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Inspection on 10/07/09 for Brookvale Care Home

Also see our care home review for Brookvale Care Home for more information

This inspection was carried out on 10th July 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

There is a Statement of Purpose available to all people in the home and their relatives available in each lounge along with other information. One relative told us `the manager made sure we had enough information so that we could decide if this was the right place`. The admission procedure is good, enough information is collected before admission so that the management can be sure that each person`s needs can be met. In the case of emergency admission, assessment is started on the day of admission and completed within the first 5 days. Staff are trained and knowledgeable and know how to care for each person in the home. A relative said ` The staff are great, they know what they are doing and they care`. Almost 100% of staff have completed training in National Vocational Qualification Level 2 in Care and two senior care staff have completed their NVQ to Level 4 in care. This means that staff are suitably trained. There is a varied and nutritious diet, each meal time there is a choice and three people at the home said they enjoyed the meals. There was no one losing weight and one relative said `My [x] has put weight on and eats really well, better than when at home`. There are a variety of activities for both groups and individuals and the management encourage the people at the home to be independent and to spend time with their families away from the service if suitable. There is good infection control in the home and this reduces the risk of infection for the people and staff in this home. One person said ` The home is always clean and smells nice`.

What has improved since the last inspection?

The administration and management of medication has improved and the staff ensure that all medication is recorded. Any mistakes are quickly noticed and action taken to ensure that each person has their medicines as the doctor prescribed. The environment has improved. New UPVC double glazing is being completed, as well as a conservatory. There is a new bathroom and one is being completed. The people in the home have been consulted during this process and regular meetings are held, this is also the case for staff. This shows that everyone is included in deciding how the home should run.

What the care home could do better:

There is not enough information in the care plans to ensure that the staff know what to do. Evaluating the care given is made difficult as there are no agreed ways to approach different needs in each person. The risk assessments are not completed all the time; the management could not show how they decide what risks there are for each person and how these are then managed to reduce risk. People admitted for respite care [short stay] do not always have up to date assessments and care plans. This is needed to show that the way a person is assisted with their care is what they want. Each person and/or their relative[s] should be involved during assessments, development of care plans and their evaluation, this ensures that the care is given as the person wishes. Clear records of all complaints and investigation for managing reported risk need to be more detailed so that the management can show how they resolve difficulties and make improvements to minimise the recurrence of incidents. Formal supervision of staff, allowing them to discuss work issues, training and other matters, is not regular.

Key inspection report Care homes for older people Name: Address: Brookvale Care Home 111 Warwick Road Olton Solihull West Midlands B92 7HP     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: Lesley Beadsworth     Date: 1 0 0 7 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 29 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 29 Information about the care home Name of care home: Address: Brookvale Care Home 111 Warwick Road Olton Solihull West Midlands B92 7HP 01217069097 01217060467 tracey.arms@heartofenglandcare.org.uk www.heartofenglandcare.org.uk Heart Of England Care care home 61 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 61 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 61, Mental disorder, excluding learning disability or dementia (MD) 61 Date of last inspection Brief description of the care home Brookvale Care Home is situated in Olton and accommodates up to 61 people with mild to moderate cognitive deficits and dementia. The home does not offer nursing care. The home is over three floors, people in the home have access to all areas and there are suitable facilities available. The home is close to local amenities, and local bus services. The home receives visits from the local church, and residents may participate in religious services if they wish. Care Homes for Older People Page 4 of 29 61 61 Over 65 0 0 Brief description of the care home People are advised to discuss fees with the manager when considering the home. Extra charges are required for personal and additional services. Further information can be acquired from the home. Care Homes for Older People Page 5 of 29 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: An unannounced visit was made, which means that the staff did not know beforehand that an inspection was to take place. Before the visit the management were asked to complete an Annual Quality Assurance Assessment [AQAA], which was completed by the registered manager and returned to us by the date requested. This told us what the service does well, what improvements are needed and improvements that have been made. It also told us how the manager could demonstrate this. We also looked at other information we had received since the last inspection. This is information from the home about accidents, incidents and any other matter that may affect the people who live there; concerns, complaints and compliments from others who use the service or visit there and information from other professionals. Care Homes for Older People Page 6 of 29 We also considered the last inspection and what this told us about the service, what they did well and where improvements were needed. While on the visit we examined records related to the care of people at the home and the staff. We checked employment and training, and discussed the running of the home and management with the deputy manager. People living at the home, some of their relatives and the staff were spoken to, and they told us about their experiences. From this information we found that the home has continued to improve and that the people using the service and their relatives told us they feel safe, satisfied with the care and happy to be there. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: There is not enough information in the care plans to ensure that the staff know what to do. Evaluating the care given is made difficult as there are no agreed ways to approach different needs in each person. The risk assessments are not completed all the time; the management could not show how they decide what risks there are for each person and how these are then managed Care Homes for Older People Page 8 of 29 to reduce risk. People admitted for respite care [short stay] do not always have up to date assessments and care plans. This is needed to show that the way a person is assisted with their care is what they want. Each person and/or their relative[s] should be involved during assessments, development of care plans and their evaluation, this ensures that the care is given as the person wishes. Clear records of all complaints and investigation for managing reported risk need to be more detailed so that the management can show how they resolve difficulties and make improvements to minimise the recurrence of incidents. Formal supervision of staff, allowing them to discuss work issues, training and other matters, is not regular. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs are assessed before admission and that the service can meet these. Evidence: There is an up to date guide which is available for those who are considering moving into the home. This is also available in each lounge area, with a copy of the last inspection report. There is also information about the Mental Capacity Act for carers. Two relatives told us that they were given information before choosing this service and felt that they had been given accurate information that helped them make a decision. Four peoples records were looked at and there was a care plan available from social services and an assessment completed by the home before admission. This ensures that the management have sufficient information to show that they can meet the persons needs. Care Homes for Older People Page 11 of 29 Evidence: One relative told us that they attended a review one month after the admission to discuss the placement with the manager of the home and the social worker. At this point the placement was made permanent. They also said This is the best place. My relative has settled and is really happy here. One person was admitted as an emergency. Their relative said The service is very good, and asked for the information at the point of admission and helped settle my relative into the home. The service also admits people for short term periods, known as respite care. The admission information was available and a care plan from social services. Care plans were not available and the records were disorganised. Discussion with the staff told us that they were aware of the persons needs. Care Homes for Older People Page 12 of 29 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. Each person can be sure that there is an appropriate plan of care in place to tell staff what assistance and care they need. Each person can be assured that they will receive their medication as prescribed by their doctor. Evidence: The service is changing over the process by which they record information. Five peoples profiles were looked at and two of these were in the new format. The care plans, which inform staff on the assistance or care needed by each person, were varied. Some had a lot of information, other were incomplete and in two instances no care plans could be found. It is important that the needs of each person are written down so that staff can refer to these, it assists in ensuring consistency in approach and also is needed to evaluate the care and assistance given, to demonstrate that it is working. An assessment of care plans should be undertaken and actions put into place to ensure that each person has suitable plans in place. After the inspection two plans of care were sent to us. These showed marked Care Homes for Older People Page 13 of 29 Evidence: improvement and stated clearly the needs of the individual and the actions to be taken by staff. This type of plan needs to be available for all people using the service, which will increase consistent care and enable staff to show that care and assistance given is appropriate. The risk assessments for each person were also varied; again some had these and others did not. The risk assessments help staff to determine the level of risk and then determine the actions to be taken to minimise this risk. The home reports that there have been a number of falls in the past eight months. Risk assessments for falls and mobility were not consistently completed. Information on how staff should manage challenging and aggressive behaviour is also inconsistent. Staff are aware of each persons needs and discussion and observation showed that each person was treated appropriately and that staff were skilled and knowledgeable. A relative told us The staff know what [A] wants and are very good another relative told us that initially the small things that make life better were not always done consistently but this had improved and they were satisfied with the care. A person who lives at the home told us It is OK here. Most of the girls look after me the way I want. I can be very vocal and I sometimes think that they dont like that. Each person has the opportunity to see the GP when needed and also other professionals such as the chiropodist, optician and dentist. There is also a community psychiatric nurse [CPN] who visits every two weeks to support the staff and assess individuals at the service. Records of these visits are made, the CPN also carries out assessments for capacity which is revisited every three months or more often if needed. Three relatives told us that they have not been involved in the ongoing care of their relatives. One relative said that they look at the care records and plans regularly. All the relatives said that the home tell them when anything changes or if there is an accident. They felt supported, included and happy that the care was good. There has been an improvement in the management and administration of medication. This was ordered, received, administered and destroyed appropriately. The paper work was properly completed and all medication in the home was accounted for. Care Homes for Older People Page 14 of 29 Evidence: The home use over the counter medication, referred to as Homely Medicines. An individual form for each person was completed and signed by their GP, the home manager and the pharmacist. This reduced the risk of incompatible medicines being given. Care Homes for Older People Page 15 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that their interests and social needs will be met. Each person can be confident that the meals will be suitable and ensure that they receive a varied and nutritional diet. Evidence: There are a variety of activities in the home and these were seen during the visit. Two people living at the home told us that they are included in the activities and that they have enough to do during the day. There is a reminiscence room on the first floor, this has been decorated and furnished to represent a room from the 40s and 50s. This area is used for small groups and can be used by visitors. There is also a snozleem. This area contains various lighting, music and comfortable seating and it is used by the people at the home, with staff, to reduce stress and anxiety. One relative said My [x] is very happy here and is always busy doing things, sometimes when I visit [x] says I am busy, you can go Care Homes for Older People Page 16 of 29 Evidence: Another relative told us that their relative was very settled and that the staff carry out all types of activities that they can join in. Religious services are held at the home and this was seen. People from all areas of the home have the opportunity to attend these. Visits into the community are encouraged. The home has the use of transport and have taken people to various local places. People at the home are also supported and encouraged to go out with their relatives, going home for short periods or other family activities. Friendships are supported in the home and each person can spend time on any of the three lounges they choose. There is a lift available to all floors for easy access. There is a garden that is maintained and each person can use this area, which is secure. A new conservatory is being built and it is anticipated this will be complete by September 2009. This will give more space and the deputy manager told us that they are planning to have parties and dances in this area. The kitchen is clean and organised and the staff are aware of the needs of each person. There are two choices for the main meal, which is served at lunch time. Each person is asked the afternoon before what they would like, and again this is checked at the time of the meal. For some people this involves showing them both meals so they can choose. There is a dining area on all three floors, people can choose where they eat. The dining areas on the first and second floor are small. Plans were seen and the architect confirmed that these will be made bigger as part of the refurbishment programme. Care Homes for Older People Page 17 of 29 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. Each person feels confident that their concerns will be addressed, paper work is incomplete and does not reflect this. Each person is safeguarded through the knowledge and actions of staff. Evidence: There is an up to date policy and procedure for reporting and dealing with complaints. These are in the Service User Guide which are located in the lounge areas of each floor. Three relatives told us that they were aware of how to make a concern or complaint known, and that they would report this to a senior carer or the management. Two relatives told us that they were satisfied with the care and the service and felt that if they had any concerns they felt confident that these would be looked at. The complaints folder did not contain suitable information. The general manager had dealt with the complaints and had this information in the Head Office. This was sent to us immediately after the inspection. This told us that the company respond in a timely manner to complaints and investigate fully. Through discussion, and as a result of complaints received, care provision and improvements have been made . It is important that this information is available in the home to show the process. There are suitable policies and procedures for the safeguarding of vulnerable adults Care Homes for Older People Page 18 of 29 Evidence: that include the National and Local strategies. The management are clear about how allegations or observed abuse should be managed and two staff spoken with were also clear about their roles and who they would report to. Information regarding safeguarding meetings was incomplete. This means that the service cannot show what the outcome of safeguarding meetings are, what actions are taken or any changes that were needed as a result of these. Staff have received training in safeguarding and are aware of their roles. Whistle blowing policy is also available, and staff have recently revisited this and signed to show they have read it and understand their responsibility to report any suspicions or actual abuse. From discussion with four staff and records it was evident that the service is supported by a CPN who assessed people for capacity. This is a requirement under the Mental Capacity Act and determines if someone can make their own decisions in various areas of their life. The management are also aware of their responsibility to each person in situations where they are prevented from fulfilling their rights [under the Deprivation of Liberty Safeguarding]. Some personal monies are managed by the service. The procedure for this is robust and protects people from financial abuse. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be assured that the home is maintained, clean and suitable for them to live there. Evidence: The service has three floor and accommodates 59 people. A decision was made to make the 1st floor exclusively for males who are admitted. A relative told us that the management had asked the people in the home and their relatives what their views were in relation to this, and also what rooms they would like. The service is maintained to a good standard and was clean and free from any offensive odours. Bedrooms are individualised with personal belongings and each person has the opportunity to have a key to lock their room if they wish. One person visited locked their room and opened it when knocked. He told us that he likes to lock his room and that staff can get in with their key but always knock. There is an ongoingnrefurbishment programme. New UPV windows are being fitted to all windows, a new conservatory is being built and changes to the internal environment is being carried out to make more communal space on the first and second floor and to up date the bathrooms. In August the reception area is to be updated. Care Homes for Older People Page 20 of 29 Evidence: The architect was spoken with and he told us that the people in the home were consulted and they chose the colour of tiles used in the bathrooms. One person in the home with a previous background as an architect was included in some of the planning. Materials used for cleaning are locked away and the housekeepers have suitable cleaning materials there are six housekeepers and five of these have completed their National Vocational Qualification in Housekeeping. The infection control is good. There is hand gel at the entrance with a notice for every one to use this. It is recommended that this is also made available in other areas. There are aprons and gloves available for all staff and these are used appropriately. Staff have received training in infection control and the management are part of the Solihull Infection Control Committee where good practices and new information are shared. At the last meeting the management shared their information on Tackling Infection. Two relatives told us that the home is always clean and smells good and that they the laundering of clothes was good. Care Homes for Older People Page 21 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be sure that they are cared for by trained staff who have been checked to ensure they are suitable to work with vulnerable people. Evidence: There are a variety of staff on duty each day to ensure that the home runs to the best interest of those living there. There are a minimum of three senior carers on duty during the day time. This ensures that the care given is supervised and that junior staff are supported while giving care. Twenty seven carers have completed their National Vocational Qualification Level 2 in care, and the remaining six carers have started this training. This will mean that 100 of care staff have a NVQ level 2 or above. Two senior staff have completed their NVQ in care at level 4. This means that the staff are suitably qualified to care for those who live at the home. All senior staff have attended Dementia Care Training and this will assist them to make suitable decision about care. They are also supported by a Community Mental Nurse who offers advice on care issues and assists with assessments. The home is supported by housekeepers and laundry staff, five of these have completed NVQ training in Housekeeping. This means that they are suitably trained to Care Homes for Older People Page 22 of 29 Evidence: keep the home fresh and clean and safe. The home also employs two Activity Organisers. This enables a variety of activities to take place, both in groups and individually. Care staff also participate in the activities and were seen to use suitable communication. Staff files were looked at and these told us that the employment process are robust and ensure that all staff employed are suitable to work with vulnerable people. There is a comprehensive induction process that is in line with the recommended Skills for Care induction training. Relatives told us that the staff are knowledgeable and that they will inform them of changes in care. They also said that the staff are caring and always appear to have time to spend with each person throughout the day. Staff have the opportunity to update their knowledge and ensure that they are using up to date practices. It was seen that the records for Fire Drills was not up to date. This is important so that staff would know what to do in the event of a fire. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be assured that the home is safe, well managed and their wishes considered. Evidence: The manager has had 13 years experience managing care homes. She is a registered nurse and has a Diploma in customer care. There continues to be improvements in this home and it was evidenced through this visit that further improvements are occurring. The care planning system is being updated and although there is information missing from some files, the staff knew what care was needed for each person. The manager returned the Annual Quality Assurance Assessment when requested and this contained information about the improvements made, what they do well and where further improvements are needed. This told us that the management are clear about how the home is running and plan for improvements in the environment, provision of care, quality of the service provided and support for staff. Care Homes for Older People Page 24 of 29 Evidence: The manager is supported by a deputy who has been working in care homes for many years and has a lot of experience. The manager and deputy are supported by an administrator which means that they can concentrate on clinical matters and work closely with the staff to ensure that the home is run to the best interest of those who live there. The manager has various meetings with staff, which ensures that staff are included in decision making and also informed of changes occurring in the home and improvements to be made. Meetings are also held with the people who use the service and their relatives, which enables them to discuss areas of improvements and to have an open forum to discuss any issues of concern or to report good practice. The activity organisers also attend this meeting to discuss activities and outings. Formal supervision of staff is not consistent. This process of staff supervision assists staff to improve and discuss training needs. The records confirmed that staff are seen and actions discussed where gaps in knowledge are recognised through the auditing system. The provider, The Heart of England, visits the home monthly and carries out an announced check of the service and how it is running. Some reports were viewed and the last report showed similar failings to those found on this visit. This tells us that the service is active in assuring the quality and takes action to ensure that improvements are made. People who use the service and their relatives are surveyed each year. The information is not analysed and there was no written information to tell us of any improvements made as a result of these. The home manages small amounts of money for each person. These are safely stored and records are kept of all money received and spent. Receipts are also kept. This system is audited by Heart of England to minimise the risk of financial abuse. A sample of maintenance information was looked at and this told us that equipment and facilities are checked to ensure they are safe to use. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 person in the service must have a care plan that clearly states their needs and the care and assistance required. This ensures that care given is appropriate, consistent and can be evaluated. 20/08/2009 2 8 13 Each person should be risk assessed to determine the level of risk and plans developed to minimise these. This is to ensure that all staff are aware and take precautions to minimise risk for each person. 20/08/2009 3 16 17 Clear records of all 15/08/2009 complaints and actions taken should be maintained. This ensures that the management can audit changes in the service and demonstrate actions taken. Care Homes for Older People Page 27 of 29 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 3 All respite residents must have an assessment before admission on each admission to ascertain if there has been any changes in needs. Each person and/or their relative should be included in the evaluation and development of care plans to ensure that assistance and care is given in a way that suits them. Records of all complaints should be available in the home to ensure that it can be demonstrated that these are dealt with promptly and professionally and actions are taken to improve the service if required. Records of all safeguarding of vulnerable adults should be maintained to demonstrate outcomes, actions taken and lessons learnt. All staff should have six supervisions sessions per year that are recorded and show any actions to be taken to improve or increase knowledge. 2 7 3 16 4 18 5 36 Care Homes for Older People Page 28 of 29 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. 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