Inspection on 22/09/09 for Daisy Bank Nursing Home

This inspection was carried out on 22nd September 2009.

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

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

Other inspections for this house

Daisy Bank Nursing Home 23/12/09

Daisy Bank Nursing Home 02/10/07

Daisy Bank Nursing Home 13/10/06

Daisy Bank Nursing Home 20/12/05

Daisy Bank Nursing Home 02/08/05

Daisy Bank Nursing Home 08/03/05

Daisy Bank Nursing Home 07/09/04

Daisy Bank Nursing Home 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Daisy Bank Nursing Home c/o Jackson, Dyson & Blundell 17-19 Leek Road Cheadle Staffordshire ST10 1JE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clowes     Date: 2 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Daisy Bank Nursing Home c/o Jackson, Dyson & Blundell 17-19 Leek Road Cheadle Staffordshire ST10 1JE 01538750439 01538750439 daisybankcheadle@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Classic Care Homes Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 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) 32 Physical disability - over 65 years of age (PD(E)) 6 Dementia - over 65 years of age (DE(E)) 4 Date of last inspection Brief description of the care home Daisy Bank is a care home providing personal care including nursing care for up to 32 elderly people. This includes care for up to six people over the age of 65 years with physical disabilities, and dementia care for up to four people over the age of 65 years. The Nursing Home is owned by Classic Care Homes Limited and is located in Care Homes for Older People Page 4 of 35 Over 65 4 32 6 0 0 0 Brief description of the care home the market town of Cheadle, Staffordshire. Cheadle town centre is closeby. It has a wide selection of amenities such as shops, leisure facilities, public houses, banks and churches. The home stands well off the road. Accommodation is provided on two floors. There is a passenger lift to provide easy access. There is ample on site car parking and the gardens are accessible around the home to people who use the service, including wheelchair users. The accommodation provides for twenty single bedrooms, with six shared (double) bedrooms. There is ample provision of toilet and bathing facilities including a wetroom/shower, communal lounges, dining room and seating areas. Current weekly fees range from £423 to £583. These are subject to annual review. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection for this service took place on 2 October 2007 and the home was given a quality rating of two stars (good). We carried out an Annual Service Review on 25 September 2008 which identified from the information we received that the quality of the service had been maintained. It is our policy to carry out a Key Inspection visit every two years for a service with a quality rating of good. This was an unannounced Key Inspection. We inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. The Registered Manager, Ruth Addison, and the Responsible Individual, Mary Nawal, Care Homes for Older People Page 6 of 35 were present during this inspection which took place over a period of 10.5 hours. We looked at peoples assessments, care plans, personnel files, complaints file, medication records and health and safety records and gave feedback throughout. We case tracked three of the people using the service. This is a focussed methodology that we use to analyse the care offered in the home. This means that we checked all aspects of their care and the records kept for them. We spoke to the people using the service, their relatives, staff and analysed surveys received prior to the inspection. Prior to the inspection visit the providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment which focuses on how well outcomes are met for people using the service. Information from this AQAA was used to plan the inspection visit and references to it have been made in this report. The AQAA was returned within the timescale and gave us a reasonable picture of the current situation within the service. It could be much improved by providing information and detail about some of the statements made. Several people who use the service have dementia or confusion and are not able to give us a full response to some aspects of their care but all are able to tell us that staff are kind to them and help them. We spoke with several relatives on the day who are frequent visitors to the home and who were able to tell us that they are satisfied with the services provided at Daisy Bank. They tell us they are made welcome and have observed over many months good interaction between the staff team and people who use the service. People who responded to surveys tell us they are satisfied with the service stating: Food always good. Care is good. Very Clean. The home does a very good job. (name) is very happy there. Friendly staff - make you feel at home. As a consequence of this visit we identified concerns, mainly with medication that we have asked the management to address without delay. From information provided we also identified that when recruiting staff the service is not taking up all the necessary checks to protect people who use the service. A recent incident, resulting in serious injury for a person who uses the service, has been investigated by the Health and Safety Officer and the Safeguarding Team. The service has put measures in place to address concerns, e.g. staff training. We have made two requirements and thirteen recommendations as a result of this visit. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Neither of the recommendations in the last Key Inspection Report have been implemented i.e. introduction of staff supervision and a training matrix. We have serious concerns about the medication practices as a result of this inspection. We have required the service to improve their systems for the recording, handling safekeeping, safe administration of medicines received into the care home to ensure that they can demonstrate that people using the service receive their prescribed medication. Improvements are needed to provide suitable and safe storage of medicines to comply with manufacturers instructions. We have also asked that all staff responsible for the administration of prescribed treatments have appropriate training, monitoring and support. We consider that the service needs to ensure that managers are fully conversant with current Safeguarding Procedures to protect vulnerable adults from abuse and neglect. They need to know how they must respond and who to contact under such circumstances. The service must then ensure that the staff team receives training in order that they may respond appropriately to any incidents of suspected abuse and/or neglect. Recruitment procedures must be improved to protect vulnerable people who use the Care Homes for Older People Page 8 of 35 service The service should carry out an audit of the internal and external environment to ensure that excessive clutter is removed to provide a safe environment for people who use the service and the staff team. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides information, including a current Service Users Guide, so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. Evidence: No requirements were made in this outcome area in the last Key Inspection report. People who use the service who returned surveys tell us that they consider they received sufficient information to decide if the home was suitable for them. The AQAA tells us that a new folder has been provided for prospective residents and their families. We looked at this document dated August 2009. The folder contains a Service User Guide. We consider this document could be further improved to meet regulation by including information about the relevant qualifications and experience of all the care staff team working at the home. The Service User Guide states that the Care Homes for Older People Page 11 of 35 Evidence: home is managed by Mary Nawal and Ruth Addison but does not specify in what capacity they operate or the structure of the service. The Service User Guide tells people that the home has a non smoking policy to comply with current legislation. However, the Statement of Purpose states that whilst smoking is generally discouraged it is allowed in the inner hallway. This is ambiguous. The documents should specify the arrangements for people to engage in social activities, hobbies and leisure interests. The contact details of the Care Quality Commission should be provided rather than the Inspection Unit details as specified. We have made it a recommendation as part of this report that the Statement of Purpose and Service User Guide are reviewed and amended to include all areas specified in the regulations. We looked at a random sample of files for people who reside in the home. We found that the manager had carried out an assessment of the persons needs prior to admission to the home. We could not find confirmation that the home had written to say they are able to meet the individuals care needs on any of the files. As we have reviewed our inspection process in line with the Inspecting for Better Lives framework we no longer make this a requirement even though it is part of the regulations (Regulation 14(d)). We do, however, consider it good practice. We have, therefore made a recommendation in this report regarding this matter. The AQAA tells us that each resident is given the opportunity to visit the home and spend some time within the home before a decision is made. This enables people to sample the service before deciding to move into the home. It is understood that any person who is publicly funded has a six week review following admission to determine whether everyone is satisfied with the placement at the home. This allows the person who receives the service and their family carers the opportunity to give their views about the care they receive at Daisy Bank Nursing Home. Daisy Bank Nursing Home does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans provide sufficient information to enable staff to deliver a person-centred service in which people are treated with respect and their rights to privacy are upheld. The homes procedures in regard to medication put the people who use the service at risk of harm. Evidence: No requirements or recommendations were made in this outcome area in the last Key Inspection Report. The AQAA tells us every resident has an individualized and holistic care plan which has been developed from their needs assessment. We found support plans set up by the home, generated from the social work care plan and the homes own preadmission assessment for all three people we case tracked to inform care staff how to provide for the persons care. Reviews of the Support Plans were carried out once a month or at point of change. The service operated a key worker system which was headed up by a nurse. Information in care plans was inputted by the key nurse who gave verbal instructions to care assistants regarding care delivery and practice for Care Homes for Older People Page 13 of 35 Evidence: each person who uses the service. We spoke with the three people being case tracked, two of whom had family visiitors on the day. We spoke with a number of other people who use the service and visitors to the home. We also observed staff interaction with people who use the service. Personal support is, in the main, responsive to peoples varied and individual needs and preferences. People tell us that staff are kind and considerate. We observed people being encouraged to be as independent as possible. Staff we spoke with had an overall understanding of the needs of people living in the home and were seen to be patient and kindly when interacting with them. Relatives spoken with were satisfied with the services provided by Daisy Bank Nursing Home. We received comments such as, they are very good with (name). They keep me informed about all aspects of their care. The staff are always welcoming. Another said I have been visiting for several years. (name) is well looked after. Records show that people have access to healthcare and remedial services. The service ensures that people unable to leave the home receive visits from general practitioners and other healthcare professionals. We noticed that there were Do Not Recusitate forms on file. The manager was aware that these must be reviewed regularly within a multi-agency framework that includes the persons general practitioner and social worker. In relation to medication the AQAA states The home has a policy for the receipt, storage and handling and administration and disposal of medication and the registered manager ensures this is adhered to. We feel that the level of care and the service provided is of a good standard.... We observed the lunchtime medication round. We are concerned that some medication is not being administered as prescribed. We saw unexplained gaps in some of the records in the Homes Twelve Week Prescription Sheets. We discussed this fully with the Registered Manager and nurses responsible for the administration of medication on the day and outline some of the other medication issues discussed below as illustration of our concerns: The temperature of the medication fridge was being recorded daily as required by regulation. However, for several weeks the temperature recorded was well below that recommended. None of the nurses or the Registered Manager had identified this Care Homes for Older People Page 14 of 35 Evidence: problem. There appeared to be some confusion as to whether the thermometers were accurate. The fridge was being used to store insulin. We had to ask the Registered Manager to contact the homes pharmacy as the insulin had been affected. As a consequence, the insulin had to be replaced immediately. It was noted that the room in which the medication trolley was stored was very warm and we have asked that an ambient thermometer is used in this area to ensure that medicines in the trolley are not adversely affected. We have made a requirement regarding correct storage of medicines. We identified that nurses were in some instances dispensing prescribed medication into medipots and giving these to care assistants to administer out of sight of the nurse. The nurses were then signing the medication administration record. It is imperative that the medication administration record is signed by the person who has administered the medication. A care assistant told us in their survey that she should not be asked to administer drugs from trained staff Some people were prescribed creams. However, the prescription sheets had no entries to confirm that this had been administered. We asked whether the prescribed creams were being administered and were told that care assistants were administering when they dressed/undressed people. It is imperative that prescribed treatments are administered and recorded by people who have been trained and are assessed as competent to do so. We have made a requirement regarding this matter. There were no protocols in place in respect of As Required medication. The protocols should identify whether each person has mental capacity to decide whether they want their prescribed medication and in what quantity. If they are not able to decide for themselves the protocol should give written advice to staff about the circumstances under which they may administer such medication. This will promote consistency and transparency of practice. We have made a recommendation regarding this matter. We have recommended that the home introduces a homely remedies policy which covers occasional use of medicines such as pain relief(e.g. paracetamol). Authorisation/permission to administer occasional homely remedies should be sought from each persons general practitioner (so that the GP may take into account other medication prescribed) regarding the administration of occasional homely remedies. This will promote consistency and transparency. We are concerned that the present medication systems put people using the service at risk and that the home is unable to demonstration that people receive their prescribed medication. We will return to Daisy Bank Nursing Home to monitor progress with Care Homes for Older People Page 15 of 35 Evidence: medication procedures and practices. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a relaxed and welcoming atmosphere. Routines are flexible to accommodate individual choice. The home offers a wholesome diet to suit peoples individual needs. Evidence: No requirements or recommendations were made in this outcome area in the last Key Inspection Report. Generally, staff are aware of the need to support people who use the service to develop their skills including social, emotional, communication and independent living skills. Individual rising and retiring times are accommodated. Televisions were switched on in two lounges throughout the day, although not many people we spoke to said they were watching them. The home has a separate dining room and people can return to their rooms to sit away from televisions if they so choose. People who use the service have the opportunity to develop and maintain important personal and family relationships. Relatives were observed visiting the home and Care Homes for Older People Page 17 of 35 Evidence: being received by people who use the service either in the lounge areas or their bedrooms. Relatives told us that they are always made welcome in the home whatever time they visit. Without exception people we spoke with who use the service and their family carers were satisfied with the service provided. We received eight surveys from people who use the service/family carers, each of whom was satisfied with the service they received from Daisy Bank. The following comments were added to surveys: Food always good. Care, kindness and friendship - good. Very clean All OK The home does a very good job. It is very clean and the meals are very nice. All of us are very happy with mums care Friendly staff make you feel at home. Cleanliness. Good food. It is a very clean and friendly place. I am well cared for. Well cooked and presented food. The staff always treat me well. Good food, activities, medical care - a friendly place. In the night they tell her she ..... can wet the pad, but she would prefer to get up and use the commode. The home provides a warm, friendly atmosphere. The staff are cheerful and supportive. They instil confidence in the relatives. There have been occasions when medical conditions could have received earlier attention from a doctor rather than waiting for a routine visit. Daisy Bank is a very good home on the whole and the efforts of staff are appreciated. Very caring in cases of illness. Rooms and residents are very clean. Food good. Toileting could be better. (Name) is sometimes desperate and has to wait - dont know the answer to this. If more attention could be given to such things and spectacles and hearing aids to make sure people are wearing them and they should be routinely checked to make sure they are working - it would be a big improvement. An occasional update with relatives would help. We monitored the menus and kitchen area on this visit. It is understood the Care Homes for Older People Page 18 of 35 Evidence: Environmental Health Officer has recently visited and allocated a five star rating for the catering. People told us on the day that they enjoyed the food served and that they are able to make suggestions for items to be added to menus. Special diets are catered for. The AQAA tells us that twenty staff have received training in malnutrition care and assistance with eating (including catering staff). We observed people eating lunch and teas on the day. Nine people need assistance to eat meals. Care staff were sensitive to the needs of those people who find it difficult to eat and gave prompts or assistance when required, making them feel comfortable and unhurried. As well as a hot lunch time meal there is an option of a hot snack at teatime such as soup or something on toast or crumpets. A variety of sandwiches and cakes are available. Everyones birthday is celebrated with a Birthday Tea (if they wish). The AQAA tells us that eleven staff have received training in safe food handling. However, the home was not able to provide evidence that its catering staff have received training in Safe Food Handling. It is important that anyone who prepares food in the care home receives Safe Food Handling training in order to promote best practice and we have made a recommendation about this as part of this report under the Management and Administration Section. The AQAA tells us that the home has regular in house activities. It is understood that there is an active Friends and Relatives Committee that arranges fund raising events such as The Summer Fayre, Barbeques and trips. There is a regular Newsletter, a tuck shop, weekly hairdressers visit, weekly mobility/exercise sessions, monthly organ recitals, monthly manicurist visit. Regular religious services are held or arranged as required. Care Homes for Older People Page 19 of 35 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. People who use the service and their relatives are confident that their complaints are listened to and appropriately handled. People using the service need to be confident that the service knows how to respond appropriately to any issues of suspected abuse or neglect. Evidence: The service has a complaints procedure which is up to date and readily available. Details of the complaints procedure are contained in the Service User Guide. The complaints procedure is also displayed in the home. Relatives spoken with and people who returned surveys tell us they know how to complain. People who use the service told us they would speak with staff or the manager if they were unhappy. The AQAA tells us that the service had received one complaint since the last Key Inspection on 2 October 2007 which had been investigated and resolved. We have received no complaints about the home in the last twelve months. There were policies and procedures for safeguarding people who use the service and staff are aware that where they have concerns they must raise these with the manager. Staff are given information about whistle blowing procedures at the start of their employment so that they know what to do if they have concerns about someone. Care Homes for Older People Page 20 of 35 Evidence: The AQAA tells us that there has been one safeguarding referral in the past twelve months. We received information about one safeguarding alert regarding Daisy Bank Nursing Home and discussed this with the registered manager who provided evidence to confirm that the issues have been investigated and resolved. As a consequence of this investigation and the serious injury involved, the Health and Safety Officer has visited the home, issued recommendations for improvement and is due to return to monitor progress. During the course of this investigation the Social Services Department put a hold on admissions to the home. This has now been lifted and social care staff are now able to refer for admissions again. It is understood that as a result of the recent Safeguarding Investigation the home has obtained a copy of Staffordshire and Stoke-on-Trent Safeguarding Protocols and Procedures although the manager could not produce it on the day of our visit. It is recommended that training in safeguarding, based on this document, is provided to all the staff team in order that they know how to appropriately respond should they have concerns. The registered manager was aware of the need to introduce advocacy services should these be appropriate where users may lack capacity. People we spoke with told us they feel comfortable and safe in the home. Care Homes for Older People Page 21 of 35 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. The home is comfortable and clean but would benefit from being upgraded to better meet the needs of people who use the service. Evidence: No requirements were made in this outcome area in the last Key Inspection report. Twenty bedrooms are single occupancy and there are also six shared (double) bedrooms. There are adequate bathrooms and toilets conveniently situated around the home. Since the last inspection a wetroom/shower facility has been installed. We checked communal areas and a random sample of bedrooms and found them to be clean, pleasant and hygienic. We noticed that the the lounges appeared overcrowded. A high proportion of people use wheelchairs and need to be moved by hoist from wheelchairs to armchairs. Visitors. naturally, bring extra seating into these areas. A carer who responded to our survey felt that the service could provide more room around the home for moving and handling. I do think the home is over-crowded. We need more room in the lounge for hoisting. Care Homes for Older People Page 22 of 35 Evidence: Another commented A second standing hoist is needed as well as new batteries for the equipment already provided. I also think there need to be better provisions of equipment that is suitable for larger clients. One person told us that they had been waiting for some weeks for a second bed in their room to be removed so that they could personalise their bedroom with small items of furniture from home. We looked into one bathroom which was obviously not being used as we could not see the bath which was full to overflowing with mattresses, cushions and other items. This would seem to be a waste of valuable space. We discussed this situation with the registered manager on the day and have asked her to look to see if there is any furniture in the lounges that can be moved to create more space. This will provide care staff with extra space when they are using hoists and wheelchairs. A review may also identify a more suitable and cooler place to store the medication trolley, for example secure storage may be provided under the staircase. The AQAA tells us there is a rolling programme of redecoration. When we arrived at 8.20 am the home smelt clean and fresh and it is reassuring that people who responded to surveys confirm that the home is always or usually clean and fresh. The home has a small laundry and separate sluice facility and employs a Laundry Assistant each morning. The majority of large items are sent to a professional laundry on a daily basis. Care Homes for Older People Page 23 of 35 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 using the service benefit from a stable workforce. The recruitment practices do not fully protect people who use the service. Evidence: No requirements were made in this outcome area in the last inspection report. The service is managed by a Service Manager and a Registered Manager. There is a care staff team of thirty one, including seven Registered General Nurses. The ancillary team consists of two cooks, 9 kitchen assistants, five domestics and a laundry assistant. There is currently a vacancy being advertised for a registered nurse. The AQAA states that of the twenty-four care assistants, fourteen have attained NVQ level 2 in Care which is approximately 58 . The AQAA does not tell us whether anyone is currently working towards this award. In the last inspection report we recommended that a Training Matrix is in place for all staff. This has not been implemented. From the information provided it was not possible to easily identify what training has been provided to all staff in the home. The Environmental Health Officer has told us that she also had difficulty. We have recommended as part of this report that a Care Homes for Older People Page 24 of 35 Evidence: Training Matrix be introduced (with supporting evidence of good quality training) that will show all staff training, together with dates of training, at a glance. This will be a useful tool to demonstrate that staff have the skills mix to meet the needs of people who use the service. We received surveys from four care staff. Three said that they were being given appropriate training but one considered that she was not given training that is relevant to their role; helps understand and meet individual needs; keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. We looked at the files of two staff - one nurse and one care assistant. Police checks had been carried out on both staff. From the information provided it was not possible to confirm that the nurse had received any Induction Training and there was no record of any supervision taking place. The care assistants file had important documents missing that are needed to comply with regulations. There should be two references, one of which is from a recent employer but there was only one character reference. There was no contract, although we were informed that the person had been in post for over a year; there was no photograph; there was no documentation to confirm that her identity had been confirmed, e.g. passport, driving licence, utility bills; none of her stated qualifications had been checked, although the registered manager told us she had asked her to bring them in. There was no evidence to confirm that she had received moving and handling training. When the registered manager asked her if she had done moving and handling training she stated that she had not. The Statement of Purpose states staff are carefully screened and references are always checked thoroughly. We asked the registered manager whether there was any documentation filed elsewhere that should be in the staff files but she said everything she had was all in the personnel files handed to us. It is imperative that the service has robust recruitment procedures to protect the vulnerable people in its care. The regulations give specific details of the documents required under Regulations 17(2) Schedule 4 and Regulation 19(1). We have made a recommendation regarding this issue as part of this report. Four care staff returned surveys. In the main they tell us that they consider they have enough support, experience and knowledge to meet the different needs of people who live in the home. Care Homes for Older People Page 25 of 35 Evidence: They added to following comments: The care staff are very good and the home is kept smelling nice and is always clean and tidy. Everyone works hard to ensure the clients needs are met. Reporting of problems/illness with the clients could be better than just verbal as sometimes it seems you are not listened to. The home is clean and well decorated. If carers run out of supplies we only have to ask and it is usually ordered. Trained staff could be more involved helping with problems. We need more help at busy times, for example taking clients to the toilet. Care Homes for Older People Page 26 of 35 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 service is managed by a registered manager who is qualified and experienced. Some areas need to be managed more effectively in order that the health and welfare of people who use the service are better promoted and protected. Evidence: No requirements were made in this outcome area in the last inspection report. One recommendations was made that formal and regular supervision should be given to all care staff. The manager has the required qualifications and experience to run the home. The AQAA, which is a legal document, was completed by the service manager. It could be improved by providing examples to support the statements made. We discussed with the service manager the advantage of updating the AQAA on a regular basis throughout the year so that comprehensive and detailed information can be provided in next years AQAA. Care Homes for Older People Page 27 of 35 Evidence: People who returned surveys and those whom we spoke with on the day expressed satisfaction with the service they received from Daisy Bank Nursing Home. There is low staff turnover and several have worked in the home for many years providing consistency for people who use the service. From information provided we are not able to confirm that regular staff supervision is in place at all levels. The last report made a recommendation that formal supervision should be given to staff. The registered manager acknowledged that formal supervision is not in place. Formal supervision is a useful tool as part of the normal management process for any service. It provides an opportunity for all employees to discuss their roles and for managers to monitor performance. Supervision ensures that that the staff group works as a team and in accordance with the homes policies and procedures. It also enables managers to identify any individual training and development needs. We have made a recommendation as part of this report for formal supervision to be introduced for care staff at all levels, including nurses. We consider that the registered manager, bearing in mind the recent injury to a person who uses the service and the subsequent safeguarding investigation, should undertake a thorough audit of the home (internally and externally) to ensure that the care home is a safe environment for people to move around in and for staff to work in. This is even more urgent as we found that there had been a further accident within the last week. We have made a recommendation under the section for Environment. We were not promptly notified of the original accident and neither was the social worker or Environmental Health Officer. It was brought to the attention of the social worker by family members. This incident resulted in the Social Services Department putting a halt on admissions until the investigation was complete. The registered manager has since worked with the various agencies. The first person who was injured has since returned to the home and we spoke with her on the day of this inspection. She is happy to return to Daisy Bank Nursing Home. We understand the Environmental Health Officer has made recommendations in relation to testing for Legionella and for hoists, including bath hoists, to be tested and maintained as required by regulation (six monthly); the maintenance of and training in use of bed rails; need to display emergency instructions outside the passenger lift and significant improvements needed in care plans and training records to make them more user friendly and the information more readily accessible. The majority care staff have received moving and handling training in the last six weeks. Care Homes for Older People Page 28 of 35 Evidence: We did not check fire records on this visit. The registered manager confirmed that they had received visits from the Fire Officer in the last twelve months. We identified that fire extinguishers had recently been serviced and recommended on the day that the extinguisher on the landing at the top of the stairs is fixed to the wall. The AQAA tells us that the home has up to date policies and procedures that are reviewed annually or as needed. The home is responsible for the security and handling of small sums of money for a number of people who use the service. We monitored the finances of four people and found these to be satisfactory with supporting documentation that showed a clear audit trail. There was current insurance in place. The current Certificate of Registration is displayed in the home as required by our regulations. Care Homes for Older People Page 29 of 35 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 30 of 35 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 Regulation 13(2). The service must ensure that all medication held in the care home is stored at temperatures recommended by the manufacturer. This will ensure that medication retains its properties and potency and is safe to administer to people who use the service 24/09/2009 2 9 13 Regulation 13(2). The administration of prescribed treatments must be undertaken by competent staff who are able to complete appropriate administration records accurately so that the service can demonstrate that prescribed treatments are being administered/applied as prescribed 30/09/2009 Care Homes for Older People Page 31 of 35 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 This will assure people that they are in safe hands 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 Statement of Purpose and Service User Guide would be further improved by including information about the structure of the service; the qualifications of the care staff team; providing information about the capacity in which named people operate; the smoking policy; arrangements for activities; the contact details of the Care Quality Commission. This will provide comprehensive information as outlined in regulations for people who wish to use the service Prior to admission to the home the registered person should confirm in writing to prospective people who wish to use the service, that having regard to the care needs assessment, the care home is suitable for the purpose of meeting the persons needs in respect of his health and welfare. This will assure people who wish to reside in the home that their needs will be met. (Regulation 14(d). The service should introduce a Homely Remedies Policy, and a small stock of homely remedies should be held (for example pain relief) in order to provide occasional medication to people who use the service. Authorisation/permission for the use of homely remedies should be obtained from each persons general practitioner (so that the GP can consider other medication prescribed). Staff responsible for monitoring the temperature at which medicines are stored should receive training on how to use appropriate equipment and what are appropriate temperatures. These staff should be monitored regularly to confirm their competence. The service should introduce a protocol for each person who is prescribed As Required medication which specifies whether the person has mental capacity to make a choice Page 32 of 35 2 4 3 9 4 9 5 9 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 and, if not, under what circumstances the As Required medication may be administered. This will promote consistency and transparency in practice. 6 18 There should be robust procedures and practices in place to monitor the competence of staff who are involved in the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. This will protect the health and welfare of people who use the service. All the staff team should receive training based on Staffordshire and Stoke-on-Trent Safeguarding Protocols and Procedures, so that they are aware of all aspects of abuse and neglect and know how to respond appropriately. It is recommended that a review is undertaken of furniture and any unused items throughout the home but particularly in the communal lounge areas with a view to removing excess clutter. The review could also identify a more suitable location to reposition the medication trolley. This will create extra space for people who use the service and also for care staff who need to move people using wheelchairs and hoists. No person should be deployed in the home until full and satisfactory written information is obtained that includes confirmation of the persons identity, two written references (one from a recent employer) and confirmation of the persons qualifications. This is to protect people who use the service from risk of harm. Staff personnel files should be reviewed to ensure that they have all necessary documentation required under Regulation 17(2) and 19(1). A checklist would ensure that no vital documents are overlooked. This will ensure that the home only employs people who have the necessary skills and will protect vulnerable people who use the service. It is recommended that a Training Matrix is introduced so that all staff training (together with dates) is visible at a glance. This will promote health and safety in the home and enable the manager to monitor and demonstrate that all mandatory and specialist training has taken place and is up to date. Staff at all levels, including nurses, should receive formal Page 33 of 35 7 18 8 19 9 29 10 29 11 30 12 36 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 supervision. This will enable managers to monitor individual performance and training needs in order that the staff team has the skills mix to meet the needs of people who use the service. 13 38 All staff responsible for food preparation should hold current Safe Food Handling certificates. This will promote health and hygiene for the benefit of people who use the service. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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