that we can evidence it has been carried out. 10 31 It is strongly recommended that the service should forward a formal application for the registered managers position to the Commission. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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