Inspection on 29/09/09 for Brincliffe Towers

This inspection was carried out on 29th September 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brincliffe Towers 02/03/10

Brincliffe Towers 20/01/10

Brincliffe Towers 06/01/10

Brincliffe Towers 01/10/08

Brincliffe Towers 06/05/08

Brincliffe Towers 08/05/07

Brincliffe Towers 11/05/06

Brincliffe Towers 13/12/05

Brincliffe Towers 06/04/05

Brincliffe Towers 21/09/04

Brincliffe Towers 26/04/04

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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: Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ     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: Sue Turner     Date: 2 9 0 9 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 36 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 36 Information about the care home Name of care home: Address: Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ 01142552821 01142552821 jeanwalker2009@live.co.uk None Ash House (Yorkshire) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: All 24 DE(E) beds are registered `or MD(E)` and are sited in a separate wing. Service users may also be aged 60-65 years. Date of last inspection Brief description of the care home Brincliffe Towers is a care home providing personal care and accommodation for 35 older people, including care for twenty-four people with dementia. The home is privately owned, and is located in a residential area of Sheffield with nearby access to public transport. The home is a large old detached house with a modern annexe attached and has very pleasant well established gardens, which overlook Chelsea Park. Care Homes for Older People Page 4 of 36 Over 65 24 24 11 0 0 0 0 1 1 0 2 0 0 8 Brief description of the care home There is a small car park to the front of the house. All of the bedrooms are single although two are registered, as doubles should there be a request to share. Seven rooms have an ensuite facility. There is a passenger lift. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. Care Homes for Older People Page 5 of 36 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: The quality raing for this service is one star. This means that people using this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 7.50 am and 3.30 pm. The registered manager is Michelle Howe who was present during the site visit. The manager and one of the registered owners, Mr Sall were given verbal feedback during and at the end of the site visit. Care Homes for Older People Page 6 of 36 Margaret Ferry, accompanied the inspector; an expert by experience visits the home with an inspector to help them get a picture of what it is like to live in the home. She spent time talking to people and making observations of daily life. Feedback from her is included in the report. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received four from people, four from staff and one from a professional. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Fourteen people, two relatives five staff and one professional were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in October 2008. The progress made has been reported on under the relevant standard in this report. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? At the previous inspection five requirements were issued. At this inspection four of the five had been fully actioned and one had been partly actioned. The requirement that had been partly actioned stated that all staff must receive training in infection control. The manager said that the majority of staff had undertaken this training. There were other staff that needed to complete the training. The manager was aware of the importance of ensuring that all staff were training in infection control as there had been an outbreak of infection at the home that had affected a number of people. Most staff had received training therefore this has been moved to a recommendation. Since the last inspection staff had undertaken further training in medication administration. The training took place over a number of months and was at a advanced level. We found that one member of staff continued to make errors when they recorded the medication they had administered. The manager and provider said that the training undertaken by this person had been thorough and detailed. They therefore made the decision to stop the person continuing to administer medication to people. Staff were fully aware of their responsibilities in safeguarding people that lived in the home. They confirmed that they had received training in adult safeguarding. They said the training had been provided by the local authority and had been very useful We saw that the fire risk assessment had been reviewed and updated. It included the precautions that needed to be in place to ensure that people who had dementia were fully protected. Care Homes for Older People Page 8 of 36 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 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 36 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 36 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. Information was provided to inform people about their rights and choices. Peoples needs were assessed prior to their admission to make sure these could be met. Evidence: The service had a joint statement of purpose (SOP) and service user guide (SUG). This provided useful information about the home. When people showed an interest in the home they weregiven a brochure. These documents should be reviewed to ensure the information provided is easier to read and understand for people who have dementia. Five people surveyed, were asked, Did you receive enough information to help you decide if this home was the right place for you before you moved in? Four people said yes; one didnt answer. Before people stayed in the home they were assessed by a social worker. The manager visited people either in their own home or hospital. This was to make sure that the home could meet the persons individual needs and requirements. Care Homes for Older People Page 11 of 36 Evidence: Information gathered from the visit and pre-assessment would then form the basis for the care plan. People said, I came to stay for a short holiday before I made the decision to live here. I came to look around with my family. Two professionals surveyed were asked, Do the services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people?. They both said Usually. Three staff interviewed said that they were able to meet the needs of the people that lived in the home and they believed that people were suitably placed. The home does not provide intermediate care. Care Homes for Older People Page 12 of 36 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 had individual care plans and risk assessments, however, these did not contain enough information so that staff knew how to meet peoples needs. This meant that peoples health, safety and welfare was inadequately protected. People were not fully protected by the homes medication policies, procedures and practices. Evidence: We checked three peoples care plans. We found that each persons health, personal and social care needs were laid out on separate care plan sheets. They detailed the area of needs, aims and care instructions and had been reviewed. However, they had not been devised using a person centred approach. They had been devised using the initial needs assessment carried out by staff at the home; therefore initial care instructions to staff lacked detail. They did not inform staff of how, when and why the persons needs should be met. The subsequent care plan reviews were inadequate and did not ensure peoples needs were fully met. We concluded from the quality of the care plans that some staff were inadequately skilled or trained in recording information. Care Homes for Older People Page 13 of 36 Evidence: The vast majority of care plan reviews stated, no changes. It was clear to us from further information in the care plan, that peoples needs had changed but this was not reflected in the review. For example one person had been assessed as needing a zimmer frame to walk. In their care plan, the information about moving and handling still referred to them using a walking stick. In the review of care there was no information about the person using the zimmer frame. We discussed this with the manager on the day of our site visit. We acknowledged that there were some improvements to the care plans, however further work was needed to make sure that staff fully understood how to support people. At the last key inspection carried out in October 2008. We recommended that staff would benefit from undertaking training in report writing and person centred care planning. The manager said that some staff had completed this training, however this was not evident in the care plans seen. We looked at the risk assessments which are devised to ensure peoples safety is maintained and we found that, overall staff had identified areas of risk appropriately and were reviewing these on a regular basis. Again it was the lack of detail in these assessments and subsequently the lack of detail in how staff were to manage these risks safely, which could result in people being put at risk. People seen looked well cared for and were dressed appropriately. Staff approached people in a sensitive way. Five people surveyed, were asked , Do you receive the care and support you need? Three people said usuallyand two people didnt answer. People said, The staff have a very caring attitude. The staff look after us very well. Relatives said, The staff are always responsive the peoples needs, medical or otherwise. People are cared for in a prompt and efficient manner. Staff at the home are very caring and pleasant. The care people receive appears to be excellent and people are well looked after, with their personal needs well catered for. There was a medication policy and procedure that staff were familiar with. Managers and senior carers administered medications. Medicines were securely stored in a locked trolley. Staff said that they had undertaken an in depth training course, over a number of weeks. Whilst checking medication records we observed issues that were of concern. We looked at peoples Medication Administration Records (MAR) sheets. On most occasions staff had signed or written a code to confirm if people had taken their medication or not. However there were some gaps. The manager said that when she Care Homes for Older People Page 14 of 36 Evidence: monitored medications, if staff had not signed the MAR sheets this was brought to their attention and recorded on the MAR Sheets. The gaps that we saw were over the past week and had not been picked up by the managers or other staff that had administered medications. One person was being administered a controlled medication. There was no Controlled Drug (CD) register. Staff were therefore recording CDs in a bound book. This record did not give details of the number of CDs brought into the home or what the balance was. The deputy manager said that this information was recorded separately on MAR sheets, however these could not be found. During the site visit we observed that people were cared for in a friendly way. Some staff were skillful in ensuring that people maintained their privacy and dignity when receiving personal care, others were not as skillful. Two health professionals were asked Does the service respect individuals privacy and dignity. One said always and the other said said sometimes. The expert by experience said, People were not taken to the toilet before lunch, to wash their hands. One person went to the toilet and left the door open. She was not checked by staff to make sure of privacy. People and staff conversed naturally, there was no disrespect shown by the staff or people living in the home. Care Homes for Older People Page 15 of 36 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. People were not fully supported to follow personal interests and activities. People were usually provided with meals that suited them. However people whose health and welfare depended on them receiving a special diet, were not fully protected. Evidence: We arrived at the home at 7:50 am. Some people were already up and moving around, others were still in bed. People said they were able to get up and go to bed when they chose. They said there was enough staff on duty to give them help and support when they needed it. We saw that people coming into the home were made to feel very welcome. The homes activity worker had recently moved from this post to be a carer. This meant that staff were covering the activities co-ordinator role. On the day of the site visit we saw that no planned activities took place. People spent their time sitting in communal areas chatting to each other. There was very little information displayed in the home about what activities and outings were available. Five people surveyed were asked, Does the home arrange activities that you can take Care Homes for Older People Page 16 of 36 Evidence: part in if you want? Three people said sometimes, one said always and one said dont know. Relatives said, I appreciate it must be difficult but there should be more outings and activities. There are long periods of time when people are just sat. The expert by experience said, Four people spoken to said they were bored, sitting and doing nothing. None remembered activities undertaken except one who recalled enjoying a walk in the nearby park. One person said they were happy to read, but the books were piled on a unit in the foyer and it was difficult finding books she liked. Others said they enjoyed watching television and chatting to each other, one person said We never go out. It would seem that activities undertaken by people are forgotten (apart from visits by the hairdresser) because there are no displays of activities, clear announcement of events, timetables for activity days or special events recorded. I could not find any evidence that any activities undertaken were suitable to peoples choices, needs and preferences. Following the site visit the manager contacted us to say that she had employed a new activities coordinator. The coordinator would work 20 hours per week, alternating times and days to suit peoples individual preferences. The manager said she had also ordered notice boards so that people were made aware of the range of activities available to them. We observed breakfast and lunch being served in the dining rooms. The dining room tables were set with tablecloths, cutlery and crockery. We saw that menus offered good choice and variety with alternative options always available. The days menu was displayed on a white board. We observed that people were given as much independence as possible at meal times. Some people drank from cups that assisted their disability. Where necessary staff assisted people, for example, cutting up their food, however people were encouraged to exercise choice and control. People werent rushed, making the ambiance in the dining room pleasant and relaxed. We spoke to the person who was cooking on the day of the site visit. They said that they usually worked as kitchen assistant but covered as cook when the full time cook was on their days off. We asked if they were catering for any people who were on special diets. They said they were not sure. We saw from one persons care plan that Care Homes for Older People Page 17 of 36 Evidence: they must have a fat free diet. The care plan said if they given fat, they would be in extreme pain. The staff who served out lunch were aware that the person shouldnt have any food with fat and gave them a plain jacket potato. We believe that very little thought and consideration had been given regarding the persons dietary needs. We were also concerned that the cook wasnt aware of this persons individual requirements, which could put the persons health and welfare at risk. One relative said, The food is good and visitors are always made welcome. The expert by experience said, I ate lunch with people in the dementia wing, dining room. Three tables were set with clean clothes, cutlery, paper napkins, small drinking glasses and one table had a small centrepiece of dried flowers. Lunch was served by the chef, from a trolley. The choice was jacket potato with cheese and beans or fish pie with cabbage. People were asked which meal they wanted, they chose and if they changed their minds they were given the second choice.Nothing else was offered. The jacket potatoes were over cooked and although the potato on the fish pie was tasty, the cheese topping was hard and the smell of the fish was off-putting.However there was very little waste. Dessert was pineapple sponge and custard. Nothing else was offered, like yogurt or fresh fruit. I saw no evidence that dietary requirements were considered, that meals were timed to suit individuals or that personal preferences, likes and dislikes were catered for. Yet every person I spoke with said that they thought the meals were good. People said, I like the food, if I dont like something I leave it. The food is very nice. I can choose what I want. Care Homes for Older People Page 18 of 36 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. Complaints were dealt with effectively. The policies and practices for referring adult safeguarding concerns assisted in keeping people safe. Evidence: People and their families had been provided with a copy of the homes complaints procedure, this was also displayed in the entrance hall; it specified who to speak to, or how to complain to agencies outside the home. The complaints procedure was easy to understand. The home kept a record of complaints, any action that had been taken and the outcome of the complaint. Since the last inspection the home had received one complaint. The manager had investigated this and the issue was resolved. We had received some anonymous information relating to the home. This information was checked and found to be partially substantiated. The manager took immediate action to resolve this. When five people surveyed were asked Do you know how to make a complaint, they all said, Yes. Relatives said, I would go to the manager. If I had any worries or concerns I could go to any of the staff and they would help me. Since the last inspection there had been 4 adult safeguarding referrals. These had been reported as agreed within South Yorkshire adult safeguarding protocols. Care Homes for Older People Page 19 of 36 Evidence: Referrals had been made by the home for advice. Prompt action was taken by the home manager to safeguard people. Adult safeguarding investigated two of these incidents. Action was then taken to ensure that people were kept safe and protected. Staff said they had completed training in adult safeguarding. Staff spoken to were aware of their role and responsibilities in dealing with any alleged safeguarding incidents. People spoken to said they felt safe living in the home. Care Homes for Older People Page 20 of 36 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 was in need of substantial redecoration and refurbishment work, which would provide people with comfortable and safe surroundings. Procedures for the control of infection were in place to promote peoples health and welfare. Evidence: The AQAA stated, We have a decoration programme in progress. All the upstairs areas, bedrooms, bathrooms and hallways have been completed. We have made the communal areas more inviting and homely and brightened up the dementia unit.. The home employed a maintenance person and a gardener. We saw that the home was maintained to an adequate standard. The gardens were pleasant. Outside sitting areas looked in need of care and attention. Shrubs were overgrown and furniture was dirty and broken. This was not an inviting area for people to sit outside and enjoy the fresh air. Lounge and dining areas were clean, tidy and suitably furnished. Some bedrooms were spacious and personalised, others looked bare and lacked homely touches. Since the last inspection some carpets had been replaced and bedrooms redecorated. There remained a significant amount of decoration and refurbishment work to be undertaken, in order for the environment to be seen as good. The manager and provider acknowledged that refurbishment of the home would be benefit people living there. Care Homes for Older People Page 21 of 36 Evidence: We saw a television in one persons bedroom that had very poor reception and that only a small number of people had TVs in their rooms. The manager said that there were problems with TV signal reception. The provider agreed to investigate and improve TV signal reception so that people, who chose to, would be able to watch television in their own rooms. The layout of the home meant that people and their friends and relatives could choose to sit in a number of communal areas. The environment didnt fully promote the privacy and dignity of people. We saw that toilets were in stalls of two; both males and females entered via the same door. Each sex a designated toilet, divided by a half wall. Bathrooms and toilets were dated with a stark appearance. No attempt had been made to make them look more homely. Windows had opaque glazing but there were no curtains or blinds to the windows. Throughout the site visit an unpleasant odour lingered in the entrance hall. This did not give a good first impression of the home. However other areas of the home were odour free. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. Some staff said they had completed training in infection control, others were still awaiting this training. It is important that all staff complete this training following an outbreak of infection at the home. The homes laundry was sited away from food preparation areas. The home had been awarded a 3 star Good Standard of Hygiene from the last environmental health officers visit. People said, I like my room its fine. My bed is always clean and my room is nice. I have everything I need in my room. A professional said, The environment, although clean could do with freshening up and re decorating. A relative said, The home is in need of improvements, to the paintwork, decorating and curtains need rehanging. The expert by experience said, Care Homes for Older People Page 22 of 36 Evidence: The offensive odour in the foyer should be investigated. Carpet cleaning everyday is a loud disruptive element prohibitive to peoples conversation. Care Homes for Older People Page 23 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers were appropriate to meet the assessed needs of people. In the main recruitment information obtained protected the welfare of people and staff were receiving training so that they were competent to do their jobs. Evidence: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. The diversity of the staff team matched the diversity of the people living in the home. On the day of the site visit staffing numbers were adequate. People said, The staff are very good and always there when I need them. If I need somebody, staff come to help me. We could do with more staff. One professional said, Staff try to cater for peoples needs, but at times the home is under staffed so the carers arent able to do their job to the best of their ability. Some carers dont seem to know what they are doing, so all staff should be trained to the same level which would improve care. Care Homes for Older People Page 24 of 36 Evidence: Staff were able to talk about the various training courses that they had attended which included fire training, moving and handling, food hygiene, health and safety and personal care. Training was provided to staff on an on going basis. A number of care staff had completed the NVQ Level 2 in care and others had commenced the training. The number of staff trained fell below the required minimum of 50 per cent of the staff team trained to NVQ Level 2 in Care. Seven staff surveyed, were asked, Did your induction cover everything you needed to know to do the job when you started? All seven said very well. When asked what the home could do better, staff said, The environment could be made so much better. We should be more organised and have better routines. I have seen a great improvement in the care given and staff moral is much better. I feel that the atmosphere within the home has improved and everybody is starting to feel part of a team. One relative said, The staff are very friendly and helpful and always willing to listen and act on concerns. Three records of employment were checked. These included the required references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. Staff files seen did not have proof of the persons identity and a recent photograph of the person. Care Homes for Older People Page 25 of 36 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 at the home was competent, qualified and experienced to run the home. There were quality assurance systems in place; these should be extended to ensure that the home is run in the best interest of people. Peoples finances were safeguarded. There were a number of concerns relating to peoples health and safety being fully protected and promoted. Evidence: Everyone spoken to and information from surveys confirmed that people, staff and relatives were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Staff said that they found the manager easy to talk to and they could go to her at any time to discuss issues or concerns. Professionals said, The home has improved in the past few months since the new manager has been in Care Homes for Older People Page 26 of 36 Evidence: place. I also think there has been a change in the attitude of the carers since she arrived. Staff have also has more training. The quality of care has improved dramatically since the new manager has started. We were told that staff meetings took place every couple of months. We looked at the minutes taken from the previous staff meetings. The last one was for July and the minutes said that no staff had turned up for the meeting, so no meeting was held. Prior to this a meeting had been planned for April. Again the minutes stated that the meeting didnt take place as no staff attended. This meant that the last meeting held was in January 2009. The manager review reasons why staff are not attending meetings and examine how information could be given to staff in an alternative way if necessary. It was also difficult to understand why staff who were rostered to be on duty on the days of the staff meetings didnt automatically attend the meeting. We acknowledge that staff should not be taken from their duties, however there should have been some staff available to attend a meeting, at some point in the day. We also saw that relatives had not turned up for meetings that were planned. People that lived in the home were included in the relatives meeting, but no resident had attended either. The company had a quality assurance system in place that consisted of questionnaires being sent out to people and their relatives. Questionnaires covered areas such as catering, housekeeping, care and administration. It is recommended that the views of visiting professionals such as district nurses, community psychiatric nurses, GPs and care management teams are obtained at intervals to give a wider range of information about the services provided by the home. We also advised that an annual report on the services provided should be completed which should include the outcome of quality monitoring. This should then be made available for people to read. The provider visited the home on a regular basis. The last report written of the providers observations of the home was in September 09, prior to this it was May 09. The reports had very little detail and did not evidence that people, relatives or professionals had been asked their opinion of the service provided. The reports were not signed by the provider. We talked to the provider about the importance of the reports (known as Regulation 26 reports) and how these should be completed each month and what should be included in these. Information received from the quality assurance audit and the Regulation 26 visits would make sure that the provider was aware of the quality of the service, that was being provided and how the service could be improved. The home handled money on behalf of some people. Three peoples financial records were checked. Account sheets Care Homes for Older People Page 27 of 36 Evidence: were kept and receipts were seen for all transactions. We were checked three peoples money and this balanced with what was recorded on the account sheet. Staff spoken to said they had recently had formal supervision with their line manager. They said that supervisions were useful and beneficial. During the site visit we observed that a significant amount of the managers time was taken up with answering the telephone. We saw that the telephone was also the fax machine and the photocopier. This meant that people rang to say dont answer the telephone because Im sending a fax and then the manager would have to inform other staff about this and then the phone line would be unattainable until the fax was received. The system was chaotic, the telephone rang throughout the day. We also observed that their is no administrator role at the home. There is a person who deals with the staff wages but no administrator to assist the manager with record keeping. The manager did not have access to a computer or the internet. We spoke to the provider about this. We were told that a computer and internet access was to be made available to the manager imminently. The provider said they would also consider changes to the telephone/fax line. Fire records evidenced that fire alarm checks and fire drills took place. Fire equipment and systems had been recently tested and serviced. A fire risk assessment had been completed and updated. The fire risk assessment included specific precautions that needed to be in place for people that had dementia. The home had a gas safety certificate and recently the electrical portable appliances (PAT) had been tested. We recommended at the last inspection that the home should have a periodic inspection certificate to certify that the electrical fixed wiring had been checked. This had not been completed. We spent time walking around the home and making observations. During this time we observed a number of concerns that put peoples health, safety and welfare at risk. Staff were seen moving one person from a chair. They moved them by a technique that is no longer recommended. Some peoples bedroom doors were left ajar. The bedrooms had toiletries left on sinks and cupboards. These could pose a risk to peoples health and welfare. Outside the home there was a grate cover missing. This meant that there was a deep void in the ground that caused a potential health and safety hazard. Care Homes for Older People Page 28 of 36 Evidence: Following the site visit the manager contacted us to confirm that the cover had been replaced onto the grate. Care Homes for Older People Page 29 of 36 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 30 of 36 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 Each persons care plan must contain adequate details to ensure that peoples needs and any changes to these needs are clearly recorded and staff know how to meet their needs. So that peoples health, safety and welfare is protected and promoted. 07/12/2009 2 8 15 Peoples health care needs must be identified. Then clear records of how peoples health care needs are to be met must be recorded. So that peoples health, safety and welfare is protected and promoted. 07/12/2009 3 9 13 MAR sheets must be signed by the person administering the medication and at the time of the medication administration. 07/12/2009 Care Homes for Older People Page 31 of 36 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 So that peoples health, safety and welfare is protected and promoted. 4 15 16 All staff must be made aware of peoples individual dietary needs, preferences and choices. So that peoples health and welfare is promoted and protected. 5 24 23 People must be provided with a clean bed and mattress. So that peoples health, privacy and dignity is maintained and promoted. 6 26 23 All staff must be provided with training in infection control. So that peoples health and welfare is not put at risk. 7 29 19 Staff files must contain proof 26/10/2009 of the persons identity and a recent photograph of the person. So that there is full and satisfactory information about each person employed at the home. 8 33 26 The provider, or their representative must carry out a visit and complete a 26/10/2009 07/12/2009 26/10/2009 26/10/2009 Care Homes for Older People Page 32 of 36 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 report, as detailed in Regulation 26 of the Care Homes Regulations. This will make the provider aware of the quality of the service, that is being provided and how the service could be improved. 9 38 13 Substances that could pose a risk to peoples health and welfare must be kept locked away. So that peoples health, safety and welfare is not put at risk. 10 38 13 The missing grate cover must be replaced. So that peoples health, safety and welfare is not put at risk. 11 38 13 People must be moved and handled using only techniques that have been recommended as safe. So that peoples health, safety and welfare is not put at risk. 26/10/2009 26/10/2009 26/10/2009 Care Homes for Older People Page 33 of 36 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 The homes SOP should contain full information about the services provided especially in relation to dementia care. This will ensure that potential residents can make an informed choice about the home and be sure needs can be met. The homes SOP, SUG and Brochure should be made available in easy to read and alternate formats so that people are made fully aware of the service they can expect to receive. Staff would benefit from receiving training in report writing and person centred care planning. Care plans should be written in a more person centred way. Staff should receive training in maintaining peoples privacy and dignity. So that people feel they are treated with respect and their privacy is upheld. A further programme of activities should be developed to include a wider and more frequent range of entertainment. Activities should take into consideration peoples individual capabilities, needs, preferences and choices. The cause of the poor television reception should be investigated and then action taken so that people are able to watch television, that has a good quality picture. A planned programme of refurbishment and redecoration work should continue so that people live in a pleasant, homely and comfortable environment. Satisfactory standards of hygiene have to be maintained. Therefore the cause of the unpleasant odour should be found and action taken to eliminate this. 50 of the staff team should be qualified to NVQ Level 2 or above. A report should be written detailing the results of the quality assurance survey. The report should highlight the actions that will be taken about any issues raised in the surveys. Consideration should b given to why staff , relatives and people who live in the home are not attending meetings. If necessary alternative arrangements should be made to ensure that everyone is given the opportunity to air their 2 1 3 4 5 7 7 10 6 12 7 19 8 19 9 26 10 11 28 33 12 33 Care Homes for Older People Page 34 of 36 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 views and received updated information about the service. 13 33 As part of the quality assurance audit, the views of visiting professionals such as district nurses, community psychiatric nurses, GPs and care management teams should be obtained to give a wider range of information about the services provided by the home. So that the manager and staff are fully supported to carry out their role, consideration should be given to providing a computer with internet access, a separate fax and telephone line and administrative support. This would help to ensure that information and records were kept up to date and accurate. 14 37 Care Homes for Older People Page 35 of 36 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). 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. 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