Inspection on 20/04/09 for Bluebrooke Residential Care Home

This inspection was carried out on 20th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bluebrooke Residential Care Home 04/12/08

Bluebrooke Residential Care Home 23/04/08

Bluebrooke Residential Care Home 23/05/07

Bluebrooke Residential Care Home 05/06/06

Bluebrooke Residential Care Home 29/10/05

Bluebrooke Residential Care Home 28/07/05

Bluebrooke Residential Care Home 02/03/05

Bluebrooke Residential Care Home 14/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcestershire B61 9LE     The quality rating for this care home is:   zero star poor 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: Philippa Jarvis     Date: 2 8 0 4 2 0 0 9 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 35 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 35 Information about the care home Name of care home: Address: Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcestershire B61 9LE 01527877152 01527557409 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oldfield Residential Care Limited care home 46 Number of places (if applicable): Under 65 Over 65 0 46 46 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. 46 0 0 The maximum number of service users who can be accommodated is: 46 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - over 65 years of age (PD(E)) 46 Old age, not falling within any other category (OP) 46 Dementia (DE) 46 Date of last inspection Brief description of the care home Bluebrooke Residential Care Home is registered to provide personal care for up to forty-six older people who are frail, or who may have a physical disability. The home may also accommodate people over the age of 55 years who have a dementia illness. The total number of people who can live in the home is forty six. Care Homes for Older People Page 4 of 35 Brief description of the care home The large, detached property, standing in its own grounds, is situated in a pleasant residential area, approximately two miles from Bromsgrove town centre. There is also a small enclosed garden that is accessible to residents. This is not safe for residents to use without supervision by staff. The home was purchased by Oldfield Residential Care Limited in April 2004. The Responsible Individual is Mr Anastasis Kayiatou, and the Company has several homes in the group. There is no registered care manager in post. There is an acting manager , Ms Lianne Sturmey. We have not received an application from Ms Sturmey for registration as the manager of the home. The Service User Guide indicates that the fees for the home are from £400 - £450 a week. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent two days at the home, talking to the people who live there and the staff. We also spent time talking with the manager on the first day, and a company director and operations manager on the second day. We looked at some records that must be kept by the home to show that it is being run properly. These included records that related to people who lived in the home and to staff who worked there. Before the inspection we asked the home to complete an Annual Quality Assurance Assessment referred to in the report as the AQAA. This is a self assessment document, that was completed by the acting manager. It allows the home to tell us what they are doing well, improvements they have made and plans for future improvements. It helped us to plan for the inspection and some of the acting managers comments are Care Homes for Older People Page 6 of 35 included in this inspection report. We were accompanied for part of the first day by an Expert by Experience. This is a person who has personal experience of using care services. Following their visit they wrote a report and their findings are reflected in this inspection report. We also received completed survey forms from people who live in Bluebrooke (completed by the activities organiser), staff and some health and social care professionals. The information from these helped us to understand how well the home is meeeting the needs of the people who live there. What the care home does well: What has improved since the last inspection? What they could do better: Whilst most staff were kind and respectful to the people living in the home, we saw some examples of staff being critical or unsupportive of situations with residents. There were also examples that we saw of staff not having the knowledge to deal with situations of challenging behaviour. Staff need more training in how to meet the needs of people with dementia so that they gain further understanding of how to meet their needs. The home needs to asssess more carefully the needs that are associated with peoples dementia and to provide guidance and support for care staff in how to deal with these challenges. The home needs to take more care to help new residents moving into the home settle into their new environment. The assessments of peoples needs were not fully completed. In particular risk Care Homes for Older People Page 8 of 35 assessments were not up to date and did not therefore draw the staff attention to where people were at risk of harm or injury. The care plans were in the process of being transferred to a new system and people did not reliably have a care plan in place that made clear the action that needed to be taken to meet peoples care needs. The garden is not safe for the residents to use. There are plans to improve it over the next twelve months. There is no registered manager in post and the home needs to ensure that steps are taken for the appointment of a permanent manager who submits an application for registration. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about Bluebrooke before moving into the home. Their needs are not given sufficient consideration either before or at the time of their admission to the home. Evidence: There is information available for people moving into the home. This has been revised since our last inspection and is more comprehensive. Four of the five residents who replied to our surveys said that they found the information available sufficient. We found that some of the information may be misleading for example saying there is a safe back garden and that people have an acute care plan when they are ill. We did not find evidence to support either of these statements. There was a copy of the most recent key inspection report available in the entrance hall. However we did not see a copy of the Service User Guide. Care Homes for Older People Page 11 of 35 Evidence: In the AQAA the service says that it carries out comprehensive pre admission assessments. We looked in detail at the file of one person who had recently been admitted to Bluebrooke. There was a pre admission assessment on his file but it was not comprehensive and provided only limited information about his care needs. He had been admitted six days before the inspection and we found that there was no care plan available on his file and that most of the assessments that we expect to be carried out following admission had not been completed. Prospective residents and their families are encouraged to visit the home to help them make up their minds about whether it is the right place for them to live. A resident was admitted on the day of our inspection and although he had visited with a family member during the previous week, he was unable to remember this. It was evident that he found the experience of admission unsettling. There was no member of staff allocated to help orientate him during the first few hours. His confusion was not helped by another resident who kept coming up to him. This situation was not managed in a way that helped his transition into the home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are sometimes not being met. This is because care plans do not provide staff with all the information they need to ensure people get the care they need in the way they prefer or to safeguard them from potential harm. Care plans do not show that the person, or someone close to them, has been involved in deciding how they will be supported. Staff are not adequately trained to understand the needs of people with dementia illnesses and to meet them in an appropriate way. There are times when the principles of respect and dignity are not put into practice and people are not treated respectfully. The homes system for handling, storing and administering medication generally ensures that people are safeguarded in this area of practice. Evidence: We looked at the experience of three people who lived in the home in some detail. We read their files and found that, whilst the home is in the process of upgrading their care plans, the ones we sampled did not contain sufficient assessment and guidance Care Homes for Older People Page 13 of 35 Evidence: for staff. For example, one person whose file we read was diabetic but there was no assessment or information on their file about their needs relating to this condition. There was an entry on the health professional record requesting regular monitoring of this residents blood sugar levels. The last entry on the chart was in January 2009 but there was no indication that the health care professional had said that the monitoring could stop. For another resident who had a tendency to be noisy, there was no guidance available for staff about how to manage this. We observed situations in the lounge that needed careful management but where there was no guidance available for staff to follow to take the potential for conflict out of situations. We spoke with staff who told us that they had no written guidance in the care plans about how to manage difficult or challenging behaviour. One example we saw was a resident who became agitated and was waving her stick around. The carer tried to take it off her and became involved in a battle of tugging rather than moving other vulnerable people away from the area. A couple of minutes later she moved this residents chair backwards without telling her what she intended to do which caused her to become upset. The Expert observed another situation where again the staff did not have the guidance to manage a situation, Two ladies were wandering round aimlessly. These were .., who was on a respite stay and ..., who was actually getting more and more agitated and aggressive as the morning progressed. I observed as .. went from one resident to another asking them questions. She came to me and then to a member of the care staff for a hug. The member of staff told her to Get off and then walked away from her muttering, Euch! I hate that, slobbering all over me. We were able to speak to some family members who visited the home at the time of the inspection and they told us that they were satisfied with the care that their relative was receiving. They also told us that the home contacted them if they had any concerns about their relative and that they were good with communication. However, we did not find evidence of the involvement of families in the assessment or care planning process. There was a book for recording all residents weights. The information in this is communal and would be better in a format where information about each person is kept separately so interested parties could read it without seeing personal information about other people who live in the home. For one person that we examined there was no record of her weight since January with no explanation of why this had not been taken. There were records in individual files of bathing. For one resident the last recorded shower was on 24th March with one refused on 14th April. This persons hair did not look as though it had been washed for some time. Care Homes for Older People Page 14 of 35 Evidence: The home had also not reviewed risk assessments on a regular basis. We read one file where the residents last manual handling assessment was dated May 2008. There was no evidence of review since that date and no written guidance to staff about how to meet her moving and handling needs, which were significant as she was not mobile and used a hoist. We wrote to the home to ask them to review this as a matter of urgency, so they were sure that staff were provided with the right guidance about how to deal with her manual handling. When we read the accident record we found that one resident had fallen out of bed and had sustained some injuries. We asked to read her falls risk assessment and found that it had not been reviewed following this fall. The cleaner told us that she had moved this residents room round to help prevent this happening again. Whilst this may be the correct course of action, the management of the home have not assessed, through her risk assessment, whether this would help prevent further falls or whether there was any further action they should take. We wrote to the home to ask them to deal with this as a matter of urgency. This had been completed by the second day of our inspection. We read one file where there was a generic risk assessment for nutrition and hydration, that was not written in a way that was personal to the needs of the resident. The scoring for this had been done wrongly and he came out as low risk not at the top of medium as he should have been. This had implications for the way that the home managed his nutrition and hydration. Some risk assessments were not personal to the people living in the home, for example each person had one for risk of scalding and burning that was not individual to them. We noticed that most of the residents appeared well presented. The Expert commented They appeared appropriately and individually dressed in clean clothing with slippers and stockings or socks in place. The ladies and gents I spent time close to had clean eyes and mouths and well manicured fingers, some of the ladies had painted nails. We observed a number of positive interactions between the staff and the people living in the home. Most of the time the staff were kindly, helpful and considerate of their dignity. However, there were times when we saw interactions that were not appropriate. The Expert described one situation, I noticed with horror a senior carer standing over two ladies who were still eating, shouting at the top of her voice, and quite aggressively, to a carer at the other side of the adjoining lounge Who the hell has done this? and given ... so and sos dinner. The carer explained that these two ladies regularly, because of their confusion, swapped dinners. The senior carer Care Homes for Older People Page 15 of 35 Evidence: swapped their dinners back, mid meal, whilst still standing over them. We also found that we were not introduced to people livng in the home as we were shown round. This was not respectful of the people living there or the fact that it was their home. Most aspects of the management of medication were carried out in a satisfactory way. The home has introduced the use of electric trolleys for medication. These were not fixed to the wall but need a key to start their operation and movement. The medication was stored in an organised way. There was no thermometer to monitor the temperature at which medication is stored. We looked at the record of administration for three people in detail. The records appeared to be fully recorded although we could not determine what had happened for one resident with one medication where there was a signature with an O over it so we could not tell whether it had been administered or not. We were told that this person did not like the taste of this medication and refused it but there was nothing in the care plan about how this situation was managed or monitored. We also looked at one persons medication record who had a medication on an as required basis. The acting manager said that she was about to introduce sheets with guidance for staff about the circumstances in which as required medication could be administered but at the time of the inspection these were not available. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is developing a range of activities for people to take part in but the activity programme is in the early stages. There is a varied menu available but the process of mealtimes is functional and not promoted as a social occasion. Evidence: We found that there was little information in peoples files about their interests or about their personal history. People appeared to choose their own daily routine although we did find that a number of people were up and dressed by 5.30am when we did a random inspection in December 2008. In these circumstances care must be taken to ensure that this suits residents needs and decisions made about whether they should more appropriately be encouraged to return to bed. Most residents were downstairs in the communal rooms throughout the day. There was little activity going on and many spent the day dozing or watching any people who were walking around. The Expert commented that at one point she and the acting manager went through a dining area adjoining the main L shaped lounge and I noticed a lady and two gentlemen slumped over dining tables with their heads resting on the tables, sleeping. I asked (the acting manager) if she thought this looked comfortable for them and she Care Homes for Older People Page 17 of 35 Evidence: told me that these people liked to do that. I asked why they werent encouraged into a more comfortable chair. She told me they chose to do this and she didnt think it was their place to force them to sit somewhere else if they didnt want to. (The acting manager) said not to worry that they always sat like that. I pointed out that I didnt think they looked safe or comfortable. The home employed an activities organiser about five weeks before the inspection. We spoke with her and she said that she is getting to know the residents. On the day we visited a small group of about five residents were painting St Georges Day flags with her. There was no evidence of other activities although she said that she hoped eventually to have some activity available in each of the lounges. In the first month she said that such activities as bowls, poetry club, bingo and knitting had been offered. She also said that they are hoping to have a monthly entertainer but at the moment there is no residents fund to allow this provision. The Expert commented on the lack of stimulation in the communal areas. When entering one lounge she said, It appeared instantly stark to me and devoid of any stimulation. There wasnt a TV or any music in here, no magazines, books or newspapers or bits and bobs to pick up and put down. It was quite a sterile atmosphere. There were no staff in attendance and the ladies and gents were just sitting and staring into space. People were not able to go outside into the garden because, although it was enclosed, it was not safe for people living in the home to use without a member of staff in attendance. We saw residents who asked to go out on the day we were there but who were told they could not do so. We spoke with three groups of visitors to the home and they all told us that they were able to visit at any time and that they were made welcome. There was a small notice board in one corridor in the home that detailed activities but no information that we saw that detailed the menu for the day. Further information about daily life in the home would be helpful for the people who live there and for their visitors. We watched lunch being served: it was minced beef, with mashed potatoes and cabbage and apple charlotte and custard. It looked appetising and those who needed a soft diet were provided with separate pureed components. There was no choice of main meal offered routinely. The residents who prefered a vegetarian diet were offered an omelette as an alternative. The Expert joined the residents for lunch and said that What I ate was very tasty and of a pleasant temperature. We noticed that some Care Homes for Older People Page 18 of 35 Evidence: people were given their food in bowls but no one had a plate guard which would have provided them with more dignity when eating their meal. The Expert commented on the meal being a functional affair and lack of individual support for residents, There was no background music or offer of different drinks and with the exception of a gentleman sitting near to me where one carer sat with him a assisted him all the way through, there was very little organised assistance with eating. It was simply a carer bobbing around giving a mouthful here and a forkful there. We expect people to be assisted on a one to one basis. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are free to express their concerns and have access to a complaints procedure. There are policies in place to prevent people from experiencing abuse or neglect but the home is not being managed in a way that ensures people receive safe care. Evidence: In their surveys people told us that they knew how to make a complaint if they were unhappy about the service they receive. Because many of the residents do not have the capacity it is more likely that their representative will make a complaint on their behalf. We did not notice a copy of the complaints procedure in the entrance hall for people to access easily although the company director said that there was one there. He also told us that each resident is provided with a personal copy of the complaints procedure at the time of their admission to the home. The home aims to have an open door approach to the management team so that any concerns can be dealt with at an early stage before they become a formal complaint. The AQAA referred to five complaints that had been received by the home. During the inspection, the acting manager told us that they had not received any complaints during the last twelve months. She was unable to find the complaints log but said that two complaints received by the Commission and referred to the provider for investigation had not been recorded in there as we would expect. However by the Care Homes for Older People Page 20 of 35 Evidence: second day of our inspection this log had been found and one of the complaints we had referred was detailed in there. There were also records of two further complaints made to the home that had been looked into with appropriate responses to the complainants. In addition there was a log of informal complaints that had been recorded when people made criticisms verbally but did not put them in writing. The home has a safeguarding policy and in the AQAA the home said that it makes sure adult protection training is implemented on a regular basis. However, we were provided with a training matrix that showed that the majority of staff had not received training in this essential area of practice. The information in the AQAA may not, therefore, be accurate although the home did acknowledge in this document that it could improve by ensuring there was more in house information pertaining to abuse and signs of abuse and that it should check staff understanding in supervisions. We were not confident that staff always understood the physical and verbal aggression displayed by the people living in the home and that they dealt with this in a way that safeguarded people appropriately (see Health and Personal Care section of this report). Some other aspects of the management, referred to elsewhere in this report, also failed to provide people with the safeguards from abuse and neglect that are required by regulation. Care plans failed to provide up to date and detailed enough information about how needs should be met and risk assessments relating to peoples state of health were not always in place. We found that staff recruitment checks were not carried out in a way that safeguarded the people living in the home from the employment of unsuitable people, and the acting manager had not applied for registration. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for the people who live there. The gardens are not a safe place for people to access and further attention needs to be paid to ensuring the environment is suitable for the client group who live there, most of whom have dementia illnesses. Evidence: The home smelled fresh and this was also commented on by the Expert. With the exception of one bedroom that we visited we found the home was odour free. The Expert commented that she arrived at 10.20am and although there is a small car park this was full and parking was impossible on the main road. This could create difficulties for people visiting the home. The communal areas in the home comprise a dining room and four lounges that can be accessed off the dining area. Whilst the quality of the decoration and soft furnishing was suitable, there was a lack of pictures, ornaments and items for stimulation. In the AQAA the home told us that they have carried out some redecoration over the last twelve months. They said that when bedroms are empty they will be properly assessed for redecoration and carpeting. There is a kitchenette close by one of the lounges that visitors can use to make a drink for themselves and the person living in the home. Care Homes for Older People Page 22 of 35 Evidence: They also told us that We are aware of the environment that people with dementia live in, providing prompts with colours and equipment in order for them to remember or recognise. We found little in the home that helped people to orientate pthemselves to their surroundings. The Expert also commented on this, I noticed as we passed through the ground floor that none of the doors held pictorial or written signage on rooms such as the toilet or bathroom to assist the residents with using or moving around their home. The corridor areas I feel need brightening and cheering up with stimulating, possibly tactile things on the walls. Bold, colourful, pictorial, signage with arrows to the lounge, to room numbers, or staircase would help to guide and remind the people living here and provide some much needed stimulus for them when moving from one area to another in the home. Also there was no indication on peoples bedroom doors about which was their room and the expert commented in her report that during her visit, she was asked seven times by residents to help her find their rooms. We were also asked by someone who was standing by her room. There was no name or picture on the door to help her recognise that it was actually her room. The home was generally clean and there were domestic staff working in the home each day. There was liquid soap and paper towels in the bathrooms and toilets to help with infection control. Information from the training matrix showed that only eight staff working in the home had received training in infection control. A new system called OTEX has been introduced in the laundry to help with infection control when washing peoples laundry and llinen. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do not always receive the care they need because the deployment and training of the staff means that there are not always sufficient staff, with the right skills, available to meet their needs. The staff recruitment procedures do not protect the people living in the home from the employment of unsuitable staff. Evidence: The staffing rota showed that on the day of inspection there was one senior carer on duty throughout the day with five care staff in the mornings until 2pm, four in the afternoons and three overnight. In addition there were domestic and catering staff. We found that there were times when the staff were very busy. In particular we saw that the new resident admitted in the late afternoon was disoriented and there was no staff member allocated to him to help him settle down for the first few hours in the home. Staff told us that several residents became restless in the late afternoon and that this was a busy time of the day. The home may need to look at the deployment of staff at busier times of the day for example the Expert reported that, When walking around the ground floor alone, later in the day I found two carers standing in here (the kitchenette) having a natter here whilst other care staff were trying to placate a lady, who by this time was getting very aggressive with staff and residents alike. Most of the staff interactions we saw were kindly and helpful. However there were Care Homes for Older People Page 24 of 35 Evidence: times that staff did not speak appropriately to the residents or provide them with the support that they needed. The Expert said I saw very few positive sociable interactions between the care staff and the residents throughout the day or occasions where they attempted to entertain or occupy the residents. Their lack of responses to displays of frustrated and challenging behaviour, probably borne out of boredom, beggar belief, as does their inability to prevent such incidents by appropriately managing and working with the ladies and gents who live in Bluebrooke. We started to look at files of care staff but the acting manager said that they have not recruited any care staff for over a year. They have employed new ancilliary staff. On those files we found that the recruitment had not been carried out to the standard we would expect to protect the residents in the home. For one person we found no copies of references on her file and the acting manager could not find her Criminal Records Bureau (CRB) disclosure check. Her POVAfirst was on her file. There was also a new member of domestic staff who was working in the home without a CRB disclosure check having been received. She had also started to work before her POVAfirst had been received. We looked at the file of a new bank carer who had been employed this year and found that her CRB disclosure check was dated after she had started employment and that her references were not taken up. The home were unable to find a training file for this employee. The service provider said that the acting manager had not known the expected standards with regard to recruitment practice and that this had been identified and the missing documents sent for. In the AQAA the home reported that all staff who had started working in the home in the last 12 months had satisfactory pre recruitment checks. This information is incorrect. We found that there were aspects of staff training that needed attention. The AQAA indicated that only five staff have done structured induction training to the expected standard. We identified that one carer had started her NVQ 2 without doing any induction training in the home. We also found that there were gaps in the expected training that staff should have done, examples of this include staff not completing training in safeguarding and infection control. The home has identified that there are times when there is no staff member on the premises who has trained in first aid and some staff are currently taking training in this area. There has also been training in health and safety and moving and handling this year. We pointed out to the service provider that 34 staff had completed moving and handling training in one day and that he needed to confirm that the training course contained the information and practical sessions that staff would need to work safely in this area of practice. We later spoke to a member of staff who confirmed that she had been involved in a practical session with her moving and handling training. Staff who undertake risk assessments have not Care Homes for Older People Page 25 of 35 Evidence: taken any training in how to undertake this function. Of particular concern was that the training matrix indicated that only ten of the staff group had taken any training in dementia care. The majority of the residents living in Bluebrooke have a dementia illness and care needs to be taken that staff have a good understanding of the condition and how to provide best care. There are examples throughout this report of staff working with residents in a way that does not show understanding of this illness. Staff are encouraged to take an NVQ qualification and a significant number have achieved this. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed in a way that promotes the health and wellbeing of the people who use the service. Evidence: There is a legal requirement that people who are in day to day charge of a care home register with us in that capacity. The previous acting manager left the home in January 2009. There is currently an acting manager in the home who has not yet applied for registration. We will write to her and to the service provider about this need for registration. She is very caring and committed but we had some concerns about her ability to manage a care home of the size of Bluebrooke and with the complexity of care needs of some of the people living there. She showed some areas of lack of knowledge and inexperience for the role. For example she did not know about proper recruitment procedures and did not review peoples risk assessments in a timely manner. She is in the process of taking training relevant for the manager of a care home. She has not received a period of induction herself from the service providers. Care Homes for Older People Page 27 of 35 Evidence: The acting manager spends some time working on the floor with the residents and staff. We found that there were times when she tried to work with residents to diffuse potentially difficult situations. Care needs to be taken to ensure that this does not remove her from the task of managing the home. The acting manager completed the AQAA and in this she gave some well detailed information about the service. However some of this did not accurately reflect what we found at the inspection. For example the AQAA states We employ a rigorous employment programme in the homeand Risk assessments are in place and monitored monthly by senior staff. Neither of these statements is accurate. We saw a number of situations with residents and staff during the time of the inspection that we considered inappropriate. In particular there were situations where we observed the inability of the staff to intervene to diffuse behavioural issues with the residents. These are referred to throughout the report. These reflect on the oversight of the management of the home in managing difficult or challenging situations. The acting manager told us that she receives good support from the service provider and the director of operations for the company. She said that they visit the home regularly. There were records of monthly visits undertaken by the service provider as required by regulation. The content of these was general in nature. Equipment in the home is serviced regularly and the home employs a maintenance man to carry out minor repairs, attend to the grden and decoration in the home. The home has bought new wheelchairs recently to make sure that these pieces of equipment are safe and comfortable for people to use. We looked at the fire log. This showed that various checks and tests are carried out on a regular basis. Staff employed in the home receive training in fire safety from an external consultant once a year and there are occasional fire drills during the year. The fire safety risk assessment has not been reviewed since September 2006. The service provider said that he was following guidance form the person who prepared this for him. However we advised him to contact the fire brigade regarding this as inevitably things change within a care home and we considered he should seek another source of advice. Care Homes for Older People Page 28 of 35 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 29 of 35 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 29 19 Regulation 19(1). 03/07/2009 You must secure sufficient information about the suitability of potential employees before they start working in the home. This must include two references, a CRB check and a POVAfirst check. This will help to prevent the home from employing unsuitable people. 2 30 18 Regulation 18(1)(c). You must ensure that staff receive the training that they need both at induction and ongoing throughout their employment. This will help to ensure that people living in the home receive the care they need from staff who have taken training relevant to the work they are doing. 31/07/2009 3 4 12 Regulation 12(1). You must make sure that 31/07/2009 Care Homes for Older People Page 30 of 35 the home makes proper provision for for the needs of people living in the home with dementia illnesses. This will help to ensure that they receive the care that they need appropriate to their condition. 4 7 14 Regulation 14(2) Each persons assessments must be kept under review. This will ensure that the home has up to date information about each persons care needs . 5 7 15 Regulation 15(2)(b) Each persons plan of care must be kept under review. This will ensure that the home provides up to date information to care staff about how to make sure peoples needs are met. 6 7 15 Regulation 15(1) 31/07/2009 People living in the home should have a detailed plan of care that describes how all their care needs in respect of health and welfare are to be met. The people living in the home, or their representative, must be involved in the preparation of the care plan. This will provide care staff with the information they need to ensure all the needs are met of people who live in the home. 31/07/2009 31/07/2009 Care Homes for Older People Page 31 of 35 7 7 13 Regulation 13(4)(c)Risk 31/07/2009 assessments must be carried out in relation to needs arising from peoples health care conditions and staff must be made aware of the outcome of any risk assessment. This will help to ensure that any unnecessary risks to the health and safety of people who use the service are identifed and so far as possible eliminated. 8 10 12 Regulation 12(5)(b) You must put arrangements in place to ensure that staff treat residents with respect at all times. This will help to ensure good personal relationships between staff and people living in the home. 03/07/2009 9 15 12 Regulation 12(4) You must make sure that people who live in the home are offered assitance with eating their meal individually. This will help to promote dignity and a sensitive approach to mealtimes. 03/07/2009 10 18 13 Regulation 13(6) You must ensure that all staff receive training in how to protect vulnerable people from abuse. This will help to ensure that they recognise abuse and 14/08/2009 Care Homes for Older People Page 32 of 35 neglect and will know what to do to prevent this from happening and what action to take if they suspect this has occurred. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 A system should be put into place to ensure that there is an initial care plan prepared for each person admitted to the home. This will ensure that staff working in the home understand what the care needs of new residents are and what action they need to take to meet these. Consideration should be given as to how to best help people at the time of moving into the home. You should ensure that continence is managed appropriately in the home so that peoples dignity is promoted. You should put a system into place to ensure that medication is stored at a suitable temperature. You should make sure that it is always possible to determine from the record of administration of medication whether a medication has actually been administered. You should continue to develop greater opportunities for stimulation and leisure. Recreational activities should be reviewed with people living in the home to ensure they meet individual need and preferences. You should ensure that mealtimes are a pleasant, social occasion so that people enjoy the experience. You should ensure that you record all complaints that are received by the home are recorded in the complaints log togehter with details of the investigation and any action taken. This will show that the home takes complaints seriously. You should continue with your plans to make the garden safe and accessible for the people who llive in the home to use. You should use a quality assurance system and monthly monitoring visits, carried out under Regulation 26, more Page 33 of 35 2 3 3 8 4 5 9 9 6 12 7 8 15 16 9 19 10 33 Care Homes for Older People effectively so that you are aware of deficiencies where they occur and can take action to remedy them. 11 38 The service provider should consult with the fire brigade about the frequency with which the fire safety risk assessment for the home should be reviewed. Care Homes for Older People Page 34 of 35 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. 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. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!