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Inspection on 22/10/08 for Cole Valley Nursing Home

Also see our care home review for Cole Valley Nursing Home for more information

This inspection was carried out on 22nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People living in the home have access to a range of Health and Social Professionals and this ensures that any health care needs are met. Visiting is flexible enabling people to maintain relationships that are important to them. Visitors are made to feel welcome and a good rapport was observed to had developed between people using the service, staff and their visitors. People who live at the home are able to personalise their bedrooms to reflect their individual tastes, age, gender, and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that peoples independence is maintained and promoted whilst maintaining their safety. Money, which is held on behalf of people at the home, was accounted for and there were good systems in place to ensure peoples finances were protected.

What has improved since the last inspection?

Floor coverings have been replaced in a number of areas improving the appear once of these areas

What the care home could do better:

A review of social activities needs to take place to ensure people who live at the home maintain a fulfilled life. The medicine management must improve to safeguard those people that live in the home. The home needs to review how it delivers care to those people with dementia in relation to environment and staff awareness. Care planning needs to reflect individual needs and be based on a comprehensive assessment. Individual needs must be monitored and any changes reflected in the care planning process. The care plans must reflect the care delivered. The Service User Guide must be reviewed so that people considering living in the home and those already there receive all the information they need. Staff need training in key areas such as dementia, manual handling, safeguarding, mental capacity and end of life care. This will ensure they have the skills and competence to meet all the needs of people living in the home. Menus need to be reviewed to ensure that people living in the home have a varied diet that meets their expectations. Recruitment procedures need to be robust to ensure that people living in the home are protected from potential harm. Induction training needs to be based on Skills Care Standards to ensure that staff new to home have a recognised induction programme that equips them with skills to meet the people`s needs. Supervision sessions for staff need to increase in frequency. This will ensure staff are supported and provided with the necessary skills to meet the needs of people living at the home needs. The quality assurance system in place needs to be reviewed to ensure that people living at the home have a service that meets all of their needs.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cole Valley Nursing Home 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN     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: Karen Thompson     Date: 3 1 1 0 2 0 0 8 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Cole Valley Nursing Home 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN 01214448887 01214411959 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) : Cole Valley Care Limited care home 45 Number of places (if applicable): Under 65 Over 65 0 45 dementia old age, not falling within any other category Additional conditions: 45 0 The maximum number of service users who can be accommodated is: 45 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 (OP) 45 Dementia (DE) 45 Date of last inspection Brief description of the care home Cole Valley Nursing Home is purpose built on two levels, with a passenger lift for access to the first-floor. Occupancy is for up to 45 residents of 65 years or above who may be suffering from dementia, a variation of registration permits the home to accept persons who are aged 50 years or above. The premises are located within the Kings Heath district of Birmingham, and situated in a residential neighbourhood close to local amenities including shops and public transport. There is a small car park adjacent to the Home and sheltered, private gardens for service users and their visitors to frequent. There is a range of communal rooms to give residents choices about where Care Homes for Older People Page 4 of 32 Brief description of the care home they wish to sit. Bedrooms are located on both floors, are of single occupancy and include en-suite facilities consisting of toilet and wash hand basin. Communal assisted bathing facilities are strategically located on both floors for ease of access. There is a range of lifting aids to assist those residents who have restricted mobility. The specialist equipment includes many pressure relieving devices and other specialist items to meet the needs of residents. The accommodation charges are 545.00 pounds per week for those who are self funding. The fee rate paid by Adults and Communities Directorate is 472.00 with residents paying a top up fee of 30.00 pounds per week. Services not included in the fee rate are hairdressing, newspapers and magazines, chiropody and toiletries. For up to date fee information the public are advised to contact the home. 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 quality rating for this servcie is one star. This means the people who use this service have adequate quality outcomes. The focus of this inspection undertaken by the Commission for Social Care Inspection (CSCI) 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 requirments, minimum standards of practice and focuses on aspects of service provision that need further developement. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a questionaire that was completed by the Care Homes for Older People Page 6 of 32 manager and gave us information about the home, staff, people who live there, andy developments since the last inspection and their plans for the future. One inspector undertook this fieldwork visit carried out over two days. The registered manager was available for the duration of the inspection. The home did not know we were coming on the first day and was not informed of when we would be returning to complete the inspection. At the time of the inspection forty-three people were living in the home and information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home by meeting and observing them, looking at medication adminstration and care files and reviewing areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us to understand the experience of people who use the service. Staff files, training records and health and safety files were looked at. At the time of the inspection two people who lived in the home, three visitors and four members of staff were spoken to in order to gain that views and comments. The weekly fee to live at Cole Valley is between 462.86 and 492.88 for people . Items not included within this fee include hairdressing, chiropody and toiletries. For up to date fee information the public are advised to contact the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 32 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. People cannot be fully confident they have all the necessary information so that they can make an informed choice about moving into the home. Pre admission information is lacking so people cannot be sure all their needs will be met. Evidence: The certificate of registration was clearly on display for people to refer to. A copy of the statement of purpose and service users guide were available at the reception for people to read at their leisure. The documents provide prospective users of the service with adequate information about the services that the home provides to assist them in decision making. They also contain advise about how the admission process is carried out. The Service User guide did not contain fee information and the ranges of costs that people could be expected to pay. It also did not contain a summary of the complaints procedure or the correct address and telephone number of the Commission for Social Care Inspection. People who use the service are not given their own copy of Care Homes for Older People Page 11 of 32 Evidence: the Service User Guide. People living at the home and or their representatives must be supplied with a Service User Guide in a format accessible to them. Different formats where discussed with the Care Manager during the inspection. The home provides care for people who require long term nursing care. People are encouraged to visit the home before moving in to view facilities, meet staff and other people who live there in order to sample what it would be like to live there. The records of one person who had moved into the home recently were looked at. The pre-admission assessment is completed on a standard format devised by the home. The pre-admission assessment did not contain sufficient information in relation to how this persons cognitive impairment would affect their care needs. The Continence assessment was also brief and was not leading to good care planning outcomes on admission to the home. Intermediate care is not provided at Cole Valley nursing home. 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. Peoples health and personal care needs are not being fully met in a consistent way placing their health and well being at risk of harm. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individual needs. It outlines what they can do and the support they require to be given by staff in order to meet their needs. Three peoples care files were looked at in detail. Care records also contained risk assessments in respect of areas such as pressure sore risk, manual handling, falls, continence and nutrition. One person was assessed as being at high risk of developing pressure sores and their care plan had a list of instructions to prevent this occurring, which included an appropriate mattress and ensuring the person position was changed on a regular basis. The mattress was observed to be on the persons bed and staff were recording on a regular basis when a change of position had taken place. Care Homes for Older People Page 13 of 32 Evidence: People living in the home had a plan of care for their diabetic needs however it omitted to state how their skin intrgrity would be maintained as they are at high risk of complications. PEG feeding was taking place in the home for a number of people. One persons records contained a letter from the hospital stating that they had observed poor hygiene around the PEG site of this person. Nutritional risk assessments were in place for people living at the home, but these were not always leading to specific care planning instructions to demonstrate how they were to be meet. Bedrail risk assessments were not in place. The management team stated that the only bedrails they used were part of the bed structure, however the use of the bedrails will need to be assessed and justified as they could be deemed as a risk and a restraint. Manual handling risk assessments were in place and a variety of equipment was available to meet the assessed needs of people living at the home. Care planning was based on a core care plan model. The one major defect with the care plans was that cognitive impairment was not acknowledged or planned for. Therefore people with dementia did not have their strengths or weaknesses incorporated into the care planning process. Instances of challenging behaviour were only recorded in the daily records, therefore challenging behaviour and its consequences was not being monitored or planned for in a proactive way. This means that future steps to reduce challenging behaviour or its effects could not be determined. There was however good evidence to demonstrate that changes in behaviour did prompt staff to ascertain first whether these were due to physical changes such as infections. People who live in the home have access to a range of Health and Social Care professionals. Care records contained detailed information of visits from these professionals and their outcomes. We were accompanied by a nurse from the tissue viability service and this led to a referral to this service for specialist advice. Medication management within the home requires further work. The medication room door was observed to be unlocked on both days we visited the home. This is concerning as the medication fridge was unlocked and the medication trolley was not secured to the wall in this room therefore medication was accessible to both people who live at the home and visitors. The medication trolleys were clean and tidy Care Homes for Older People Page 14 of 32 Evidence: therefore allowing for ease of access to find drugs. The medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by a dispensing pharmacist. The home has copies of the original prescription (FP10s) but these were not being used to check in that months medication when it entered the home. It was brought to the trained nurses attention that in one instance an original prescription dispensed by the GP had different quantities to what was received in the home. A small random audit of medications was carried out by us and the majority of these audits were correct. Returns were not always being recorded in the returns book therefore medication could not be audited or accounted for. The medication quantity of one person who had recently been admitted to the home had not been recorded and therefore again could not be audited. The home also needs to seek guidance on the suitability of administration of medication via the PEG (Medically assisted) route. One persons room visited contained a number of prescribed and non prescribed creams which were not recorded on the MAR chart. These needed to be removed from the room so as to ensure that they are not administered inadvertently. The medication room was warm but the exact temperature was not known. The home must monitor the temperature of the room to ensure it does not exceed 25c as this compromises the stability of the medication stored in the room. Staff at the home were monitoring the temperature of the fridge to ensure medication stored in here was held at the right temperature. The home has links with the local hospice. Staff have not received any training in terminal illness. The manager confirmed that staff would be receiving training in end of life care. This training is vital to ensure that staff have the up to date skills and competence to provide care. Care Homes for Older People Page 15 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. A nutritionally balanced menu is available but there is limited choice meaning people who live at the home do not experience a variety of different foods. Activities are provided but need to reflect to the needs of residents. Evidence: Visiting was flexible enabling people to visit at a time that suited them so that people living at the home can maintain contact with family and friends. Families informed us that they were invited to come and spend Christmas with their relative in the home if they wanted to. Relatives also informed us that they could have a meal with their family member if they wished and that tea and coffee was always available. There was no evidence of rigid rules or routines in the home and people who live there can go outside on their own or with friends and family as they choose, depending on their ability. Relatives stated can come and go as please and have stayed over night if ...has been ill. This ensures that people living at the home and their relatives can maintain strong links. The home has an activities co-ordinator who works 24 hours per week. Activities are Care Homes for Older People Page 16 of 32 Evidence: recorded in the persons care plan. Activities are mainly group orientated but due to the high percentage of people living at the home with cognitive impairment these activities need to be reviewed. The activities co-ordinator has attended a one day course to help them meet the needs of people who live at the home. Activities marking special events were not taking place such as Bonfire night and Saint days. This was discussed with the manager. Whilst some aspects of marking these specific days might be problematic the home needs to explore ways of marking these annual events. By marking different periods of the calendar year with events this provides stimulation and interest for people living at the home. Breakfast is served in peoples bedrooms. People who live at the home go to the dining room for their main lunchtime meal. The lunchtime menus are on a two week menu cycle. Teatime meals are on a one week rota. There was evidence of Asian and AfroCaribbean meals being prepared for people who lived at the home. Specialist diets are catered for which included pureed, diabetic and high calorie diets. The catering team did not know which people living at the home were diabetic but stated that care staff did and that the food prepared was no different for those with diabetes. No fresh fruit was observed in the home. On the first day of the inspection visit the lunchtime choice for people living at the home was beef or beef burgers. Catering staff confirmed that bananas were occasionally available but no other fresh fruit. Food to mark special occasions or days was not being catered for with the exception of Christmas. Relatives spoke positively about the food provided for people living at the home during the Christmas period. Choice of food was therefore available but limited. Comments received about food from a number of sources were varied from tasteless to food quite nice. At the lunchtime on the first day of our visit care staff were observed to be chatting to each other whilst assisting persons who live at the home with their food. This is not good practice and is distracting for those people with cognitive impairment who should be talked to whilst being assisted as this helps prompt then to remember to eat. Care Homes for Older People Page 17 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. Peoples concerns are listened to and acted upon. The arrangements for safeguarding are not comprehensive and therefore potentially place people at risk. Evidence: The home has a complaints procedure that is available enabling people to raise concerns where necessary. The complaints procedure is only in one format and not accessible to all people living or using the service. The home has received two complaints since the last inspection. One was sent to them directly from the complainant and the other was forwarded from the Commission. Both were responded to according to the homes policy and procedure. Relatives confirmed that they were able to approach the manager with concerns and these were dealt with appropriately. There have been three safeguarding referrals since the last inspection. All contained the same element in relation to care practice. Training in the staffing section of the report for further information. A random sample of five staff training records were looked at during the inspection but only one of the five had received training in safeguarding (adult protection). Care staff spoken to confirmed they had not received training but thought it may have been covered in their NVQ training. Staff knowledge in relation to the procedure for referrals was mixed and all staff need to be sure of their role in protecting and promoting the Care Homes for Older People Page 18 of 32 Evidence: well being of people in their care. Staff have not received training in relation to the Mental Capacity Act. They have worked with other professionals to ensure people who live at the home have their rights and risks such as an Independent Mental Capacity Advocate (IMCA). Whilst this is positive staff still need training so that they are aware of their responsibility in supporting people who lack mental capacity to make decisions. It is concerning as this legislation has been available for some time and a significant number of people living in the home have some form of cognitive impairment. The home will need to make arrangements for the mental capacity act when it becomes active legisaltion from 1 April 2009 Care Homes for Older People Page 19 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. Some improvements are needed in the environment to ensure that it is suitable to meet all the needs of the people living there. Evidence: The home is split into three sections. There are a number of communal areas around the home, which consist of three lounges and one dining room. Bathrooms and toilets are positioned conveniently around the corridors and have specialist equipment in them to support people with their mobility. At the last inspection issues were raised with regards to the malodour in some peoples bedrooms. The floor covering has been replaced in a number of areas around the home and this appears to have resolved the problem. All bedrooms have en-suite facilities consisting of a toilet and wash hand basin. Bedrooms are personalised and people are able to bring in their own possessions to reflect their taste and interest. Bedrooms visited were clean and tidy. All bedrooms doors have suited locks. The home needs to consult with those organisations that specialise in promoting good practice in dementia care as at present the decoration of the home does not aid Care Homes for Older People Page 20 of 32 Evidence: orientation. The homes laundry is located on the ground floor. The laundry has the necessary equipment to ensure that peoples clothes are laundered appropriately. Once clothes are laundered they are returned to the person bedroom. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home are not always supported by suitably trained staff. This could have an impact on peoples health and well being. Evidence: At the time of the inspection there were forty three people living in the home. The duty rota indicated that there was a least two trained nurses throughout the day with six care staff on duty of a morning and an afternoon. Night cover consisted of one trained nurse and three care staff. In addition to this there are domestic and catering staff. The manager for the majority of shifts is rostered as supernumerary. The home has a bank and uses agency staff to cover vacant shifts. There is a stable group of staff with a low staff turnover, which provides continuity of care to people living at the home. Recruitment records sampled however showed that the checks had not been robust for example staff had commenced employment at the home on Criminal Record Checks carried out by another employer whilst the home awaited the result of a check they were processing. The manager was advised to consult the CSCI website for guidance on this matter. The home has only recruited three new members of staff since its previous inspection visit. We were given a copy of the induction booklet. The induction programme Care Homes for Older People Page 22 of 32 Evidence: requires further work to ensure it meets the Skills Care Standard. Staff have individual training records kept in their personal files therefore we looked at five staff files to ascertain what training had occurred. The Registered Manager is providing manual handling training at present for staff but there has been slippage in the number of staff that are currently up to date with this training placing both staff and people living at the home at risk. Of the five staff sampled two had not received training. Records indicate that over eighty percent of care staff had completed NVQ 2 training or above in care. This training improves staff knowledge and skill and leads to improved outcomes for people living in the home. Care Homes for Older People Page 23 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 home is not always well managed or run in the best interests of the people living there. This lack of good managment could compromise peoples care. Evidence: The management team consist of the registered manager and administrator. The manager is experienced and has recently attended two clinical nursing courses to keep up to date with current practice. The management office was located at the front of the building near to the front entrance and this provides the opportunity for people living in the home and visitors to access them easily as there was an open door policy and this was observed during the inspection. Meetings with people living in the home and their relatives was not taking place however relatives confirmed that the manager was always accessible and that she was available one evening a week in the home for anyone who could not make the standard administration working hours of the home. Care Homes for Older People Page 24 of 32 Evidence: The manager is being supported by the team working in the home however there has been slippage in a number of areas such as staff training and supervision. The AQAA submitted to us prior to the inspection identifies that the employment of a deputy manager would benefit the smooth running of the home on a day to day basis. A quality assurance system is in place. A quality assurance folder was seen in reception area of the home. The quality assurance information read like a summary of intention not what had been found and how this would be used for improvement. The folder also contained also a statement that all staff have received training in Adult protection training which is updated regular Our evidence suggests this is not so and that the majority of staff have not received this training. Questionnaires were in the reception area for relatives or visitors to complete. Supervision is not taking place for staff on a regular basis. Staff were able to demonstrate an awareness of equality and diversity issues. Prior to the inspection an Annual Quality Assurance Assessment was completed. The document gave us all the information we asked for and was returned in a timely manner. It did not however reflect our findings at this inspection in a number of instances for example the AQAA stated, our medication audits prove we comply with pharmaceutical guidelines regarding administration, receiving and disposal of medication. See health and personal care section for concerns about this. Another example Supervision undertaken regularly with documentation of proof we did not find this as stated above. Personal finances of people living at the home were discussed with the care manager. A small sample of money held by the home for people was audited. Money is held in individual wallets with records and receipts to demonstrate transactions. A sample of records in relation to servicing and checking of equipment were inspected to determine health and safety systems in the home and they were found to be up to date e.g. Gas safety certificate, fire equipment and electrical hardwiring. These were found to be satisfactory with the exception of the fire panel which did not pass inspection in September 2008. The home will need to forward evidence to demonstrate these issues have now been rectified. Care Homes for Older People Page 25 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 26 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 9 13 All medicines must be stored 13/02/2009 in compliance with their product licence, the medication room temperature must not exceed 25c This will ensure that medication will be stable 2 9 13 All medicines must be stored 13/02/2009 correctly in accordance with their product licence. This will ensure that the medications stability is not compromised. 3 9 13 .The prescription must be checked prior to dispensing the medication and to chekc the dispensed medication and the medicine charts against the prescription accuracy. All discepancies must be addressed wiht the healthcare professional To ensure that people living at the home received the 13/02/2009 Care Homes for Older People Page 27 of 32 correctly prescribed medication at the correct time. 4 18 13 Staff need up to date training in safeguarding. This will ensure that staff are aware of their role and how to promote and protect the well being of people living in the home. 5 29 19 All staff working at the home 28/02/2009 must have a CRB clearance check carried out prior to commencing work. This will ensure the safety and well being of people living at the home. 6 30 18 Staff must have an induction 28/02/2009 that is equivalent to the Skills Care Standards program This will ensure that staff have the skills and competences to meet person living at the home needs. 7 30 18 Staff must have manual 30/03/2009 handling training every year. This will ensure that staff and people living at the home are protected from any potential harm whilst being transferred. 8 30 18 Staff who have not received training in safeguarding and mental capacity must receive this. 30/04/2009 30/03/2009 Care Homes for Older People Page 28 of 32 This will ensure that people living at the home have their rights and risk protected and promoted. 9 36 18 Staff should receive supervision which is documented at least six times a year. This willl ensure that staff are appropriate supervised to meet the needs of people living in the home. 10 38 13 A certificate is required to demonstrate tha tthe fire panel is in correct working order. This will ensure that everyone in the home has their safety protected in the event of a fire by a working fire panel system. 13/02/2009 30/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Registered Person must ensure that the Service User Guide includes all relevant information in a accessible to people so that they can make an informed choice. Not fully implemented from October 2007 key inspection The Pre admission assessment should contain sufficient information to ensure that no one is admitted to the home with out all their needs being assessed. Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessible to the staff delivering the care and be a reflection of the care given. Care plans must be reviewed and amended at the point where a person needs change or routinely and staff must be aware of these changes. Page 29 of 32 2 3 3 7 Care Homes for Older People 4 8 Turn chart must be put in place to demonstrate how frequency a person deemed at risk has their position changed to relive pressure. Continence assessments must be reviewed and should look at cause not symptoms. From the establishment of the cause then the staff at the home should implement the correct promotion of continence programme. It is recommended that all unwanted medication is recorded in the returns book so that staff are able to demonstrate a clear audit trail. It is advised that the home installs a new system for cream management that means staff dispensing the precribed creams have a MAR chart in the persons bedroom and that staff who dispense the cream sign this chart. All creams that are no longer prescribed should be removed from the bedrooms to reduce any chance of error. Activities that mark special occassions and calendar dates should be introduced to the home so that variety from everyday experience means a more stimulating and fulfiling outlook for people living at the home. Activities should be reviewed to met people needs taking into account past lifes, experiences, expectations and any level of cognitive or physical impairment. Menus and quality of meals needs to be reviewed to ensure it allows people a choice and mets their likes, dislikes and expectations. It is recommended that the home obtain a copy of Department of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training so that staff are aware of their responsiblity and peoples rights are protected. The home should assess the decoration and signage around the home for the high number of people living in the home with cognitive impairment. It is recommended that an audit of all staff training is carried out and that any identified deficits are planned for. Staff should receive training in dementia care to ensure they have the skills, knowledge and competence to meet peoples needs. A review of the quality assurance system is needed to ensure that the home is run in the best interests of people living there. This should include an analysis of how the the data is collected and how this informs the actions for improving the quality of care provided to people living in 5 8 6 9 7 9 8 12 9 12 10 15 11 18 12 19 13 14 30 30 15 33 Care Homes for Older People Page 30 of 32 the home. An action plan should be drawn up from this quality assurance process with timescales as to when things will be achieved and who is responsible for achieving these. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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