Inspection on 09/04/09 for Crown Meadow Care Centre

This inspection was carried out on 9th April 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crown Meadow Care Centre 08/06/10

Crown Meadow Care Centre 18/03/10

Crown Meadow Care Centre 24/05/07

Crown Meadow Care Centre 25/09/06

Crown Meadow Care Centre 27/02/06

Crown Meadow Care Centre 29/07/05

Crown Meadow Care Centre 16/11/04

Crown Meadow Care Centre 26/05/04

Crown Meadow Care Centre 11/02/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB     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: Ann Farrell     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB 01215200700 01215578279 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Southern Cross Care Centres Limited care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 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) 35 Date of last inspection Brief description of the care home Crown Meadow Nursing Home provides nursing care for up to 35 people who are over 65 years of age. The home is situated on a main road close to Great Bridge, Tipton and other local shops and amenities. The property is a purpose built three-storey building with parking to the front and garden at the rear of the property with patio and seating that can be used when the weather permits.. The home consists of 31 bedrooms, 4 of Care Homes for Older People Page 4 of 32 Over 65 35 0 Brief description of the care home which are doubles and all have en-suite facilities. There is a large lounge/dining room on the ground floor fronted by a conservatory, which forms the entrance of the home plus a small quiet lounge on the first floor. Bedrooms are located on all floors and there is a hairdressing salon and staff room on the second floor. There are two passenger lifts giving access to all areas of the home and there is one assisted bathroom that is suitable for people with mobility problems on each floor; showers are also available in most bedroom en-suites. Information in the form of a welcome pack and service user guide were available in the reception area, so people had access to information about the services and facilities availaable in the home. The notice advised people to ask for a copy of our latest inspection report if they wished to see it. The information available did not include the range of fees and people will need to discuss this with the manager at the time of making enquiries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs and and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 21st May 2007 and the home was given a 2 star quality rating. An annual Service Review (ASR) was completed on 12th June 2008. The Annual Service Review process does not include a visit to the home, but information is obtained from various sources in order for us to make an assessment as to whether there have been any changes in the service since the previous key inspection and at the time information indicated there were no significant changes to suggest a visit was required. This inspection found the home provided adequate outcomes for people and a further key inspection will be undertaken within one year. Care Homes for Older People Page 6 of 32 Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. One inspector undertook the fieldwork visit over one day. The manager was available for the duration of the inspection. The home did not know that we were visiting on that day. At the time of inspection thirty two people were living in the home and information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection five people who live in the home, two visitors and five staff were spoken with in order to gain comments. The feedback was generally satisfactory and included comments such as, The staff are alright they do what they can; The food is good and they were very enthusiastic about the activities with the activities co-ordinator. There was an established staff team with a low staff turnover, so staff were aware of peoples needs. However, there were areas that need to be reviewed and developed to ensure peoples needs are met and these have been identified in the section below (What the service could do better) The inspector would like to thank the manager, people who live in the home and the staff for their hospitality throughout this inspection. What the care home does well: What has improved since the last inspection? What they could do better: The manager needs to consult with people about the service user guide and make changes necessary to ensure the information is up to date, relevant and informative to people moving into the home. The care planning process needs to be developed in order to provide documents that are easily accessible to staff and provide a person centered approach to care, so staff have the information they need to meet peoples individual needs. Arrangements for regular visits by health professionals should be in place and records maintained. The manager should discuss the follow up and monitoring of chronic diseases with medical professionals to ensure peoples health and well being is maintained to optimum levels. The medication systems needs to be more robust to include the correct storage, handling and administration of medication, so medication is stored properly and people receive medication prescribed to them that is within the manufactures product information. Care Homes for Older People Page 8 of 32 Systems should be in place to ensure the correct moving and handling procedures and pressure relief are in place to encourage/maintain peoples independence, reduce the risk of injury and any complications arising. A system for checking the rubbers on walking frames regularly should be in place to ensure they are safe to use and reduce risks. Care staff would benefit from training in respect of clinical areas such as health conditions; tissue viability etc. so they have the knowledge and understanding to meet peoples needs effectively. People living in the home who smoke would benefit from an appropriate facility to smoke, so their individual needs are met. Systems should be introduced to record informal complaints and concerns to ensure a pro-active approach and demonstrate continuous development and improvement in the home. Systems should be in place to ensure all staff have a knowledge and understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards commensurate with their position to ensure they are aware of how to support people who lack capacity. A review of staffing levels should be undertaken and action taken to ensure there are adequate staff on duty at all times to meet peoples needs using a person centered approach in a timely manner. Systems should be in place to ensure at least two references are in place and available for inspection plus regular checks of nurses registration numbers in order to safeguard people living in the home through robust recruitment and retention procedures. Management should review arrangements for meetings with staff, people living in the home their relatives to ensure good systems for feedback and communication, which can feed into the quality assurance process and enhance outcomes for people living in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information made available to people before they move into the home requires updating, in order to assist them to make an informed decision about moving into the home. Peoples needs are assessed before they move in, so staff have the information required to meet their needs initially. Evidence: The home has a welcome pack and service user guide available in reception, which provides information about the services and facilities in the home. It states the service user guide is also available in audio cassette form if required, so that it is accessible to people with sight problems. Copies of the service user guide were also available in each persons bedroom for reference purposes. On inspection we found the document did not provide up to date details in respect of our name, address and contact details; also the section on the customer feedback did Care Homes for Older People Page 11 of 32 Evidence: not indicate when the feedback was obtained. Although the document gave a range of information, their own quality assurance process identified people did not find the service user guide helpful. It is recommended that further feedback be sought from people to determine how it could be improved in order to make it more useful to them. It should then be updated to reflect the changes and suggestions made. The home provides care for people who require long term or respite care. People can visit the home before moving in, so they can view the facilities, meet staff and other people who live there in order to sample what it would be like to live there. The people who were spoken with stated their relatives had visited on their behalf or they were aware of the home from visiting other people before moving in. Staff undertake a pre-admission assessment for all people before they move into the home to determine if their needs can be met appropriately. On inspection of the records for two people who had moved into the home recently it was found that staff had completed a satisfactory assessment and they had obtained copies of assessments from social workers. The assessment completed by staff from the home did not indicate if the person or their relatives had been involved in the process to ensure a person centered approach. The staff draw up a pre-admission care plan based on the assessment ensuring staff have sufficient information initially to meet peoples needs following admission to the home. Following admission to the home there is a trial period of one month and a review is held at the end of the month with the person, staff and any relevant others. This provides an opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. 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. The systems in place for planning peoples care and meeting health care needs requires further development to ensure a person centered approach. The medication system needs to be more robust to ensure people receive medication that is prescribed for them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of their needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, nutrition, skin etc. for all the files sampled. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being is promoted. Care Homes for Older People Page 13 of 32 Evidence: Following admission to the home staff undertake a further assessment and provide more detailed care plans. The manager stated in the AQAA that they were now developing person centered plans for individuals. The files were found to be large documents with lots of information and care staff stated they did not generally use them, but relied on verbal information from the nurses. Although verbal information is very important care plans should contain all the information to ensure peoples needs are met and provide consistency. Some of the comments in care plans were vague and some areas were repeated. Generally it was found that the planning of care was inconsistent and therefore we could not be certain that each person had plans of care that were up to date, accurate and addressed their needs. The daily records completed by the nursing staff generally gave information about aspects of personal care, which had also been recorded by care staff on charts in peoples bedrooms. The information lacked detail about peoples health, social and psychological welfare. This was discussed with the one of the nurses and it should be reviewed to ensure more meaningful record keeping. Some care plans did not give information about aspects of care, but referred to other documents e.g. in one case it referred staff to an instruction booklet for details about a pacemaker. In another staff had to refer to dietitian recommendations about feeding by a tube into the stomach (PEG). Also the care plan gave no details about the care of the person during feeds, care of the feeding tube and the arrangements for administration of medication etc. All these areas should be clearly documented as this could result in poor care practices and evaluation of care may not be accurate. Moving and handling risk assessments were in place and in one case it stated the person could not weight bare, and to use a standing hoist. This is not appropriate as a standing hoist should only be used when a person can weight bare. In another case the stand aid was used to transfer a person from a chair to a wheelchair and they could walk with the aid of staff. This does not enable them to maintain abilities and develop their confidence. Staff were also observed using inappropriate handling technique when assisting someone to transfer. Manual handling procedures and support for each persons mobility needs to be reviewed to ensure they achieve their potential and the correct equipment and techniques are used. One person had been identified at risk of pressure sores and falls. A pressure relieving mattress was in place, but the care plan did not provide details of this or the management, frequency or techniques used for pressure relief. There was no evidence of a pressure relief charts and it was observed that the person sat in a wheelchair all Care Homes for Older People Page 14 of 32 Evidence: morning at the dining table. We also saw other people sitting at the dining table in wheelchairs from the time of rising for breakfast until lunchtime without pressure relief. This raises concerns about pressure relief, mobility, lack of stimulation/activities and it could be seen as a form of restraint. During the course of the morning it was noted the some people did not get up until 11am at which time they had breakfast. One person stated they had been awake for hours waiting for staff to come to them, as they needed help getting up. Others stated, The staff do their best, but indicated that they had to wait for assistance and some appeared reluctant to use their call bell. Lunch was served at 12.30. and if people eat breakfast very late it could impact on peoples appetite and dietary intake. The manager will need to review this area. During the inspection it was noted that the rubbers on a persons walking frame was worn, which could put them at risk of falls. A system should be developed for checking walking frames and action taken to replace any worn rubbers. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP is in agreement). There was evidence of visits by the GP plus other health and social care professionals such as nurses, social workers, chiropodist and optician. However, the records did not confirm that visits by chiropodist, optician and dentist were occurring regularly. On discussion with the manager about monitoring of chronic diseases she stated one person was attending the renal unit and it would be followed up there, but there was no evidence of this. Such follow up ensures peoples health and well-being. The manager will need to follow up this area with health professionals and take action where appropriate to ensure peoples well being is maintained and clear records should be retained in the home. On discussion with care staff they had a basic knowledge of peoples needs, but lacked information about conditions and why certain practices were followed. It is recommended that care staff be provided with training in these areas, so they have a good understanding, so peoples needs are met effectively. Feedback from people living in the home was satisfactory about the care being provided. Staff were generally observed to communicate well with people. Comments from people living in the home included; Staff are alright, they do what they can. Its alright here. I am looked after OK. The homes medication system consisted of a blister and box system with printed Care Homes for Older People Page 15 of 32 Evidence: Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Medication was stored in locked cupboards in a locked room with the exception of new medication entering the home and medication that had been destroyed. These should also be stored in locked cupboards to comply with regulations and ensure safety. It was also noted the medication trolleys were not secured to the wall as required for safety purposes. On inspection of the medication for the current month it was found that audits for blistered medication were correct but the audits for boxed medication were not correct or could not be audited due to lack of information. The manager was unable to locate the previous MAR charts, in order to make further checks. Therefore the system was not robust. One persons care plan stated to use barrier cream and there was no barrier cream prescribed on the MAR chart. The details of one persons medication had been hand written by staff on the MAR chart and this had not been signed by any member of staff to ensure it was correct. A member of staff was seen handling medication in their hand. This was drawn to their attention, as it is poor practice. A requirement was made at the last inspection to ensure medication was stored at 25 degrees or below. Temperature recordings showed that the room was above this at times. An assessment of this should be undertaken and appropriate action taken to ensure the temperature is maintained within recommended limits during the summer months. The nurse was observed to be giving the morning medication when people sat at the dining table to have their breakfast. Care must be taken as this means that some morning medication is not given until after 11am and then afternoon medication is given after lunch at approximately 1pm. There should be at least four hours between medications. Also it was noted that insulin injections were given when people were sitting at the dining table for breakfast, which impinges on peoples privacy and dignity. The service user guide indicates that a telephone is available if people wish to make a call and people can have one installed in their bedrooms to enable them to communicate with friends and relatives in private if they wish. Lockable storage facilities are available in bedrooms for the storage of valuables/medication etc. if people wish. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the opportunity to lead an active life and maintain their relationships and friendships. There are some restrictions due to availability of staff. Meals are of a good quality and meet peoples needs. Evidence: Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. There was good interaction between staff and visitors making them feel welcome. This was confirmed on discussion with people who were visiting the home. Comments included; Its lovely, we are here most days. I can come when I want and staff are friendly. Bedrooms were individualized and personalised according to peoples wishes. They are able to bring personal items of small furniture, pictures, ornaments etc. so providing a home from home atmosphere in their bedrooms. There is a four-week rotating menu, which told us that there was a variety of nutritious meals and people living in the home confirmed that they are offered a choice each day. Special diets can be arranged for reasons of health, taste and cultural/religious preferences and some special diets were being catered for at the time of inspection. For people who get up late there is only a short period between breakfast and lunch, this may impact on their Care Homes for Older People Page 17 of 32 Evidence: appetite and therefore their nutritional intake. The manager should review this area. The dining tables at breakfast and lunchtime were nicely laid with linen tablecloth and condiments. Comments from people living in the home about the meals included; The food is good The food is good, you get a choice and plenty to eat You dont go to bed hungry Although there is choice in some areas, there are areas where choice is restricted due to staff availability, such as getting up, going to bed, and going out. People living in the home who required assistance stated they had to wait for staff to come and help them in order to get up and go to bed, therefore they could not always choose a time that suited them. This area will need to be reviewed in order to provide a person centered approach An activities co-ordinator is employed Monday to Friday afternoons and there were a variety of activities on offer in order to stimulate people. They included a George Formby afternoon, St Patricks Day celebration, flower arranging, auction, bingo, arts and craft, reminiscing, hands and nails pampering, etc. On day of inspection skittles were played in the afternoon and there were a range of Easter bonnets in the reception area ready for the Easter bonnet parade the next day. The activities co-ordinator was very enthusiastic and produces a monthly newsletter for people living in the home and their relatives. She stated there were meetings with relatives and fund raising activities were taking place in order to fund other activities enhancing peoples life. The activities co-ordinator stated that funds had been used to buy equipment, as there was no equipment when she started the job and currently they are planning a day out with a trip to the zoo. People living in the home were enthusiastic about her and stated Shes great- I get bored when she is not here The hairdresser visits on a regular basis enabling people to have their hair tended to professionally if they wish, which enhances self-esteem. Religious needs are met with regularly visits from clergy and some people go out to church. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place so people are protected from harm. Evidence: A complaints procedure was on display in the reception area and in the service user guide. A copy of the service user guide was in each persons bedroom advising him or her of the procedure if they wished to raise any concerns. However, the service user guide needed to be updated to ensure people had up to date information and contact details of who to raise concerns with if needed. On discussion with people living in the home they were not aware of the procedure, but stated they would raise concerns with the manager. There is a complaints book where staff record any complaints and two had been recorded since the last inspection. One was from us in relation to odour in the home. This had been responded to promptly and action taken to ensure there were no further re-occurrences. One was from another outside organisation and staff had responded to it appropriately. There was no record of any complaints/concerns in the home. This could suggest the staff only record formal written complaints and concerns are not recorded anywhere. It is recommended that suitable systems be developed to record informal complaints and concerns and action taken in order to demonstrate a pro-active approach and continued improvement. Records indicated that most staff had undertaken training in respect of safeguarding Care Homes for Older People Page 19 of 32 Evidence: and on discussion with members of staff they had a satisfactory knowledge of the procedure within the home. They had some general knowledge about the whistle blowing procedure, but there was no evidence of training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards. Systems will need to b put in place to ensure staff have the knowledge, commensurate with their position, of these pieces of legislation, so they are aware of the procedures for supporting people who lack capacity to make decisions and are kept updated with recent legislation. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and comfortable environment Evidence: The home is a detached three-storey building with adequate off road parking to the front of the building for visitors. The exterior is very well maintained and is on a main bus route close to local shops and amenities. A partial tour of the home was undertaken and it was found to be warm, clean and maintained to a good standard. Decoration, floor coverings and furnishings were of a good quality. The main kitchen was clean, well located and well equipped for its purpose. There was one large lounge/dinning room with a conservatory to the front forming the front entrance, plus a small quiet lounge on the first floor providing a choice of areas to sit. There are twenty-seven single bedrooms and four double bedrooms with en-suit toilet and shower facilities, so enhancing arrangements for privacy. A call bell facility was available in each bedroom, so people can call for assistance if required. Bedroom doors were lockable, which staff can access in an emergency and lockable facilities were available in peoples bedrooms to store thier valuables etc. enhancing arrangements for privacy. Care Homes for Older People Page 21 of 32 Evidence: There are people living in the home who smoke, but there is no facility in the home and they have to go outside into the garden in order to smoke. When this was raised with the manager she stated she had obtained a quote for a shelter, but had been told it was too expensive. A senior manager present at the time stated that she would authorise it, so that people would have an appropriate place to smoke their cigarettes. There was one assisted bathing facility on each floor and three separate toilets on the ground floor within easy access of the lounge/dining room. Corridors have handrails fitted for use by people with mobility problems and two passenger lifts enable people to access all areas of the home. The home has a small garden to the rear, which has seating and tables for use by people and their visitors, when the weather permits. There is a laundry, which was well organised. Gloves and aprons were available for staff use, so reducing the risk of cross infection. Care Homes for Older People Page 22 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. Satisfactory recruitment systems are in place for employing new staff, ensuring people are protected. Further staff training is required in some areas and staffing levels need to be reviewed to ensure individuals needs are met in a person centered manner. Evidence: The manager works on a full time basis and is supported by a nurse on each shift, some of whom are bank staff working two to three shifts a week. The duty rota indicated there were at five care staff and one nurse during the morning, one nurse and four care staff in the afternoon and one nurse and two care staff overnight. From the rotas seen this was usually achieved with the exception of two days due to sickness. At the time of visiting there were thirty two people living in the home and the information provided indicated that everyone needed assistance with washing/dressing plus at least half of them required two staff for assistance during the day and night. A number of people did not get up and have breakfast until late and some had been awake for several hours, others independence was not encouraged and some people remained sitting at the dinging table from the time of getting up until lunch time without pressure relief. This suggests that there is not enough staff on duty during the morning to meet peoples individual needs and provide a person centered approach. A Care Homes for Older People Page 23 of 32 Evidence: review of staffing levels must be undertaken and appropriate action taken to ensure everyones individual needs are met in a timely manner. Ancillary staff such as domestic, laundry, catering, administration and maintenance staff support care staff. On discussion with people living in the home they voiced no complaints, but indicated that they were worried about using their call bell. They stated, The staff are alright they do what they can. The manager does help the staff. The recruitment procedure was generally satisfactory from the sample of recruitment files seen. Protection of Vulnerable Adult checks (POVA), written references and risk assessment had been completed before the employee began work whist waiting for a Criminal Bureau Check. This ensures people are protected from the risk of having unsuitable staff work in the home with them. However, it was noted that one person only had one reference available and checks on nurses registration was not up to date. Following employment new staff undertake the homes induction training. There is also a rolling programme of basic training provided by an in house trainer that included fire safety, manual handling, health and safety, food hygiene etc. Records indicated that 50 of care staff had completed NVQ level 2 training in care. This training ensures staff have the appropriate skills and knowledge to care for people living in the home. As identified in other parts of the report training should be given in respect of the Mental Capacity Act, Deprivation of Liberty Safeguards and conditions affecting people living in the home. This will improve staff knowledge and benefit people living in the home. Care Homes for Older People Page 24 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. Systems are in place to ensure the health and safety of people living in the home. Some areas in respect of health care and staffing levels need to be reviewed and action taken to address shortfalls in order to improve outcomes for people. Evidence: The manager is a registered nurse, with many years experience, who has completed the Registered Managers Award and is registered with us. The quality of the service is monitored via a number of systems within the home, which includes regular audits of various aspects by the manager and senior managers. It was stated there were regular manager surgeries providing an opportunity for people to meet with her outside normal hours, but there was no record of these. Meetings with staff plus meetings with people living in the home and their relatives were held intermittently and minutes were available. The manager stated the meetings with relatives were not well attended and it was recommended that alternative methods should be sought to improve feedback and discussion with them. Care Homes for Older People Page 25 of 32 Evidence: A senior manager undertakes monthly regulation 26 visits; validation audits are undertaken alternative months by a senior manager and surveys are sent to people living in the home about various aspects annually. The manager showed the result of some resent surveys and an action plan to follow up on any areas identified. This process provides opportunities for monitoring the home in various areas and action to be taken to provide improvement. As identified earlier in the report some areas in respect of health care, moving and handling, medication and staffing levels need to be reviewed and action taken to address shortfalls, so that outcomes for people living in the home are improved. Small amounts of money are held on behalf of people living in the home and they have bank accounts where appropriate. The manager stated she did not act as appointee or agent for any one living in the home. The systems in place for the safekeeping of peoples money appeared to be robust and it was stated that a senior manager undertook regular audits to ensure peoples money was well managed. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed. The document gave brief information only about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. There are systems in place for servicing and maintaining equipment to ensure the health and safety of people living and working in the home. A sample of records were inspected and they were found to be satisfactory. Maintenance checks had been completed on the fire system and equipment, so that people are safe in the event of a fire occurring. Checks were made on hot water outlets to ensure it is maintained at a satisfactory temperature to prevent scalding. Care Homes for Older People Page 26 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 27 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 Systems must be in place to ensure the correct manual handling procedures are used at all times. To ensure the safety of people living in the home. 09/05/2009 2 8 13 A system for checking all walking frames must be implemented. To ensure they are safe for use. 09/05/2009 3 9 13 The temperature of the medication room must be maintained at 25 degrees or below. To ensure the safe storage of medication. 09/05/2009 4 9 13 All mediction must be stored 28/05/2009 in locked cupboards and trolleys must be secured to the wall when not in use. Care Homes for Older People Page 28 of 32 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 To ensure the safe storage of medication. 5 9 13 All handwritten medication must be countersigned by two members of staff. To ensure safe practices within the home. 6 9 13 There must be a robust 09/05/2009 medication systems in place to include the accurate administration and recording of all medication given to people. To ensure people receive the medication prescribed for them. 7 28 18 A review of staffing levels 09/05/2009 must be undertaken and action taken to ensure there are sufficient staff on duty at all times. To ensure peoples needs are met in a timely manner. 8 29 19 Two satisfactory references 09/05/2009 must be obtained for all staff before they commence employment in the home. To ensure people are protected by the recruitment procedure. 09/05/2009 Care Homes for Older People Page 29 of 32 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 Staff should consult widely about the content of the service user guide and then update it to provide a document that is up to date, useful and user friendly for people moving into the home and their relatives/representatives. Daily records completed by nurses should be meaningful and include details about peopls health, social and psychological welfare, so can be monitored. All care plans must be up to date, person centered and provide detailed information about the action required by staff to meet peoples needs to ensure consistency in care. Arrangements for pressure relief and maintaining/encouraging peoples mobility should be reviewed and suitable systems put in place to ensure people maintain their abilities and complications are prevented. It is recommended that staff are provided with training in respect of health care topics, tissue viability, etc. to ensure staff have a greater understanding of peoples needs improving outcomes for people living in the home. Systems must be in place to ensure everyone has the opportunity of regular visits by health professionals. Advise should be sought about monitoring of chronic diseases such as diabetes, high blood pressure etc. to ensure peoples well being and all details must be recorded to demonstrate this. A review of arrangments for the administration of insulin should be undertaken to ensure peoples privacy and dignity is resepcted at all times. A review of morning medication procedure should be undertaken and any necessary action taken to ensure medication is given at appropriate intervals to ensure appropraite medication levels are achieved. A system for recording informal complaints or concerns with any follow should be implemented to ensure a proactive approach and continued improvements. Systems should be in pace to ensure all staff have a knowledge and understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards, so they they are aware of current legislation and and know how to support people who lack capacity, commensurate with their role. Page 30 of 32 2 7 3 7 4 8 5 8 6 8 7 9 8 9 9 16 10 18 Care Homes for Older People 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 11 12 19 33 It is recommended that suitable facilities are provided for people who smoke. A review of the arrangements for meetings with staff, people who live in the home and their relatives should be undertaken and action taken to ensure good systems of communication that can feed into the quality assurance process. 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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