Inspection on 16/12/09 for Breme

This inspection was carried out on 16th December 2009.

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

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

Other inspections for this house

Breme 28/11/06

Breme 25/01/06

Breme 28/06/05

Breme 01/02/05

Breme 22/06/04

Breme 26/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Ravenhurst

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Breme 46 Providence Road Bromsgrove Worcestershire B61 8EF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Bromige     Date: 1 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Breme 46 Providence Road Bromsgrove Worcestershire B61 8EF 01527571320 01527882218 breme@orbit.org.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited care home 60 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 60, Learning disability (LD) 60, Old age, not falling within any other category (OP) 60, Physical disability (PD) 60 Date of last inspection Brief description of the care home Breme House is a purpose built 60 bedded home in a residential area of Bromsgrove, which is close to the town centre and is on a bus route. Care Homes for Older People Page 4 of 32 Over 65 0 0 60 0 60 60 0 60 Brief description of the care home The home offers a service for 60 older people who may have a physical disability and mental health needs associated with older age. Additionally the home is registered for 2 people over the age of 65 who have a learning disability and has a separate 8bedded unit for people who have dementia. The home is on three floors and all the bedrooms are single and en-suite with toilets and showers. The upstairs rooms can be accessed by passenger lift and there are handrails throughout the building. Separate toilets and bathrooms are adapted for people with physical disabilities. Communal lounge, dining facilities and kitchenettes are provided on all floors and there is an attractive garden. The registered providers for the home are Heart of England Housing and Care Ltd for whom Mr John McCarthy is the responsible individual. Mrs Karen Keen is the homes registered manager. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 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, the commission completed the last inspection of this service on the 28th November 2006. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, staff working at the Care Homes for Older People Page 6 of 32 home and a health professional who works with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We have not received any complaints about the service since the last inspection and we have made six safeguarding referrals since October 2008. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be improved to ensure they are reviewed and updated when peoples needs change to ensure staff understand what is required and people can be sure their needs will be met. The overall management of medication needs to be improved to ensure people receive their medication as prescribed and are not placed at risk of harm through incorrect Care Homes for Older People Page 8 of 32 storage of medicines. Communal towels and flannels need to be washed at higher temperatures to prevent the risk of cross infection. Further training is needed in care record and medication management to ensure peoples care needs are met at all times and people are not placed at risk of harm through poor management of medication. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to start using the service are assessed prior to admission to ensure their needs can be met by the home. Breme does not offer a dedicated intermediate care service. Evidence: The home provides written information for prospective people who may us the service. This information is available in the home. We saw information on a notice board in the home telling people a copy of the homes inspection report is available. The manager told us the information is available in large print and different languages. They do not currently provide an easy read version of this information which may be more suitable for people who have moderate to severe dementia. The Annual Quality Assurance Assessment(AQAA) completed and submitted by the manager before the inspection tells us pre-admission assessments are carried out at Care Homes for Older People Page 11 of 32 Evidence: the location of preference prior to a placement being agreed. They also ensure an up to date Adult Community Assessment is received prior to a placement being agreed. We case tracked a person who had recently started using the service and we saw the home had received an Adult Community Assessment before they were admitterd. We saw this person had been admitted to the home earlier in the year and the home had carried out an assessment before the person was admitted. The outcome of a recent safeguarding investigation for the service highlighted an action point for the home to review their pre-admission assessment documentation to include the assessment of people with dementia who may exhibit sexual behaviour. The manager told this has not been completed. We received surveys from a health care professional and people who use the service. The healthcare professional told us the service usually ensure the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. Five people who use the service told us they received enough information before they moved into the home. 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. Care plans need to be written, reviewed and updated as peoples needs change to ensure staff are fully aware of the current care needs and people can be confident they will get the care they need at all times. The overall management of medication needs too be improved to ensure people received their medication as prescribed and are not placed at risk of harm through incorrect storage of medicines. Evidence: The AQAA tells us people who use the service have a detailed person centred care plan with involvement of the resident and relatives (where appropriate). Care plans are reviewed monthly. We looked in detail at the care of two people who use the service. Overall the first care plan we looked at was person centred and informative and the care plan had been signed by the person using the service. There were some areas that needed to be reviewed. For example, the care plan stated the person used Diprobase cream for dry skin. We spoke to this persons keyworker and they told us they had not used any cream for this person. We did not see any cream in the persons bedroom or on their Care Homes for Older People Page 13 of 32 Evidence: medication chart. We asked a senior carer about the cream and they told us they had ordered the cream five days ago but it had not arrived. She told us they would chase it up that day. The moving and handling risk assessment told us the person uses a walking stick, but the assessment stated the person was mobile with a frame. The nutritional risk assessment was dated 26th August 2009 and it had not been reviewed since the person was readmitted to the home. The second care plan had not been thoroughly reviewed since the healthcare needs of this person changed and they are now spending all their time in bed. For example, the care plan lacked information for staff about pressure area care and the prescribed creams to be used for skin care. The information about how the home were managing this persons pain relief was confusing. The person had been prescribed different types of medication for pain relief by the Doctor but there were no clear instructions for staff to ensure they understood when to use the medication. The moving and handling risk assessment contained conflicting information. The care plan stated the person needed to be checked by staff every 15 mins but there was no documentation to show these checks were being done. The nutritional risk assessment had not been reviewed since 2nd October 2009. We were shown charts which are used to record the food and fluids taken by the person. These were poorly completed. Records showed the home had requested support from the District Nurse and they had provided pressure relieving equipment to prevent the persons skin becoming sore. Records showed the home were in regular contact with the Doctor as this persons needs changed. We returned to the home two days later to complete the inspection. The care plan had been reviewed. It was much more detailed and was person centred, although it needed more detail about pressure area care and the frequency it is given, fluid monitoring and the creams prescribed for care of the persons stoma. We spoke to staff about the care need of the people we case tracked. They had a good knowledge and understanding of their care needs, although what was happening in practice did not always correspond with the information in the care plans. Surveys completed by five people who use the service told us they always receive the care and support they need and the home make sure they get the medical care they need, and one person responded usually. Written comments in the surveys told us a good standard of care provided, I am very happy here, well fed and also well cared for, what more can I say. Meets all care needs. Most care staff are very caring cannot do enough for you. Very happy at Breme. Staff surveys told us they give the service users all the care they need as well as promoting independence and offer many activities. Puts clients needs first. Care Homes for Older People Page 14 of 32 Evidence: Residents are really well looked after and are treated like family. The home have notified us of three medication errors which have happened in the home in the last 12 months. It is positive the home have told us about the errors. We looked at the management of medication for the people whose care we tracked. The medication administration records(MAR)are used to record medication received by the home. Any handwritten entries were signed by two staff to ensure accuracy. One person had seven MAR charts and a number stated in the allergy section none known, although the person did have an allergy to penicillin. We saw staff had used a code s which is not a recognised code on the MAR chart, although they had written what the code referred to. We saw a gap on one MAR chart where the medication had not been signed as being given as prescribed by the Doctor. We saw a number of different types of medication prescribed for a person as when needed but there was no information in the care plan about the medication to provide clear information for staff to ensure it is used correctly and consistently. We carried some random audits of medication to see if they are being given as prescribed by the Doctor. We found inaccurate numbers of medication for two prescribed tablets for one person we tracked, which indicated staff had signed for the tablets but had not given them. We looked at the homes storage of medication. The home were not checking and recording the temperature of all areas where they store medication and in one room the temperature at 16:00hrs on the day of the inspection was 26 degrees Celsius which is above the manufacturers recommended temperature for storage of medication. We looked at the recorded refrigerator temperatures on one floor and these showed for a seven day period in November the temperature was above the recommended range of temperatures for storage and the refrigerator contained insulin. Storing medicines outside of the manufacturers recommended temperature range can be harmful to the medicines and may place people at risk of harm. We saw two cabinets used to store controlled drugs. Neither were fixed to a solid wall which does not comply with legislation. Staff who gave out if they have the guidance available which is produced for care homes by the Royal Pharmaceutical Society of Great Britain. They were not aware of this guidance. We showed them the document on the website and the manager obtained a copy immediately. We returned to the home two days later to complete the inspection. The manager told us she had put thermometers in all of the medication store cupboards and they are now monitoring the temperatures in all medication storage areas. We observed staff speaking respectfully to the people who use the service. We Observed staff knocking on doors before they entered peoples bedrooms. We observed staff giving medication for pain to a person who was in bed who has dementia. The staff were very kind and gentle and they told the person what the Care Homes for Older People Page 15 of 32 Evidence: medicine was for and if they would take it. The person looked very well cared for and comfortable. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident the home will be able to support them to follow their personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to continue these relationships. People are offered a variety of health meals and snacks at a time and place to suit them. Evidence: The information in the AQAA told us all staff are now involved in spontaneous and structured activities. The home have adopted the Eden principles. This is to create a human habit where life evolves around close and continuing contact with plants, children and animals to combat loneliness, boredom and helplessness. One of the senior lead care staff is the Eden Champion for the home. The home has a pet cat, budgie and two rabbits. They also encourage people to visit with animals. Children from local schools come and do voluntary work at the home. We spoke to the activity coordinator who is employed by the home. She told us a monthly plan goes out in the newsletter to each person and a weekly one is put up on the notice boards around the home. People who use the service give feedback to the activity co-ordinator about the quality of the programme. She told they are trying to Care Homes for Older People Page 17 of 32 Evidence: build in more one-to-one time with people in the programme. People are encouraged to be involved with the community. Groups of children from two schools come in each week and play games, chat, and read poetry to the people who use the service. People were recently taken to see the local school production of Scrooge. The children are supervised whilst they are in the home by their teacher and the activity coordinator. We saw a young person with the activity coordinator who comes to the home to do work experience.on work experience. Staff have raised funds and have purchased their own mini bus. Once a week people are taken out, for example they have recently visited the Black Country Museum, West Midlands Safari Park, meals out and shopping at Merry Hill. Staff give up their own time freely to take the people out and about into the community and to provide evening events such as quizzes and bingo in the home. Relatives are encouraged to attend. The manager and staff told us the people who use the service make cards to sell and raise funds for activities and they have bingo evenings and staff do bag packing at the local supermarket to raise additional funds as the annual budget provided by the provider organisation is only £300 per annum. They have received a donation of £1400 from a local company. The home produce a monthly newsletter informing people who use the service of what is going on in the home and giving them advanced notice of the months planned activities. Comments in surveys from people who use the service told us, I enjoy going out on trips. One person the home could do better if there were more activities. It could possibly do better on days out if the money was available. Staff told us in surveys what they do well; activities things for people with different needs, also outside entertainment. We look after our residents well, taking them out in the mini bus, just one to one chat. Give the service users all the care they need as well as promoting independence and offer many activities. Puts clients needs first. Encourages them to take part in social activities of their choice. Promote Eden and deliver a high level of care. We saw information in the care records about peoples diet and preferences. The nutritional risk assessments for both people had not been reviewed and updated and we saw food and fluid charts were being poorly completed. We looked at the menus and saw they are a five week rotating menu. They offer a continental breakfast, choice of main meals and supper although a vegetarian choice is not available every day at lunchtime. Snacks are available throughout the day upon request. We observed lunch service in the small unit for people with dementia. We saw two people sitting at the dining table which was nicely laid. One person was sitting in the lounge and being assisted to eat by a carer. Some people were having lunch in their bedrooms. When Care Homes for Older People Page 18 of 32 Evidence: the carer finished serving lunch she sat down to lunch with the people at the table. Staff in this unit do not wear uniforms. This is evidence of recognised good practice for the care of people with dementia. People who use the service in surveys told us the meals are very good. I am very happy here, well fed and also well cared for. We ate lunch at the home of cauliflower cheese, mashed potato and grilled tomatoes. It was nicely presented, very hot and tasty. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Breme can be confident any concerns will be listened to and acted upon. Procedures are in place and staff are trained about safeguarding people to ensure people who use the service are protected from harm. Evidence: The numerical information in the AQAA tells us the home have received seven complaints in the last 12 months and four have been upheld. They have made one safeguarding referral in the last 12 months. We have not received any complaints about the service and we have made six safeguarding referrals since October 2008. We discussed these with the manager and they do not have an outcome for two of the referrals. Surveys from people who use the service told us they know how to complain and staff always listen to them if they have any concerns. All staff spoken to and surveys completed by staff indicated they were aware of the homes complaints procedure. The training matrix shows staff have received training about safeguarding people from abuse and all staff spoken with were clear of the action they would take if they suspected any abuse in the home. The manager and deputy have received training Care Homes for Older People Page 20 of 32 Evidence: from Worcestershire County Council about the Deprivation of Liberty safeguards. The training matrix shows eight staff to date have received this training internally. The manager told us no one using the service is currently subject to any safeguards by they have consulted the local coordinator about the need to make an application on two occasions. Staff confirmed good recruitment practice in completed surveys and staff spoken with told us about the recruitment procedures in the home. We looked at a staff file and this confirmed good practice to ensure only suitable people are employed to work at the home. We were asked for our identification when we arrived at the home; this is good practice. Care Homes for Older People Page 21 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. People who use the service live in a clean and comfortable environment which has been adapted to suit their individual needs. Improvements need to be made to the management of house linen and the kitchenettes to prevent cross infection. Evidence: The AQAA tells us they provide a purpose built residential home. The environment is clean, homely, hygienic, accessible and safe for residents, meeting all current legislation and good practice requirements. The home no has a maintenance person five days per week although the hours remain part time. The numerical information in the AQAA all the equipment in the home has been serviced in the last 12 months. The manager told us the call system is on a service contract and is maintained if it becomes faulty. We looked at the parts of the home used by the people we case tracked. All areas seen were clean and tidy and there were no bad odours. Peoples bedrooms were nicely decorated and were personalised with their own possessions. The small unit for people with dementia has adopted a recognised approach to dementia care. The unit is not locked and people can walk freely about the home. They can access the garden via a door off the lounge. The unit has a very homely feel about it and shelving has been put up in the corridors containing items of interest for people to pick up and look at. There are two material murals on the wall which are very bright and provide Care Homes for Older People Page 22 of 32 Evidence: different textures for people to touch and feel. Soft toys are tucked behind the handrails in the corridors. Items of interest are placed on the tables for people to rummage through. There is a budgie and goldfish in the lounge and the house cat wanders freely about the home. Staff have given up their own time during the night to redecorate the toilets and bathrooms on the unit. The manager told us they are looking to install a shed as a workshop in the garden and put up washing lines to enable people who use the service to continue to do practical tasks of daily living. We saw one person having all their own furniture being delivered to the home and put into their room. The home use communal towels and flannels. We looked at the laundry to see how they managed foul laundry. Foul laundry is washed using a system where the bags open up in the wash so staff do not have to open the bags once sealed. It is washed at a sufficiently high temperature to prevent cross infection. We established the communal towels and flannels used in the home are being washed below 65 degrees Celsius. This is not high enough to prevent cross infection. We saw the kitchen units in the kitchenettes on the two floors of the home. The laminate coating has come away from the unit in places. This increases the risk of food contamination as the surface is porous and cannot be cleaned. These unit needs to be replaced as a matter of urgency. The AQAA tells us 100 of the staff have received training in prevention and control of infection. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the people who use the service. Staff are well recruited to ensure only suitable staff are employed at the home. Further training is needed in care records and medication management to ensure peoples care needs are met at all times and people are not placed at risk of harm through poor management of medication. Evidence: On the day of the inspection there were two lead care staff on each floor of the home with two care staff. There was an additional carer who worked between the floors. On the unit for people with dementia there were two staff. Two senior lead carers were also on duty. The manager and deputy are full time and their hours are supernumerary to the care staff rotas. A team of ancillary and catering staff are also employed by the home. The rotas confirmed these are the usual care staff numbers on duty. The manager told us the staffing levels have always used a ratio of one to seven, and one to four on the dementia unit. Seniors are in seven days per week and are additional to these ratios of staff. Due to dependency levels on the top floor they always have an additional staff member for this floor. If people are on palliative care extra staff are brought in. The home use the Bartel dependency score to assess dependency. Staffing levels are reviewed monthly. Care Homes for Older People Page 24 of 32 Evidence: Information in surveys from staff and people who use the service told us there are always or usually enough staff available. Staff spoken with told us they have enough staff on duty. Comments in surveys from people who use the service about the staff told us, they are good people. The home is all I need and the staff wonderful. Very happy at Breme. Staff told us, Breme is a very good place to work. Everyone gets on well. I feel I get a lot of support. They support all staff. I feel nothing could improve our home. Staff work well together, from managers to housekeepers. I would like to tell you how happy Im in my job and I wouldnt want to work anywhere else. Breme is a brilliant place to work. I have worked in the care sector for over 14 years and in many homes within Worcestershire and I have to admit I do really love working at Breme and I love my job. The AQAA told us 74 of the staff have achieved or are working towards an NVQ qualification. The AQAA tells us the home operate thorough recruitment procedures. This was confirmed by looking at staff files for recently recruited staff. Staff told us they have received their mandatory training and the training matrix confirms this information. Staff have received specialist training, for example as dementia care, palliative care, and stroke. Staff who administer medication told us they have received training and the training matrix shows staff have received care planning training. We found some shortfalls in the homes management of medication and in the quality of the care records. This indicate staff need further training in these areas. Staff told us they have received induction training which is ongoing. The AQAA told us all new staff complete the Common Induction Standards. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is generally well managed to ensure it is run safely and in the best interests of the people who use the service. Evidence: The manager has just completed her Diploma Level Course in dementia care. The manager and deputy have completed their IOSHH health and safety course and attended a recent refresher course. All their mandatory training is up to date. They have both attended training by Worcestershire County Council about the Deprivation of Liberty safeguards. The deputy manager has completed her NVQ 4 working towards management and leadership. She is delegated the responsibility of monitoring the quality of the service. She holds meetings with the people who use the service and the staff. Questionnaires are given to the people who use the service and their relatives when the initial four week review is held for new residents and then they receive annual questionnaires to complete. Short stay and respite people are given questionnaires at the end of their Care Homes for Older People Page 26 of 32 Evidence: stay in the home. They told us there have not been any recent action plans needed from the information gathered in the surveys. Forms for complaints and compliments are available on each floor, and any complaints are audited quarterly. The home do not currently seek feedback from visiting healthcare professionals to the home. They told us care plans are monitored each week. They look at several each week across the whole home, this includes checking to see if assessments are up to date and the plan has been reviewed. They told us they are getting better at writing person centred care plans. We looked at the monthly visit reports required by regulation carried out by a representative of the organisation who owns the home. The visits are not in line with the requirements of the regulation. They are not unannounced and there is no information to show they are speaking with staff and people who use the service during these visits to make judgements about the standard of the care and the environment. We looked at the management of money for the people whose care we tracked. This confirmed thorough management and recording of peoples money. The numerical information in the AQAA told us all equipment has been serviced in the last 12 months, although there was no date for servicing the call system. The manager told us this is on a maintenance contract and the contractor is called out when needed. We looked at the maintenance checks for the window restrictors and these were recorded as being checked each month. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15(1)(2) Care plans must be detailed and care needs reviewed as peoples needs change. To ensure staff understand what is required and people can be sure their needs will be met. 31/01/2010 2 8 13 13(2) To make arrangements to ensure the administration of prescribed medication is recorded on the medication records. To ensure people who use the service are receiving the medication as prescribed. 31/01/2010 3 9 13 13(2) To make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. 31/01/2010 Care Homes for Older People Page 29 of 32 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 This is to ensure that medication does not deteriorate which can make the medication ineffective and possibly harmful to the people living in the home. 4 9 13 13(2) 28/02/2010 To make arrangements to ensure that controlled drugs are stored in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the Royal Pharmaceutical Society of Great Britain. This is in order to ensure that controlled drugs are stored safely to prevent misuse. 5 9 13 13(2) To make arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when needed and what constitutes needed for the named person. 31/01/2010 Care Homes for Older People Page 30 of 32 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 This is to ensure that there are clear directions for care staff to give medicines prescribed when required. 6 26 13 13(3) Foul laundry must be washed at temperatures above 65 degrees Celsius. To ensure it is thoroughly clean and controls the risk of cross infection. 7 30 12 12(1) 31/01/2010 You must ensure that staff have the correct skills and competences to enable them to carry out their role effectively. So that people are not placed at risk of harm through neglect of care. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/01/2010 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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