Inspection on 28/05/09 for Briar House Care Home

This inspection was carried out on 28th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briar House Care Home 08/12/08

Briar House Care Home 18/06/08

Briar House Care Home 21/11/06

Briar House Care Home 18/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ     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: Ruth Hannent     Date: 2 8 0 5 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 31 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 31 Information about the care home Name of care home: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ 01553760500 01553760510 briarhouse@schealthcare.co.uk 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) : Ashbourne (Eton) Limited care home 62 Number of places (if applicable): Under 65 Over 65 50 62 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 2 0 0 8 1 2 2 0 0 8 Briar House is a care home providing residential care for up to 62 older people. Within its registered numbers the home offers services to 50 people with dementia. The home is situated in a residential area in the North of Kings Lynn approximately one mile from the town centre. The home was purpose built in the late 1990?s. The accommodation is provided on two floors serviced by stairs and shaft lift. All rooms are built for single occupancy and there are only two rooms that do not have integral en-suite facilities. The home is situated in its own grounds and provides ample parking space. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Briar House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for care at the home is £358 to £565. Care Homes for Older People Page 4 of 31 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was carried out 6 months after the last key inspection when the home had been rated a poor service. The home did not return an action plan following the last inspection so information to make judgements prior to this inspection could only be achieved from the AQAA (Annual Quality Assurance Assessment) that had been completed by the Operations Manager for the company who own Briar House. The requirements set at the last inspection had not been addressed in the AQAA so it was unclear if these requirements had been met. Some of these were outstanding requirements from the previous report of June 2008. The Commission had received 16 residents comments completed by either themselves Care Homes for Older People Page 6 of 31 or with the help of their relatives and 3 staff surveys and these comments have been included in this inspection report. To assist with this inspection report two Regulatory Inspectors and a Pharmacy Inspector from CQC spent time at the home checking records, looking at care plans, auditing medication, observing interactions, talking to staff and residents and touring the building. What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Older People Page 8 of 31 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the new Manager now in post and two assessments seen the home should now be assessing appropriately to ensure residents admitted to the home are appropriately placed and can have their needs met. Evidence: The previous inspection showed limited information had been obtained as part of the assessment process. On this inspection, evidence was found of two recently admitted residents with completed assessment documents. For example, details taken in February show a person having a risk assessment regrading falls, moving and handling details, continence management, some personal care and health needs and likes and dislikes such as meals and preferred times. The assessment for assisting with dementia care needs are written on a seperate document which had also been partly completed. On meeting these residents the details, although not fully completed, gave a picture Care Homes for Older People Page 11 of 31 Evidence: that was relevant to them and enabled the home to make a judgement that the needs for those people could be met. The new manager in post talked in detail about clear assessments and told us that no person would be accepted at the home if the home could not meet the needs after an assessment had been carried out. On the day of this inspection, the Manager, prior to meeting with us, was out at the local hospital carrying out assessments on potential residents . Until the actual site visit no information had come to the Commission to say assessments were now being carried out fully. The AQAA completed by the Operations Manager gave no details about this past requirement and no action plan following the last inspection had been received. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are improving in information but more detail needs to be included for the way people like to dress and their social support requirements. Health care needs are met. Some staff do understand respect and dignity when assisting with the support for residents and do offer personal care in private. Evidence: On the day of this inspection three care plans were looked at in detail. Two were from recently admitted residents and one was from a resident who has been in the home for some time. Because the home is split into three areas one plan from each area was chosen. One of these is from a person who had been admitted for emergency repite. The information in the care plans, although not fully completed, gave details on the care support required by the notes on the medical history of this person. Seen was information on washing and dressing, support with continence, moving and handling Care Homes for Older People Page 13 of 31 Evidence: assessment, nutrition support and some risk factors acknowledged such as verbally aggressive and low in mood. It was difficult to see how the person or the family have interacted with the care plans but review dates had been completed. Even though there appeared some better care plan details than previously written and seen at the last inspection, people were still found to be inappropriately dressed. Stockings, tights, socks and suitable underwear were missing. Hair appeared unkempt and not washed and nails were long and dirty on some residents. A resident was walking around with trousers that were far too long that presented a trip hazard but until this was pointed out no staff member appeared to notice. Although the National Minimum Standards 7.2 asks for the personal, health and social care needs to be met it was very difficult to find how the social needs would be met with limited recordings in the care plans. The Life story books that could have helped with the background and understanding of social support were not completed. One was found to hold only one line of information and another had nothing written in it. The AQAA does not tell us anything about the healthcare support for residents even though this was a requirement in the last inspection but information and progress sheets written in the care plans give a picture of the support offered by the District Nurse for pressure areas, the interaction from the CPN for one particular person and the continence advice from the local specialist for another. Each resident is registered with a local GP with the home having a service from a number of local Doctors and District Nurses. A Doctor arrived during this visit and was assisted by a Senior in an appropriate manner. The resident was seen in private in their bedroom behind a closed door. Throughout the day staff were observed interacting with people and offering personal care in a private area. Some conversations were a bit child like such as going to play on the swing sweetheart, when a person was being hoisted, was overheard and another staff member was witnessed wiping residents mouths without even talking to them. Yet another member was very courteous and spoke appropriately and correctly asked the resident in which room they would like to have their lunch. The inspection of the medication standard was conducted on 3rd June 2009 by the Commissions pharmacist inspector Mark Andrews. We looked at how medicines are managed on the first floor of the home and we discussed issues arising with the manager during the inspection. When we arrived for inspection the senior carer on duty said all medicines scheduled for the morning medicine round had already been given to people. We confirmed this by checking records of medicines administered. Overall we found few gaps in records Care Homes for Older People Page 14 of 31 Evidence: for medicine administration. The home is also now keeping records for the application of externally prescribed medicines. We conducted sample audits of medicines and found that the home now has a system in place to allow medicines to be accounted for. We found a few minor discrepancies and overall significant improvement compared to the previous inspection. However, we noted that an inhaled medicine prescribed for twice daily administration had been recorded as administered three times daily on six recent days. The manager agreed to take urgent action to resolve this. The manager confirmed that the home is currently conducting its own monthly audit of medicines and this was discussed emphasising the need to ensure medicines are fully accounted for. We looked at how the home is ensuring people taking anti-coagulant warfarin do so safely and in line with most recent blood test result instructions. We found that dose changes of warfarin following blood tests were being properly recorded and records indicated the warfarin was being given properly however for one person a container of recently discontinued 1mg tablets remained in the medicine trolley and had not been promptly removed. The home has provided additional medicine information alongside medication charts to assist in safe medicine administration. This includes medication profiles and written information for people prescribed medicines for occasional use. We looked at a small sample of the profiles and found that for one person the medicines listed were significantly different to those on the medication chart and currently prescribed. When we looked at written information for people prescribed medicines for occasional use we found that information about the administration of painkillers was scant and did not include individualised signs of people with dementia being in pain. Notes for one person indicated that the person would indicate when they needed pain-relief but a member of staff on duty agreed this was inaccurate. We found no evidence of staff being provided guidance on assessing peoples pain. When we observed part of the lunch-time medicine round, we noted that the member of staff conducting the medicine round followed safe procedures for medicine administration, however we noted that the administration of pain relief relied solely on people verbalising that they were in pain. For another person prescribed haloperidol for the occasional management of behavioural disturbance a care plan was available relating to non-medicinal interventions but there was no written guidance about when the medicine should be used and at what dose. This care plan had been written January 2009 and not since reviewed. During the inspection we looked at training records for staff authorised to handle and administer medicines. There are currently 10 members of staff who have received Care Homes for Older People Page 15 of 31 Evidence: training and specimen signature lists were seen to be available alongside medication charts, however, we identified that some had most recently received training in 2006. An NVQ trainer was present at the home during the time of inspection. The manager confirmed that further NVQ training was to be made imminently available to senior members of care staff. We found medicines were safely and securely stored on the first floor. One person living at the home who self-administers their medicines had them kept securely in a locked cabinet within their room. The manager confirmed that the home has ordered and is awaiting a number of cabinets to fit into rooms for the storage of external medicines, however, until then such medicines are being kept in the medicine storage room. We were given assurances by the manager that there are no medicines in peoples rooms not being kept securely. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some residents do experience an expected lifestyle but some do not. Friends, relatives and visitors can stay in contact and visit as and when they wish. Meals are well balanced, appealing and enjoyed by the residents. Evidence: On walking around the building it was noticable how the areas in the main ground floor and first floor were looking more inviting and items were around for people to stop and look at such as various hats on coat hooks, a doll therapy area and old style pictures and posters on various walls. The residents were already gathering for the planned coffee morning with freshly baked scones from the kitchen. There is also a newly made coffee/tea bar area where the residents had been making fresh bread previously. The afternoon was spent celebrating a birthday with again fresh scones and a large home baked cream birthday cake. Residents came from the upper floor to the downstairs lounge and joined in. Three comments from relatives sent to the Commission prior to this inspection do tell us that some activities do take place but that they are not always suitable for everyone. People who are in their rooms do not always have the Care Homes for Older People Page 17 of 31 Evidence: attention like those who join in group activities was one comment received. Unfortunately the activities and stimulation for people who live in the Lavender area is not evident. There was no interaction or stimulation for a number of residents who stay in their own room. Radios were on and playing but no records show what the person likes to listen to. No details were recorded on how and when each person had their social care needs met and daily progress sheets just reported listening to radio. The reaction to this lack of stimulation/social support was for a number of residents to be heard calling or shouting out. One person was observed by us to throw over her zimmer frame and wait for it to be picked up. This must have happened on at least 10 occasions, with staff just picking up the frame and walking on. One staff member did spend time sitting and assisting someone with a drink in the lounge. The conversation and smiles that were taking place showed that the time together was relaxed and was being enjoyed by both parties. On looking in the individual care plans there is limited information on the social support required for these residents and in the daily records there is nothing written on how staff dedicate time to ensure social time is given. The home does have areas where people can sit with visitors or they can go to their own rooms. On the day of this inspection a large family of visitors arrived to celebrate the special birthday and did use a seperate room for a small family gathering. The new Manager showed us the minutes of the recent relatives meeting that had been held. Comments received prior to this new Manager starting told of meetings that had been planned and then cancelled. The Manager is also about to start a regular newsletter that will be sent out to all relatives to keep them informed of what is happening at Briar House. The most recent newsletter was seen during this inspection. The home has recently recruited a new chef. The feedback from residents and staff have been very positive. The meals have improved greatly. We have better portion sizes now. Better food. Are just some of the comments heard. The meal of the day is on a large wipe board in the dining areas and both the Chef and the Manager have just returned from the training on the Nutmeg programme. The chef talked about his homemade puddings, pies and cakes. He uses full fat milk and cream and will support anyone with any special dietry requirements. The new Manager is planning to place the days menu on the individual tables to stimulate conversations at mealtimes. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and families can now be assured that their complaints will be listened to and acted upon and that residents will be safeguarded by the correct policies and procedures being adhered to. Evidence: The comments received from families and dated from back in April 2009 show some concerns on the way complaints are dealt with. Too many promises and no action is one comment made. The new Operations Manager and the new home Manager have now started following the clear procedure written by the company to ensure complaints are listened to and acted upon. One written complaint looked at, that talked of a room that had an odour, was seen by us and no odour was detected and a Senior staff member spoken to said the family were happier. The home have re scheduled the timetable for the domestic staff to ensure the cleaning is carried out appropriately. The new manager has also stated that she will act immediately a complaint is made and ensure the suitable outcomes are acheived. According to staff, complaints have not been followed through in the past and only time will tell if this new Manager will act appropriately when complaints are made. The AQAA did not tell us anything about safeguarding on this occasion although this was a past requirement but the home does have posters displaying training planned and all staff are CRB checked before employment commences. On talking to two staff, Care Homes for Older People Page 19 of 31 Evidence: both stated they would report on any concerns but in the past had not had any faith that anything would be done. Both said they are beginning to trust the new Manager and feel action would take place as and when needed which did not always happen with previous Managers. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has improved the environment for the comfort of residents and the home does appear cleaner but some improvements could make it much better. Evidence: The home is appearing a bit brighter since the last inspection. Areas have pictures and stickers on the walls and signage to direct people have started to be placed around the home. The gardens are looking untidy and need improving to allow residents to sit out and enjoy this time of year. Plans were discussed on making a nice patio area outside the activities room for people to be able to come and go but at present the garden is not at a safe level to be used. The Maintenance Officer holds all the record books for building checks that include fire and health and safety. Whilst checking the risk assessments in the building it was noticed that all bed rail risk assessemnts had a tick as all being in place, yet on checking, these were not all in place. This makes the records seem inaccurate and all the maintenance books need auditing to ensure the information is correct. A requirement that has been ongoing for this home has been the lack of suitable bath facilities to enable anyone to have a bath as and when they wish. The home has now purchased new electonic baths that will raise and lower allowing hoist to be pushed Care Homes for Older People Page 21 of 31 Evidence: close to the bath. These, at present are sitting wrapped and waiting to be installed in the next few weeks. The Operations Manager explained that the original company who were to install the baths had gone out of business and the home has had to wait to have the baths installed. The home now has a hoist for each area of the home. Two downstairs and one upstairs. Everyone was up and dressed who needed to be on this visit and staff were not delayed in getting people ready by lack of equipment. The equipment appeared in good working order and are checked by the Maintenance Officer with records held and serviced every six months by a specialist company. On the day of this visit the heating and lighting could not be checked as the weather was hot and bright and no heating was on. It was noted that the previously ill fitting fire exit door had been repaired and no gaps to cause draughts were seen. The Senior Staff member spoken to reported that the corridor by the fire door is always cold in the winter so this problem will need to be looked at again in the bad weather. It was noted that a gap in another fire exit door was in another area of the home which should also be repaired. Residents rooms appeared clean and tidy with domestic staff appearing very active with the carpet cleaner and general cleaning. Two sluice rooms were looked at and appeared cleaner and used for their purpose and not littered with unsuitable items. A comment had been received at the commission from a family member who is not happy with the cleanliness of the home and her relatives room. This room was looked at during this visit and although cluttered with incontinent pads appeared fairly clean and no odour was detected. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stability of the numbers of competent staff on duty needs to be in place to ensure at ALL times residents needs can be met. The home is working towards all staff holding an NVQ qualification to ensure residents are cared for by safe hands. Staff are recruited safely and training is now offered so that residents will be cared for by appropriate people. Evidence: The new Manager and Operations Manager told us the staffing levels throughout the home for the 54 people who live there at present appeared to be meeting the needs of the residents. We observed closely the Lavender unit where 9 people live. Only two carers were found to be on duty and this did not appear adequate for the high level of need these residents require. The management assured us that there should be three on duty and this is recorded on the rotas and that they would investigate where the third staff member was. The Senior in this group stated that often staff have been taken from the three allocated when the home is short elsewhere. The new Manager is now aware of this and will look carefully at the staff rotas to ensure all residents have the suitable number of care staff to meet their needs. Care Homes for Older People Page 23 of 31 Evidence: 4 care staff, plus activities staff were downstairs and 4 care staff were upstairs. This appeared suitable and residents should be supported appropriately by this quota. If numbers of residents increase the staffing levels will need to be revised. The Operations Manager reassurred us that the levels will not be changed. (We did receive a call after this visit, but before this report was completed, to state the staffing levels had been reduced). This has since been discussed and the numbers of staff will remain as found on the day of the inspection and will only be looked at in the future if the levels of need of residents alter. The new manager has actively encouraged all staff who do not hold and NVQ qualification to sign up to the course and during the week of the inspection a representative was visiting the home to introduce the qualification to all employees, including anxilliary staff. One staff personnel file was looked at on this occasion. The most recently recruited staff member is the Chef. His records show that a gap in his employment history was not checked out during the interview. Overall rating in the inteview was good. Two references were in place before employment and both rated this person as good. The POVA first was sent for and returned three days after the start of the employment date and the CRB is still awaited. On questioning this, the Chef started to clean and prepare the kitchen and did not mix with residents. This person does not work alone with residents and therefore is suitable to work in the kitchen on the receipt of the POVA check. A copy of the job description and a note to say a staff handbook had been issued was recorded. On talking to this person it was clear the new Manager had been working with and supporting with training to carry out the job correctly. (The week previous to this inspection a course on the Nutmeg menus had been attended). The new Manager showed us the planned training for all staff that was on display and who had signed up to what course. Some Senior staff are trained as trainers and on the day of this inspection a session was taking place on dementia in the dining room. The training had not been up to date with no Manager being in post until the beginning of the month of the inspection. The effort seen in getting the training to a required level is on the top of the new Managers list. Staff spoken to felt the training now will improve as long as they are not taken from the floor, leaving the home short of staff. This has happened in the past and the residents have not had enough staff on duty as we train stated one staff member. This was discussed with the new Manager who has reassured us this will not happen from now on. Care Homes for Older People Page 24 of 31 Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is very new in post but has managed other homes and is qualified to do the job. Staff are already noticing a change. Quality assurance monitoring will be carried out and all stakeholders will be involved. Residents money is safe guarded. Staff are beginning to have regular supervision. The health and safety of residents and staff is being protected. Evidence: This home has had a problem finding a suitable Manager to run this home after two Managers have left in the past six months. This has caused a lot of uncertainty and lack of faith from the staff. This new Manager has been in post only three weeks and already the staff are beginning to notice a difference. We have been having problems with a staff member for a long time. This Manager is actually dealing with it at long last was comments from two staff members. This person has many years of experience and has an RMA, NVQs and is an NVQ assessor. Care Homes for Older People Page 26 of 31 Evidence: The Manager has already held a relatives meeting and is planning to hold these regularly (minutes seen). A newsletter is to be circulated. Questionnaires are to be posted to all families and professionals involved with the home. The Manager told us that her office is open to anyone who wishes to talk to her and that confidentiality will be maintained. The residents money was not inspected on this occasion. The check on some accounts was made six months ago and the system is thorough with no errors found. The Administrator is the same person and the procedures used by Southern Cross are robust and safe. A staff list was seen of all the staff who had recently had supervision. This is now an undertaking by the Manager to ensure that all staff have the required 6 per year sessions. This was not a regular occurance in the past and needs to be adhered to. As this Manager is very new some of the records of safe working practices were still to be checked. To date the fire records were current, COSHH safety data sheets are in place. All staff have had mandatory training or are booked on the courses over the next few weeks. (full lists seen on the office wall). The accident records were looked at and were completed correctly. Regulation 37 notifications had been sent through to the Commission and details of these were discussed. There has been a big effort to ensure the home has safety notices in place as noted by this new Manager there had been the lack of safety data notices in the kitchen and fire zone areas around the home. These are all now in place and easy to see. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16 The responsible person must 01/02/2009 ensure that recreational facilities that occupy and stimulate residents is available for all. (Repeat Requirement) To ensure that all residents are offered suitable occupation and not left sitting with nothing available. Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Details in the care plan 01/07/2009 should be written in detail to show the persons preferences for presonal care support. Residents should be assisted to dress appropriately. 2 12 16 The recreational/social 01/07/2009 support for all residents to ensure they are occupied and stimulated must be in place. This is an outstanding requirement with a timescale of 01/02/09 and enforcement action may now be considered. Particular attention needs to be given to those who have dementia or cognitive impairment who may not be able to voice their own needs. 3 19 23 It is required that records of maintenence are accurate. 01/07/2009 Care Homes for Older People Page 29 of 31 To ensure that all equipment is maintained correctly and records are accurate for the safety of residents. 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 7 The recording of ALL support for person centred care should be in the persons care plan that comprehensively covers health, personal and SOCIAL. It is recommended that medicines no longer in use are promptly removed from medicine trolleys to avoid confusion It is recommended that medication profile information is kept up to date and accurate at all times to avoid the potential for confusion when medicines are administered. It is recommended that written guidance for the administration of medicines prescribed for occasional use is improved so that individualised information is available on the circumstances when such medicines can be used. It is recommended that pain assessment tools are used to assist staff when considering the administration of painkillers. It is recommended that refresher training is made available for members of care staff who have not received recent training on medicine management. The gardens do need to be inviting and safe for residents to be able to use. It is recommended that the heating and lighting is checked throughout the building as and when the weather changes to ensure the home is warm and bright throughout. The effort on ensuring the health and safety within the home should continue and records updated to reflect these checks. 2 11 3 11 4 11 5 11 6 7 19 25 8 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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