Inspection on 01/06/09 for Chestnut Lodge

This inspection was carried out on 1st June 2009.

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

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

Other inspections for this house

Chestnut Lodge 10/07/08

Chestnut Lodge 19/07/07

Chestnut Lodge 20/07/06

Chestnut Lodge 30/01/06

Chestnut Lodge 14/09/05

Chestnut Lodge 02/11/04

Chestnut Lodge 18/05/04

Chestnut Lodge 29/01/04

Chestnut Lodge 06/08/03

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: Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ     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: Brenda ONeill     Date: 0 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ 01215513035 F/P01215513035 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) : Mrs Evelyn McIntosh,Mrs Catherine McHugh care home 15 Number of places (if applicable): Under 65 Over 65 15 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Chestnut Lodge is a home providing residential care for up to 15 older people. The premises consist of 2 large houses that are joined, and situated on a busy main road with shops nearby. The home has a well-maintained garden at the rear, with a paved patio area, and furniture for those people living in the home that wish to sit outside in fine weather. There is parking for 2-3 cars at the front of the property. Accommodation is provided on three floors consisting of a mix of single and double rooms. There are ample communal bathing and toilet facilities. The home has two sitting rooms, one at the front of the house and another at the rear overlooking the garden. The atmosphere of the home is very homely. A shaft lift gives access to upstairs rooms. Care Homes for Older People Page 4 of 32 Brief description of the care home The range of fees charged at the home was not in the service user guide. People should contact the home for this information. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on July 10th 2008. This inspection was carried out over one day. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have Care Homes for Older People Page 6 of 32 to let us know about by law and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, 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. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent six Have your Say surveys to people who use the service and six to relatives. Four surveys were returned to us, two from the people living in the home and two from relatives. These views have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Comprehensive risk management plans must be in place for all the identified risks of the people living in the home. This will ensure people are not exposed to any unnecessary risks. Care plans should be further developed to detail all the needs of the people living in the home and how these needs are to be met by staff. They should reflect the care being given by the staff in the home. This will enable any new staff in the home to be able to offer care appropriately to the people living in the home. To ensure health care visits to the people living in the home are easy to track staff Care Homes for Older People Page 8 of 32 should ensure they record the information on the appropriate sheet. Staff should ensure footrests are used on wheelchairs unless there is a specifically documented reason why this should not happen. This will ensure that the people living in the home are not put at risk of injury. Staff should enable people living in the home to pursue their preferred social activities so that they lead fulfilling lives. The quality assurance system in the home should be progressed. This will ensure there is a system in place to continually improve the service offered to the people living there. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for people thinking of moving into the home to help them decide if the home could meet their needs. The pre admission assessment procedure ensured the needs of the individuals were known to staff before admission. People wanting to live in the home were able to visit prior to admission to assess the facilities available. Evidence: There was a service user guide for the home and this had been updated since the last inspection. It included up to date information about the home and was available in large print for people with any visual impairments. The manager did need to include the range of fees that were charged at the home so that people had all the information they needed to help them decide if the home could meet their needs. The manager also needed to ensure that the telephone number for the Commission was included in the service user guide in case anyone wanted to contact us and did not want to have Care Homes for Older People Page 11 of 32 Evidence: to write to us. There had been one person admitted to the home since the last key inspection. The pre admission assessment procedure for this person was sampled. The manager had obtained a copy of the social workers assessment and the care plan that had been drawn up with the individual. The assessment was quite detailed and gave a lot of information about why the person needed to go into residential care and what they would need from the home. The home had also undertaken a brief assessment of the individuals needs. This gave some details of the risks the person was exposed to, their health concerns and what their basic needs were. This assessment did not indicate where it was undertaken and was not dated. The manager told us the assessment was carried out when the person went to visit the home prior to admission. It was recommended that the assessments are dated and the venue detailed so that it can be shown people are assessed by the home prior to admission and that they can visit if they wish. The individual who the assessment referred to was spoken with and he confirmed he had visited the home to have a look around before moving in. He said he had settled quite well and was happy with the service he was receiving. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Due to the lack of detail in the care plans people may not have their needs met in a way that suits them. Some of the risk assessments needed to be further developed to ensure the people living in the home were fully safeguarded. The system in place for medicine management had improved and ensured people received their medication as prescribed. Evidence: The care for two of the people living in the home was tracked during the course of the inspection. One of the people had moved into the home quite recently and one had lived there for some time. Both had care files which included a document entitled Core care plan chart this gave some details of the history of the person, their families and why they were in the home. The document detailed such things as the individuals interests, their preferred rising and retiring times, whether they had any specific dietary needs and what their interests were. Care Homes for Older People Page 13 of 32 Evidence: In a separate folder there were other care plans. These were entitled Service user assessment and daily care plans. These detailed the preferred daily routines of the people living in the home such as where they liked to spend their time, when they preferred to have either a bath or a shower and any specific diets. There were some good details in some parts, for example, likes to have three pillows and likes to have the night light left on. There were also some details of to what extent people could direct their own care, for example, knows what she likes and does not like. There was little information included in the plans about how staff were to meet the identified needs of the individuals. For example, for one person the plan stated needs assistance with daily washes but there was no detail of what assistance was needed. For another person it stated staff wash/comb hair this person was seen to have her hair plaited in a very specific way. This was not detailed in her care plan. This person had specific cultural needs in relation to hair and skin care. These were not detailed in the care plan. When we spoke to the staff in the home they were able to tell us what people were able to do for themselves and what assistance they had to give to ensure peoples needs were met. From what was seen, what staff told us and the records in the home it was clear people were receiving a lot more care than was detailed in the care plans. Care planning was discussed with the manager. It was recommended that all the information for the people living in the home was collated into one care plan that detailed all individual needs and how these were to be met by staff. There was a very stable staff group at the home who knew the people living there well but if any new staff started it would be very difficult for them to know where to find information, what the specific needs of people were or how they were to meet them. The risk assessments that were on file for people were not comprehensive enough. For example, one person was clearly at risk of falling and this was detailed but the risk assessments did not say how staff were to try and minimise this. Staff were able to tell us they observed the individual, ensured he had his stick and walked with him. These measures need to be documented to ensure staff follow them consistently. Another person had diabetes and there were some details on file about how staff would recognise if the person had high or low blood sugar and what to do but this information was not all included on the risk assessment. The risk assessment had other details, for example, the risks of eating too much West Indian food. All this information needed to be on one management plan for the persons diabetes and further information included as to what the safe range of blood sugar levels were. Again when we spoke to staff they were able to tell us about the risks the individual was exposed to and what they should do if the diabetes was unstable. However if any new staff started they would not have this knowledge and would need to have some documentation to refer to. Care Homes for Older People Page 14 of 32 Evidence: People did have nutritional assessments undertaken which highlighted if they were at risk. No tissue viability assessments were seen however it was detailed in care plans that staff were to check skin integrity and the bathing and showering records showed this was being done on a regular basis by staff and they were recording any problems with skin and what was done about it. There were letters on one of the files sampled that implied one of the people living in the home had some challenging behaviours. Professional help had been sought by the manager and there had been some changes to medication. There was no mention in this persons care plan or risk assessments about this behaviour. When speaking to staff they were able to describe this behaviour, when it was likely to occur and how they managed it. The information they gave about the behaviour and how they managed it was consistent. Again this needed to be documented so that all staff had a point of reference and were able to read how to manage the behaviour. The people living in the home were satisfied that there health care needs were met. They told us that they could see a doctor if they wanted to. The district nurse was seen to visit the home during the inspection. Daily records and care files showed that people had access to health care professionals such as chiropodists, opticians, doctors, district nurses and so on. It was difficult to track if the health care needs of the people living in the home were fully met as visits by health care professionals were recorded on daily records and not the sheets specifically intended for this. It was recommended that the appropriate sheets were used as with the build up of daily records the information will become increasingly difficult to track. Daily records did give some information about the personal care needs of the people living in the home being met and their general well being. People spoken with were satisfied with the service they were receiving and generally looked well cared for. However it was noted that none of the men living in the home had shaved on the day of the inspection. When the manager was asked about this she said this would not have been their choice. She was heard to ask staff to take one person for a shave. Staff should ensure that the personal care needs of the people living in the home are met in a way suited to them so that they can be assured they are comfortable. It was also noted that staff were not always recording accidents on the appropriate accident forms only in daily records. It was strongly recommended that accident forms were completed as they included a lot more information than the daily records and the information could be needed at a later date. The accident forms would also show that accidents were being managed in the best interests of the people living in the home. Care Homes for Older People Page 15 of 32 Evidence: The issues raised at the last inspection in relation to medication management had been addressed and people were receiving their medication as prescribed. Medication was administered via a monitored dosage system and staff had been trained to use the system. Medication was being acknowledged when coming into the home and signed for when administered. Any balances of medication held in the home at the end of the cycle were brought forward to the next MAR (medication administration record). A random audit of the medication was undertaken and the balances of the medication held in the home were found to be correct. One tablet could not be audited as it was not clear how many had been received into the home.This was a relatively minor error and there was evidence that the tablet had been administered to the individual concerned. We were told there was no controlled medication being administered in the home. No issues were raised by the people living in the home about their privacy and dignity. Staff addressed them appropriately and assistance with personal care was offered discreetly. There were privacy screens in shared bedrooms, toilets and bathrooms had appropriate locks on the doors and there was a lockable piece of furniture in almost all the bedrooms. The locks on the bedroom doors had been replaced since the last inspection so that people could have keys to their rooms. However the type fitted allowed people to leave their keys in the doors when inside their rooms and staff would not be able to enter should there be an emergency. We were told that no one in the home had requested a key and the manager stated she would change the locks if people did want keys to ensure they were not put at risk. There were two bedrooms with a fire exit route through them which meant that the occupant of one room could access another persons bedroom. However this had been a long standing arrangement in the home. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were no rigid rules or routines in the home and the people living in the home were able to spend their time as they chose. There were activities available for the people living in the home but it could not be shown that these met the needs of everyone. The people living in the home were satisfied with the meals served to them and cultural diets were being catered for. Evidence: The day of the inspection was quite busy at the home. An outside entertainer came to do some music and movement with the people living in the home, the hairdresser visited and a church service was conducted. The home had a relaxed atmosphere throughout. People were seen to take part in the activities, spend time quietly in the lounges, watch TV and chatting amongst themselves. The activity records in the home had lapsed in April. Up to that time recorded activities included such things as, music man, sing a long, balloon games, old movies, quizzes and church services. The recorded activities were quite repetitive. The manager said other activities did take place, for example, students were often placed in the home and would undertake activities with people such as arts and crafts. There was some Care Homes for Older People Page 17 of 32 Evidence: evidence of this on the walls in the home. Staff needed to record all the activities people took part in to show their social needs were being met. People spoken to in the home had mixed views about the activities. One said she got bored and there was not much going on. Another person seemed quite happy with the activities facilitated by staff. The two satisfaction surveys returned to us indicated that home usually and sometimes arranged activities for people to take part in. We were told by staff that they facilitated an activity every day. Meetings were held with the people living in the home and these were chaired by a visitor from the church. The minutes for these meetings were not in the home on the day of the inspection therefore we could not see if the range of activities available in the home had been discussed with people. The care plans gave some indication of peoples preferred leisure activities, for example, one stated the individual liked reading the newspaper, taking part in activities in the home and enjoyed going out for a walk. The daily records showed that he did have a newspaper on occasions and did take part in some of the arranged activities but there was no evidence to suggest that he had gone out of the home at all. The daily records indicated relatives and friends visited the home at various times throughout the day. Some of the people living in the home went out with their relatives. There were regular visits to the home by people from the local churches. The people living in the home were able to exercise some control over their lives. Those people spoken with were satisfied that they were able to choose how they spent their time and if they declined to take part in an activity staff respected this. They were able to choose when to go to bed and get up, what they ate what they wore and so on a daily basis. The people spoken with were very satisfied with the food served to them at the home saying it was very good, there was too much and they had choices The menus seen were varied and nutritious and showed that people had the choice of having such things as cooked breakfasts if they wished. The records of food being served to the people living in the home had improved and reflected the menu in most instances. There was some evidence of West Indian food being served but this was not always being documented. The manager told us the cook had been shown how to prepare West Indian food appropriately to meet the cultural needs of some of the people living in the home. Food records did not indicate how any diabetic diets were being catered for. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were listened to and their views acted on. The training staff had received and the policies and procedures on site ensured people were being safeguarded. Evidence: We were told there had been no complaints lodged at the home since the last inspection and none had been lodged with us. The completed satisfaction surveys returned to us by the people living in the home and their relatives indicated that they knew who to speak to if they were unhappy about anything and that any concerns were addressed appropriately. It was recommended that the manager sets up a system for recording minor issues or grumbles that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. As it was only a small home staff spent a considerable amount of time with the people living there. Staff knew the individuals well and the relationships between them were seen to be good. People were very comfortable in the presence of the staff and the manager which would give them the confidence to raise any issues. We were told that when meetings were held with the people living in the home they were encouraged to Care Homes for Older People Page 20 of 32 Evidence: raise any concerns. As the minutes for the meetings were not available in the home we were not able to evidence this. There were appropriate adult protection procedures on site. We were told that staff had received training in adult protection issues since the last inspection. Some of the staff spoken with confirmed this however there was no training matrix on site so it was difficult to ascertain that all staff had undertaken this. When staff were spoken with they were aware of the risks people were exposed to and how to minimise these to ensure they were safeguarded. Recruitment procedures at the home were robust ensuring people were safeguarded. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care was being provided in a homely, comfortable environment that was generally well maintained. Evidence: The home is quite small and provides the people living there with a homely environment. There was no doubt that the people living in the home were very comfortable. There had been some further redecoration to the home since the last inspection and the dining room flooring had been replaced. The home had ample communal space with two lounges, a dining area and a large entrance hall. All areas were adequately furnished and decorated. It was noted that although the carpet in the entrance hall and one of the lounges is cleaned regularly it was still stained. This should be replaced as soon as funds allow. There was a well maintained garden to the rear of the home with seating available for the people living in the home. As at the last inspection there were bathing and toilet facilities on all floors. Some of the facilities were quite basic but all were usable. Care Homes for Older People Page 22 of 32 Evidence: The aids and adaptations throughout the home appeared to meet the needs of the people living in the home. These included assisted bathing and toilet facilities, emergency call system and shaft lift. There were wheelchairs available for those people that needed them. It was noted that staff were using the wheelchairs without footrests which is very dangerous practice and can lead to the people using them being injured. This was addressed quickly by staff but the manager must monitor this practice on an ongoing basis as it has been raised in the home before. Several bedrooms were seen during the tour of the home. These varied in size and were a mixture of singles and doubles. The rooms were comfortable and it was evident that the occupants were encouraged to personalise their rooms to their choosing. As mentioned previously bedrooms did not have the appropriate locks fitted. Some of the bedrooms were in need of decoration and one in particular needed new flooring. The kitchen was clean and tidy. The laundry was not inspected during this visit. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate staffing levels and a well trained staff group were able to meet the needs of the people living in the home. There were robust recruitment procedures in place ensuring the right people were employed and that the people living in the home were safeguarded. Evidence: The AQAA for the home stated there had been no staff turnover at the home since the last inspection and this was confirmed by the manager. The stable staff group was very good for the continuity of care of the people living in the home. Good relationships between the staff and the people living in the home were evident throughout the inspection. As the home was quite small the staff had a considerable amount of contact with the people living in the home. Surveys returned to us indicated staff were available when needed. One person commented: This is a special place who give time and love to our relatives and friends and give us peace of mind long may they continue. Rotas indicated there were always a minimum of two care staff on duty and often there were three. The home also employed a cook five days a week. On the cooks Care Homes for Older People Page 24 of 32 Evidence: days off someone else was designated to do the cooking. The rotas had improved since the last inspection and were more a true reflection of the staffing in the home. The manager was still on the rota for 12 hours seven days a week. She said she did not always do all these hours but was always on call to staff at these times. As no new staff had been employed since the last inspection recruitment was not checked at this inspection. However the recruitment procedure at the home was found to be robust at the last inspection ensuring only appropriate people were employed in the home. The information on the AQAA indicated that 10 of the 11 staff employed at the home had NVQ level 2. Staff that were on duty were interviewed and some of these also had NVQ level 3. Staff confirmed they had a considerable amount of training including manual handling, fire awareness, first aid, food hygiene and medication management. It was not possible to determine what training all the staff had undertaken as there was no training matrix for the home and the manager was struggling to find the relevant information. It was strongly recommended that the manager developed a training matrix for the whole home that detailed what training staff had undertaken and when. This will enable easy tracking of when staff are due to take any updates. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensured the smooth running of the home. The quality monitoring system needed to be progressed to ensure there was a system in place for continuous improvement based on seeking the views of the people living in the home. Evidence: The manager of the home is also one of the owners. She knew the people living in the home very well and was able to tell us about their needs, likes, dislikes and preferences. The people living in the home were very comfortable in her presence. Staff were very positive about the manager saying she was friendly and approachable. As at the last inspection there was no doubt that overall the home offered a good level of service to the people living there but the recording let them down in some areas, for example, care plans. Unfortunately this could lead to some individuals not having their needs met as they would like particularly if any new staff started working in the home. Care Homes for Older People Page 26 of 32 Evidence: It was also noted that the office was very disorganised and the manager was having difficulty locating some things. It was suggested that all paper work in the office was reviewed and what ever was not needed was archived. Files for the people living in the home and the staff needed to be more structured and easy to follow. The manager stated that she had a quality assurance folder but this was not on site at the time of the inspection. Staff confirmed that they had meetings but the minutes for these were not available. We knew that a visitor from the church had meetings with the people living in the home however the minutes for these were not available either. There needed to be some evidence on site that the quality of the service in the home was being monitored with a view to it being improved for the people living in the home. The home did not handle any money on behalf of the people living there on an ongoing basis. If anyone needed anything it was purchased by the manager and relatives, Social Care and Health or solicitors then reimbursed the money. The manager was satisfied that all the people living in the home had access to money if they needed it. One exception to this was one person whose personal allowance was sent to the manager by cheque in the name of the home. The manager then cashed this and paid the money to the individual concerned. Records for this were being kept. This arrangement had been set up as the individual did not have a bank account. Health and safety in the home was generally well managed. Staff had received training in safe working practices. The home was well maintained and safe. The information indicated that the servicing of the equipment was up to date. The records for this were sampled and all were found to be in order. The in house checks on the fire system were up to date and fire drills were being undertaken. The issues raised at this inspection in relation to health and safety were staff not using footrests on wheelchairs and the need for risk assessments to be more comprehensive. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Comprehensive risk management plans must be in place for all the identified risks of the people living in the home. This will ensure people are not exposed to unnecessary risks. 14/07/2009 2 22 13 Footrests must be used on wheelchairs at all times unless otherwise is specifically detailed in individual care plans. This will ensure that the people living in the home are not put at risk of injury. 30/06/2009 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 user guide should include all the information people would need to help them decide if the home could meet their needs. Page 29 of 32 Care Homes for Older People 2 3 Pre admission assessments undertaken by the home should be dated and the venue included so that it can be shown they were carried out prior to admission and people are able to visit the home if they wish. Staff should ensure that people have their personal care needs met in a way suited to them to ensure they are comfortable. It is strongly recommended that care files used on a daily basis are reorganised so that only the relevant documents and information are held on them. This will ensure staff are able to find all the necessary information. Care plans should be further developed to detail all the needs of the people living in the home and how these needs are to be met by staff. They should reflect the care being given by the staff in the home. This will enable any new staff in the home to be able to offer care appropriately to the people living in the home. To ensure health care visits to the people living in the home are easy to track staff should ensure they record the information on the appropriate sheet. It is recommended that accident forms are completed for all accidents that involve the people living in the home. This will ensure adeqaute information is recorded and that accidents are managed in the best interests of the people living in the home. To evidence the social needs of the people living in the home are being met staff should: - Ensure they complete the activity records on an ongoing basis. - Enable the people living in the home to pursue their preferred leisure activities. Food records should include details of any foods served to meet the cultural or medical needs of the people living in the home. This will show people are receiving an appropriate diet. The minutes for the meetings with the people living in the home should be kept on site to show people have been consulted on an ongoing basis. It is recommended that the manager sets up a system for recording minor issues or grumbles that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. There should be evidence on site that staff have undertaken training in adult protection issues. This will ensure they are able to manage any issue appropriately. Page 30 of 32 3 7 4 7 5 7 6 8 7 8 8 12 9 15 10 16 11 16 12 18 Care Homes for Older People 13 20 The flooring in the entrance hall and lounge should be replaced.This will ensure the home is kept to an acceptable standard for the people living in the home. All bedrooms must be furnished and decorated to an acceptable standard for the people living in the home. It is strongly recommended that the manager develops a training matrix for the whole home that details what training staff had undertaken and when. This will show staff have the skills and knowledge needed to acre for people effectively. It is recommended that all paper work in the office is reviewed and what ever is not needed is archived. Files for the people living in the home and the staff needed to be more structured so that they can be followed easily. The quality assurance system in the home should be progressed. This will ensure there is a system in place to continually improve the service offered to the people living there. 14 15 24 31 16 31 17 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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