Inspection on 21/01/10 for Bryden House Nursing Home

This inspection was carried out on 21st January 2010.

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.

Other inspections for this house

Bryden House Nursing Home 16/02/09

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 13/03/2010.

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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Bromige     Date: 2 1 0 1 2 0 1 0 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: 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: www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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 and outings. Care Homes for Older People Page 4 of 29 Over 65 30 30 0 0 1 6 0 2 2 0 0 9 Brief description of the care 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: We, the commission completed the last inspection of this service on the 16th February 2009. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service and their relatives. Care Homes for Older People Page 6 of 29 The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We have received one complaint about the service which we passed to the manager to investigate. There have been three referrals to the local multi-agency safeguarding process all relating to allegations of neglect of care for three people who use the service. The outcome of the investigations was one was inconclusive and two were proven. Action plans were put into place by the home to prevent any recurrence of these incidents. 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: 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 8 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 9 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 who wish to start using the service are assessed prior to admission to ensure their needs can be met by the home. Bryden House does not offer a dedicated intermediate care service. Evidence: The AQAA completed and sent to us by the manager before the inspection tells us that before they agree to admit someone to the home, a full pre-admission assessment is carried out to ensure that all needs can be met. We looked at the care records for a person who has recently started using the service. We saw a pre-admission assessment was carried out by a representative of the home before the person moved in. The manager told us this assessment was carried out over the telephone. We saw a pre-admission draft care plan had been completed for this person, but this document was not dated or signed by the person who completed it. There was enough basic information in the care plan to enable the home to prepare Care Homes for Older People Page 10 of 29 Evidence: for the admission of this person. We received eight completed surveys from people who use the service before the inspection. Six people told us they received enough information before they moved into the home. Care Homes for Older People Page 11 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. Care plans need to be written, reviewed and updated as peoples needs change to ensure staff are fully aware of the current care needs and people can be confident they will get the care they need at all times. There are some improvements needed to the homes management and storage of medication to ensure it is safe and people are not placed at risk of harm through incorrect storage of medicines. Staff respect peoples privacy and dignity. Evidence: In the AQAA we were told care plans are centred on their individual, personal needs and continual assessment and updating is carried out. Pressure sore prevention is high on our list of priorities and residents are monitored daily to ensure that their skin is viable. We looked in detail at the care of two people who use the service. During the inspection we saw that these and other people had been helped to look their best by staff, for example, people were wearing clothes that had been nicely laundered and their hair and nails were well looked after. We saw staff knocking on bedroom doors Care Homes for Older People Page 12 of 29 Evidence: before going into peoples rooms and we heard staff speak to people in a caring and respectful manner. The surveys we received from the people who use the service were overall positive. One person told us, the staff look after us well, keep us clean, warm and happy. We sent out surveys for staff and health professionals who visit the home, but we did not receive any completed surveys before the inspection visit. The manager told us care plans have been reorganised to make them easier to access information. She told us no one using the service have developed any pressure sores, but they have one person with a longstanding pressure sore. We looked at the care records for the two people whose care we tracked. This is so we could find out what assistance they needed with their care. We spoke to staff to find out if their understanding of the care needs of these two people was the same as the information in the care plan. We found there was important information that was not included in the care plans and staff were not always carrying out care as stated in the care plan. This can lead to an inconsistency in care, which may place the person at risk of not receiving the care they need. For example, the care plans indicated that one person needed weighing each week but the last recorded weight in the care plan was 19th December 2009. The other person needed weighing every month, but the last recorded weight was October 2009. The manager told us staff are checking their weights but they are not updating the care plans with this information. We looked at the nutritional risk assessment documentation. This told us the person required help to eat, but the care plan told us they ate independently. The outcome of the MUST assessment was not completed. One of the MUST assessments had not been reviewed since October 2009. Care plans do not give information about the type of incontinence products in use for the people. Staff told us this is kept in another folder. This information needs to be held in the plan of care so the information is all available in one place. We saw in the progress records for January 2010, the GP had been contacted twice by the home. The care plans had not been updated following the changes to their care needs. There was no care plan in place for an acute problem which had been discussed with the GP where they had prescribed treatment for this acute problem. We looked at the records of personal hygiene for one person. These were poorly completed. Over a 17 day period in January 2010, only one shower/bath had been recorded and the person had only been assisted with oral hygiene care on four Care Homes for Older People Page 13 of 29 Evidence: occasions. We showed these records to the manager of the home at the time of the inspection. We looked at the pressure setting for an air mattress for one person. We saw the mattress was set at 80. We spoke to staff about the correct setting for this mattress as there was no information in the care plan. They showed us the records for this which showed it should be set between two to four, but this did not correspond with the motor settings. Staff checked and told us this was incorrect and the setting should be 60 in line with the persons weight. We saw Aqueous cream and Cavilon spray in a persons room, but there was no information about this in the care plan. Staff told us they use E45 cream for this person. We looked at the homes management of medicines for these two people. We carried out audits of some of the medication in use and these were all correct, which shows people are being given their medication as prescribed by the GP. We saw there were no signature gaps on the medication administration record charts(MAR) and staff were the majority of the time using the MAR to record medicines received. The allergy boxes were not completed on the MAR. We saw handwritten entries on the MAR and with the exception of two entries they were signed as checked by a second person for accuracy. We saw staff had written permission from the GP to crush some tablets. We did not see any risk assessments to show that staff had assessed the capability of people managing their own medication. Staff are not always including the use of medication prescribed as when needed in the care plan to ensure staff understand why and when this is given. Staff are not recording the administration of prescribed food supplements or creams and ointments on the MAR. We looked at the storage of medication in the home. We saw staff are monitoring and storing the medication at the correct temperatures to ensure it is not damaged by excessive heat or cold. We saw Controlled Drugs are being stored in the correct cupboard, but it is not fixed correctly, and it is not a solid wall. We saw the staff are using insulin pens for two people. They are storing these in the refrigerator when in use. Neither of the pens were labeled with the persons name, to ensure staff use the correct pen. We told the staff they do not need to store the insulin pens in the refrigerator when they are in use, only stock of insulin pens need to be stored in the refrigerator. We saw an oxygen concentrator and an oxygen cylinder in one persons room. There was a notice on the door warning people about this due to the risk of fire. We saw the oxygen cylinder was not standing in an oxygen stand. This needs to be obtained to Care Homes for Older People Page 14 of 29 Evidence: ensure the cylinder does not fall over onto anyone and it enables the cylinder to be easily transported. The last report made a recommendation about how the home receive information about dosage changes for medication which reduces the thickness of the blood. The manager told us they now receive this information from the GP via facsimile. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. They home need to improve their provision and recording of social care provided to ensure they are able to demonstrate they are meeting each persons needs. People are able to keep in touch with family, friends and representatives and the home supports them to continue these relationships. People are offered a variety of healthy meals and snacks at a time and place to suit them. Evidence: The atmosphere in the home was very welcoming, friendly and relaxed. Visitors are made welcome at the home and we saw they have a good relationship with the staff who work at the home. In the AQAA we were told we have a varied activity programme and employ a full time activity co-ordinator. Trips, entertainers, arts and crafts, one to one sessions are just some of our activities. In the section, what they could do better, it stated more trips are needed and more involvement within the community, schools etc. There has been a change of activity co-ordinator since the last inspection. We saw information about entertainment displayed on the notice board in the home. Staff told us they have a routine programme of activities, such as an organist once a month, Care Homes for Older People Page 16 of 29 Evidence: bingo on a Monday and lunch club on Friday. They told us they hire a mini bus for trips into the community and the last trip out was last Summer. Staff told us they have a budget each month of £40 and this only covers the entertainer, the staff have to raise any further monies through raffles etc. Staff told us Holy Communion is not provided on a regular basis at the moment as they are unable to find a minister to carry this out. Staff told us a service usually takes place every two months. We looked at the social care for the people we case tracked. One person had an informative life history. Staff told us both people have one to one time with the activity person. The one to one time and any activities attended by the people who use the service is not being recorded in the persons care records. This information needs to be recorded in the social care section of the care plan for each person along with their care plan and life history. We asked people who use the service in a survey if the home arranges activities that they can take part in if they want. We received eight completed surveys and their response was one said always, two usually, and five sometimes. We saw the menus were displayed in the entrance of the home. The manager told us the catering manager goes around every day in the morning to ask people their choices. There are always two choices available on the menu and other choices are available such as omelette or salad. We looked at a sample of menus and saw a continental breakfast is provided to people in their rooms. A cooked breakfast is available upon request. They are offered a choice of two main meals at lunchtime, but there is not a vegetarian option on the menu. At supper time there is soup each day with a main course. On some days a choice of sandwiches as an alternative is shown. Any alternative choices for supper are not shown on the menus we saw. We asked people who use the service in a survey if they like the meals at the home. We received eight completed surveys and their response was four said always, three usually, and one sometimes. There were some shortfalls in the monitoring of people at risk nutritionally. Please refer to the health and social care section if this report. 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. People can be confident that staff will take notice if they have concerns and do what they can to put things right. Staff know they have a duty to protect people from the risk of abuse or neglect. Evidence: The numerical information in the AQAA told us they have not received any complaints or made any safeguarding referrals in the last 12 months. This information is not accurate as we are aware of two complaints which have been made since the last inspection. We discussed these complaints with the manager at the time of the inspection. The manager told us this information was not in their complaints file. Four days after the inspection the manager sent us information by email about the outcome of one of the complaints which was in the form of a notification. She also sent us information to show they had investigated the second complaint and it was upheld. The home wrote a letter of apology to the complainant. There has been three referrals to the local multi-agency safeguarding process since the last inspection relating to allegations of neglect of care. The outcomes were, one was inconclusive and two were proven. One outcome required the home to arrange further training for staff about wound care and the manager has told us this has been done. Care Homes for Older People Page 18 of 29 Evidence: The completed surveys from people who use the service and their relatives told us they all knew how to make a complaint. Staff spoken with were aware of the homes complaints procedure. Staff we spoke to were clear with us that if they believed someone was being treated badly they would report this to the manager of the service or, if they felt it was not being dealt with, to us or social services. This was the first time this Inspector had visited the home. We were not asked for any identification. We looked at the training of staff in the home and 71 of the staff have received safeguarding training in the last 12 months. 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. People who use the service live in a clean and comfortable environment which has been adapted to suit their individual needs. Improvements need to be made to the sluicing facilities in the home to ensure the health and safety of the staff. Evidence: Bryden House is a three storey home building situated just off a large roundabout on the outskirts of Kidderminster. There is a ramped access to the building with a secure access. All floors of the home are accessible via shaft lift. There is a small garden to the front of the home. As stated in the last report, the garden leads directly onto the car park and busy road. There have been no changes to this area since the last inspection. The manager told us they intend to erect a fence between the garden area and car park in March 2010 to ensure the safety of the people who use the service. As we walked around the home we saw portable heaters in corridors of the home. The manager said this is because one of the two boilers is not functioning and they are using these to keep the temperature up in the home. She said they have risk assessed the use of the heaters. The home was warm at the time of the inspection. The manager told us in the AQAA how they have improved the environment and its facilities through provision of more profile beds, new flooring in some bedrooms and the dining room, a quiet room has been created on the ground floor, a new boiler has Care Homes for Older People Page 20 of 29 Evidence: been fitted and a programme for the replacement of all fire retardant curtains has started. We saw people had made their bedrooms their own by having personal belongings around them that are important to them. The home was clean and warm. The laundry was organised and linen and towels are washed at the correct temperatures to prevent cross infection. The ironing room is very small for the home, although the manager told us they are planning to extend it to make it larger. Staff told us hygiene standards have improved, as they steam clean air mattresses each week, and propad mattresses are cleaned and checked to ensure the waterproof covering has not become porous. Staff told us they have a mechanical sluice which is fully functional on the middle floor. The mechanical sluice on the ground floor has been condemned. They have a manual sluice on the top floor. Staff told us they wear gloves when manually sluicing commode pots and urinals. This is not sufficient to prevent possible cross infection from water splashes and inhalation. The manager was advised staff need to wear gloves, aprons, goggles and masks when using these manual sluice facilities to ensure the health and safety of the staff. One mechanical sluice is not sufficient for a 30 bedded home providing nursing care over three floors. This needs to be addressed by the owners. There is a team of domestic staff who do the cleaning in the home and a part time maintenance person who deals with all routine repairs and safety checks in the building. We saw the records for checking the window restrictors and regular checks had been recorded. The AQAA told us all their equipment had been serviced in the last 12 months with the exception of the five year electrical installation check which was overdue. The manager confirmed this was done in November 2009, but the certificate was not available in the home. 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 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. Staff are well recruited to ensure only suitable staff are employed at the home. Evidence: The information in the AQAA told us the staffing levels are five to six carers plus one RGN for the morning shift and five carers plus one RGN for the afternoon shift and three carers and one RGN on the night shift. At the time of the inspection there was one nurse and five care staff on duty for 27 people using the service. We looked at the staffing rotas for a two week period. Over the Monday to Friday of both weeks, they showed there is a nurse on duty 24 hours a day with five to seven carers in the morning and five to six carers in the afternoon. On Sunday 17th January 2010 there was only four care staff on duty, and for the weekend of 23rd and 24th January the staff rotas show projected numbers of only four care staff on duty for all day shifts. The staff rota for nights for the same two week period has 10 shifts where there are only two care staff on duty with the nurse. These highlighted shifts are not staffed in line with the information in the AQAA completed by the manager. The manager works full time and her hours do not appear on the staff rotas. Care Homes for Older People Page 22 of 29 Evidence: People who use the service told us in surveys there are always or usually enough staff on duty in the home. We did not receive any completed surveys from staff who work at the home. A comment from a relative told us, they often do not have the mid morning cup of tea. X (persons name, enjoy that drink more than any other. I know its down to staffing levels. The information in the AQAA told us they have not used any agency staff in the last three months. The home employ male and female staff from a multi-cultural background. The AQAA told us recruitment checks are carried out for all staff prior to employment. We checked the records of how recent staff were recruited and found that a good process was followed and all the required pre-employment checks were done to help ensure the staff employed were suitable. Care staff told us they had received induction training and all their core mandatory training in the last 12 months. For example, fire, moving and handling and health and safety. The manager gave us a copy of the training matrix for the home and this shows all staff have received their mandatory training. The training plan highlights when staff training is overdue. There are some gaps where training is due but overall most staff are up to date with their core training. The AQAA told us 75 of the staff are trained in NVQ two. The manager told us other courses such as tissue viability course are available all the year and the home intend to send staff on these courses. A palliative care course is booked for February 2010 and this will include syringe driver update training for the nurses. Training for the care of specialist feeding tubes is updated each year. The manager told us they have an induction programme for nurses, which is in line with the Skills for Care Standards, but the most recently recruited nurse has not started this induction training yet. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is generally well managed to ensure it is run safely and in the best interests of the people who use the service. Evidence: The AQAA told us the manager has her Registered Managers Award. The manager and deputy manager told us they have not received any training about the Deprivation of Liberty safeguards (DoLs). She told us this training is planned for April 2010. No person in the home is subject to a referral to DoLs. The manager showed us the leaflets she has for staff about DoLs after they have received the training. The manager told us the organisation have a policy about DOLs. The AQAA completed and sent to us by the service before the inspection was brief in parts and some of the information in the dataset about complaints and safeguarding was not accurate. Group meetings are held for people who use the service and their families. This Care Homes for Older People Page 24 of 29 Evidence: provides an opportunity to put forward any comments or suggestions to the manager. A copy of the minutes of the last meeting in November 2009 are displayed in the home. The manager told us the frequency of the meetings has reduced at the request of the relatives. Staff meetings are usually held monthly. The manager told us questionnaires went out last August. There was an action plan which was brought up at a meeting after wards. The action plan was about communication. The home are going to produce a newsletter to improve communication. The ongoing systems of audit continue as reported in the last inspection report. Monthly audits continue as before and more robust auditing of the staff files take place by the manager and deputy monthly. In addition staff files are audited each month by the manager or her deputy to ensure they meet the required standards for recruitment, supervision and training of staff. Quality monitoring visits are carried out monthly by a representative of the organisation who own the home. These visits are unannounced and they seek views from people who use the service and its staff. We looked at the management of money for the people whose care we tracked. This confirmed thorough management and recording of peoples money. The AQAA told us all their equipment had been serviced in the last 12 months with the exception of the five year electrical installation check which was overdue. The manager confirmed this was done in November 2009, but the certificate was not available in the home. We looked at the maintenance checks for the window restrictors and these were recorded as being checked each month. Care Homes for Older People Page 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 15(1)(2) Care plans must be detailed and care needs reviewed as peoples needs change. To ensure staff understand what is required and people can be sure their needs will be met. 01/03/2010 2 9 13 13(2) 01/04/2010 To make arrangements to ensure that controlled drugs are stored in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe custody) regulations 1973 and in accordance with the Royal Pharmaceutical Society of Great Britain. This is in order to ensure that controlled drugs are stored safely to prevent misuse. Care Homes for Older People Page 27 of 29 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 3 12 15 15(1)(2) Social care plans must be in place and sufficiently detailed and their needs reviewed. So that staff ensure people are supported to continue to enjoy their individual hobbies and interests. 01/03/2010 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 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. 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. 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