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Inspection on 13/01/09 for Braunstone Firlands Care Centre

Also see our care home review for Braunstone Firlands Care Centre for more information

This inspection was carried out on 13th January 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Braunstone Firlands Care Centre Gooding Avenue Braunstone Leicester LE3 1JS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Wroe     Date: 3 0 0 1 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Braunstone Firlands Care Centre Gooding Avenue Braunstone Leicester LE3 1JS 01162558809 01162558809 firlands@prime-life.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prime Life Ltd Name of registered manager (if applicable) Rachel Court Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: No person under 55 years of age falling within the categories MD or DE may be admitted into the home except for the named person identified in the registration report of 22 December 2006 Date of last inspection Brief description of the care home Braunstone Firlands Care Centre is a care home providing nursing and personal care for up to twenty-four residents with mental health conditions including dementia. Braunstone Firlands has twenty single rooms and two shared rooms, without en-suite facilities. The home has a rear courtyard garden, which is accessible to residents. Braunstone Firlands is part of the Prime Life Group and is situated in Braunstone, Leicester. The entrance to the home is opposite Braunstone Park. There is public transport to the City Centre. Accommodation is provided over two floors with access between the floors being via stairs or a passenger lift. Communal areas are provided Care Homes for Older People Page 4 of 32 care home 24 Over 65 24 24 14 14 Brief description of the care home on both floors of the home. The fees range from £270 to £543 and may vary in accordance with the assessment of care needs carried out. People who live at the home are responsible for any additional charges such as hairdressing, personal toiletries, and private chiropody. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home on 13th January 2009. The manager, Rachel Court, helped us with our inspection. Our inspection of the home lasted a total of nine hours. As part of our inspection, we sent out surveys to the home for people who live there to fill in if they wanted to, so they could tell us what they thought about the home. One person sent us replies. They gave us positive answers to our questions, telling us they were mainly happy with the care they received. We also sent out surveys to staff, and we received one responses from a member of staff. They gave us positive responses to our questions, and told us they liked their work. Care Homes for Older People Page 6 of 32 The main way we do our inspections is using a method we call case tracking. This means looking at the care given to people in different ways. The ways this was done are: - talking to the people who live in the home - talking to staff and the manager watching how people are given support - looking at written records. We also looked at information that the provider sent to us. We were able to speak with three people who live in the home during our visit and with the relative of one person. One person praised the home and the care given. We spoke to two members of staff during our visit to the home, who told us about working in the home and gave us their views. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information in this report just about what we checked in this inspection. We have kept details about individual people out of the report, to make sure these things are kept confidential. What the care home does well: What has improved since the last inspection? What they could do better: We found that the Statement of Purpose does not have enough information about how the service meets the needs of people with dementia and about the nursing input for people who receive nursing care. There are some gaps in staff training, in areas which are important for their role and in helping them to keep people safe. There were some care practices which had not been identified as peoples needs and put in care plans - they were explained to us as just the way things had been done for a long time. Not everyone had regular access to a dentist, and the manager was unclear about Care Homes for Older People Page 8 of 32 whether dental services were available. More stimulation needs to be provided for people who are more dependent and less able to independently occupy themselves. Proper provision must be made to make sure that peoples health and other dietary needs are met and they are not put at risk. Not all serious incidents which have affected the wellbeing of people living in the home have been reported to us - this must be done. There have been a number of incidents where people have been found fallen or with injuries. Since people have access alone to different parts of the building, it may be worth looking at how they can be better protected and supported by the environment. The home environment could be improved to give easier access and orientation for people who have dementia. The manager forms part of the care team, working shifts on the floor, which does not always work out, because she is called away to management tasks. The recruitment processes are not wholly safe - the provider is not taking full care to ensure that members of staff are safe to work with residents. The manager needs to be enabled and supported by the provider to make changes that she feels would benefit people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live in the home could benefit from more information about the service so they can be confident their needs will be met. Evidence: We saw that the home has a Statement of Purpose, which is written information giving details about the home and the service provided. The Statement of Purpose says that Braunstone Firlands provides nursing care to people who have needs associated with their mental health, including dementia. There is limited information about how the specific needs of people who have mental health conditions, or dementia will be met (describing for example how person centred care is offered, or how the environment is set up to meet peoples needs). There is a leaflet which is given to people called The Mysterious World of Dementia, which does give some information about key workers and reviews for people, and talks about the changes that can happen for people and for families when someone has dementia. Care Homes for Older People Page 11 of 32 Evidence: When we inspected, there were fifteen people living in the home receiving nursing care, and five receiving residential care. There is no information to detail the different kinds of needs or service given for people who require nursing care and those who require residential services, or to detail the nursing input into the home. The manager of the home is not a nurse, and the Statement of Purpose does not give details about how nurses are accountable for their clinical work. The Statement of Purpose does give information about how people are assessed to move into the home. An assessment is usually carried out by the manager, who will find out what peoples needs are and whether the home can meet them. We saw there were assessments in place for people who live in the home. The Statement of Purpose gives information about staff training in the home. It says that all staff receive some compulsory training, such as moving and handling. Our inspection followed a recent inspection by the Health and Safety Executive, which found that not all staff had been trained in moving and handling. This is training that any members of staff who are involved in assisting people to move must have, to make sure people are supported safely. When we visited we found that staff had still not all received training. However, the manager has told us since our inspection, that almost all remaining staff who are involved in moving residents in the home had training on 23rd January 2009, and that the homes policy is being put into practice that only staff who have had training will be involved in moving people who live in the home. The Statement of Purpose also gives information that staff are encouraged to have training in other areas, like dementia awareness. While not all staff have had yet this training, the manager has told us that staff have been given an in-house training booklet about dementia, and that training from an external trainer was going to be given to staff by the end of February 2009. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home cannot be fully confident that all their needs will be met. Evidence: We found that each person has a care plan, which gives information about their care needs. Some of these were quite detailed, and we saw that they were reviewed every month. These are not fully person-centred for each person, with some aspects being duplicated for each resident. But there was some good information within some care plans, and they included risk assessments, to make sure people were looked after safely. We did find that, while there was detailed information in care records, this was not always complete, nor did it mean that peoples care needs were always being met. We found that there were some care practices in the home which did not relate to peoples defined needs, but which the manager told us, had been a pattern which was in place before she came to manage the home. For example, one person whose care we tracked, was brought into the lounge in the morning, and stayed in the lounge until Care Homes for Older People Page 13 of 32 Evidence: after lunch when they were put to bed for a rest. They then remained in their bed until the following morning. There was no information in the persons care plan to detail this or to explain a need for it - and the manager and staff could give no explanation about why this was done. The manager and staff told us there were other residents also who stayed in the lounge in the morning and then went to bed for a rest and remained in their beds until the next day. The manager and staff were not able to tell us about how this related to any particular care needs. One member of staff told us they find out about people by reading assessments and care plans, but that there is no particular expectation on staff to read care records at particular times. Another member of staff told us that they did not know much about one residents background, saying Without reading them up, I forget. The manager and staff made sure that people were kept safe from risks of falling out of bed or chairs by providing suitable equipment, such as bed sides or tilting chairs. As these can be seen as restraints, we would advise the manager to prepare specific risk assessments in relation to their use. We found that people are not always being given regular health checks to ensure they remain healthy. The manager told us there was a difficulty getting NHS dentists in the area, but when we asked whether she had tried to do this, she said she hadnt for every person. She also said it was difficult to get people to the dentist because of lack of transport. Those people who expressed a need for a dentist were getting a service, but there was not a regular system of checking for all residents. Staff carry out health care needs assessments for people, such as looking at risks of pressure sores, nutritional needs and movement. However, we found that some actions which staff were supposed to carry out to monitor peoples health and follow their care plans, was not always being done as regularly as their care plans would suggest. While staff were weighing people to monitor peoples health and wellbeing, this was not always being recorded or done consistently. We found from records that there was quite a large number of incidents reported where residents had been found fallen or where there was an unexplained injury to them, meaning that there had not been a member of staff around to see what had happened. The manager told us that she is bringing in a new system to monitor falls and injuries - to help find out what the risks and needs are for people. When we saw staff supporting people who live in the home - helping them to eat or do other tasks - we saw that they communicated with them gently, and treated them with sensitivity. We did not see much evidence during our visit of interaction with residents, apart from to do tasks like giving meals, although there are some activities offered for Care Homes for Older People Page 14 of 32 Evidence: people to get involved with. We found that people received little stimulation, despite care plans stating that they should be encouraged to be involved in social acitivities or that staff should spend time talking to them. Some people were left for long periods of time. Staff told us that for some people they just use continence pads rather than also supporting and encouraging them to go to the toilet regularly. We looked at medication records and stocks for some people who live in the home. We found that medication was mostly dealt with well. The nurse who was on duty was able to tell us about the kinds of medication people had, what it was for, and what side effects there may be. Staff stored medication safely and kept proper records. We did observe one member of staff handling individual tablets, which is not best practice for safety (we told the manager about this). The manager told us that a new safety store cupboard had been ordered, which will meet current regulations for safe storage of controlled medicines. We saw that staff generally treated people with kindness and care. We did find that some of the language used to describe whether people need support when eating was not akin to treating people with dignity - for example members of staff and the manager used the words feeders and non-feeders to describe whether people need help to eat. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people who live in this home are enabled to have a good lifestyle. Evidence: We found that there are some activities offered for people to take part in. One member of staff told us that they hold a knitting circle each week for those people who either want to knit or read out the patterns. They said they also do baking with residents, and have fortnightly bus trips. Sometimes the staff put music on for residents, and there is a church service once a month. One member of staff told us they would like to see more staff on duty so they could do more activities with residents. While we visited, we saw that one member of staff did try to get some people interested in playing a game, but residents declined her offer. Some people stayed in the same lounge for the length of our inspection, while others went for bed rest after lunch - and for the remainder of the day (discussed in previous section). The daily life for people who are physically independent is more stimulating, in that they are able to move around, and to eat their meals in a communal dining room on the first floor, and to participate more easily. However those people who require additional support (for example the use of a hoist to move them) have a life Care Homes for Older People Page 16 of 32 Evidence: which is largely limited to one of the ground floor lounges and their bedrooms. Staff are not sufficiently showing how they identify the social and emotional needs of people, and how they will meet their needs. Visitors are made to feel welcome in the home. We spoke to a relative of someone who lives in the home, who told us that the staff have been brilliant, and if they werent Id be the first to tell you... The staff have gone out of their way to accommodate me as well, they always make me feel welcome. One person who lives at the home told us that its not too bad but would prefer somewhere else to here, a home of my own. But they said if they didnt like anything in the home they felt able to say so. One relative we spoke with was not aware that the home could hold small amounts of money for residents, and said their relative could benefit from that. We saw that the food is served in a sensitive and calm way. Those people who are able to go to the first floor dining room enjoyed lunch at attractively laid out tables. They were offered a choice from the menu. For those people who need a liquidised diet, the food portions are kept separate. Breakfasts and teas are prepared in the home, which has an equipped kitchen. Main meals (at lunchtime) are brought in from the Prime Life Central Kitchen. Whilst there are choices offered to people, for some these are not choices that reflect their preferences or needs. One person has a medical health condition which restricts their diet, and the manager told us that they currently do not have their dietary needs catered for. Staff and the manager told us that they have to sort through whatever is provided by the Central kitchen to work out what the person can or cannot eat. The persons health continues to suffer and there are problems in identifying the correct foods from what is supplied. This is not acceptable. One member of staff told us that they cooked a Caribbean meal once to provide choice to residents, as well as to meet cultural preferences - but this is not something that is provided regularly or offered as an option, even though staff would like to offer it. There were differing views expressed about the food. The manager and staff were not wholly positive about the food provided by the central kitchen. The provider told us that there is a communication book sent out with each meal, so staff can give feedback. This communication system does not seem to be working effectively in the home at this time, and it may be worth the provider looking at how to make it more effective. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is attention to safeguarding, people who live in this home cannot be fully confident that they will be safeguarded from harm. Evidence: There is a complaints procedure in the home, and one resident who responded to our survey told us that they know how to make a complaint and feel that they are listened to by staff. Members of staff we spoke were able to tell us about action they would take if they suspected or witnessed that someone was at risk of harm. There have been two recent safeguarding incidents in the home. These were issues that were reported by staff and followed up. Following one incident of concern, the manager was asked to ensure that an extra member of staff was on shift in the mornings from 7am to 8am to be able to better support residents. The manager told us that this measure is still in place. The investigation into the second incident is ongoing. We found that there were some issues of concern relating to peoples safety. We looked at records of accidents and incidents that have taken place in the home. Care homes must report serious incidents which affect the wellbeing of residents to us. Whilst there is some reporting, we did find that there were some incidents of concern about risk to residents that had not been reported to us, as required. Where services Care Homes for Older People Page 18 of 32 Evidence: do not report this can potentially have put people at ongoing risk of harm. Some members of staff have had training about how to intervene safely to defuse situations where peoples behaviour is challenging to them. But some members of staff have not had training. From what we found about the needs of people who live in the home, and some peoples behaviours, it would benefit staff and residents if all staff were fully trained. We found that the service had not shown how new members of staff were supervised to ensure they did not have isolated contact with residents before full clearance from the Criminal Records Bureau (CRB) was received (see also Outcome Area 6). As reported earlier in this report, there have been a large number of instances in which residents have been found by staff when they have fallen or have injured themselves. In addition, staff told us about times in which they have found residents in the basement of the home, who have wandered there by themselves. Whilst the provider has told us that there are no risks to residents in the basement area, it would be better if there was more consideration given to how to ensure safety and security in the home. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the living environment in this home is clean and fresh, it does not wholly meet the needs of everyone who lives in this home. Evidence: We found that the home was warm, clean and tidy, in individual bedrooms and communal areas. During our visit maintenance workers from Prime Life came to test fire systems, and to carry out maintenane tasks. We saw that they responded immediately to an issue brought up by someone who lives in the home. Whilst the home is brightly lit, there are not many ways in which the environment helps people with dementia to orientate themselves. There are name signs on bedroom doors, but these are small and quite high up, so not very easy for people to read. There are no colour schemes or signs to distinguish one part of the building from another. People who live in the home are able to move freely around, if they are mobile. However, there are some parts of the premises which are not wholly safe for residents and which they can have isolated access to, such as the basement and the garden. Given the number of accidents in the home where people have been found fallen, the provider might consider looking at the environment and how it supports or provides Care Homes for Older People Page 20 of 32 Evidence: risk to people. There is a laundry room in the home, where washing of clothes is done. The member of staff who deals with the laundry told us that the temperature for the hot water in the washing machine comes from the boiler - but there was no evidence to show the washing machine met the minimum temperatures for safe infection control. Towels and sheets go to an external laundry service. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are not fully protected by staffing arrangements, but the provider is striving to ensure that this is improved. Evidence: The shift pattern for care staff in the home is generally 8am to 8pm and 8pm to 8am. There is a nurse on duty at all times. In the morning four members of care staff are on duty - which we found includes the manager, who is on the rota as a member of care staff and is not supernumary. This means that the manager is involved in doing all the tasks of the care staff - including supporting people to get up, get washed and dressed, helping people to move and feeding them where needed. In addition to this, the manager has to do her role as a manager of the home, getting called into the office to respond to social workers and other callers, and doing other management tasks. The manager said to us: It impacts on the staff because it puts more pressure on them... I work upstairs so that there is always two people on each floor. She told us she has spoken to her managers to raise this as a concern. A member of staff we spoke to told us they felt there were not enough staff on duty to do what needed to be done. Staff said that they felt that the manager could not always help out properly because she gets called away to do management tasks. We consider this to be an area of concern given some of the other issues highlighted in this report about peoples care and are asking the provider to look at staffing - relating to staffing levels and Care Homes for Older People Page 22 of 32 Evidence: competency. Staff told us about different kinds of training they have had to carry out their role, including food hygiene, fire safety, medication administration. Six members of staff have completed National Vocational Qualfication (NVQ) Level 2 in care. One staff member told us in a questionnaire: The training I have been given is relevant to my role. I understand more now than I have ever done about caring for the elderly. There are some gaps in training (as identified earlier in section 1) and the provider should make sure that all staff have training which would enable them to properly support people. Staff are asked to fill in an application form, provide information about themselves and supply referee contact details. We found that for two members of staff only one written reference had been received prior to them starting employment (Regulations state that two must be obtained). However, this had been dealt with by the provider, to ensure it would not happen again. For three members of staff, we found that they had begun working in the home before full clearance had been received from the Criminal Records Bureau (CRB). While this is permitted in exceptional circumstances, there must be proper supervision of staff in place to ensure that staff without CRB clearance do not have any contact on their own with residents. There was no evidence to show us that this had been considered and put in place. (This is commented on as a safeguarding issue under Outcome Area 4). Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home cannot be wholly confident that it will be well managed. Evidence: The manager has been managing the home since April 2008. She has recently been registered by us. Staff told us that they felt the manager was approachable. One person said that they felt she included the staff more, and another said that you can talk to her but you know where you are with her. Staff gave us mixed feedback about whether they got one to one support from the manager - one person said they regularly did, one person sometimes, and one person said It would be nice for the manager to discuss with me how I am, how I am working as new rules do come up now and then, so that I know that I am doing my job properly to the best of my ability. The manager gave us information about how staff are managed in the home. The manager does not have a nursing qualification, but the deputy manager does - so the Care Homes for Older People Page 24 of 32 Evidence: deputy is responsible for the clinical supervision of nurses working in the home (however they are on extended leave from work at the present time). It is positive to see that there is now an established manager in the home. But we do have concerns about the managers role in some of the issues that we noted during our inspection (as detailed in other parts of this report). This includes aspects such as the practice of taking people for prolonged bed rest, without a proper explanation as to why this is needed, and a failure to follow up on dietary needs related to someones health. The manager was unclear about some aspects of peoples care, and unable to put into practice some measures that she felt were needed to improve things. The provider told us they carry out their own processes to check how good the service is. Staff meetings are held, and members of staff told us they feel able to give their views. We were not able to check in detail on this occasion about financial arrangements for people who live in the home. The manager told us she does not deal with finances for people. But we did see that attention is given to safeguarding peoples welfare, in that they are supported to get the help they need in managing their finances. Staff have had some training to help them to make sure they carry out their roles safely (we have discussed previously about gaps in this). Staff told us they are given protective clothing and equipment to help them carry out personal care. We saw a booklet of policies and procedures produced by Prime Life for staff, which has a section about health and safety. There is also a safety leaflet, which gives good information about moving and handling. However, there is not a policy in place about moving and handling, which should include details about aspects such as expectations of training and checking of equipment. Staff did tell us that they check equipment to make sure it is safe, but a policy would help the manager to ensure that all aspects of health and safety are carried forward, including ongoing training for staff. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose 30/04/2009 must give full information about the services provided, particularly in the following area: the different kinds of needs or service for people who require nursing and those who require residential services; what form the nursing input into the home takes. This is to ensure that people have all the information they need to make an informed choice about whether to come to live in the home and about what service they will receive. The provider must ensure that how someone is cared for is based on their assessed needs and set out in their csare plan. 30/04/2009 2 7 15 Care Homes for Older People Page 27 of 32 This is to ensure that people are cared for in a way that meets their needs. 3 8 12 The provider must ensure that all people living at Firlands have access to a dentist, and that they have the opportunity to undergo yearly dental checks. This is to ensure that peoples dental health is maintained. 31/03/2009 4 12 16 The provider must give more 31/03/2009 attention to providing stimulation for people in the home who have greater support needs. This is to ensure that everyone in the home has the chance to enjoy a better lifestyle. The provider must ensure 28/02/2009 that proper provision is made to meet the dietary needs of anyone in the home who has a particular health condition which specifically impacts on their diet. This is to ensure that everyone receives a healthy, balanced and nutritious diet, which meets their needs and wishes. The provider must ensure 30/04/2009 that all staff receive training in how to safely manage and defuse situations in which 5 15 16 6 18 18 Care Homes for Older People Page 28 of 32 someone behaviour may be challenging. This is to ensure that situations can be defused safely, and staff and residents are protected from harm. 7 18 19 The provider must ensure 28/02/2009 and evidence that proper arrangements are put in place to supervise workers and ensure they have no isolated contact with residents, in the exceptional circumstances that a member of staff begins work before an enhanced Criminal Records Bureau has been received This is to ensure that the provider safeguards as far as possible the safety of residents. 8 18 37 The provider must ensure 28/02/2009 that all serious incidents which may affect the wellbeing of people who live in the home are reported to the Commission for Social Care Inspection (as set out by the regulation). This is to ensure that people are safeguarded from harm. The provider must check that the washing machine meets infection control safety requirements. 10/03/2009 9 26 23 Care Homes for Older People Page 29 of 32 This is to eliminate the spread of infection through the laundry process. 10 27 18 The provider must ensure 28/02/2009 that Staff are able to meet residents needs at all times. This is to ensure that residents wellbeing is not compromised by lack of sufficient numbers or sufficiently competent staff 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 1 It is recommended that the Statement of Purpose contains more detailed information about how the service will meet the needs of people who have mental health conditions and/or dementia, so that people have a clearer idea of what kind of service they can expect. It is recommended that risk assessments are put in place, to address the specific risks of restraint, where people are being supported by the use of equipment such as bed sides and tilting chairs. It is recommended that person-centred plans are developed for each resident, so that staff can ensure that their needs and wishes are met holistically. It is recommended that the provider ensures that focussed attention is given to how to prevent falls and injuries to residents. It is recommended that all staff ensure tablets are not handled when being given out, to maintain health and safety. It is recommended that consideration is given to the language used by the manager and staff to ensure it is in keeping with principles of dignity in providing care. It is recommended that attention is paid to giving people a proper choice at mealtimes, including where this may be a 2 7 3 7 4 8 5 9 6 10 7 15 Care Homes for Older People Page 30 of 32 cultural choice. 8 15 It is recommended that the provider looks at the communication systems about the meals provided in the home and gives consideration to the ideas of the manager and staff. It is strongly recommended that the provider implements measures to safeguard residents from the risk of injury or harm in their daily lives in the home. It is recommended that the provider looks at how to ensure that everyone has safe and supportive access to the home, free from risk. It is recommended that the provider develops the home environment in a way which would benefit people who have dementia and help them to orientate indpendently and easily. It is strongly recommended that the manager is enabled to make changes that she feels are needed to improve the service for people living in the home and meet their needs. It is strongly recommended that a moving and handling policy is put in place in the home, to set out the requirements and actions for ensuring safe moving of people at all times. 9 18 10 19 11 19 12 31 13 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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