Inspection on 18/11/08 for Bloomsbury House

This inspection was carried out on 18th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bloomsbury House 08/08/07

Bloomsbury House 01/08/06

Bloomsbury House 28/11/05

Bloomsbury House 06/05/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bloomsbury House Anchorage Road Sutton Coldfield West Midlands B74 2JP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bloomsbury House Anchorage Road Sutton Coldfield West Midlands B74 2JP 01213553255 01213088091 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Senex Ltd Name of registered manager (if applicable) Ms Vanessa Hammond Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Bloomsbury House is a large three storey Victorian house, providing personal care for 15 older people. The Home is close to Sutton Coldfield, and nearby is public transport and local amenities. There is car parking to the front and rear. The entrance is at the side of the home where there is a ramp. There are 15 en suite bedrooms, accessed by a passenger lift. On the ground floor there is a large lounge and a dining room. Communal toilets are throughout the home; and assisted bath or shower rooms on each floor. The home does not have a hoist, so people needing this for manual handling will not find the home suitable. There is an enclosed garden, and the home is smoke free. A GP, dentist, optician and private chiropodist visit regularly, although people can use their own. The fees in the service user guide are £410 to £465 per week. People funded by their local council may need a top up. Additional charges apply to: hairdressing, dry cleaning, private chiropody, toiletries, newspapers and may apply Care Homes for Older People Page 4 of 32 care home 15 Over 65 15 0 Brief description of the care home to eyeglasses. The fee range applied at the time of our visit. Enquiries should be made to management for up to date information. Care Homes for Older People Page 5 of 32 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: One inspector visited the home for 10 hours. The home was not informed that we would be visiting. We examined records, talked to people, staff and visitors. Care practice and a meal were observed. Medication was inspected with management and care staff. We discussed our findings with the manager. Prior to our visit the home supplied information to us in the form of its Annual Quality Assurance Assessment (AQAA). Information from this and from other sources was also used when forming judgements on the quality of service provided at the home. The home was last inspected on 08/08/07, and since then has kept us informed of required events. We also received 10 out of 26 surveys sent to people, relatives and staff. During our visit we case tracked 3 people that the manager helped us to choose: the Care Homes for Older People Page 6 of 32 newest admission, a person with a specific health condition, and a person most independent. We closely examined their records, equipment and rooms and spoke with them and their staff. We also sampled other records about people, staff and the running of the home. We would like to thank people in the home, visitors and staff for their assistance. There were 6 requirements from a previous inspection, of which we found 4 fully met and 2 we replaced. We left an immediate requirement at our visit to ensure peoples safety, and appropriate action was taken by the management within the required timescale. As a result of our visit we made 4 further requirements and 7 recommendations. What the care home does well: What has improved since the last inspection? Since the last inspection the following improved to meet requirements and recommendations from the last inspection: The service user guide is available in more formats so it is appropriate to people who may want to use the homes services. Care plans now include peoples abilities, decision making, mental wellbeing and preferences. People have more access to health care, and professional visits are recorded. People help to form weekly menus and shopping lists, and there is a pictoral menu. There is a controlled drugs register and a policy about medications prescribed as required, so that staff know when to use the medication, and health professionals advised on safe levels and combinations. Each room has a lockable facility for people to keep valuables, money and medication if they self manage. Care Homes for Older People Page 8 of 32 Staff recruitment checks have improved to ensure staff are safe to work in the home. There is now a cook and a part time activities coordinator, so care staff have more time with people. An additional shower was installed, that is walk-in. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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. There is useful information in various formats, and opportunities to try the home to help people decide if it is suitable. Everyone has an assessment to confirm their needs can be met. Evidence: People and their relatives told us they had enough information, clarity on fees and services and the home meets their needs: Im very happy here. Its not home, but its the next best thing. Im well looked after. My...[family]...chatted with my social worker and brought me to look around. I like it here... Although my mother did not want to go into residential care, she is (grudgingly) very happy at Bloomsbury. On our visit there were 14 people in the home and one vacancy. We saw up to date information about the home, management and staff in the service user guide and statement of purpose. The guide is now available in formats so that it is accessible to Care Homes for Older People Page 11 of 32 Evidence: people with sensory and communication needs, and people with confusion or mild dementia. There is clear information on what the service can and cannot meet, the fee range and what it includes, and services at an additional cost. There is missing information required by law about room sizes, and although fire safety is mentioned this is insufficient to tell people about necessary precautions for their safety, or where these are displayed in the home. The guide we saw did not have the homes aims, objectives and philosophy attached as per page 3. The homes information could improve by explaining how privacy and respect, cultural and religious needs are met, and sexual orientation. Also how care plans are agreed with people, their representatives, access to local advocacy services, and how best interest decisions are reached if necessary. People and families are encouraged to visit and share a meal to meet others living there. Trained staff confirm needs can be met after an improved assessment of peoples abilities as well as needs. We case tracked someone funding their own care, who visited several times and agreed/signed their initial care plan. A review was held after a 28 day trial period, when they confirmed they wanted to stay. Someone else funded by a council had formal review minutes. Everyone we spoke to during our visit is happy at the home and with their care. One relative told us they were amazed how quickly their relation settled into the home because of dementia and self neglect, and explained how well they are thriving. Another family with a Power of Attorney signed the contract and works in partnership with the home to manage the persons finances to maintain their wellbeing, lifestyle and close family relationships. Fees are increased annually in January for people funding their own care, and 28 days notice is given. Care Homes for Older People Page 12 of 32 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. People are treated with respect, have privacy, choice and independence. Care plans need more detail and accuracy so that people have the right care to meet their needs and health. People need to be protected by the medication system, which needs improvement. Evidence: A relative told us that ...care, health and social needs are met. There are comprehensive assessments of needs and screening of risks that include peoples ability to make decisions and consent to care, their mental health and life history so that people are understood. Care plans are formed that maintain peoples preferences and independence. In general we saw that people have access to health care and specialists, and most people have flu injections and annual health checks. We saw examples of good practice in meeting peoples preferences and communication modes. Care plans include the time people go to bed, whether they sleep with the light on, etc. There were choices considered with a couple to maintain intimacy and privacy; Care Homes for Older People Page 13 of 32 Evidence: self medication after a risk assessment; and staff assisting two people with continence programmes. One persons stroke affects their speech and they do not always use the right words. Their care plan says what makes them tearful, behaviour to expect when they are fearful and what causes this. A multi agency meeting was held about a person with some incapacity to make decisions and medication was reduced as their mental health is stable. A relative told us about someone who is gaining weight who would not eat before admission. This shows us that a number of people have good outcomes. However, screening to assess people at risk of falls and malnutrition needs more accuracy, and care plans need more detail to prevent unnecessary risks we saw. Some screening tools scored the same matters differently, affecting the degree of risk assessed and 2 people did not have monitoring measures who needed this. For example, one person is assessed to be at low risk, but nutritional supplements are prescribed. Staff need detailed instruction on how dietary needs are to be met and monitored, although the manager knew peoples needs well. Monthly weighing takes place, but unusual weight gain of over 11 pounds in one month for a person at risk of malnutrition was not queried. It is likely the scales needed to be reset. Two people case tracked have dietary needs and significant weight loss, although one is now gaining weight. A dieticians advice about food fortification to raise calorie content was not on one care plan. And although the manager told us this was taking place, we found that the cook was not aware of this and neither were care staff ensuring this was done. We saw someone with swallowing difficulty choking during a meal we observed. Their care plan lacked clarity on which food to mash, cut small or to avoid while they are waiting for a speech and language therapist. We saw another person with borderline diabetes eating a pudding with sugar on the contents, which staff did not check. They do not have food monitoring records about sugar consumption, so we are not clear on how this is overseen and reviewed. However the person had a recent annual blood sugar level check with a specialist nurse. People at risk of falls are not accurately assessed or reviewed after incidents, to prevent harm and recurrence, and referrals to health specialists could improve safety and their mobility. Rescoring the falls risk tool has not been consistent when there is a history of falls. Management confirmed that there is uncertainty about completing the risk scoring tool. Mobility plans did not have detail and we saw staff assisting someone who fell several times over 10 months to mobilise with a rollator in an unsafe manner, increasing the likelihood of a fall. Their care plan just says assist with one carer, but the person has fallen forward, backward and at night. During the inspection the manager arranged for Care Homes for Older People Page 14 of 32 Evidence: a commode to address night time risks. Another person is recovering from a fracture and is fearful of mobilising. The people we queried have not been referred to a falls clinic or specialist . We did see a variety of other health specialists people have access to, including district nursing for flu injections and someones pressure sore that healed. We made a requirement for peoples immediate health safety and confirmed appropriate action was taken within the required timescale. There are no concerns known to us about immediate risks for anyone else currently in the home, and the manager has kept us informed about care planning improvements. Management are aware that there should be care plans about peoples specific conditions and medication, so that staff are aware of symptoms, side effects and contraindications and staff are clear on what to watch out for, record and when to seek health specialists. All care staff have accredited medication training. We are told they are supervised and periodically observed to determine their competence, but these observations are not recorded. Annual appraisals of staff performance we saw do not confirm medication competence. There are regular internal and external audits of the medication system, by the manager and local pharmacist. Although there were improvements in medication records since the last inspection, we cannot be sure people are having medication as prescribed. We found that medication is not fully auditable because records do not always include surplus stock and checks when medication is received into the home. We found two examples where medication stock exceeded the administration records and we could not be sure it was administered. Management said they will investigate this and take appropriate action. One person is determined safe to manage their own medication after a risk assessement. They have a lockable facility in their room for secure storage to protect other people in the home. But there is no medication administration record for drugs ordered for this person and checked into the home, and there are no compliance checks to ensure they are self administering as the doctor intended for their own wellbeing, and using the secure storage. Medication storage also needs improvement so that people have stable medication for their health. There is an appropriate controlled drugs cabinet but it is not in use and is not rag bolted to the wall, as legally required, for public protection. The current storage method must be changed. At the time of our visit no one was prescribed controlled drugs but a Schedule 2 drug was due. This had become lost between the GP and chemist, which was appropriately queried by the home when it did not arrive. Care Homes for Older People Page 15 of 32 Evidence: Temperature checks of the medication fridge are within the safe range. However we saw eyedrops in the fridge that did not need to be kept cold, and open nutritional supplements dated but not kept in the fridge as their instructions required. Manufacturer instructions should be read when medication is received in the home, or queried with the pharmacist. The room temperature where medication is stored is not checked as within the safe range. Care Homes for Older People Page 16 of 32 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. There are activities and exercise for mental and physical stimulation, and people can continue their independence, lifestyle, beliefs, and relationships in the home and community. Menus are planned with people, who also make daily choices about their appearance and clothing. Food safety checks and provision for special diets need to improve for peoples health. Evidence: Care staff and a part time activities coordinator undertake activities with people in the home. We saw a variety of examples and a poster on display. People told us they like dancing and exercise games to music. There are indoor and outdoor games and activities appropriate for peoples interests, sensory and physical impairments. People use of Ring and Ride to go out on their own or with visitors, attend luncheon clubs and a day centre. Contact with relatives is encouraged except at mealtimes, and relatives told us they are kept well informed. Visitors can stay over in the guest room, and eat for a small fee. There is a poster up with visiting times but this does not match the service user guide regarding the time visitors should leave the building for peoples security. There Care Homes for Older People Page 17 of 32 Evidence: is a pay phone in the hallway which does not give full privacy. There are flexible routines and daily choices, so people decide when to get up and go to bed, what to wear, and where they want to eat. Staff use peoples preferred names, are respectful and are polite and converse with people while helping them. Some people manage their own finances and medication, and one person has their own car. The weekly menu is decided with people in the home, using photographs for those who need support to choose. People also prepare their own personal shopping lists if they need assistance to make purchases. There is a cooked breakfast two days a week, and we saw that some people choose to eat breakfast and tea in their rooms. On our visit people had a choice in the morning of two types of meat for dinner, but by dinner time they couldnt recall what they were eating. A daily menu on the table might help. Paper napkins are used, and we saw people needing help and prompting fed in an unrushed way, preserving dignity. Care staff prepare sandwiches for tea. Most people told us that they liked the food, but that sometimes it could be warmer, spicier or have more variety (eg not tomato sandwiches). Management told us there is more choice since a residents meeting discussion about this. Improvements were made about nutrition and special diets following the inspection (see Health and Personal Care). Management systems need to ensure that food safety checks are maintained so that food is safe (see Environment). All staff are trained in safe food handling. Care Homes for Older People Page 18 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence that action will be taken to any concerns or complaints. Their financial interests are safeguarded. Policies, procedures and public information should be reviewed to protect peoples legal rights. Evidence: There is a complaints process that is clear with appropriate timescales. We note from a Regulation 26 report sent to us after the inspection that a Director confirmed with people that they know who to report a concern to both inside and outside of the home. There is a poster displayed in the entrance hall with up to date CSCI contact details. This could be improved by adding the council customer relations contact details. Since the last inspection there have been no complaints made to the home or to CSCI. Staff know what to do if a concern is reported to them and could explain this to us. One carer did not have adult protection training, the other did, so one could describe abuse and poor practice in more detail. Clearly the induction helps staff to understand what needs reporting. Adult protection is taken seriously because the homes policy and procedure is linked to the local council multi agency protocol. Improvements have been made to recruitment checks so that staff are safe to work in the home. Care Homes for Older People Page 19 of 32 Evidence: Just before the inspection a concern was raised with us by the council about a delay in seeking medical help. We examined the homes records and discussed this with the manager. Satisfactory explanation was provided, and Bloomsburys good daily record keeping allowed us to confirm we had no concerns to the council. Management faced a common dilemma for care homes - a person found on the floor who could make their own decisions but did not want a doctor even though they were in pain. The home later involved a doctor for advice on pain relief and the doctor did not feel the injury required treatment. We recommend in future that medical clinicians make the decisions on peoples capacity to consent to an examination. Consent is understood, and staff have had training. Mental capacity is assessed on admission, but it also needs to be reviewed. Liquid medication is used for night sedation for wandering for one person, in consultation with their relative and doctor. Records should also note the views of the person and whether they have mental capacity to decide on this form of restraint as the least restrictive option. Policy and procedures about this should be reviewed. People and staff also need contact details displayed or in the service user guide to make use of local advocacy services to help them make decisions, and about information in order to vote. We checked peoples money given to the home for safekeeping as personal allowances and found there is good accounting. It is spent in accordance with peoples wishes, health and social care needs. One relative said they recently had a written statement of account. We saw signed contracts regarding people funding their own care, including one by a Power of Attorney, which the home had checked is legally registered. This is good practice. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bloomsbury is homely, comfortable, safe and generally well maintained. People personalise their rooms and have equipment that meets their needs. Systems need to ensure that food and hot water are safe, and the spread of infection is prevented. Evidence: The home is in a residential area near public transport and amenities. It does not stand out as a care home. Entry is confused by signs inside and outside of the building that do not match. The side entrance to the home leads to a hallway, and on our visit this was piled high with boxes from the chemist waiting collection. Management have taken positive steps to arrange smaller boxes as they take up considerable space but do not pose a hazard. There are only single, ensuite bedrooms so people have privacy. People bring their own possessions and personalise their rooms, some of which have photos on the door. Most rooms have door locks, although one persons was broken. People have the equipment they need, which the home maintains, a call system in their rooms. No one in the home needed bedrails at the time of our visit. There are toilets and assisted bathing facilities on both floors, conveniently located and a maintained lift. If people fall, the home has an inflatable device to help them get up instead of a hoist. Care Homes for Older People Page 21 of 32 Evidence: We found that actual hot water temperatures are not recorded and a shower was not tested to prevent people being scalded. We made an immediate requirement for peoples safety, and appropriate checks are now in place. However we note that one shower still slightly exceeds the Health and Safety Executive safe limit. The home appears fresh and clean, and there has been no outbreak of contagious infection. However we found that management systems are not ensuring peoples health and safety is protected to best practice standards. We saw only one cleaning schedule that has not been completed since August 08, so we cannot be sure they are followed. There are mops stored in the visitors and staff toilet. In this room the liquid soap dispenser wasnt fully working, the paper towel dispenser was blocked and a cloth towel was in use. These present risk of spreading infection. Bloomsbury House have the council Safer Food Better Business scheme, which is best practice guidance. Since our last inspection the council made food safety requirements and recommendations; the manager said these were immediately acted upon. However we found that best practice has not been sustained as there were missing dates on open items in the fridge, gaps in records of fridge/freezer temperature and food probing records. Management systems need to be more robust so that food is safe for peoples health. The laundry system is good, although clothing goes missing when labels are no longer clear. Care Homes for Older People Page 22 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are checked to be safe to work in the home. They are trained and supervised to meet peoples needs. Management need to confirm that staff are competent in their roles. Evidence: Since the last inspection, staff have more time with people in the home because there is now a cook, and a dedicated activities coordinator two days a week. Staffing is kept under review as peoples needs change. Current staffing comprises: AM (8am to 2pm) 1 Senior / 2 Carers PM (5pm to 10 pm) 1 Senior / 2 Carers Night 1 Waking and 1 Sleeping Carer There is little staff turnover and consistency is provided by staff doing extra hours, avoiding the need for temporary staff. Staff are happy about this and feel supported by the manager, who will also cover shifts. We examined staff files and saw that improvements have been made to recruitment checks to confirm that people are safe to work in the home. Staff confirmed they have a good induction to safe working practices, and are knowledgeable on their roles and people in the home. Supervision is held at least six times a year, and there are staff Care Homes for Older People Page 23 of 32 Evidence: meetings and staff handovers that help them pass information to eachother about changes. Most staff have NVQ 2 qualifications, which exceeds national minimum standards. They are encouraged to undertake higher qualifications and training about peoples conditions, such as dementia awareness. We saw a training matrix, used to keep track of mandatory courses attended, and there is a staff development plan. Management confirmed that prior to our visit, training for staff was applied for about nutrition and health. We also saw that there is further infection control training planned, as the AQAA told us that only half the staff have been trained in this area. Most training is provided in house, and the manager used simulations from council training on mental capacity to share learning with staff, to keep their practice up to date and lawful. We saw posters about anti coagulent drugs and superbugs in the treatment room to continue staff learning. Staff have first aid training but we are unclear whether the level has been assessed in accordance with their role. There should be a first aider on each shift that can meet peoples needs in an emergency. Staff may need hands on refreshers periodically in safe manual handling and assisting people to mobilise as we saw practice that could harm their backs when seating people in the dining room. Newer staff told us they do not perform certain roles yet, such as medication administration. Management explained that they have training, are supervised and observed. Competence is checked by observation more than once a year but we did not see written appraisals and supervision records that note these observations to confirm competence. This is especially important regarding medication, and to ensure safe working practices, respect and dignity is maintained. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team are qualified, long experienced and run the service in peoples best interests and with accountability. They seek peoples views and act on them quickly responded to matters we raised on our visit. Quality monitoring needs to improve, as well as systems, so that peoples health, welfare and safety is promoted and maintained. Evidence: The registered manager is also a Director of this family business, and has appropriate qualifications and long experience in running the home. The manager is supernumerary so has time to conduct audits, supervise staff and review policies and procedures. People, relatives and staff told us that the manager is approachable and responsive. There is no office, so the manager uses the guest room, a laptop computer, and publishes her mobile phone number in the homes guide so that people and their relatives can contact her. Care Homes for Older People Page 25 of 32 Evidence: The manager has undertaken dementia and Mental Capacity Act training to keep up to date, then devised a mental capacity form and has cascaded learning to staff. She provides support, supervision and leadership to staff, and continues to develop the service. For instance, a new keyworker system so that people have one staff member who gets to know them well. Staff feel supported, have meetings and people have consistent staff who know their needs and are safe to work in the home. Appraisals of staff performance needs to improve and inform the staff development plan. The AQAA provided us with the required information, and shows management understand value for money. The home is run in the best interests of people using the service, and people are consulted about the running of the home. Matters we raised during our visit were rapidly addressed. The manager completes audits on medication and care plans, and ensures people are consulted about the running of the home. She is supported by a Director, who also has management qualifications. This Director undertakes unnannounced visits and completes reports about health and safety, quality, policies, facilities and progress on regulator reports. These Regulation 26 reports are not kept on the premises as required so that the manager can progress actions, but monthly reports August to October 08 were sent to us as requested following the inspection. Management are conducting the necessary checks and audits, but these are not based upon legal changes, best practice and national minimum standards. Management must keep up to date, and review their systems and conduct self checks in line with these. We recommend an action plan is progressed so that the quality rating returns to good and prevents unnecessary risks. Fire drills are held 6 monthly and we were told there is an up to date fire safety and evacuation assessment for the home. We did not see individual evacuation plans in care records, and public information on fire safety precautions needs to improve in the service user guide. There was no incident and accident audit to identify any preventable patterns and actions to prevent recurrence. Management confirmed immediately following our visit that a system is now in place monthly for individuals and six monthly for the entire home. We were also sent an up to date gas safety certificate. We discussed with the manager the need for systems to improve and sustain standards of hygiene, food safety and infection control to regulator requirements, which was also an issue at the last inspection. Another regulator also found food safety improvements needed. Care Homes for Older People Page 26 of 32 Care Homes for Older People Page 27 of 32 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 28 of 32 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 15(1): Care plans must have 31/03/2009 sufficient detail to instruct staff about peoples health, personal and social care needs, including their conditions, mobilising with equipment, nutrition, medication, and the advice of specialists. This is so that people have the right care to meet their needs and health. 2 8 12 12(1): People recovering 31/03/2009 from injuries that affect their mobility, and people with recurrent falls should have access to the advice of a health specialist. The home needs to promote peoples health, recovery and safety and liaise with the GP. 3 9 13 13(2): The quantity of all medicines received and any balance carried over from previous cycles must be 31/03/2009 Care Homes for Older People Page 29 of 32 recorded on the medication administration record, including people managing their own medication that staff order. Regular checks must take place for people self managing medication to ensure they are taking it as prescribed and storing it safely. Controlled and Schedule 2 drugs must be stored in a cabinet in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973, amended in 2007. All medicines must be stored in compliance with their product licenses. People need stable medication, administered as the doctor intended for their health. Safe storage of drugs protects people in the home and community. 4 9 18 18(1)(a): The registered person must ensure that staff are competent to manage, administer and witness medication. This is so that peoples health is promoted and protected. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 30 of 32 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose must contain legally required information for the public, as in Schedule 1, Care Home Regulations 2001 and any amendments. Policies, procedures and public information should reflect new laws and the Mental Capacity Act codes of practice about peoples rights and decision making, and be crossreferenced to abuse and employment procedures, especially forms of restraint. Mental capacity needs to be reviewed regularly, and access to local advocacy services should be known, publicised and used. An assessment of roles should be used to decide the level of first aid training staff require so that rotas have an appropriate skill mix to meet peoples needs in an emergency. We advise that manual handling, personal care and medication practice is observed and recorded, and audits consulted to confirm staff competence at least annually. Reports of unnannounced spot checks about health and safety, and quality under Regulation 26 must be kept on the premises so that the manager can take appropriate action, and they are available to the Commission. The registered person must periodically audit incidents and accidents, identify any preventable patterns and take action to eliminate them as far as possible, for individuals as well as the entire home. Essential Steps, Safer Food Better Business best practice guidance and CSCI guidance on national minimum standards should be used to form an action plan and improve standards of record keeping, infection control, cleaning, food and fire safety. 2 18 3 27 4 30 5 33 6 33 7 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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