Inspection on 01/04/09 for Buchanan Court Nursing Home

This inspection was carried out on 1st April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buchanan Court Nursing Home 25/04/08

Buchanan Court Nursing Home 13/11/07

Buchanan Court Nursing Home 04/06/07

Buchanan Court Nursing Home 12/10/06

Buchanan Court Nursing Home 09/02/06

Buchanan Court Nursing Home 28/06/05

Buchanan Court Nursing Home 18/01/05

Buchanan Court Nursing Home 28/07/04

Buchanan Court Nursing Home 02/02/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Buchanan Court Nursing Home Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR     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: Ram Sooriah     Date: 1 5 0 4 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 38 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 38 Information about the care home Name of care home: Address: Buchanan Court Nursing Home Sudbury Hill Buchanan Court Care Centre Harrow Middx HA1 3AR 02084233311 02084232299 buchanoncourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne Homes Ltd care home 85 Number of places (if applicable): Under 65 Over 65 85 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 85 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Buchanan Court belongs to Ashbourne Plc, which has been taken over by Southern Cross Healthcare, a national provider of care homes mainly for the elderly. The care home is found in Sudbury Hill and is easily accessible by public transport as the area is well served by buses. The closest underground station is Sudbury Hill, which is about 10 minutes walk away. There is an extensive parking area in the grounds of the home and there are maintained lawn/shrubs areas in the front and at the back of the home. Care Homes for Older People Page 4 of 38 Brief description of the care home There are some shops and amenities in Sudbury but Harrow on the Hill, where more shopping facilities and amenities are available, is about five minutes drive from the home. Buchanan Court is purpose built and consists of three floors. Accommodation is provided in a mixture of single and double bedrooms with en-suite facilities although most of the double bedrooms tend to be used as single bedrooms. As a result even though the home is registered for 85 elderly residents requiring nursing care, only about 60 beds are in use. Each floor accommodates an average of 20 residents. The manager of the home is Mrs K Khan. She is supported in her duties by a deputy manager and line management from Southern Cross Healthcare. The home charges fees ranging from 600 to 750 pounds weekly, depending on the needs of the residents and the fees structure of the placing authority, if the resident is publicly funded. On the first day of the inspection there were 43 residents in the home. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains the findings of a key unannounced inspection that took place on Wednesday 1st April from 10:20-16:50, Friday 3rd April from 10:00-16:45 and finished on 15th April from 14:00-16:30. The last key inspection was unannounced and took place on the 25th and 28th April 2008. During the period of time between the inspections, we monitored the home from notifications that were received and from contact with the home and other social and health care professionals. We also met with the responsible person for the service on two occasions, to discuss improvement in the home. During this inspection we talked to at least eight residents and two visitors to the Care Homes for Older People Page 6 of 38 home, toured the premises, looked at a sample of records, inspected the management of medicines and talked to about fifteen members of staff. We also received four satisfaction questionnaires from residents/relatives. We have used all the feedback, where possible in writing this report. We thank all residents for their feedback and contribution to the inspection and the manager and all her staff for their cooperation and support during the inspection. What the care home does well: What has improved since the last inspection? There has been an improvement in the involvement of residents and of their representatives in discussions about care plans. Residents and/or their representatives are invited to attend review meetings and to discuss the plans of care. The care plans for the management of pressure ulcers were more comprehensive than they have been in the past. The items of equipment that were in use were identified and recorded in the care plans. The repositioning regime in place to move residents to prevent pressure ulcers from developing, was also clarified in the care plan. The management of medicines has improved and past requirements have been met . There is a system of audits to ensure that any omissions or errors are picked up and addressed without delay. Good records are kept when medicines are received in the home and when administered or not administered to residents. The home has carried out a customer satisfaction survey and a comprehensive report was available to summarise the findings of the survey. The home has a new manager who has been registered in the past. She said that she will apply to be registered as soon as possible. There has been an attempt to ensure that residents valuables and property are Care Homes for Older People Page 8 of 38 appropriately recorded. This work however is not yet fully completed and there is some way to go to complete this work. What they could do better: The home did not have a permanent manager from October 2008 to February 2009. This could have been contributory to the findings in this report. There seemed to have been a lack of leadership and monitoring to ensure continuity of the improvement that has been noted during the last inspection and discussed in our meetings with the responsible individual of the home. Now that the home has a permanent manager, it is expected that improvement will continue in the home. We noted that residents did not always have the most up to date service users guide in their rooms. The service users guide and the statement of purpose have to be updated to reflect recent changes within the home, including the management. Copies of the updated service users guide can then be offered to all residents, replacing the ones that are in the bedrooms of residents. The needs of residents must be carefully assessed to make sure that the home will be able to meet the needs of the residents and the preadmission assessment must be completed as fully as possible. The skills and competencies of nursing and care staff must be considered when deciding whether the home will be able to meet the needs of a prospective resident. While the home is well able to meet the general needs of older people, staff did not demonstrate the knowledge and confidence to care for people with more complex needs such as those having a terminal illness or those who are on long term use of oxygen with other healthcare needs. With more in depth training in clinical areas, particularly in managing end of life care and terminally ill people, there are no reasons why staff will not be competent to care for residents with more complex needs. The requirement with regards to improving the standard and quality of care plans is repeated, as it was noted during the inspection that care plans were not always clear about the actions to take to meet the needs of the residents and were not always updated when the needs of residents changed. The care records did not always describe the cultural and religious aspects of the needs of residents. Without this there is no guarantee that the needs of residents will be met. The home must demonstrate that it is managing the care of all residents with a Health Care Associated Infection (HCAI) to a consistently high standard and according to national guidelines, to ensure that the infection is cleared as soon as possible and to promote the interests and welfare of residents with an HCAI. The home must ensure that all items of equipment to use in an emergency are prepared and ready to be used should there be an emergency. We found that the suction equipment was not ready to be used in an emergency. The home provides a range of social and recreational activities to residents and care plans are in place to address these needs. However it would be good to have some information about the background of each resident to give a perspective on their life as Care Homes for Older People Page 9 of 38 an individual person and to ensure a real person centered approach to their care. A few bedrooms, although generally in a good state of decoration, were not that well personalised and looked bare and uninviting. There has been some improvement in the checks that are carried out when employing people to work in the home. In one case though, the checks had not been carried out as thoroughly as they should have been. The home provides mandatory training but not all members of staff were up to date. Training was lacking in a few areas including manual handling and infection control. The home should also provide training in clinical areas to improve the skills and competencies of staff in caring and supporting the residents that are accommodated in the home. The requirement with regards to ensuring good records of residents property and valuables, is repeated as the records that were in place during this inspection, were not of a satisfactory standard. 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 38 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 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people who are referred to the home receive the necessary information for them to make an informed decision about moving into the home. The prospective residents needs are assessed prior to them being offered a place in the home. The home is well able to care for people with generally older people care needs but staff did not fully demonstrate that they were able to care and support residents that have more complex needs or needs other than older people care needs. Evidence: We asked two residents whether they received enough information about the home before they became residents. They both said that they had the opportunity to visit the home and ask questions prior to deciding if they wanted to live in the home. One of the residents said that Buchanan Court was the next best thing after home, so they decided to move in. The four residents who responded to questionnaires said that they receive information about the home prior to deciding to move in. Care Homes for Older People Page 12 of 38 Evidence: In cases when prospective residents are not able to visit the home because of their condition or because they may be in hospital, their relatives and friends are encouraged to visit the home and to ask questions about the service. The home has a service users guide (SUG) and a statement of purpose (SoP). Copies of the SUG were available in the bedrooms of residents, but we noted that at least one copy was about three years old, prior to Southern Cross taking over the home. The other copies had the names of management staff that have left the home about 5 to 6 months ago. The responsible individual for the home had also changed as a result of an internal restructuring. We therefore ask that the SUG and the SoP be amended to reflect the recent changes in the management of the home. The manager stated that all residents that are admitted to the home are given a contract. We found that two new residents had copies of the homes contract in their files. The contract are comprehensive and are signed either by the resident or their representatives. It has been the norm for the home that prospective residents needs are assessed by a senior member of staff prior to them being offered a place in the home. Two residents care records were inspected for the preadmission assessment. This was present in both cases, but in one case the assessment was well completed, signed and dated and in the other case the preadmission assessment was not so well completed. The residents questionnaires that we received showed that residents always or usually receive the care and support that they need. Two persons said that staff work hard caring for the people that live in the home. Another person said that staff do not always notice when residents are ill. We followed this statement through but without information about a concrete example we were unable to fully looked into this statement. We did however note that residents who were acutely ill, had care plans in place addressing these needs. The home accommodates residents with older people needs. However, during the tour of the premises we noted that a resident was living in the home with what seemed to be predominantly young physically disabled (YPD) adults needs. The resident did not have any obvious older people care needs and there was little available in the home to meet the particular needs of that resident. There were no other YPD residents for the particular resident to engage with, and we were not clear about the amount of motivation and stimulation that the resident received from staff to engage in social and recreational activities and in the local community. Our conversation with staff showed that staff have a good understanding of older people needs but do not have such a Care Homes for Older People Page 13 of 38 Evidence: good understanding of YPD residents needs. Another resident had predominantly end of life care needs. We found that apart from the manager, there were no staff on the unit where the resident was accommodated that have had in depth training on end of life care. Staff that we talked to, confirmed that they have not had in depth end of life training and they stated that they were not confident in managing the medicine regime of people who are terminally ill and the equipment that may be required, particularly during the last stage of life. Care Homes for Older People Page 14 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service or their representatives are involved in drawing up and agreeing the plan of care but the care plans were not that comprehensive in a few areas. As a result there is not always a guarantee that residents needs will be met. Staff in the home have a good understanding of older people general personal and health care needs, but were not always that familiar with people who have more complex care needs such as those with a terminal illness. Staff ensured careful management of the medicines in the home to ensure the safety of residents. Care records did not always appropriately address the end of life care of residents. As a result it is not always clear whether the end of life care needs will be met according to the wishes and instructions of the residents or their representatives. Evidence: We examined five care plans. We noted that some were completed quite comprehensively but a few were not that comprehensive. The assessment of the needs of residents on admission was in some cases well completed and in other cases not so Care Homes for Older People Page 15 of 38 Evidence: well completed. For example the needs assessment of one resident had no information on the eyesight, hearing, sexuality, fears for the future and dying. The section of the assessment of the needs of a resident on expressing sexuality said not shown and did not have any information about the things that define them as an individual, such as the way they dress and present themselves, whether they wear make up and their partners/friends. Care plans were in place when needs were identified. These were on the whole comprehensive but at times these did not clearly describe the action to take to meet the needs of residents. Two care plans on pain said give prescribed analgesia and did not clarify the analgesia that have been prescribed for the respective residents, when these needed to be given and the regime in place to manage the pain. One care plan on manual handling did not contain the action to take to move the resident from the bed to chair or vice-versa. Another care plan had not been updated when the urinary catheter of a resident had been removed and there were no actions in place to manage the incontinence. A resident, who was on oxygen when they required it, did not have a care plan in place to manage this need. There were care plans in place to address the cultural and spiritual needs of residents. One said to offer assistance to express cultural and spiritual needs and preferences but did not say what these were. The care plan for a resident that belonged to a smaller religious denomination did not clearly describe how the ethnic, cultural and spiritual needs of the resident would be met. The care records addressed the end of life care needs of residents to some extent but these were not that comprehensive. The care plan that was in place for a resident with end of life care needs did not clarify their needs, including the spiritual dimension of this aspect of care, and the action to take to meet their needs. Care plans of residents that have been in the home for some time, even years, still contain actions such as discuss with next of kin, ascertain whether burial or cremation, when this information, in most cases should have been clarified when the care plans were first completed. Residents presented as appropriately dressed and with a good standard of personal hygiene. Female residents were appropriately groomed and male residents were on the whole appropriately shaved, if that was required. The questionnaires from residents that we received, showed that residents were always or usually satisfied with the support that they get in this area. Those who spoke to us told us that their privacy and dignity were mostly met by staff. All residents were registered with a GP and there were records about the outcomes Care Homes for Older People Page 16 of 38 Evidence: when they were seen by the GP or by other health care professionals such as the chiropodist, optician and tissue viability nurse. Residents said that they always or usually get the medical support that they need. There were three residents in the home with pressure ulcers. Records were in place to demonstrate that the pressure ulcers were being managed appropriately. Evidence was also available to show that the pressure ulcers have been seen by the companys tissue viability nurse and/or the PCT tissue viability nurse for guidance about the management of the pressure ulcers. Two of the residents developed the pressure ulcers in the home but according to the manager, the pressure ulcers were all showing signs of healing. We looked at the care records of two residents with a Health Care Associated Infection (HCAI). One of the residents had a care plan with clear actions and interventions to manage and address the infection. There were also records about tests that were carried out to check on the status of the person with regards to the HCAI. The other resident seemed to have been cared for in her room from about November 2008 with no clear records available, to show how the regime to treat the infection was being implemented. It was also not clear whether residents with HCAI needed to be cared for in their rooms (isolation) or whether they could join other residents in the communal areas. It seemed that one of the residents was cared for in her room while we were informed that the company policy is not to isolate residents with this particular HCAI. The issue about whether resident should be cared for in their rooms must be made clear in the care records of residents to make sure that residents are not kept socially isolated, unless it is their wishes to be on their own . Care plans should also clarify the action to take to treat and monitor the condition of residents, to eventually clear the infection. A pain chart was used in the home to support the assessment and the monitoring of the pain of residents, but these were not used appropriately and as an active tool to monitor the level of pain of residents. For two residents the tool was used once daily routinely. The pain charts should be used when residents say that they have pain and to monitor whether the analgesia and the regime that is prescribed is effective in managing pain. The way that pain was being managed suggested that staff would benefit from more training in this area. At least two members of staff were not familiar with the medicines and the equipment (syringe driver) that are used in terminal care. Conversation with them also showed that they would benefit from substantially more in-depth training, rather than basic training, in understanding end of life care and in managing symptoms when people have a terminal illness. Care Homes for Older People Page 17 of 38 Evidence: Another resident who was very frail and had complex needs was sat in their chair from about 07:00 till after lunch. They said that they got tired sitting out for so long. Whilst this set up might have been appropriate when the resident was less frail, there was no evidence that this has been reviewed with what the resident said. It is acknowledged that it was beneficial for the resident to sit out and their wishes to get up at the time, but perhaps the time that they spent in their chair could have been less on any one occasion and they could have sat out more frequently in one day, alternating between bed and chair, to ensure that they were more comfortable. We asked about the first aid equipment in place in the home. We were informed that these were kept on the first floor. There was a first aid pack with mouth pieces and dressings. We checked the suction equipment in place and noted that the connecting tube was wet. As a result we were not sure whether the equipment was clean and ready to use in an emergency. The tube is normally renewed after use and therefore should not be wet. A moist environment also promotes the proliferation of microorganisms that could be a source of infection. We looked at the accidents records in the home and found that all accidents/incidents were appropriately recorded. In some instances there was not enough information on the accident/incident records to inform the reader about the cause of the accidents/incidents, but the manager was able to provide an explanation about the accidents/incidents by looking at other records and by asking staff. We noted that a few accidents/incidents occurred in the lounge area and we asked about the presence of members of staff when these accidents/incidents happened. It was not always clear whether there were members of staff in the lounge area when the accidents/incidents occurred. We looked at the management of medicines on all three units. We found that the clinical rooms were clean and tidy. There was air conditioning to maintain a constant temperature to store medicines and the temperature of the rooms and of the medicines fridges was monitored and recorded. There were records to show that staff audited the management of medicines at least once a week. This was good practice. We found that the amounts of medicines that were received in the home were appropriately recorded and that medicines were signed when administered or that a code was used when these were not administered to describe the reasons for not administering the medicines. The amount of medicines that was administered when a variable dose had been prescribed was recorded and the instructions with regards to how and where to apply topical medicines were also recorded. The management of controlled medicines was of a good standard and all records with Care Homes for Older People Page 18 of 38 Evidence: regards to controlled medicines were in place. There was a date on the containers of most liquid medicines when these were opened, except for one medicine. However, it was clear that the medicine had not yet expired because of the dispensing date. Care Homes for Older People Page 19 of 38 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. The home on the whole provides suitable internal and external social and recreational activities to suit the needs of residents. The meals that are provided to residents take into consideration their individual choices and are varied and nutritious. Evidence: There were care plans in place to address the social and recreational needs of residents and records were kept about the activities that residents have been engaged in. The satisfaction survey that was conducted by the home during the last year showed that the provision of internal and external activities was an area that did not score so well. The manager told us that she has a plan for improvement in this area that involves the activities coordinator spending more of her working time with residents and organising more individual and small group activities. Prior to that the activities coordinator had also been working as a receptionist, as part of her normal working hours. The survey that we carried out showed that the majority of residents were pleased with the activities that are arranged in the home and that the activities coordinator is very popular among the residents. Care Homes for Older People Page 20 of 38 Evidence: We found that the form about the life history of residents were not completed and therefore the care records contain little information about the past experiences and backgrounds of residents and it was not always clear if the plans of care to address the social and recreational activities of residents were tailored to their individual needs. The manager stated that the home is in the process of using a Personal Preference Plan to record aspects about the social and recreational needs of residents. We noted a programme for outside entertainers that have been booked to perform in the home, on the notice boards that are available on each floor. There are usually two sessions every month. There was also a programme for day to day activities on the notice boards. A communal activity was arranged on most days of the weeks and on other days there were one to one interactions. As Easter was fast approaching, the programme of activities reflected activities in relation to Easter such as decoration and making Easter cards. Other activities were planned for St Georges Day. There are weekly visits in the home by representatives from the local churches, details of which are available on the notice boards. Residents are also able to go the local churches if they wish to and if they are able to go out. The home has a mini bus that can be used for the provision of outings. One resident said that she has been to many places on the bus. The activities coordinator said that shopping trips in the local area have been arranged and that when the weather is warmer, more outings and trips will be arranged for residents. We observed lunch on the first day of the inspection. There was oxtail soup, turkey escalope, swede and boiled potatoes as the main choice and vegetable goulash as the second choice. Other choices were prepared for residents such as omelettes, salads and vegetable curry. For desert there was fruit salad, yogurts and ice cream. The fruit salad was tinned fruit and we think that it could have been improved by using fresh fruits. Feedback from people that we spoke to and questionnaires that were returned to us, showed that the majority of people were satisfied with the quality and variety of meals that are offered to them. One person said that the chef does a good job. Another said that they do not eat all the food that is on the menu and that the chef prepares other meals for them. Care Homes for Older People Page 21 of 38 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 reassured that their complaints will be taken seriously and addressed, if they have to complain. The manager and her staff are aware of the safeguarding procedure of the local borough, to make sure that residents are as safe as possible. Evidence: We looked at the complaints register of the home. There had been three complaints in 2008 and one complaint in 2009. All were addressed within the appropriate timescales. One of the complaints had also been referred to the safeguarding adults team of the local borough. With regards to safeguarding, there has been a total of three referrals since the last inspection. The complaints procedure is available in the SUG and in the reception area of the home. Residents that we spoke to said that they would speak to the nurse on the floor if they had any concerns and staff said that they would refer all complaints to the manager. Three out of the four respondents to questionnaires said that they were aware of the complaints procedure. The manager was aware of the safeguarding adults procedure of the local borough and so were members of staff, when we asked them about this. Care Homes for Older People Page 22 of 38 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. The home is maintained and decorated to provide a pleasant environment for residents, although some of the bedrooms of residents could have been personalised to a better standard. Whilst the home was mostly clean and free from odours, an infection control audit has not yet been completed to find out how well the home meets established standards with regards to infection control. Evidence: The grounds of the home were on the whole maintained and tidy except for some rubbish in an area of the car park that needed to be disposed of. We were informed that the rubbish has been there for about 4 to 5 weeks. The manager stated that she will arrange for a skip. Bushes, shrubs and the lawn were in good order for the time of the year and we also noted that the gardeners were attending to the grounds of the home on the second day of the inspection. The home was mostly clean and warm and we did not find any odours, although we noted that the carpet needed cleaning in some areas. The home did not have any of its three carpet shampoo machines in working order and staff had borrowed a carpet shampoo machine from another Southern Cross home to clean the carpet. Another machine was later hired to address the amount of carpet cleaning that was needed. Care Homes for Older People Page 23 of 38 Evidence: We were informed that the carpet machines have been broken since December. Each floor has its own communal and dining areas. These areas were in an appropriate state of decor and appropriately furnished. Clutter that used to be in the communal areas have been removed and a quiet corner has been provided where residents can sit with their visitors. We noted that residents were encouraged to use all the communal areas. The communal bathrooms and showers were in good working order. There is one of each on each floor. All bedrooms are en-suite. Most of them have a wash hand basin, toilet and a bath, with a few having a shower instead of a bath. However the position of the baths (against the wall) and the layout of the en-suite areas, makes it difficult to use these areas, particularly by dependent residents, who require a hoist to be transferred. The baths in the en-suites are therefore of limited value to most of the residents that are accommodated in the home. Bedrooms of residents were appropriately decorated and maintained. Most of the double bedrooms were being used as single bedrooms, with the exception of a couple who shared one of the double bedrooms. Some residents were encouraged to bring their personal items of possessions and furniture but in many instances, although the bedrooms have been painted in pleasant colours and the carpet has been replaced, we noted that the bedrooms were not well personalised with pictures, photos and other items of decorations. We noted that there were many pressure relief overlays on divan beds and in at least one instance we noted a pressure relief replacement mattress on a divan bed. These items of equipment most of the time do not fit the divan beds appropriately and may therefore not provide appropriate pressure relief as intended. There are also comfort issues for residents associated with divan beds, as the top of the beds cannot be raised as with a profile bed, and manual handling issues for staff, as the divan beds cannot be lowered or raised. As some of the divan beds are not on castor wheels, these may be difficult to move. As noted in the section under Personal and Health Care, there were a number of residents with a HCAI. The training records showed that about 50 of all staff who require this training, have had training in the area of infection control. We asked the manager and staff if an infection control audit has been carried out in the home, as per the Department of Health audit tool, Essential step to safe, clean care. We were informed that the home would carry one of these audits in the near future. As there were issues about the understanding of one of the HCAI, we ask that an infection control audit be carried out as soon as possible. Care Homes for Older People Page 24 of 38 Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriate staffing levels to meet the needs of residents. Recruitment checks were not always thoroughly carried out to ensure the safety of residents. Whilst staff generally receive training in the home, there was some lacking with the provision of mandatory training and training in specific clinical areas, to ensure that staff were fully skilled and competent to care for the residents that are accommodated in the home. Evidence: The staffing level on each floor consists of a trained nurse and three carers during the day and a trained nurse and one carer at night. The staffing level on night duty has improved, as previously there was a trained nurse that was responsible for the first and the second floors at night. In relation to the numbers of residents that were accommodated in the home at the time of the inspection, the staffing levels were good. Staff in the home seem comfortable and competent to provide the usual care to meet the general needs of oder people. Our inspection has shown that they do not seem so comfortable when they have to care for residents with more complex needs such as those with a terminal illness and with palliative care needs. Care Homes for Older People Page 26 of 38 Evidence: Feedback about staff from residents was mostly positive. Three respondents said that staff listen and act on what they say. Two said that staff are always available when they need them and two said usually. One resident mentioned that a minimal number of staff are not so nice and sometimes do not talk to them when they attend to them. The manager said that she was going to look into this matter. We looked at the personnel files of three members of staff. One member of staff worked in the home then left and returned to work in the home again after a period of about six months. We noted that a new CRB was not in place and there were no new references particularly one from the last place of work. The other two members of staff have been in post for some time and seemed to have had all the necessary checks to ensure that they were suitable to work in the care home. New members of staff are offered induction to the home according to the common induction standards, as per Skills for Care. Evidence was kept in the form of induction records. Staff also receive supervision but records showed that they do not always receive supervision every two months.The manager stated that she will prepare a plan to ensure that all members of staff have supervision at least once every two months or six times a year. The manager kindly provided a training matrix to provide information about the training that staff have completed. The home has about 55 members of staff. Training has been provided in mandatory areas such as fire training, food hygiene, health and safety, manual handling and prevention of abuse. Staff have also received training in pressure area care, customer care, care planning and first aid. 9 members of staff have received training in palliative care and pain management, but the depth of the training that has been provided is not very clear as care workers seemed to have received the same training as trained nurses, who are normally responsible to manage the medicines regimes that are required to manage symptoms in palliative care. Trained members of staff who spoke to us also said that they needed more training in this area to understand the pain management regimes and the equipment that is used to manage symptoms in palliative care. There was some lacking in the provision of mandatory training, as we noted that 5 members of staff last had fire training in 2007 and were therefore not up to date. 27 were not up to date with manual handling and about 50 of the staff team have not had training in infection control. We discussed training in clinical areas for nursing and care staff with the manager and the operations manager, as according to the training matrix and feedback from members of staff, there did not seem to have been much training in clinical areas. The Care Homes for Older People Page 27 of 38 Evidence: operations manager informed us that the organisation has trainers to provide and outsource training to address any training needs that may be present, including training in clinical areas. The home has about 25 carers and according to the manager 17 of them have at least an NVQ level 2 qualification in care. The home therefore has 50 of its carers trained to NVQ level 2 in care or above. Care Homes for Older People Page 28 of 38 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. The home is on the whole managed appropriately to ensure that it meets its aims and objectives and those of the organisation. It has a quality management system to monitor the quality of the service that it provides. The management of residents personal money is of a good standard but their property and valuables were not fully recorded. As a result residents interests might not be fully safeguarded. Health and safety issues are appropriately addressed by the home to ensure the safety of all people who use the premises. Evidence: The home has a new manager. She started work in the home in February 2009. The manager who was in post during the last inspection resigned in October 2008. The current manager has run care homes and is familiar with the national minimum standards. She is a trained nurse and has an Advanced Certificate in Management but stated that she will complete the registered managers award. Care Homes for Older People Page 29 of 38 Evidence: There was evidence that the manager has held a number of meetings with staff to communicate her sense of direction. For example minutes were available for trained nurses meetings, floor staff meetings and care staff meetings. During the inspection we noted that there seemed to have been a delay in getting some items of equipment repaired or replaced. For example there was a fridge and a freezer that were not working in the kitchen. We were informed that one of these items of equipment has been broken for about one month and the other for about two months. The three carpet shampoo machines have also been broken for about three months and have not been repaired or replaced. We were informed that these issues will be addressed but the home will certainly benefit if the request for repairing and replacing items of equipment is more speedily dealt with. The home implements the quality management system of Southern Cross. The manager carries out monthly audits and every two months there is a validation audit that is carried out by the operations manager. The last operation manager rated the home as orange (on a scale of red, orange, green and blue, where blue is the highest score). The manager has since done an audit and the home has scored a green. There has been a customer satisfaction survey that had been carried out some time ago. A report was available to summarise the findings of the survey. Line management also visits the home to carry out monthly monitoring visits, as required by legislation. The management of the personal money of residents was checked. We noted that good records were kept and the system was clear and easy to audit. Each resident that has money with the home has a sub-account of a main bank account that is dedicated to residents personal money. Interest is added to each residents sub-account as required. We noted that all receipts were kept with a clear explanation of expenses that have been made on behalf of residents. The safe was tidy and an up to date list was available about the content of the safe. The individual record for the property and valuables of each resident was however not always kept up to date as a number of residents had items of jewelery that had not been recorded. There was some evidence that the home has started to address this issue. The home carries out regular checks of the fire detection equipment and fire emergency light system. There was evidence that staff receive regular fire drills. Up to date emergency fire plan and fire risk assessment were available for inspection. The home also had a health and safety risk assessment and contingency plans to deal with Care Homes for Older People Page 30 of 38 Evidence: emergencies. Records were available to show that the water temperature was monitored at hot water points to which residents had access to. Wheelchairs, window restrainers and bed rails checks were also undertaken monthly to ensure that these were in a good state of repair. The home had an up to date portable appliances test certificate, a wiring test certificate and a gas safety test certificate. A certificate was also available to show that the water system has been tested for legionella. LOLER certificates were available for the hoists and the lifts, to demonstrate that these have been tested. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1,2) Care plans must be clear 31/07/2008 about the action to take to meet the individual needs of residents while taking the cultural and ethnic aspects of the needs of residents (Previous requirementtimescale 31/07/07 and 31/03/08 partly met). As part of the processes to 31/07/2008 prevent financial abuse, the registered person must ensure that as far as possible there is an up to date record of residents valuables and property, to provide an audit trail. (Previous requirementtimescale 31/03/08 partly met). 2 35 17(2,3) Care Homes for Older People Page 32 of 38 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 3 14 The preadmission 01/07/2009 assessment should be fully completed to ensure that all available information is recorded to demonstrate how the decision to accept the resident in the home has been reached. To demonstrate that all the needs of prospective residents have been fully assessed before they are offered a place in the home. 2 4 14 That the home carefully 01/07/2009 considers the needs of prospective residents with regards to whether the home is suitable for the residents and whether staff are competent and skilled enough to meet the needs of the residents, before offering them a place in the home. Care Homes for Older People Page 33 of 38 To make sure that the home will be able to meet the needs of residents that are admitted. 3 7 15 Care plans must be clear 03/08/2009 about the action to take to meet the needs of residents. These must take into consideration the cultural and spiritual aspects of the care of residents. To make sure that all the needs of residents are accounted for and would be met 4 8 13 That all suction equipment be clean and ready to use should there be an emergency To ensure that prompt support and attention can be provided when residents are not well 5 8 12 The home must ensure the 01/07/2009 provision of a consistent and high standard of care and support to people with a Health Care Associated Infection. To ensure that all residents receive the support and care that they require. 6 9 13 The opening dates on all liquid medicines must be recorded. To make sure that residents do not receive medicines have not expired 01/07/2009 01/07/2009 Care Homes for Older People Page 34 of 38 7 11 12 Staff must be given training 01/07/2009 in end of life care and in the management of terminally ill people for them to be able to confidently address this aspect of care in care plans and to provide a high standard of care to people who are terminally ill. To ensure that people with palliative care needs receive the care that they require. 8 22 16 Residents needs must be appropriately assessed with regards to whether they require an adjustable bed. To ensure the comfort of residents and the safety of staff. 01/07/2009 9 26 13 The home must carry out an 01/07/2009 infection control audit as per guidance from the Department of Health in the document: Essential step to safe, clean care. To ensure that the home has effective infection control system in place. 10 26 17 All members of staff must have all the relevant checks prior to them being offered employment in the home. To ensure compliance with the recruitment procedure and to ensure the safety of people who use the service 07/07/2009 11 31 18 All members of staff must have yearly updates in mandatory training. All 07/08/2009 Care Homes for Older People Page 35 of 38 members of staff who could be involved in the transmission of infection, because of the work that they do, must have infection control training. Training must be also be provided in clinical areas that are relevant, according to the needs of people that are accommodated in the home. To ensure that staff are skilled and competent to care for residents. 12 35 17 An up to date record of the valuables and property that are brought into the home, must be kept. To ensure the safety of residents possessions 06/07/2009 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 The service users guide and the statement of purpose should be updated to take into consideration the various changes that have occurred within the service. That the pain chart be used as an active tool in the management of pain rather than just a task that need to be completed because the chart has to be used, with no obvious benefit to the resident. All accidents/incidents records should be thoroughly recorded and there should be at least one member of staff in the communal areas or where there is a gathering of residents to supervise them and to ensure their safety. The home should ensure that the life history section of the care records of residents is completed appropriately to 2 8 3 8 4 12 Care Homes for Older People Page 36 of 38 provide background information about residents that can be useful in caring for them and organising social and recreational activities that suit their needs. 5 24 The bedrooms of residents should be personalised to a better standard to promote a familiar and homely environment for residents. The process of getting authorisation to repair or replace broken items of equipment must be reviewed to ensure that there is no significant delay in ensuring that the items of equipment are repaired/replaced. 6 31 Care Homes for Older People Page 37 of 38 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. 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