Inspection on 16/02/09 for Bryden House Nursing Home

This inspection was carried out on 16th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bryden House Nursing Home 21/01/10

Bryden House Nursing Home 15/01/08

Bryden House Nursing Home 09/01/07

Bryden House Nursing Home 27/10/05

Bryden House Nursing Home 11/05/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bryden House Nursing Home Marlpool Lane Franche Kidderminster Worcestershire DY11 5DA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Lyndon     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bryden House Nursing Home Marlpool Lane Franche Kidderminster Worcestershire DY11 5DA 01562755888 01562755887 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 30 old age, not falling within any other category physical disability Additional conditions: 0 0 The home may accommodate a maximum of 6 people aged 55-65 years in either of the above categories. Date of last inspection Brief description of the care home Bryden House Nursing Home is located on the outskirts of Kidderminster town centre. The home offers nursing and residential care for up to thirty people who may also have dementia care needs. There are communal lounges, dining rooms, toilets and specialist bathrooms within the home. All bedrooms offer single accommodation. Off road parking is provided for visitors and there is ramped access to the front of the home. There is equipment available to assist people to move around the home. Our last inspection report is available within the home for people to read. Current fee rates are available from the home on request. items not included within the accommodation charge include private chiropody, hairdressing personal toiletires Care Homes for Older People Page 4 of 32 Brief description of the care home and outings. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements minimum standards of practice, and focuses on aspects of service provisions that need further development. One Inspector undertook this visit to the home over eight hours, and the registered manager assisted throughout. There were twenty eight people living at the home, and one of these was receiving hospital treatment. Twenty four people were receiving nursing care, and five people were receiving residential care. The home did not know that we were visiting that day. Care Homes for Older People Page 6 of 32 Information was gathered from speaking to, and observing people who lived at the home. Three people were case tracked, and this involves discovering their experiences of living at the home, by meeting or observing them, looking at medication and care files, and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. We spoke with four people who live at the home, three visitors, and three staff. It was not possible to speak to a number of people who live at the home due to them having dementia. Staff files, training records, and health and safety files were also reviewed. Prior to our visit, we sent out random questionnaires to people who live at the home and staff who work there. Feedback received was mainly positive and comments received are included in this report. Ten completed questionnaires were returned from people living at the home and seven from staff members. The registered manager and provider also completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gives us information about how well the home think they are performing. It tells us how they have improved, and about plans for further developments. It also gives us some numerical information about the people living at the home and the staff. Other information obtained and used in the planning of this visit, included notification reports of any accidents or incidents involving people living at the home, and any complaints received. No immediate requirements were made at the time of this visit ,which means that there was nothing urgent for the home to do to ensure the safety of the people living there. What the care home does well: Pre admission assessments are completed and confirmation letters are sent out so that people know that their needs can be met before they move in. People have access to a range of Health and Social Care Professionals and this should ensure that their health care needs are met. Staff support people living at the home in a sensitive and respectful manner so that their dignity and self esteem are maintained. People have the option of having a key for their bedroom doors so that they can keep personal items secure. There is a range of activities arranged and offered to all people living at Bryden House that meets their individual needs and interests. Individual religious beliefs are respected and opportunities for religious worship are provided as requested. There is an open visiting policy and people have the choice of where they entertain their guests so that they can meet in private if they wish. Communication between the homes staff and relatives of people living at the home is good. People are able to exercise control over their daily lives and this promotes their independence and individuality. A variety of healthy meals are served and these meet any special requirements for reasons of health or taste preferences. People living at the home and the people important to them are confident that actions will be taken to address any concerns that they may raise to the staff and management team. People are encouraged to personalise their rooms with items that are familiar to them so that they are relaxed in their surroundings. The registered manager is very committed to improving the quality of the lives of people living at Bryden House. People feel confident that they can speak with the manager at any reasonable times that they choose. People living at Bryden House are involved in decisons about the running of the home. Maintenance records are well maintained and equipment is checked so that it should be safe to use. People told us: There is always a welcoming and friendly atmosphere to visitors. Care Homes for Older People Page 8 of 32 We were made to feel welcome here. They told me that now my husband is here I am like family here. They came to assess my husband. He has only been here for a month but I cant fault them. Medically the service is very good. Doctors usually arrive in no time at all. My wife has everything she wants in here. There are always staff around if my Mother needs any help. If anything is requested it is done. The home is very well managed and management are always very approachable and helpful. What has improved since the last inspection? What they could do better: Current arrangements for pre recruitment checks on new workers is of concern and places people at risk of harm. Information about the home should include details of fee rates so that people know what they will have to pay if they live there. Daily reports did not include information about the support provided to people regarding their social and emotional care needs. This may prevent them from receiving the support that they require in these areas. Arrangements in place to take verbal instructions over the telephone regarding a change of medicine dosage may result in the person receiving the wrong dose of medication and does not safeguard staff. Current arrangements mean that people do not always know what meals are available on a daily basis. Care Homes for Older People Page 9 of 32 Arrangements to manage risk of cross infection need to be improved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission processes are thorough and people have enough information in order to decide whether they would like to live at the home. Evidence: The statement of purpose and service user guide was available in the home for people to refer to. These were both informative, easy to read and available on audio cassette for people unable to read. Information about fee rates was not included, and this will prevent people from having this information when deciding whether to live there or not. The registered manager said that these could be produced in other languages on request. People are encouraged to visit the home in order to sample what it would be like to live there. Care Homes for Older People Page 12 of 32 Evidence: Nursing staff undertake pre admission assessments for prospective people in order to establish whether their care needs could be met at the home. This included detailed information about the persons preferences in respect of their daily lives and social and health care needs. An initial care plan is written from this information and a letter is sent out to the person seeking accommodation or their family to confirm that their individual care needs could be met at the home. We met with a relative of a person who had recently come to live at the home who said We were made to feel welcome here. They told me that now my husband is here I am like family here. They came to assess my husband. He has only been here for a month, but I cant fault them. Intermediate care is not provided at Bryden House. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning health provision and care delivery is good and this means that the health and personal care needs of people is being met. Evidence: Assessments of peoples individual physical and social care needs are undertaken on admission to the home and care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves and in what areas they require support. Since our last visit, staff had received training about care planning and the system was audited on a regular basis. As a result of this, much hard work had been undertaken in order to improve the care plans at the home. Three care plans were examined and we found that they had been personalised and identified the specific support required by staff in order to ensure that people received care and support in the ways that they preferred. After meeting with these people it was clear that the care provided reflected the information recorded within the care plans. Since our last visit a supplementary document had been introduced and this provided information about the daily Care Homes for Older People Page 14 of 32 Evidence: preferences of people living at the home. This is also used when planning individualised care. The document did not identify whether people had a preference about the gender of carer supporting them with personal care needs however we discussed this with people living at the home and no concerns were raised. The registered manager told us that she would amend the document to include this information. We sampled a care plan that had been written for a person who had developed sore skin and this included good detail about the condition of the skin and the nursing care to be provided. The sore skin had now healed and it is recommended that the care plan for this be resolved and a new care plan identifying that the person is at risk of sore skin be written. Suitable pressure relieving equipment was available for this person and this will reduce the risk of the skin becoming sore again. We sampled a care plan relating to a person who had diabetes and this had good detail about the signs of complications of the disease and the specific care to be given so that health care needs are met. A care plan written for a person who became agitated at times identified the trigger factors for this. This will enable staff to reduce the risk of this person becoming agitated and unsettled. Records included a number of personal risk assessments so that measures could be taken to minimise the risks for individuals. These included the risk of sore skin moving and handling continence falls and nutrition. The daily information record identified the nursing care and treatments provided. It is recommended that this also includes information about the support provided regarding the social and emotional care needs of people living there. This information can be used when assessing the effectiveness of care provided. Written records regarding personal care provided identified that people were receiving care and support at the times that they required. There was evidence that staff monitored peoples, health care needs for example one person had lost weight prior to coming to live at the home so staff recorded all of the food and drink that this person consumed in order to assess whether enough calories were being consumed. Care reviews are undertaken involving people living at the home their representatives social workers and the homes staff. This provides all present with the opportunity to put forward their suggestions for improvements if any needed regarding the care provided. Care plans are also reviewed regularly in order to assess the effectiveness of care provided. There was evidence that people living at the home and their families are involved in this. Written records are kept within the care plans evidencing that Care Homes for Older People Page 15 of 32 Evidence: relatives are kept informed about any matters regarding a persons care. People have access to a variety of health and social care professionals, including opticians, dieticians, specialist nurses and speech therapists. People have the option of retaining their own doctor on admission to the home, if the doctor is in agreement. One relative who completed a questionnaire prior to our visit said Medically the service is very good. Doctors usually arrive in no time at all. Since our last visit improvements had been made regarding the management of medication. Medication administration charts were well maintained and stock balances of medication checked on the day of the visit were correct. Medication audits are undertaken regularly and this should ensure that any errors are identified and rectified. No one currently living at the home chooses to self administer their own medication however individual lockable storage facilities are provided in bedrooms if people choose to do so. We were told that two staff members take a verbal telephone instruction from the doctors surgery if the dose of Warfarin (a blood thinning drug) is altered on the evening that the test has been taken. This is not good practice and may result in an incorrect dose being administered. We discussed this with the pharmacy inspector who advised that the home discuss this procedure with the primary care trust in order to review this and safeguard both people living at the home and staff. People appeared to be well supported by staff to choose their preferred clothing appropriate for the time of year their age, gender and culture. Staff were observed to assist people in a respectful manner and this maintains their dignity. People have the option of having a key for their bedroom door so that they can keep their personal items secure. The preferred names of people living at the home were recorded within their care plans and staff were observed greeting them by these names. Staff are involved in a dignity in care programme and this means that people living at the home should receive care and support in the ways they prefer. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a lifestyle that meets their needs and expectations. Evidence: An activities co ordinator is employed at the home on a part time basis and we spoke with this person during our visit. She told us that there was a range of activities that people could choose to participate in including handi crafts, Pat a Pet, trips out and film afternoons. Pub lunches and tea parties are arranged in summer months. Written records confirmed that these took place and visitors met during the visit stated that one to one time is spent between the activity co ordinator and people who are unable to join in with group activities. There was an activity plan on the wall and it was evident that people are encouraged to pursue interests of their choice. This should improve their confidence and enhance the quality of their lives. A hairdresser visits the home twice a week and there is a hair salon within the home so that people can enjoy the experience of going to the hairdressers. The latest copy of the homes newsletter was on display for people to read. A number of people choose to have a daily newspaper of their choice delivered to them. Magazines, books and films of interest were readily available for people to access within the home. Care Homes for Older People Page 17 of 32 Evidence: Peoples preferences regarding their religion are supported and respected and church services and holy communion are held at the home regularly. None of the people currently living there are of a non Christian faith. There is an open visiting policy and we saw that there was a good number of visitors at the home during the time that we were there. We spoke with a number of these people and one relative said Everything is great here. Its clean, comfortable and warm. All of the staff are very friendly. One relative who completed a questionnaire prior to our visit said There is always a welcoming and friendly atmosphere to visitors. People have a choice of where they entertain their guests so that they can meet in private if they wish. There is a relatives, family and friends notice board and this included details of the last group meeting for these people. Other information of interest including details of the Alzheimers Society was on display. Menus identified a choice of nutritious meals, cooked breakfasts and snacks were available throughout the day and night so that people would not be hungry. Special diets can be prepared for reasons of health or cultural/religious preferences. At the present time diabetic meals were being prepared. The main lunch time options on the day of the visit were either home made chicken and mushroom pie or sausage and apricot platt with bakewell tart yoghurt or fresh fruit for dessert. If people do not like either of these options they have a choice of other meals which are always available within the home. One person had chosen to have a cheese and onion omelette on the day of our visit as she didnt want either of the two main meal options for the day. This person told us My omelette was beautiful. There were both hot and cold meal options available at tea time. We spoke with the catering manager and she confirmed that catering staff meet with people living at the home on a daily basis in order to find out what they would like to eat from the options available. She told us that extra calories are added to the meals of people who are deemed to be at risk of losing weight. The registered manager stated and we observed that people can be served their meals wherever they choose. Food was well presented and staff were assisting people with their meals in a respectful manner. The menu on display in one of the dining rooms did not reflect the meals available on the day of the visit. This may prevent people from making an informed choice about what they would like to eat. As a result of a recent environmental health inspection, the home was granted a three star rating in this area. This demonstrates that food is prepared in a hygienic manner. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that concerns they raise will be acted upon so that improvements can be made regarding their daily lives. There are safeguarding systems in place that should protect people from harm. Evidence: The complaints procedure is displayed in the home and is included in the statement of purpose and service user guide. The registered manager told us that this information could be produced in other languages and formats on request. In addition comment cards were available throughout the Home. This means that people should know how to make a complaint if they need to. We met one relative during our visit who said I speak to the manager about various things but on the whole everything is ok. All other people met during the visit told us that they knew how to make a complaint and said that they would be happy to raise any concerns that they may have with the staff team. This demonstrates that there is an open and friendly atmosphere at the home. The complaints register included detail of a recent complaint received by the home about the care provided at the home. There was evidence that investigations in to the issues raised had been undertaken. The result of this was that the issues raised had been unfounded. Since our last visit there has been one incident of an adult protection nature involving a person living at the home. In response to this the management team followed the appropriate local safeguarding procedures in order to protect people Care Homes for Older People Page 20 of 32 Evidence: living there. Training statistics showed us that 92 of staff had undertaken recent training about the protection of vulnerable adults. Staff met during the visit told us that they were confident that they knew what actions to take should an allegation of abuse arise in the future. The protection of vulnerable adults policy was in line with local safeguarding guidelines and this means that people should be protected from abuse. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean comfortable and homely place to live which meets their assessed needs. Evidence: There is a small garden area at the front of the home and this is suitable for wheelchair users. This area had recently been tidied and flowers planted. Plans were in place to add a decked area and gazebo so that people could enjoy this facility in warmer weather. We saw that the garden leads directly onto the car park and busy road. The registered manager stated that people do not use this area unaccompanied by staff. Due to the high number of people living at the home with dementia care needs it is recommended that a risk assessment be undertaken regarding this in order to instruct staff about how to minimise the risk of accidents occurring. Decoration furnishings and fittings were of a good standard and fit for purpose throughout the home. The reception area of the home was warm and inviting and furnished to a good standard. Information of interest to people living at the home their visitors and staff was on display in this area. There is no facility for people to smoke within the home however the registered manager stated that this would be reviewed should the need arise. Since our last visit there had been a number of improvements regarding the internal Care Homes for Older People Page 22 of 32 Evidence: environment of the Home. There is a rolling programme of refurbishment and redecoration in place. A new walk in shower facility has been created and a new hair salon created. There is a choice of comfortable lounge and dining facilities on all floors. These were newly decorated in a homely style. The registered manager stated that the aids and adaptations available met the needs of people living at the home. This included pressure relieving equipment so that people should not develop sore skin and moving and handling equipment so that people who are not able to move independently can be transferred safely. She also told us that the assisted bathing and shower facilities available met their needs. We saw that specialist equipment is obtained for people to use on an individual basis if required for example one person had a chair made especially for their use. Bedrooms contained personal belongings so that people felt relaxed in their surroundings. One relative met during the visit said My wife has everything she wants in here. Despite it being a cold day the temperature within the home was comfortable on the day of the visit. We found that the home was clean and fresh throughout and hand washing facilities were located throughout. There are two mechanical washers for the hygienic cleaning of commode pots however we were told that the staff are manually cleaning plastic bed pans and urinals as no mechanical equipment is available for this. A risk assessment and infection control procedure was not available for this so actions must be taken in order to protect staff and reduce the risk of cross infection. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who receive training so that they should have the knowledge to meet peoples needs.The failure to follow procedures regarding recruitment checks of new workers has meant that people may not be protected or safe in their home. Evidence: The registered manager stated that there is one registered nurse and five care assistants on duty during day time hours, and one registered nurse and two care assistants on duty overnight. The staffing rotas identified that on two occasions during the previous weekend the home worked with just four care assistants on duty during the day. The registered manager told us that this was due to last minute staff sickness and that she had worked the shift herself. This had not been identified on the rota. In addition details of the hours worked by the registered manager deputy manager and activities co ordinator were not recorded on the rota and this prevents an accurate assessment of staff provided from being undertaken. Housekeeping kitchen maintenance and administration staff are employed so that people should be assisted in all aspects of their daily lives. The management team provide on call support to the nurse in charge of the shift so that they are supported within their job roles. One relative who completed a questionnaire prior to our visit said There are times Care Homes for Older People Page 24 of 32 Evidence: when asked the staff seem to take a long time to carry out the request. A concern of a similar nature was also brought to our attention during the visit. This was discussed with the registered manager and operations manager. It was noted, however, that other people spoken with during the visit including staff and visitors were satisfied with the number of staff on duty and had no concerns to raise in this area. One relative met during the visit said There are always staff around if my Mother needs any help. If anything is requested it is done. We met with staff during our visit and they told us that they enjoyed working at Bryden House and that staff moral was good. There is a low staff turnover and agency staff are not used. This should promote continuity of care for people living there. The gender mix of staff reflected that of people living at the home so that care should be provided in an understanding manner. Three staff recruitment files were sampled and all of these were pertaining to people who had recently begun working at the home. These identified that a number of them had been employed prior to all necessary information being obtained. This included new workers being employed without references and protection of vulnerable adult and criminal record clearance. This is of concern and does not protect people living at the home. This was brought to the attention of the registered manager and operations manager during the visit. We were told that the reason for this was that new workers begin their paperwork induction prior to the necessary checks being undertaken including a protection of vulnerable adults check. We would not consider this to be good practice aand does not safeguard people living at the home. New workers undertake comprehensive induction training that should provide them with the necessary basic skills in order to care for people living at the home. Since our last visit staff had undertaken recent training relevant to their jobs including care planning, safe management of medication, nutrition, dementia care awareness and epilepsy. Forthcoming training includes the mental capacity act and wound care. 52 of care staff had achieved a minimum of NVQ level 2 in Care and other staff were currently working towards this and NVQ 3 in order to gain knowledge about providing care for people living there. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager and organisation are keen to make and sustain improvements so that the home is run in the best interests of the people who live there. The failure to follow procedures regarding recruitment checks of new workers has meant that people may not be protected or safe in their home. Evidence: The registered manager has been in post for two years and has had much experience of working within a care management role. She has relevant qualifications and has undertaken recent training so that she has the skills and knowledge to lead the staff team. During our visit people living at the home, visitors and staff made positive comments about her management style. We saw that people approached her with ease. One staff member who completed a questionnaire prior to our visit said If there is a worry or a problem the manager is always happy to talk it through and get it sorted. One relative said The home is very well managed and management are always very approachable and helpful. The registered manager is supported by a Care Homes for Older People Page 26 of 32 Evidence: deputy manager, a clinical manager and an administrator. There are clear lines of responsibilities within the management team and this should mean that people living at the home and staff are supported well. Quality monitoring visits are undertaken regularly by senior external managers in order to improve the services provided at the home. People living at the home are consulted during these visits so that they are involved in the running of the home. Group meetings are held for people that live at the home and their families. This provides people with the opportunity to put forward any comments or suggestions about the service provided, and gives them the opportunity to have an input into decisions about the home. A copy of the minutes of the most recent meeting held in January 2009 was on display in the home so that people could access it. In addition the registered manager told us that she meets with people and their visitors on a daily basis so that any issues or suggestions can be addressed straight away. Staff meetings are held regularly and we saw that the minutes of the most recent meeting held in January 2009 was available for staff who were unable to attend to see. Service satisfaction questionnaires had been sent out to people in order to obtain their views about living at the home. The operations manager told us that the results of these will be analysed at head office. A report of areas in which the home does well and areas that require improvement is sent to the home with an action plan of how to improve the service provided. Feedback is given to people living at the home and their relatives so that they can discover what actions have been taken in response to their suggestions. An example of this is that in response to a suggestion made by visitors the internal porch can now be accessed without having to wait for a member of staff to open the door. The safety of people living at the home is not compromised as there is a secure front door leading into and out of the home. There is a comprehensive system of auditing all elements of the service provided at the home and whilst this should ensure that people receive a good standard of service., attention is required to audit staff files. This is in order to identify and address concerns raised about poor staff recruitment practices. Failure to obtain all necessary information about new workers prior to them being employed at the Home does not adequately protect people from harm. Details of this are included within the previous section of this report. There is a facility for the safekeeping of small amounts of personal money that people living at the home can use if they choose to do so. The system for the receipt of money was robust and an audit trail of monies received and spent was kept. It was Care Homes for Older People Page 27 of 32 Evidence: however not possible to audit actual monies held for each person as the money was pooled into one bank account. People are however able to find out individually how much money they have in the account at any time and an individual statement is sent out to people each month. We looked at the staff supervision planner and saw that this has been amended to reflect that staff now receive six formal supervision sessions and an annual appraisal each year. Staff met during the visit told us that they were supported within their job roles. Training records identified that the vast majority of staff had undertaken recent training about health and safety issues for example fire safety, moving and handling, food hygiene and first aid. Staff had participated in fire drills so that they should have the necessary skills and knowledge to act safely in the event of a fire. A health and safety committee had been formed and a notice board was within the home displaying information about health and safety issues. Accident records were well maintained and included details of actions taken as a result of accidents involving people living at the home. Accident audits are undertaken in order to monitor any trends or patterns thus reduce the risk of future accidents of a similar nature. Whilst a new laundry facility was being created, laundry arrangements were temporarily set up within one of the dining rooms located on the ground floor of the home. The registered manager told us that this room was not being used as a dining room however it was still set up with a dining table and chairs. Measures must be taken to prevent vulnerable people having access to laundry equipment so that their health and safety is maintained. People had a choice of other dining facilitties throughout the home. Maintenance records were well maintained and safety checks were undertaken on equipment so that it should be safe to use. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Systems must be in place so 19/03/2009 that new workers do not commence employment at the home until all necessary information is obtained about them. This is in order to safeguard people living at the home. 2 38 13 Arrangements must be made so that vulnerable people do not have access to laundry equipment. This is to maintain the health and safety of people living at the home. 26/03/2009 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 Fee rates should be available to people so that they know how much they will have to pay if they want to live at the home. Care Homes for Older People Page 30 of 32 2 7 Daily reports should include detail of how the social and emotional needs of people have been met. This means that the effectiveness of the care provided can be assessed. A system should be implemented to store the care plans of resolved needs separately from current care needs in order to prevent confusion about the care to be provided. 3 9 The system for receiving drug dosage changes should be reviewed so that people receive the correct dose of medicine and staff are safeguarded. Menus on display should reflect the meal options for that day so that people know what meals are available. A review of the suitability of the front garden for the use of vulnerable people should be undertaken in order to maintain the health and safety of these people. Systems in place for the cleaning of plastic toiletting equipment should be reviewed so that staff are protected and the risk of cross infection is reduced. A review of staffing levels and allocation of staff on duty should be undertaken so that people receive care and support at the times they require. A review of the system in place for the auditing of staff recruitment files should be undertaken so that any shortfalls in procedures can be identified and actions taken. A system should be in place so that people can access their own money held for safekeeping at the times that they choose. 4 5 15 19 6 26 7 27 8 33 9 35 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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