Inspection on 23/03/09 for Bramley Court

This inspection was carried out on 23rd March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Bramley Court 22/02/10

Bramley Court 16/11/09

Bramley Court 26/11/07

Bramley Court 16/01/07

Bramley Court 02/05/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER Lead Inspector Patricia Flanaghan Unannounced Inspection 23rd March 2009 08:15 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000066491.V374676.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000066491.V374676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramley Court Address 251 School Road Yardley Wood Birmingham West Midlands B14 4ER 0121 430 7707 0121 474 2944 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.schealthcare.co.uk Southern Cross Care Management Limited Miss Deborah Clarke Care Home 76 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (39) of places DS0000066491.V374676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within other category (OP) 39 Dementia (DE) 37 The maximum number of service users who can be accommodated is: 76 26th November 2007 2. Date of last inspection Brief Description of the Service: Bramley Court is a 76 bedded purpose built care home providing 24 hour nursing care. The Dementia House is located on the ground floor of the Home and can accommodate a maximum of 39 residents with dementia. The first floor is a 37 bed-nursing unit, which also currently has some residential care beds. On both floors the residential care facility will be phased out and no further residential care admissions will be accepted. The Home has level entry access and the first floor can be accessed by a passenger lift. It has wide corridors and handrails to assist residents to maintain their independence. The home has hoists and stand aids that can assist residents with decreased mobility, and pressure relieving equipment is available for residents who require this to prevent skin sores. All bedrooms have en suite toilet facilities, and there are assisted bathing facilities to meet the needs of the residents who require this assistance. The Home has dining room facilities and lounge areas. Kitchen and laundry facilities are located in the basement of the home. Bramley Court is situated in a suburb of Birmingham with public transport and limited amenities close by. There is limited off road parking available at the front of the Home and a small-enclosed garden/patio area to the side of the home for residents use, weather permitting. DS0000066491.V374676.R01.S.doc Version 5.2 Page 5 Contact details for CSCI are displayed throughout the Home and our most recent inspection report was available for anyone interested to read. Notice boards are available throughout the Home displaying forthcoming activities, the Home’s newsletter and other information of interest to residents, visitors and the staff. Current fee rates are not included in the statement of purpose or service user guide but can be obtained from the Home. Additional charges include hairdressing, toiletries, newspapers/magazines and private chiropody. DS0000066491.V374676.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. Two inspectors, including the pharmacist inspector, undertook the inspection visit to this home. The visit took place between 8:00am and 4:00pm and staff and people who live at the home did not know that we were coming. Before the inspection, we looked at all the information we have about this service, such as information about concerns, complaints or allegations, incidents and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. We looked at the Annual Quality Assurance Audit (AQAA) which the manager completed and returned to us before our visit. This is the managers review of the service and gives us information about how the service has progressed in the last 12 months. We sent out random surveys to fifteen people who live at the home and ten staff in order to gain peoples views about the service. Nine people who live at the home and four staff completed and returned surveys to us. Comments were generally positive about the home and are included in this report. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We talked to people who use the service and observed their interaction with staff. We looked at the environment and facilities provided and checked records such as care plans and risk assessments. We also looked at staff duty rotas, training and recruitment records. We talked to the manager, two nurses, four care staff, the cook and an activity co-ordinator. We also spoke with four visitors to the home. Five people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. DS0000066491.V374676.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: DS0000066491.V374676.R01.S.doc Version 5.2 Page 8 Improved medicine management systems must be installed in the dementia care unit to ensure that the health and wellbeing of the people who live in the home are fully met. The home should review staff availability so that peoples needs are met in a timely manner and in a way that meets their wishes. Opportunities for people to engage in meaningful and stimulating activity should be reviewed to ensure it is accessible to all people who use the service, whatever their needs or abilities. This should enhance the quality of life for people living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066491.V374676.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066491.V374676.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. Quality in this outcome area is good. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments ensure that people know their needs can be met prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the information given to people before they move to Bramley Court. Everyone is given a copy of the statement of purpose and user guide, which is available in the hallway of the home along with our most inspection report. We spoke with two people who live at the home who both said they had enough information about it before they moved in. They had not visited beforehand, but said their families had looked around the home and that they had an opportunity to change their minds once they had been there a while. DS0000066491.V374676.R01.S.doc Version 5.2 Page 11 We looked at the assessments that had been completed for two people who had recently moved to Bramley Court. The assessments were comprehensive and included all the information required in order for the home to assess if it could meet peoples’ physical and mental health needs and how many carers are needed for support. We saw that notes are made of the person’s social interests, hobbies, religious and cultural needs. There is a separate pre admission assessment completed for people with dementia care needs so the home can ensure that their specialist needs can be met. Before the person is admitted a draft care plan is developed which outlines the care and support to be provided for that person. Bramley Court does not provide intermediate care. DS0000066491.V374676.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. People living in this home can be confident their needs will be recognised and met and they will be treated with respect and dignity at all times. The medicine management was excellent on the nursing unit on the first floor. Medication management on the dementia unit needs to improve so that all people can be confident they will receive their medication as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Bramley Court have very varied needs, for example some people can care for themselves with some support, others have communication difficulties arising from dementia and others have very high physical needs requiring care in bed. The last inspection report identified some areas for improvement so the service could meet peoples varied health and personal care needs better. We looked in detail at records for five people with varying support needs, and spent some time talking with and observing people who live there. DS0000066491.V374676.R01.S.doc Version 5.2 Page 13 We saw that each person had care plans and risk assessments that detailed the care they needed. Care plans are kept under regular review and changes to care are recorded. Baseline observations of resident’s blood pressure, pulse, temperature and weight had been recorded on or as soon as possible following their admission. This is good practice and would support staff when monitoring any deterioration or improvement in a persons well being. Risk assessment had been reviewed and completed in all care plans examined. These include risks related to pressure areas, falls, mobility and nutrition. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. For example, a person who had previously developed a pressure sore had been identified as being at high risk of acquiring pressure area damage. A care plan had been written with guidance for staff on how to minimise the risk of a pressure sore occurring. We observed that there was pressure relieving equipment, such as a specialist mattress, in use for this person. This supports this person’s plan of care and decreases the risk of deterioration in their health and well being. Staff spoken with were able to explain the person’s care needs and what they do to ensure that the person’s needs are met. A further person had been identified as being at risk of losing weight. Daily written reports show that all efforts had been made to encourage the person to eat and help them to increase their appetite. A care plan was in place to instruct staff on the nutritional needs of the person, food likes and dislikes and referral had been made to the GP and dietician for advice and support in managing this person’s care. The home develop care plans for short term care needs. For example, one person had a chest infection, which necessitated a visit from the GP, and a course of antibiotics was prescribed. A comprehensive care plan was developed to ensure that staff met the person’s needs. Entries in each person’s health records and comments by people living in the home confirmed that they are supported in getting access to relevant health care professionals when needed. This includes access to GP, Chiropodist, Community Psychiatric Nurse and Optician. One care plan contained clear documentation to show that a person had received ongoing treatment from a dentist. The manager told us that the home has a very good relationship with the local GP surgery, who visit regularly to see people in the home. This should mean that people receive specialist advice about their healthcare needs. One person commented in their completed survey, “If my mother has needed medical attention she has been seen straight away and we have been contacted immediately.” DS0000066491.V374676.R01.S.doc Version 5.2 Page 14 Written daily reports in care files provided information on people’s day-to-day life in the home and provides details on their health and well being. Entries had been signed, dated and timed by the member of staff making the entries. This ensures accuracy provides information, if required, of the staff member deemed responsible for ensuring care needs are met. People told us during our visit and in surveys returned to us that they were happy with the care they received at the home. Comments included: “My relative receives very good care;” “All the staff are excellent and very professional.” ” The home cares for all my relative’s needs and support me emotionally.” The pharmacist inspection took place at the same time as the main inspection. It lasted four hours. Eight people who live in the homes medicines were looked at, together with their medicine administration record (MAR) charts, care plans and daily records. The medicines are kept in dedicated medication rooms on each floor. Air conditioning systems had been installed ensuring that all medicines were stored at the correct temperature to maintain their stability. Both rooms were very tatty, untidy and dirty. They lacked adequate locked storage space resulting medicines awaiting return to the pharmacy stacked up in boxes in the room. We, the commission were assured that they were part of the refurbishment programme but no time scale was given as to when this was to take place. A bracelet was found in one Controlled Drug cabinet. This should be reserved for the storage of controlled drugs only to limit its use. Key security was also a problem on the dementia unit as a set of keys, which opened the Controlled drug cabinet and other storage cabinets were kept in an unlocked drawer instead of being held by the nurse in charge. Anyone gaining access to the medication room would have access to the cabinets within. The mornings medicine round started after breakfast had finished, in line with Southern Crosss policy. This resulted in the medicine round not being completed until 11:30, which then had an impact on the lunchtime round which started at 2pm. At least four hours should elapse between medication rounds to reduce the risk of potential overdose. On the nursing unit, nursing staff had checked in all the medicines against a copy of the current prescription and recorded exactly what had been received. Audits indicated that the medicines had been administered as prescribed and records reflected practice. Both nurses spoken with had an excellent knowledge of the medicines they handled and this was commended. They DS0000066491.V374676.R01.S.doc Version 5.2 Page 15 understood what the medicines were for and would be able to fully support the clinical needs of the people who live in the home. The care plans were very good and would enable staff to understand the clinical needs of the people. All relevant information was recorded in a succinct way and it was easy to find. A few problems were found on the dementia unit. Nursing staff had failed to check in one persons medication correctly resulting in one medicine not being administered. No checks had been made with the residents doctor, to confirm the current medicine regime. Nursing staff had failed to obtain a further supply of two medicines and the resident had been without them for two days. No prescription was on order to obtain the supply. The manager assured us that this would be obtained as soon as possible. Medicines for the dementia unit were kept in three medication trolleys - two for the day time use and one for night time use. If a medicine had been dispensed in one box or bottle only this was moved from one trolley to the other. Some medicines were unaccounted for and some medicines had been signed as administered when they had not been. In one instance staff had signed that they had administered the same dose of medicine twice, indicating that the person received twice the prescribed dose. In reality this did not happen but this indicates that the staff did not read the medicine chart fully or accurately record what they had done in all instances. Regular audit checks take place but some of these were inaccurate so their benefit was questionable. Staff had failed to check the medicines received into the home adequately as there was no copies of the current prescription to check them in against. The care plans lacked detail and did not support the prescribed medication. Without such detail staff would not be able to fully meet the clinical needs of the people who live in the home. One nurse was spoken with from the dementia unit. She had a good knowledge of the medicines she handled. She though failed to identify how one mistake had happened, which was cause for concern, especially as she was responsible for checking in the medication. The manager was very proactive during the inspection and keen to put additional systems in place on the dementia unit to address the matters of concern found. Further training on the medicines used in dementia had been booked for staff on the dementia unit and refresher medication training for staff on the nursing unit. DS0000066491.V374676.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 and 14 Quality in this outcome area is adequate. Activities offered may not meet all the needs and expectations of the people who live at the home. People are offered a choice of meals to meet their dietary, cultural needs or preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The approach to activities and events occurring both in and outside the home has improved since the last key inspection. An activities coordinator is employed in the home for each floor and work 4 hours a day, 5 days a week in planning and delivering activities to those people who want to take part. The manager told us that she would like to see the role developed and in particular for those people who cannot come out of their rooms in the day. This is good practice and means that care staff levels are not depleted. A planned programme of activities such as arts and crafts, board games and quizzes takes place daily. A copy of the programme is available in the home. Outside entertainers, such as singers, regularly perform in the home. DS0000066491.V374676.R01.S.doc Version 5.2 Page 17 The case files of people case tracked contained some details of their hobbies, interests and past working life. Several people living in the home spend much of their day in bed because of their care needs. The service could improve the opportunities for these people to engage in meaningful and stimulating activity to enhance the quality of their lives. A record of group and individual activities is maintained in the home. Activity records should include detail about the success of each activity in order to plan for future activities. People were seen to come and go from the home as they chose to and Ring and Ride came to collect one person to take them to a social club while we were visiting. This encourages their independence and enables them to maintain links with the community. Peoples preferences regarding their religion are supported and respected and church services and Holy Communion are held at the home regularly. This ensures that people can continue to follow their religious needs if they choose to. A hairdresser visits twice a week so that people can have their hair styled in a way that they prefer. The home has an open visiting policy and people can see their visitors in the privacy of their own rooms should they choose to do this. This means that people can maintain the relationships that are important to them. Relatives and friends were seen to visit during the day of inspection. People told us that visitors are made welcome and the visitor’s record demonstrated that people can visit when they want to. Visitors told us: “I come and go as I want, I am always made welcome” “I visit every day and am greeted by name. Staff ask me if everything is ok.” People are encouraged to personalise their rooms to their own individual tastes and this was evident when we looked around. There is a four-week menu in place and this offers two hot choices at lunchtime and a choice of soup and sandwiches or hot snack in the evening. The manager told us that Southern Cross had recently implemented a menu which was nutritionally balanced. The manager also said that people were asked what their favourite meals were and these were incorporated into the menus. Evidence of this was seen in completed quality questionnaires undertaken by the home and in the minutes of residents meetings. We made a brief visit to the first floor dining room during the lunch time service. The day’s choice of meal was braised steak or macaroni cheese served with mashed potato, swede and cauliflower. Pears and custard or ice cream was offered for dessert. People were offered fruit juice or water during their meal. If people do not like what is on offer they can choose an DS0000066491.V374676.R01.S.doc Version 5.2 Page 18 alternative. The meal was served from a heated trolley brought up from the kitchen. Meals were delivered to people who chose to eat in their room. People made positive comments about the food provided in the home. Comments received during the visit and from people who completed surveys include; “The food “The food “The food “We have is very good. There’s so much choice;” is excellent;” is fresh, well presented using local produces;” found that the food provided is very good and plenty of it.” DS0000066491.V374676.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. People told us that they would initially raise concerns with their relatives or representatives who would speak to the manager on their behalf, but they said they felt they could go to the manager or senior carer and they would be listened to. People and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: “The manager always listens, she seems to get things done.” “I can talk to any of the staff.” DS0000066491.V374676.R01.S.doc Version 5.2 Page 20 Evidence was available that the manager makes a timely and objective response to concerns made directly to the home. A record of complaints received by the home is maintained along with the action taken by the home regarding each issue raised. The service has recorded 13 complaints since the last key inspection. One complaint raised concerns about whether the home had taken appropriate action to maintain the safety of a resident a resident injured during a fall in the home. The manager recognised this complaint as safeguarding issues and made appropriate referrals to Social Services for investigation using joint agency guidelines. The referral was investigated and recommendations made which the manager has implemented. There have been five incidents of a safeguarding nature since our last visit and the manager has notified the appropriate authorities of these in order to protect vulnerable people living at Bramley Court. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Training records examined show that most staff have had training in recognising signs and symptoms of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures and her responsibilities for responding to allegations of abuse; this was further evidenced by the appropriate referral of allegations. DS0000066491.V374676.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good, The home is well maintained and provides a pleasant place for people who use this service to live. There systems in place to prevent the spread of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bramley Court offers accommodation on two floors for up to 74 elderly people. The ground floor accommodates people who require both nursing care and dementia care. The first floor provides a service for people who need nursing care. Some of the accommodation and facilities in the home were seen while visiting and talking to people, their families and staff. People who live at the home were observed making use of all the communal spaces. Several bedrooms, including the people involved in case tracking, were viewed. Rooms were comfortable, cosy and well decorated with en suite facilities. Most DS0000066491.V374676.R01.S.doc Version 5.2 Page 22 of the rooms visited showed that they were attractive and homely. People said that being able to bring in small items of furniture and other furnishings such as pictures and cushions helped to make their bedrooms comfortable. We asked if the rooms and furniture were comfortable. A person told us “It’s lovely. I’m very comfortable here.” Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. There are systems in place to prevent the spread of infection. Staff have access to gloves and aprons, there is also liquid soap and paper towels for hand washing purposes in all toilets and bathrooms. The home was clean and fresh on the day of the visit. DS0000066491.V374676.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number of staff on duty is not always sufficient to meet the needs of people living in the home at all times of the day. People benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that there were two registered nurses and five or six care assistants on each floor during the day and one registered nurse and three care assistants on duty on each floor at night. Agency workers supplement the staff team at times to cover absence or sickness. The manager told us that the home no longer rely as heavily on agency workers, as before, and they tend to be regular workers so that this does not impact too much on the continuity of care for the people living there. Comments made by people who use the service and their visitors during the inspection visit indicate they are not happy with the calibre of agency staff supplied to work in the home. We also received a number of negative comments in the surveys returned to us. Comments include: “There’s none of them (agency workers) as good as regular staff, the amount of times I see them on their mobile phones when they should be working is DS0000066491.V374676.R01.S.doc Version 5.2 Page 24 unbelievable. The phones should be taken off them when they come in, it’s not right they can get away with this, when people are shouting for help;” “Agency staff don’t appear to speak or understand English;” “The care is not very well organised when agency staff are on duty;” “If I want anything, it depends on who is on duty. If from agencies, you might as well talk to the wall.” The use of agency staff is reducing as some new care staff have been recruited. The Manager said that there were still one full time vacancy and two part time vacancies that they hoped to recruit to soon. The care team also work alongside ancillary workers such as housekeeping, administration, maintenance and kitchen staff. People expressed concern that it sometimes took quite a long time for staff to respond to call bells or requests for assistance. People commented in the surveys: “During the night the call button is answered reasonably quickly. This is not necessarily the case during the day. We know the day staff have more to do, so are frequently low on numbers, but half an hour and more is too long to wait for attention, usually a pad change is needed.” “Quite often the call button is not within reach, left hanging on the wrong side of the bed or on the floor behind it;” “The response to the alarm in the bedrooms is very slow, I worry if there is an emergency and people are waiting for the staff to attend to them.” During conversation a person also told us that sometimes she had to wait for a long period of time for staff to come and take her to the toilet. A visitor also commented that they would like to see a prompt response to call bells. While we were visiting people on the top floor at 4pm, we heard a person calling from the lounge for someone to take them to the toilet. Two visitors were visiting another person in the lounge at this time. We approached a care assistant in the corridor and asked her to assist the person. The care assistant told the person that they would be back in about 15 minutes to help them to the toilet before the evening meal as they would then be “toileting all the residents.” This conversation took place in front of other residents and the visitors. This practice doesn’t promote peoples’ dignity or give assurance that daily routines are based on individual needs and preferences. DS0000066491.V374676.R01.S.doc Version 5.2 Page 25 This also reinforces the need for staffing levels to be based on the dependency of people living in the home to ensure that their care needs can be met in a timely manner and in a way which maintains their dignity. A review of two staff files confirmed that recruitment practices for the home are good. Staff files contained evidence of protection of vulnerable adults (PoVA) checks and Criminal Records (CRB) checks. These were completed before staff commenced working in the home. References obtained were appropriate. Records of interviews are maintained to support equal opportunity practices within the home. Robust recruitment practices will support the safety of people living in the home. A training matrix is maintained to show training sessions attended by staff. Staff spoken with said that they had attended fire training, moving and handling and infection control. Training records showed the date and topics covered in the training. A number of specialist training courses have also been accessed, for example, stoma care and mental health awareness training, The manager stated in the AQAA that 50 of staff have a National Vocational Qualification in Care. She also stated that 5 care staff are currently working towards obtaining the qualification. The home ensures that staff have an induction into the home, which consists of basic training, working with someone for two weeks and then working through the Skills for Care induction This should mean that people are cared for by competent staff. DS0000066491.V374676.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked at the home for eighteen months and is registered with us. She is experienced in the care of older people. She is a Registered General Nurse and has completed the Registered Manager’s Award (NVQ Level 4). Staff, people living in the home and visitors said the manager was approachable and regularly spent time on both units. The organisation is seeking to employ a deputy manager to support her in the home. One person DS0000066491.V374676.R01.S.doc Version 5.2 Page 27 commented in their survey, “I think the present manager has made a big difference to this home.” Records seen indicated that systems are in place to obtain the views of the residents, relatives and other stakeholders about the service. Southern Cross conduct annual quality assurance audits. A copy of a quality assurance survey from October 2008 was seen, the results are also available on the notice boards throughout the home for people to examine. Regular meetings are held with relative, residents and staff, and minutes of the meetings held in March were seen. Reports were seen for regulation 26 visits made by the provider to monitor the care and service they provide and ensure that the home is being run in the best interests of people who live there. Records seen indicate the provider has procedures in place for handing peoples’ money and personal effects given to them for safe keeping. Incidents and accidents that happen in the home are recorded and were available for examination. The manager completes a monthly accident audit to analyse any patterns that occur. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. The home confirmed in a pre-inspection questionnaire forwarded to the commission that health and safety checks had been completed. A sample of service and maintenance records were examined and found to be up to date. The staff training matrix identified that the majority of staff have undertaken training in safe working practices such as moving and handling, infection control, fire and food hygiene. Training for new staff in moving and handling was due to take place in April. Risk assessments for safe working practices were available with evidence of review. . DS0000066491.V374676.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000066491.V374676.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The right medicine must be administered to the right service user at the right time and dose and records must reflect practice. Nursing staff must ensure that all the medicines received into the home are as prescribed by the GP or other health professional . This is to ensure that the health and well being of the service users who live in the home 2 OP27 18(1) Staff must be available to provide care for people at the times that they require in order to prevent waiting for assistance for an unacceptable length of time. Attention should be given to peak times of activity in the home. This will ensure that people’s care needs can be met safely at all times. 23/04/09 Timescale for action 23/04/09 DS0000066491.V374676.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is advised that the controlled drug cabinet is reserved for the storage of controlled drugs only. It is advised that the nursing staff leave at least four hours between medication rounds to reduce the risk of potential overdose. It is advised that the medication room is refurbished and the storage cabinets are used to safely store medication. It is advised that the medication room is cleaned and tidied on a regular basis to ensure documentation and medication can be located easily. It is recommended that training be provided for suggestions for activities for residents with dementia and people who are unable to participate in group activities. Activity records should include detail about the success of each activity in order to plan for future activities. Opportunities for people to engage in meaningful and stimulating activity should be reviewed to ensure it is accessible to all residents, whatever their needs or abilities. This should enhance the quality of life for people living in the home. The manager should have information about agency workers that shows they have been trained for they job they have been employed to do and that they are suitable to work with vulnerable adults. 3 OP9 4 OP12 5 OP12 6 OP29 DS0000066491.V374676.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000066491.V374676.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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