Inspection on 08/01/10 for Brambles

This inspection was carried out on 8th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brambles 31/10/06

Brambles 20/10/05

Brambles 04/05/05

Brambles 18/10/04

Brambles 10/05/04

Brambles 23/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Brambles Birchfield Road Redditch Worcestershire B97 4LX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Bromige     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Brambles Birchfield Road Redditch Worcestershire B97 4LX 01527555800 01527548888 brambles@heart-of-england.co.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited care home 60 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 60 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: Old age, not falling within any other category (OP) 60 Dementia (DE) 60 Physical Disability (PD) 60 Date of last inspection Brief description of the care home Brambles is a purpose built home for older people who may have a physical disability and/or mental health needs associated with old age. Additionally the home has registration for one older person with a learning disability and registration for one person under 65 who has a physical disability and mental disorder. The home is set in a residential area of Redditch which is about half a mile from local amenities and Care Homes for Older People Page 4 of 31 Over 65 0 60 0 60 0 60 Brief description of the care home convenient for public transport. It is on three floors, there is a passenger lift to all levels and handrails fitted where necessary. All bedrooms are single and have en-suite facilities. Communal adapted toilets and bathrooms are available on all floors. There is also a garden area, which can be accessed by residents. The home is owned by Heart of England Housing and Care Ltd, for whom the responsible individual is Ms Michelle Shawcross. The registered home manager is Mrs Margaret Hook. The email address for the home is: brambles@heart-of-england.co.uk Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 31 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: We, the commission completed the last inspection of this service on the 31st October 2006. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments Care Homes for Older People Page 6 of 31 have been included within this inspection report. We also received completed survey forms from people who use the service, staff working at the home and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We have not received any complaints about the service since the last inspection. There has been a referral to the local multi-agency safeguarding process due to an allegation of theft of money from a person who uses the service. The home has continued to update us with the progress of the investigation. Subsequently a carer was dismissed and reported to the Independent Safeguarding Authority for potential inclusion on the list of people barred from care work. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be improved to ensure they are reviewed and updated when peoples needs change to ensure staff understand what is required and people can be sure their needs will be met. The overall management of medication needs to be improved to ensure people receive their medication as prescribed and are not placed at risk of harm through incorrect storage of medicines. Communal towels and flannels need to be washed at higher temperatures to prevent the risk of cross infection. Further training is needed in care records and medication management to ensure peoples care needs are met at all times and people are not placed at risk of harm through poor management of medication. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. People who wish to start using the service are assessed prior to admission to ensure their needs can be met by the home. Brambles does not offer a dedicated intermediate care service. Evidence: The AQAA completed and sent to us by the manager before the inspection tells us pre-admission assessments are carried out in the community and at Brambles for prospective people who may use the service. We looked at the care records for a person who has recently started using the service. We saw a pre-admission assessment was carried out by a representative of the home before the person moved in. A close relative of the person being assessed was involved in this process. The information obtained was informative and provided enough information to enable a care plan to be prepared ready for admission of this Care Homes for Older People Page 11 of 31 Evidence: person to the home. There was no information about the medication this person was taking. This needs to be obtained at each assessment to find out what they are taking and why and how much assistance is needed to enable the person to manage their medication safely. We received completed surveys from three health professionals who visit the home. In the survey we asked if the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people? The response was one stated always, one usually and one sometimes. A comment from one health professional stated, the service could improve if they acquire as much of the residents medical history before taking them on as residents. We have found it difficult to provide adequate medical cover when there is a lack of acurate information regarding new residents past medical history. Care Homes for Older People Page 12 of 31 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. Care plans need to be written, reviewed and updated as peoples needs change to ensure staff are fully aware of the current care needs and people can be confident they will get the care they need at all times. The overall management of medication needs too be improved to ensure people receive their medication as prescribed and are not placed at risk of harm through incorrect storage of medicines. Staff respect peoples privacy and dignity. Evidence: We looked in detail at the care of two people who use the service. During the inspection we saw that these and other people had been helped to look their best by staff, for example, people were wearing clothes that had been nicely laundered and their hair and nails were well looked after. We saw staff knocking on bedroom doors before going into peoples rooms and we heard staff speak to people in a caring and respectful manner. The surveys we had sent back to us gave a very positive picture about the care provided by the staff at the home. We asked people in the surveys what the home Care Homes for Older People Page 13 of 31 Evidence: does well and we were told a high standard of care. Mostly providing good care and support looking after the people very well. It provides good care and support. We are well cared for at all times. The care staff look after the service users well and supports where needed. Care staff give me everything I need. We spoke to three relatives during the inspection and they were all very complimentary about the staff and the care they provide. We looked at the care records for the two people whose care we tracked. This is so we could find out what assistance they needed with their care. We spoke to staff to find out if their understanding of the care needs of these two people was the same as the information in the care plan. We found there was important information that was not included in the care plans and staff were giving care that was not included in the care plan. Staff did not always have a good knowledge of the care needs, which can lead to an inconsistency of care and places these people at risk of not receiving the care they need. For example, one person did not have a care plan for management of their diabetes, pain and continence. Staff spoken with told us the person was not diabetic and had no continence problems. We saw specialist pads in the persons room for management of continence. The person who uses the service told us they use pads and they may need assistance with them at times. The night care plan told us the person needs help to change their pad at night, but the care plan did not specify which type of pads are used by this person. One person was taking medication to reduce the thickness of their blood. There was no care plan for this, giving instructions to staff about what to look out for such as any bruising or bleeding, and certain drinks they are not allowed to have if they take this medication. There was no information in the care records telling us why the person was taking this medication. We asked a senior carer for this information but they were not sure why this medication was prescribed by the GP. We saw in the care plan this person had dry and flaky skin. The District Nurse was dressing this persons leg but the care plan did not tell us why the District Nurse was dressing the leg and how often. We saw this person had dry skin on both of their legs and we saw a tube of Aqueous cream in their room. There was no information in the care plan about any creams that needed putting on for the dry skin. The senior carer was not aware the person had any cream in their room and told us the District Nurse was dressing the leg daily due to ulceration of the skin. We saw the person did not have any dressings on their leg. The person whose care we tracked told us the District Nurse was dressing her leg as it was oozing fluid but was not coming any more as it had improved. We looked at the care of a person who was receiving end of life care. The care plan stated the person was spending all of their time in bed. There was no information Care Homes for Older People Page 14 of 31 Evidence: about how staff washed and cared for this persons hair. Senior care staff and care staff told us they get this person out of bed periodically for a shower and wash their hair. We looked at the moving and handling risk assessment to see what equipment staff need to use to move this person whilst in bed. There was no equipment mentioned on the risk assessment. It told us they used a wheelchair occasionally, but how this person is transferred to the wheelchair was not stated. We saw a special sheet in the persons room and staff confirmed they use this to move the person whilst in bed. Staff told us they do not use a hoist due to the person being so frail. They said they lower the bed and gently ease the person out onto the wheelchair. They told us the family are in agreement with this technique. This information is not in the risk assessment and there are no instructions for staff authorising this practice for moving and handling of this person. This places the person and staff at risk of injury through poor communication and practice. We saw the nutritional risk assessments for the two people whose care we tracked. Neither were completed accurately as the staff had failed to take into account medical problems which increase the risk of poor nutrition. The care plan for one person said they were prescribed a dietary supplement called Fortisip by the GP which should be given twice a day. The care plan instructs staff to monitor the persons weight and record the Fortisip on the fluid chart. It was not clear from the care plan if the person was eating other foods. We looked at the fluid charts for the last three days and we saw no Fortisip recorded. The fluid charts are not being added up at midnight to monitor the persons fluid intake and output every 24 hours. The medication chart did not have any Fortisip written on it. The senior carer told us the person is not being given Fortisip anymore, but two care staff told us this person was still having Fortisip. Care staff told us this person was eating very well and they were not able to weigh them due to their frailty and the District Nurse had agreed with this, but the care plan did not contain this information. We looked at the management of medication for these people. One person who had recently started using the service did not have any medication listed on the preadmission assessment. The medication administration chart (MAR) was handwritten. We asked the senior carer for the hospital discharge letter with the list of medication prescribed. We checked if the home had transcribed this information accurately on the MAR chart. The entry for tablets for pain relief on the MAR was not the same as on the discharge letter. We asked to see the box of medication and it could not be found. We saw the person had been admitted with a stock of 32 pain relief tablets and the MAR had entries showing 36 tablets had been given since admission. The home had run out of stock of this medication and it was unclear where they got the stock from to continue to give to the person until more stock was obtained. We were unable to Care Homes for Older People Page 15 of 31 Evidence: clarify the correct dose prescribed and the home agreed to contact the GP immediately to clarify this information. The MAR charts are used to record medication received by the home. One MAR chart was handwritten and the boxes for signing under the corresponding dates of administration were barely legible. The chart had been photocopied before completing. This is poor practice and could lead to administration errors of medication. The manager told us this had happened as they are in the process of changing pharmacy. We did a random audit of medication for two other tablets and found the medication was being given as prescribed. We advised the manager to ensure staff dated the box of medication when opening and indicate the first dose on the MAR to ensure they are able to carry out audits checks in the home. We looked at how the home store medication. Medication needing refrigeration is stored correctly and the staff are checking the temperature of the fridge each day to ensure it is being stored according to the manufacturers instructions. We looked at the storage of other medication. Controlled medicines are not being stored correctly as the cupboard is incorrectly fixed and the wall it is fixed to is not solid. The staff are not recording the temperature where they store non refrigerated medication. The rooms where this is stored are hot and do not have any natural ventilation. If medication is stored above the recommended temperatures it can damage the medicine and make it harmful to the people taking it. Care plans do not have any information about medication that is prescribed as when required to ensure staff know why people are prescribed the medication and when to give it. Care Homes for Older People Page 16 of 31 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 excellent 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 can be confident the home will be able to support them to follow their personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to continue these relationships. People are offered a variety of healthy meals and snacks at a time and place to suit them. Evidence: The atmosphere in the home was very welcoming, friendly and relaxed. Visitors are made welcome at the home and we saw they have a good relationship with the staff who work at the home. One person told us she sees her visitors in the privacy of their room and staff bring them a tray of tea. In the AQAA we were told about the range of activities that take place in the home. It told us they employ two activity coordinators; one arranges internal activities and one external activities and outings. The homes activity programme tends to be spontaneous to peoples wishes and requests. The AQAA told us due to the improvements made to the social care provision in the home they have noticed people are more settled. Care Homes for Older People Page 17 of 31 Evidence: Surveys from people who use the service told us about the activities and food in the home. They said the home provide good food. Organise activities. The home also has a very good activities organiser who puts a great deal of effort into the role. The care is very good also the food and activities, I am happy here. We saw staff sitting playing cards with one person. A very large flat screen television was in the lounge and a group of people were seen enjoying the programme that was on. We saw people who use the service chatting to each other in the lounge. People told us there are activities each day offered by the staff and it is their choice to join in or not. They also told us they had been taken out recently to a garden centre by Evesham. We saw that mealtimes were relaxed and that most people were helped to go to the dining room to join others for meals. People told us they sit at the same tables with the same people for meals and this is their choice. The dining tables were well presented with linen table cloths and napkins. We saw staff assisting people with their meals as required. Lunch was served from a hot trolley in the dining room and the meals are individually served. Lunch was fish or egg and chips. Staff were seen giving people a drink with their meal. We looked at the menus and saw the home produces a three week rolling menu. Cooked breakfast is available each day. There is a choice of main course available each day, but not always a vegetarian choice on the menu every day. Also available each day are jacket potatoes and salad. For supper they have a choice of sandwiches or a warm snack. Soup is available every day at teatime. The homes menu is on display in the home. Care Homes for Older People Page 18 of 31 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 be confident that staff will take notice if they have concerns and do what they can to put things right. Staff know they have a duty to protect people from the risk of abuse or neglect. Evidence: The numerical information in the AQAA told us they have not received any complaints in the last 12 months. We have not received any complaints about the service. There has been a referral to the local multi-agency safeguarding process due to an allegation of theft of money from a person who uses the service. The home told us about the incident but when we contacted them they had not referred it to safeguarding. The manager made the referral and the home have been cooperating with the Police whilst they are conducting their investigation. The home has continued to update us with the progress of the investigation. Subsequently a carer was dismissed and reported to the Independent Safeguarding Authority for potential inclusion on the list of people barred from care work. Staff we spoke to were clear with us that if they believed someone was being treated badly they would report this to the manager of the service or, if they felt it was not being dealt with, to us or social services. This was the first this Inspector had visited the home. We were not asked for any Care Homes for Older People Page 19 of 31 Evidence: identification. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a clean and comfortable environment which has been adapted to suit their individual needs. Improvements need to be made to the laundering of house linen to prevent cross infection. Evidence: Brambles is in a residential area of Redditch. The building has pleasant gardens which are accessible to the people who use the service. It is a three storey building and you enter the home at the front on the middle floor. There is lift access to all floors. The manager told us in AQAA how they have improved the environment and its facilities through provision of a new summer house, garden benches, chairs and tables. The patio has been extended and they have created more beds for flowers and vegetables. They have a rolling redecoration and refurbishment programme to ensure the home is maintained to a good standard. We saw the communal rooms and chairs were laid out in groups to enable people to chat or watch the television. We saw people had made their bedrooms their own by having personal belongings around them that are important to them. The home was clean and warm. The laundry was clean and well organised. We asked staff who work in the laundry how they launder bed linen, towels and flannels. They Care Homes for Older People Page 21 of 31 Evidence: told us they wash everything between 40 to 50 degrees Celsius. This is not high enough to prevent cross infection. Foul laundry is washed using a system where the bags open up in the wash so staff do not have to open the bags once sealed. It is washed at a sufficiently high temperature to prevent cross infection. Staff told us they wear disposable gloves for loading the machines with dirty laundry but they do not wear aprons. We explained they need to wear aprons to ensure they do not contaminate their uniform. There is a team of domestic staff who do the cleaning in the home and a full time maintenance person who deals with all routine repairs and safety checks in the building. We saw the records for checking the window restrictors and wheelchairs in the home and regular checks had been recorded. The AQAA told us all their equipment had been serviced in the last 12 months. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the people who use the service. Staff are well recruited to ensure only suitable staff are employed at the home. Further training is needed in care records and medication management to ensure peoples care needs are met at all times and people are not placed at risk of harm through poor management of medication. Evidence: On the day of the inspection there were 11 care staff on duty to cover the three floors. These numbers include lead care staff (one was covering two floors), care staff and breakfast care staff. The manager and deputy are full time and their hours are supernumerary to the care staff rotas. A team of ancillary and catering staff are also employed by the home. The rotas confirmed these are the usual care staff numbers on duty. Staff told us in surveys there are always or usually enough staff on duty in the home. Staff spoken to confirmed there were enough staff on duty in the home. One person told us they had spoken to the manager recently about the need for more staff due to increased dependency and this had been addressed. The information in the AQAA told us they have not used any agency staff in the last three months. The home employ male and female staff from a multi-cultural Care Homes for Older People Page 23 of 31 Evidence: background. The AQAA told us recruitment checks are carried out for all staff prior to employment. We checked the records of how recent staff were recruited and found that a good process was followed and all the required pre-employment checks were done to help ensure the staff employed were suitable. Staff told us they had received induction training and all their core mandatory training in the last 12 months. For example, fire and moving and handling. The manager sent us a copy of the training matrix for the home and this shows all staff have received their mandatory training. Other training which has been provided includes dementia, challenging behaviour and end of life care. Staff told us in surveys they received training to enable them to carry out their role. One comment said the home encourages training, and keeps staff up to date. We found some shortfalls in the homes management of medication and in the quality of the care records. This indicate staff need further training in these areas. Care Homes for Older People Page 24 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is generally well managed to ensure it is run safely and in the best interests of the people who use the service. Evidence: The AQAA told us the manager has NVQ level 5. Staff told us the management of the home is very good and the manager is always there if needed by staff. The senior managers of the home have received training about the Deprivation of Liberty safeguards (DoLs). No person in the home is subject to a referral to DoLs. The manager told us they have given leaflets to staff about DoLs and there is training booked for later this month. We saw these leaflets in the care offices in the home. The AQAA completed and sent to us by the service before the inspection was informative and well completed. To monitor the quality of the home through seeking feedback from people who use the service the home give out questionnaires to be completed. Meetings are held with people who use the service on a regular basis and they are service user led. We spoke to a person whose uses the service who is the Care Homes for Older People Page 25 of 31 Evidence: residents champion for the home. She told me she chairs the meetings for the people who use the service and reports back to the home manager. The manager told us this person goes to the manager and agrees any actions following the meetings on behalf of the other people. We looked at the monthly visit reports carried out by a representative of the organisation. The manager told us the visits are sometimes announced and sometimes unannounced. The last visit took place in December 2009 and focused on the management of medication in the home. The reports are not currently in line with the requirements of the regulation. They are not always unannounced and there is no information to show they are speaking with staff and people who use the service during these visits to make judgements about the standard of the care and the environment. We looked at the management of money for the people whose care we tracked. This confirmed thorough management and recording of peoples money. The numerical information in the AQAA told us all equipment has been serviced in the last 12 months. We looked at the maintenance checks for the window restrictors and these were recorded as being checked each month. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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)(2) Care plans must be detailed and care needs reviewed as peoples needs change. To ensure staff understand what is required and people can be sure their needs will be met. 26/02/2010 2 9 13 13(2) To make arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when needed and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required. 26/02/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 13 13(2) 26/03/2010 To make arrangements to ensure that controlled drugs are stored in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) regulations 1973 and in accordance with the Royal Pharmaceutical Society of Great Britain. This is in order to ensure that controlled drugs are stored safely to prevent misuse. 4 9 13 13(2) To make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure that medication does not deteriorate which can make the medication ineffective and possibly harmful to the people living in the home. 26/02/2010 5 26 13 13(3) Foul laundry must be washed at temperatures above 65 degrees Celsius. 26/02/2010 Care Homes for Older People Page 29 of 31 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 To ensure it is thoroughly clean and controls the risk of cross infection. 6 30 12 12(1) 26/02/2010 You must ensure that staff have the correct skills and competences to enable them to carry out their role effectively. So that people are not placed at risk of harm through neglect of care. 7 33 26 The monthly visits carried out by the provider must be unannounced and in accordance with this Regulation. To ensure they monitor the quality of the service being provided to the people who use the service. 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 31/01/2010 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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