Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 24/11/09 for Deerwood Grange Nursing Home

Also see our care home review for Deerwood Grange Nursing Home for more information

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

What the care home does well

People are supported to keep in touch with their family and friends so they can maintain relationships that are important to them. Relatives can visit at any time and are made welcome. Satisfactory pre employment checks are completed on all staff before they start working at the home so to help protect the people living there from harm. Many of the staff that work there have worked there for a long time so they know the people living there well. Activity staff are employed so that people can be engaged in activities that they enjoy. There is a large garden at the back of the home so that people have a nice view from their lounge and if they want to can spend time outside.

What has improved since the last inspection?

Staff communicated better with the people living there so helping to respect their privacy and dignity and ensure their well being. Staff told people what they were eating and supported them to eat their meal if needed so respecting their dignity. Some rooms had been redecorated and carpets replaced to make the home more comfortable for people to live in. More equipment had been bought to help staff to move the people living there safely. Staff said that they had more meetings so they were informed about what is going on in the home. Staff have worked with people and their relatives on making `memory boxes` for each person. This helps people to recognise their room, remember who they are and what they have achieved in their life and helps staff to treat people as an individual. More pictures have been put around the home making the environment more stimulating to live in.

What the care home could do better:

People should have the information they need about the home to help them make a choice as to whether or not they want to live there.Assessments should be completed before people move in that detail what the person needs so it is clear whether or not their needs can be met at the home. Staff should have the information they need so they know how to support the people living there to meet their needs. Staff should monitor people`s weight to ensure they have no underlying health needs which could affect their well being. Staff must support people to ensure that the risks of them having sore skin are reduced. Staff should follow the advice of health professionals to ensure that people`s health needs are met. Medication must be given to people as prescribed to ensure their health and well being. All the people living there should be given the opportunity to take part in a variety of activities that they enjoy. Clearer records of food eaten by each person should be kept to ensure they have a varied, nutritious diet and the foods they like to ensure their health and well being. Incidents that affect the safety of the people living there must be reported appropriately to ensure that people are safeguarded from harm. Accidents should be analysed and investigated to ensure that if possible the risks of people being hurt can be reduced. The home should be redecorated and furniture replaced where needed so that it is safe and comfortable for people to live in. The home should be kept clean and free from offensive odours so it is pleasant for people to live in. External and internal lighting should be sufficient to ensure that people can move around safely. Staff should have sufficient breaks between shifts to ensure they can meet the needs of the people living there. All staff should have the training and support they need so they know how to support the people living there to meet their needs and ensure their well being. Reports of the representative of the provider visits should be available in the home to show that action is being taken to improve the home for the people living there. Staff should be involved in regular fire drills so they know how to support the people living there if there is a fire. Fire risk assessments must be in place to ensure that the risks of there being a fire are minimised and staff know how to support individuals in an emergency. People must be moved safely to avoid risk of injury to them and to staff.

Key inspection report Care homes for older people Name: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD     The quality rating for this care home is:   zero star poor 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: Sarah Bennett     Date: 2 4 1 1 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 36 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 36 Information about the care home Name of care home: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD 01213550060 F/P01213550060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BAMH (MIND) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 23 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: Dementia (DE) 23 Mental disorder, excluding learning disability or dementia (MD) 23 Date of last inspection Brief description of the care home Deerwood Grange is a large detached adapted nursing home in the Four Oaks conservation area of Birmingham. The home is approached from a driveway, and is set back from the main road. To the rear of the building are large gardens, which are utilised by the people living there in good weather. The building work to extend the Care Homes for Older People Page 4 of 36 Over 65 0 0 23 23 0 8 1 2 2 0 0 8 Brief description of the care home home has provided most people with single bedrooms apart from one that is shared. There are two large lounge areas, and a large dining room. The extension has also provided a new laundry, a disabled toilet and down stairs shower room. The upstairs bathroom has been converted into a new shower room. There is a new staircase to access the first floor of the extension, access to the first floor using the passenger lift is via the original building. The home provides nursing care to people over the age of sixty-five with a diagnosis of dementia and/or mental health issues. The home is staffed 24 hours a day and there is always a qualified nurse on duty. Care Homes for Older People Page 5 of 36 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. This inspection was carried out by two inspectors over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered including notifications received from the home. The home is required to tell us about incidents Care Homes for Older People Page 6 of 36 and accidents that happen there. We did not ask for the Annual Quality Assurance Assessment (AQAA) until just before our visit so this was not yet required to be returned to us. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by four people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, the manager and staff on duty were spoken with. Due to their needs many of the people living there were unable to tell us what it is like to live there. To help us find this out we used the Short Observational Framework for Inspection (SOFI) tool. This involved observing four people in the lounge for two hours and how staff and the other people living there interacted with them. Following our visit we had concerns about the safety of the people living there and the management of the home. We met with the operations manager and operations director to discuss our findings. They have assured us that they are taking action to improve the home for the benefit of the people living there. We have also shared our concerns with social services, the contracts department and the fire service. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: People should have the information they need about the home to help them make a choice as to whether or not they want to live there. Care Homes for Older People Page 8 of 36 Assessments should be completed before people move in that detail what the person needs so it is clear whether or not their needs can be met at the home. Staff should have the information they need so they know how to support the people living there to meet their needs. Staff should monitor peoples weight to ensure they have no underlying health needs which could affect their well being. Staff must support people to ensure that the risks of them having sore skin are reduced. Staff should follow the advice of health professionals to ensure that peoples health needs are met. Medication must be given to people as prescribed to ensure their health and well being. All the people living there should be given the opportunity to take part in a variety of activities that they enjoy. Clearer records of food eaten by each person should be kept to ensure they have a varied, nutritious diet and the foods they like to ensure their health and well being. Incidents that affect the safety of the people living there must be reported appropriately to ensure that people are safeguarded from harm. Accidents should be analysed and investigated to ensure that if possible the risks of people being hurt can be reduced. The home should be redecorated and furniture replaced where needed so that it is safe and comfortable for people to live in. The home should be kept clean and free from offensive odours so it is pleasant for people to live in. External and internal lighting should be sufficient to ensure that people can move around safely. Staff should have sufficient breaks between shifts to ensure they can meet the needs of the people living there. All staff should have the training and support they need so they know how to support the people living there to meet their needs and ensure their well being. Reports of the representative of the provider visits should be available in the home to show that action is being taken to improve the home for the people living there. Staff should be involved in regular fire drills so they know how to support the people living there if there is a fire. Fire risk assessments must be in place to ensure that the risks of there being a fire are minimised and staff know how to support individuals in an emergency. Care Homes for Older People Page 9 of 36 People must be moved safely to avoid risk of injury to them and to staff. 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 10 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have the information they need about the home and may not be sure that their needs will be met there. Evidence: The statement of purpose and service users guide did not include all the information that people would need to make a choice as to whether or not they want to live there. The manager said that these are being updated. He stated that when this is done all the people living there would be issued with a copy. The manager said that these documents are not produced in any other formats, which would make them accessible to people who have dementia. We looked at the records of two people who had been admitted to the home since we last visited. Before they were admitted an assessment was completed by the home to assess whether or not their needs could be met at the home. These were brief and lacked detail. For example, it stated whether or not the person required assistance or Care Homes for Older People Page 12 of 36 Evidence: not but not what type of assistance they needed. Therefore, it is not clear how a decision was reached that their needs could be met. Care Homes for Older People Page 13 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people living there are not always met, which could impact on their well being. Evidence: We looked at the records of four of the people living there. The manager said that they were implementing a new care plan format, which would make it easier for staff to know how to support individuals. One persons records had this format in the file but it had not been completed. Care plans were similar for each person sampled and were not centred on the individual person. One persons records indicated that they recently had an infection. There was no care plan that showed how staff are to care for the person to ensure their well being. One person had developed a small sore on their skin but their care plan had not been updated to reflect this. Care plans had been reviewed generally monthly. Records sampled included an assessment of the risk of one person in developing pressure sores. It was not clear what the risk was, as a score was stated but there was no key as to what this score meant. The manager did not know but later in the Care Homes for Older People Page 14 of 36 Evidence: day said that one of the nurses knew and would be putting this in each persons records. This could lead to people not being supported appropriately to reduce the risks of them developing pressure sores. Weight records for one person showed that they had lost seven kilogrammes in nine months but no action seemed to have been taken about this. The deputy manager said that the weighing scales had recently been re calibrated so several peoples weight records had differed. They hoped that now staff could get an accurate picture of how much each person weighed and if they were losing or gaining weight. This is important as a significant loss or gain of weight can be an indicator of an underlying health need. One persons records showed they had been weighed in October but not at any other time. No other weight records could be found but the manager said that everyone is weighed monthly. Information was available in peoples records as to how to calculate a persons body mass index (BMI) but this had not been calculated so that it was not clear what the persons healthy weight should be. One person cannot be weighed using the scales due to their health needs. Staff measure the persons thigh to determine whether or not the person has lost weight. Records showed that from May to October 2009 the person had lost five centimetres from their thigh but there was no record of any action being taken about this. Their care plan did not give staff any specific guidance as to how to measure the persons thigh so it may be that the measurements are not accurate. Staff spoken to said that they did not know whether one person had their own teeth or wore dentures. The persons care plan stated the person wore dentures which needed to be cleaned every day. If staff do not know how to support people this could lead to their needs not being met. Records were kept of when health professionals had been involved with the person. One persons records showed that their medication had been changed but did not say why or how this would help to meet their health needs. One persons records stated they only saw the chiropodist and their social worker during 2009. However, other records sampled indicated that they had been seen by the GP. This makes it difficult to track what the persons health needs are and what action is being taken to meet them. One persons records indicated that they had a wound that appeared to have healed but staff were to continue to nurse the person on their back or their left side to relieve pressure on the persons skin. Records showed that staff should alternate the persons position from their left side to their back every three hours and record this. Records Care Homes for Older People Page 15 of 36 Evidence: sampled showed that the person was not moved every three hours and on two occasions had been moved onto their right side, which would mean that they were putting pressure on their wound. For two days sampled it was not recorded that the person had been moved at all. One member of staff spoken to stated that the person should be alternated between their left and right sides and on their back. This does not show that staff know how to support the person to ensure their health and well being. We looked at the medication for the people we case tracked. Medication is kept in locked cabinets in a locked room. The qualified nurses give medication to the people living there. We found that some medication had not been given. Some Medication Administration Records (MARS) had not been signed but the medication seemed to have been given as it was no longer in the pack for that particular day. Nurses spoken to did not know why this medication had not been given or signed for. There was no space on the MARS for nurses to state why they may have not given a person some of their medication, which nurses said made it difficult to record at the time why they may not give it. One person was prescribed pain killers three times a day but over a seven day period this was not given for one of the doses. There was a photograph at the front of each persons MARS so that unfamiliar staff would know who to give the medication to. Some people are prescribed as required (PRN) medication. It was not clear when to give the person their medication or how much of it to give. The deputy manager said this was left to the nurses discretion. Clear protocols should be in place so that staff know how much and when to give a person their medication to ensure their well being. Some people are prescribed controlled drugs. These were stored in a separate locked cabinet and recorded appropriately to ensure they are not misused. The stock kept in the cabinet matched with the amount stated in the book indicating that they are given as prescribed. Audits had been completed of the medication by a nurse each month. The medication they had sampled matched with the records indicating that medication had been given as prescribed. People were dressed in individual styles that reflected their age, gender, cultural background and the weather. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there are not always supported to experience a meaningful lifestyle, which could impact on their well being. Evidence: One full time and one part time activity staff are employed to spend time with the people living there engaging them in activities they enjoy. Activity staff were observed doing quizzes with individuals to stimulate their brains, massaging their hands, talking to them about the things they were interested in, playing with a ball and taking them out for a walk to the park. Records sampled showed that people went to the park, had hand massages, chatted to staff and played with a ball. Several records did not record any activities taking place. Staff were asked if they would be recorded elsewhere but they said they would not be. So, records sampled indicated that people did meaningful activities on about six days in a month. The TV in the large lounge was on the Yesterday channel which showed programmes that were relevant to the age of the people living there. Since we last visited a larger TV had been provided so that it was easier for people to see. Records sampled showed that people are supported to keep in contact with their Care Homes for Older People Page 17 of 36 Evidence: family and friends so they can maintain relationships that are important to them. Staff were observed making visitors welcome during the day. Records showed that when one person was unwell their relatives were able to visit during the day and night so they could spend time with them. Records sampled showed that monthly meetings take place with the relatives of the people living there. Minutes showed they discussed what is going on in the home with activities, redecoration and staffing. They also talked about memory boxes. These were seen outside each persons bedroom, helping them to recognise this. They contained photographs and pictures that related to the persons life and the people important to them so to remind the person who they are and what they have achieved and give staff an understanding of the person as an individual. Relatives are encouraged to help with these and provide photographs and information about the persons life. We observed four people during the SOFI in the large lounge in the morning. We found that staff interacted with the four people for 36 per cent of the two hours. One person was interacted by staff only once (they were asleep for the majority of the time), another person six times, another eighteen times and the other nineteen times. The majority of interactions by staff were positive and none were negative. This is an improvement from our last visit. We saw that generally staff interacted well with the people living there. We did observe staff walking into the lounge, look around without saying anything to people and walk out again. In a period of two hours in the large lounge we noted that none of the people living there were offered a drink. Staff were observed to come in and sit down with a drink and we were offered a drink. The deputy manager said that at 11am people are usually offered a drink, as this is one of the set drink times. However, people were not offered a drink until 12.05pm and the room was warm, which may impact on peoples health and well being. The manager said that there is always a choice of what people can eat for their main meal and they were looking at the menus and updating them where needed so that people had a choice and a nutritious and varied diet. One staff spoken with said the manager had introduced choices and a vegetarian option. We observed lunch being served. Staff were dishing up the same meal for all people which was chicken pie, potatoes and vegetables until one staff told another that there was a choice of chicken pie or cauliflower cheese. The staff said that they had just found this at the bottom of the trolley. Staff then asked people which they wanted. This does not indicate that staff know that there is always a choice for people. Care Homes for Older People Page 18 of 36 Evidence: Tables were well presented with cloths and staff put aprons on people who needed them to protect their clothes. Staff told people what they were doing. Staff sat with people who needed support, telling them what they were eating and supporting them appropriately. One person banged on the table throughout the meal and often pulled at the table cloth, which upset some of the other people sitting at the table. One person decided they did not want their meal. Staff offered them a sandwich which they asked to be taken into the lounge so they could eat it without being disturbed by others. Care plans should show staff how to support individuals at mealtimes so that people can enjoy their meals in a relaxed atmosphere. People were offered hot and cold drinks with their meal. Some people need to have their food liquidised so it easier for them to swallow. Items of food were separated and not all liquidised together so it looked more appetising. However, it was disappointing to observe that for people who had liquidised food their food was served in plastic bowls, making it less attractive. Food records sampled showed some variety including fruit and vegetables however, not all records stated what the meal was. The record just stated main or pudding so it was not possible to assess whether the person was having a diet that met their nutritional and health needs. Staff said that the food is good and always cooked fresh. Care Homes for Older People Page 19 of 36 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. Arrangements generally ensure that the views of the people living there are listened to but do not always ensure that they are safeguarded from harm. Evidence: The complaints procedure included the information that people would need so they know how to make a complaint if they are unhappy with the service provided. It was not produced in any other format that would make it more accessible to the people who live there. The complaints log showed that one complaint has been made since we last visited. We were aware of this complaint and are satisfied that appropriate action was taken to investigate and resolve the issues raised. The procedure for safeguarding vulnerable adults included the relevant information. There was a flow chart that was easy for staff to follow should there be a need to report any incidents regarding safeguarding the people living there from abuse and harm. From sampling accident records we found a high number of reports of unexplained bruising to the people living there. The records did not indicate that these had been referred to social services as a safeguarding issue. One incident related to a person receiving extensive bruising to their eye but the cause of this was unknown. Another related to a person who spends their time nursed in bed being found with extensive bruising to their arm but the cause of this was unknown. The deputy Care Homes for Older People Page 20 of 36 Evidence: manager said that these had not been referred to social services as safeguarding but they had informed the GP. Social services are the lead authority in safeguarding vulnerable adults and all issues of a safeguarding nature must be reported to them so they can decide if any action is needed and what this is. We reported two of these incidents to social services the day after our visit and are awaiting the outcome of these referrals. In February this year we received information from a social worker about a person living at the home sustaining bruising to their wrist and eyes but the cause of this was not known. This was investigated and the home were informed of the need to report these issues as safeguarding. The findings of this inspection show that this advice had not been followed. The manager said that all staff had received training in safeguarding. They said that the training coordinator at the organisations head office manages all the training and would notify them if staff needed updated training in any areas. Staff said that they had received all the training they should have when they first started although they did not specify that they had received safeguarding training. Care Homes for Older People Page 21 of 36 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. Arrangements do not always ensure that people live in a homely, comfortable and safe environment that meets their individual needs. Evidence: Since we last visited we found that the environment had been made more stimulating for people to live in. Several new pictures had been put on walls, some of which had several different textures that people could touch. There were several things of different textures around the home to help people to stimulate their senses. The manager said that they hope to replace the cooker and had received quotes for this. The roof had been leaking but had been repaired. The ceiling was stained from this and now required repainting. In the hall outside bedrooms on the first floor the lighting was quite poor as some bulbs were not working. These should be replaced to ensure that lighting is adequate so that people can move around the home safely. We saw that a large window on the stairs was wide open, leading to a balcony at the front of the home. The manager said that they did not think that any of the people living there would be able to climb through the open window. Given the needs of the people living there this should be risk assessed to ensure it is safe. When we left the home it was dark and there was no outside lighting. As the home is Care Homes for Older People Page 22 of 36 Evidence: on a private road there are no street lights. Minutes of a meeting showed that providing lighting outside had been discussed by staff. This needs to be considered to ensure the safety of staff and visitors to the home. The carpet had recently been replaced in the large lounge making it more comfortable. The carpet in the small lounge was worn and the manager said this was going to be replaced. In the large lounge we saw that the cushions on some chairs were sunken so could be uncomfortable for people to spend time sitting in. Next to the TV there was a cabinet that contained some videos. The shelf was broken and the videos were scattered around it. there were several items on the shelf above the fireplace including rolls of paper towels, pairs of glasses and hair rollers. This does not make a comfortable environment for people to relax in. Bathrooms and toilets had a picture sign on to help people identify where these were. However, they were locked so that if people were able to go to the toilet by themselves they would not be able to. This does not help people to be as independent as possible. A risk assessment should be completed to ensure that it is in peoples best interests to lock these. Recently a new hoist had been purchased and the Operations Manager said after our visit that another one would be delivered by the end of that week. This means that a hoist would be available on each floor to help people to be moved safely. Memory boxes have been provided outside bedrooms to help people identify their bedroom. Bedrooms seen had lino on the floors. Although some people may prefer this to carpet, staff said that all rooms had this flooring. Some work had been done on personalising bedrooms but further work was needed to ensure that bedrooms reflected the tastes, needs and interests of the individual. Some bedroom furniture was broken. The manager said this was to be replaced. There is one shared bedroom. The manager said that both these people had shared a room for several years and it was their choice to continue to do so. All bedrooms were locked, staff carry a master key to open them and they can be opened from inside. The manager said they were locked because some people wander into each others bedrooms. This should be risk assessed to ensure there are no alternatives to doing this that would give people more choice as to when they go in and out of their bedroom. The manager said that they had recently purchased new carpet cleaners so that carpets could be cleaned more often. There was a strong odour of urine when we arrived at the home. We saw that the carpet in the hall on the first floor was stained and in need of cleaning. We saw in the bathroom on the ground floor that continence Care Homes for Older People Page 23 of 36 Evidence: pads were stored on the floor out of their bag. This could increase the risk of cross infection. Care Homes for Older People Page 24 of 36 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. Arrangements for staffing, their support and development are variable, which could impact on the well being of the people living there. Evidence: At night there is one qualified nurse and two care staff. The night before one person had a fall and needed to go to hospital for treatment. The deputy manager was on call so went to the hospital with them. A bank nurse was due to be the qualified nurse on duty that morning but had rung in sick. So the deputy manager had to be the qualified nurse on duty. As he had been called out during the night he was not able to be there for the start of the shift. When we arrived the night nurse was still on duty but was relieved soon after. The qualified nurse for the afternoon shift was also the qualified nurse for the night shift so was working two shifts together without a break. They said that they do not do this very often, only occasionally. Staff should have sufficient breaks in between shifts to ensure they can meet the needs of the people living there. The manager said they were currently recruiting for a nurse vacancy. There would also be another nurse vacancy when the deputy manager took up the post permanently as they were acting in this role currently. There were also vacancies for care staff, one part time at night and one full time for days. These posts were being recruited to. One nurse was suspended pending investigation so this post also had to be covered. Shifts are covered by bank or agency staff. In the morning there was one agency care staff Care Homes for Older People Page 25 of 36 Evidence: who worked there often, so knew the people living there. In the afternoon there were two agency care staff, one of whom had not worked there before. The nurse on duty showed them around the home and introduced them to the people living there. Minutes of staff meetings showed that these were held about every two months. There was an agenda on the notice board for a staff meeting that day but this did not happen. Minutes stated a list of points and did not indicate that much discussion took place. Staff said that there had been more staff meetings since the new manager had been in post. The majority of staff have achieved National Vocational Qualification (NVQ) level 2 or above in Care. This should ensure that they have the skills and knowledge to meet the needs of the people living there. One staff told us that they were doing NVQ level 3 and hoped to achieve this soon. The manager said that staff recruitment records are kept at the organisations head office. However, there was evidence for us to see that Criminal Records Bureau (CRB) checks had been completed for staff recruited since our last visit. Application forms and references were also available for us to look at for these staff. These showed that staff had been recruited appropriately and checks had been done to ensure that suitable people are employed. The starter checklist seen with the staff records did not indicate whether or not the PIN number for nurses had been seen. So it was not clear whether it was checked that nurses are registered with the Nursing and Midwifery Council (NMC) and therefore fit to practise. The deputy manager said that this information is held at the head office. The manager said that the training matrix is held on the computer and the training co ordinator is based at the head office. They said that if staff needed refresher training in any area then the training co ordinator would email the manager to inform them of this. The manager said that as he had not received any emails regarding staff needing training then all staff must be up to date. Staff said that they had received training in communication, health and safety, fire safety, food hygiene and moving and handling. One staff had recently completed a dementia care course at a local college although another staff said they had received no specific training in dementia care. Given the needs of the people living there it is essential that all staff receive this training. Care Homes for Older People Page 26 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements do not ensure that the health, safety and welfare of the people living there is promoted and protected, which could impact on their well being. Evidence: Since we last visited the registered manager has left and another manager had been recruited. The manager has been in post since July this year and has several years experience of managing care homes. Although they are a Registered Learning Disability Nurse they have had significant experience in working with people who have dementia. Throughout the day we found that the manager did not know where things were and constantly referred us to the deputy manager, who as stated previously in this report was the qualified nurse on duty. Staff said that they thought things had improved since the new manager had been in post. However, our findings are that the home has deteriorated in meeting the standards and regulations. Following our visit we met with the operations manager and operations director to share our concerns. They informed us that they would be taking appropriate action to ensure that the home was well run to benefit the people living there. Care Homes for Older People Page 27 of 36 Evidence: We saw reports made by committee members of the organisation following their visits to the home every three months. These showed that improvements were being made in personalising bedrooms, signage and memory boxes. The manager said that the operations manager visits regularly but the reports of these visits were not available. Fire records included a risk assessment that was written by the previous manager and was due to be reviewed in June this year. This did not seem to have been reviewed. Records showed that the fire equipment is serviced by an engineer and regularly tested by staff to make sure it is working. The last record of a fire drill was in March this year. The manager said they had identified the week before that another fire drill was due but this had not been done. We were informed that a fire drill was held the next day. Staff spoken to said they had received fire awareness training but had not been involved in fire drills. This means that there may not be sufficient staff on duty if there was a fire that would know what to do. Individual risk assessments were not in place to state how each person would need to be supported if there was a fire. Given the needs of the people living there and that some people are nursed in bed these must be in place. We shared our concerns about fire safety with West Midlands Fire Service. As stated previously in this report accident records showed that there have been a high incident of people sustaining bruising, the cause of which is unknown. The manager said that he audits the accident forms and records showed that these were audited monthly. The audit from October showed that in a month there were six reported incidents of people having bruising where the cause was unknown. There was nothing recorded that any investigation had taken place about this, it just stated that the cause was unknown. Body maps should be completed for all accidents and further analysis undertaken to assess if there is any reason where action could be taken to reduce these injuries. The records for one person who is nursed in bed stated that they had sustained extensive bruising to their arm. Staff reported this to the GP who visited a couple of days later. Staff had recorded that the GP had said the bruising could have been caused by poor manual handling. Staff said that they had training in moving and handling and that the nurses or managers tell them how to move people. One persons records had not been updated when their needs had changed to show staff how they needed to support them to move. Another persons moving and handling risk assessment had not been reviewed since August 2008 but their other records indicated that their mobility needs had changed since then. This means that staff may not know how to support them to move. Care Homes for Older People Page 28 of 36 Evidence: We observed that staff supported people safely when using a hoist to move them, telling them what they were doing so as to reassure them. We observed staff supporting people to walk. Staff were seen put their hands under peoples armpits to support them, which could cause injury to the person. They were also seen to be dragging people along which could make them unsteady and cause injury to the person and to staff. one accident record showed that in October a member of staff had hurt their back while assisting a person to move. We saw that gas and electric equipment had been tested regularly to ensure that it was safe to use. Staff had tested the water temperatures regularly and these were within the recommended safe temperatures so that people were not at risk of being scalded. Care Homes for Older People Page 29 of 36 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 36 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 7 12 Care plans must clearly state how staff are to support the person. So that people are supported in the way they need and ensuring their well being. 28/02/2010 2 8 12 Staff must support people appropriately to ensure the risk of their skin becoming sore is reduced. To ensure peoples health and well being. 31/12/2009 3 9 13 Medication must be given to people as prescribed. To ensure their health needs are met. 31/12/2009 4 18 12 All safeguarding incidents 31/12/2009 must be reported appropriately to the relevant authorities. Care Homes for Older People Page 31 of 36 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 safeguard the people living there from harm and ensure their well being. 5 30 18 All staff must receive training in dementia. So they know how to meet the needs of the people living there. 6 38 13 The fire risk assessment must be regularly reviewed and updated where necessary. To ensure that the risks of there being a fire are reduced. 7 38 12 People must be supported to 31/12/2010 move safely. To ensure their safety and well being and that of the staff supporting them. 8 38 13 Individual risk assessments 31/01/2010 must be in place as to how people need to be assisted if there is a fire. To ensure that staff know how to assist people safely. 31/12/2010 30/04/2010 Care Homes for Older People Page 32 of 36 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 People should have information about the home so they can make a decision about whether or not they want to live there. A detailed assessment should be completed before a person moves into the home to assess whether or not their needs can be met there. When peoples needs change a care plan should be put in place so that staff know how to support the individual. Clear records should be kept of action taken and advice given by health professionals so that staff know how to support each person to ensure their health and well being. All staff should be aware of each persons needs so they know how to support them to ensure their well being. Staff should monitor peoples weight and take action where needed to ensure that their health needs are met. Pressure area risk assessments should clearly state what the risk is so that people are supported appropriately to reduce the risk of them developing a pressure sore. Protocols should be in place for all as required (PRN) medication prescribed to individuals to ensure that people receive the medication they need to meet their health needs. People should be offered regular drinks to ensure their health and well being. Staff should interact with the people living there at all times in a way that respects their dignity. People should be supported to take part in regular activities that they enjoy to ensure they have a meaningful lifestyle. Care plans should show staff how to support individuals at mealtimes so that people can enjoy their meals in a relaxed atmosphere. Food records should clearly state what the person has eaten to ensure they are receiving a varied and nutritious diet that meets their individual needs. All people should be served food that looks attractive and respects their dignity regardless of their dietary needs. 2 3 3 4 7 8 5 6 7 8 8 8 8 9 9 10 11 12 10 10 12 15 13 15 14 15 Care Homes for Older People Page 33 of 36 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 15 16 15 16 People should be offered a choice of meals to ensure they can have the food that they enjoy. Consideration should be given to producing the complaints procedure in a format that would be easier for the people living there to understand. All staff should have the training needed so they know how to safeguard the people living there from abuse and harm. External lighting should be provided so that it is safe for staff and visitors when leaving or arriving at the home. The window on the stairs should be risk assessed to determine whether it is safe or not to leave it open. Chairs should be replaced where needed to ensure that they are comfortable for people to sit in. Sufficient lighting should be provided to ensure that people can move around the home safely. Redecoration should be done where needed to ensure people live in a homely and comfortable environment. Risk assessments should be completed to ensure that it is in peoples best interests to lock the bathrooms, toilets and bedrooms. Bedrooms should reflect the tastes, interests and needs of the individual. Bedroom furniture should be replaced where needed so that bedrooms are comfortable and safe for people to spend time in. Continence pads should be stored in bags so to reduce the risk of cross infection. The home should be clean and free from offensive odours so it is comfortable for people to live in. Staff should have sufficient breaks in between shifts to ensure they can meet the needs of the people living there. Records should be available to show that nurses have current registration with the Nursing and Midwifery Council (NMC) and are therefore fit to practise. Copies of reports of the monthly visits by a representative of the provider should be available to show that audits are Page 34 of 36 17 18 19 20 21 22 23 18 19 19 19 19 19 21 24 25 24 24 26 27 28 29 26 26 27 29 30 33 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 taking place to improve the home for the benefit of the people living there. 31 38 Staff should have the information they need so they know how to support each person safely to move around to ensure their well being. Body maps should be completed for all accidents and further analysis undertaken to assess if there is any reason where action could be taken to reduce these injuries. All staff should be involved in fire drills so they know what to do and how to support the people living there if there is a fire. 32 38 33 38 Care Homes for Older People Page 35 of 36 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 36 of 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!