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Please note that the information on this website is now out of date.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 02/09/09 for Drummuir Nursing and Residential Home

Also see our care home review for Drummuir Nursing and Residential 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

Peoples rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff . All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. People could choose to have their meals in the dining room or in their own rooms. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. People are able to bring in furniture and personal belongings to personalise their private room. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of people were very complimentary about the staff working at the home. All said that staff were warm, caring and friendly. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as "very good" . People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported.

What has improved since the last inspection?

Care planning process has improved although some additional developments are recommended. Health care needs are now met and staff can more readily identify when people needs change. Shortfalls were noted at the last inspection with regard to the management of medication. These shortfalls have now been addressed. Medication is now managed within best practice guidelines. Staff recruitment procedures have improved with all staff now having all required checks in place. Staff training opportunities have also significantly improved with all staff having now completed all mandatory training. NVQ training and further training opportunities are now being developed. Induction training for new staff is now in place.

What the care home could do better:

Information relating to the home needs to be updated to ensure that it provides information for anyone thinking of moving into the home. Consideration now needs to be given to ensuring that the care planning process is consistently completed for all people living at the home. All the Registered Nurses now need to be completing these to the high standard seen in some of the plans. This should include ensuring that all are completed with a person centered approach in mind. Social and recreational opportunities are currently limited although it is hoped that this will improve in the very near future. Some areas of the home were did not smell fresh and clean during this inspection. The management need to ensure that all areas of the home smell fresh at all times. The home has not had a consistent manager for some time. We have been unable to assess any skills any manager may have as no manager has been registered with us for a significant period. We have been told by Southern Cross that a new manager has been recruited and should be starting employment in the very near future. Southern Cross must ensure that the manager submits an application to become registered with us as soon as possible.

Key inspection report Care homes for older people Name: Address: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ     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: Justine Button     Date: 0 4 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 28 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 28 Information about the care home Name of care home: Address: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ 01278422144 01278420397 drummuir@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne Boss Limited care home 38 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Elderly persons of either sex, not less than 60 years, who require general nursing care Up to eight places for personal care Up to two persons of either sex, between the ages of 50-60 years who require general nursing care Date of last inspection Brief description of the care home Drummuir Nursing Home is situated in a quiet residential area close to the town centre of Bridgwater. The home is not purpose built. Drummuir is registered with the Care Quality Commission provide general nursing care for up to 38 older people, although the home can only accommodate a maximum of 31 people. This includes up to 8 people who require personal care. There is a registered general nurse on duty at all times. The home has has a new manager in place who is not yet registered with the Commission. The fee range is between 421.00 pounds and 600.00 pounds. This does not include hairdressing, newspapers, toiletries, optician and some activities. 0 3 0 3 2 0 0 9 0 Over 65 38 Care Homes for Older People Page 4 of 28 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: This key unannounced inspection was carried out over one day by one inspector. An additional half a day inspection was completed by the Care Quality Commission pharmacist. At the last key inspection conducted in March 2009 a number of concerns and issues were identified. As a result of this the home received 0 stars poor rating. The purpose of this inspection therefore was to assess the progress towards meeting the requirements made and to ensure that the care and support to people living at the home was improving. As a result not all standards were assessed on this occasion. We would like to thank the interim manager and the duty staff for their time and hospitality shown to us during this visit. The home completed an Annual Quality Assurance Assessment, AQAA, prior to the last Care Homes for Older People Page 5 of 28 key inspection A number of surveys were sent to people living at the home, of which 5 were completed and returned to us. People living at the home who responded to surveys all described their ethnicity as white British. Residents are over 65 years of age. We were able to see and observe staff interactions with many residents, meet several relatives, discuss care issues with staff and discuss the management of the home with senior staff. Comment cards about the service from visiting professionals were also forwarded to the us at the time of the inspection. The focus of this inspection visit was to inspect relevant key standards under the Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were four service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, staff recruitment files, staff training records, quality assurance processes and staff supervision records. We also conducted a tour of the premises. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Information relating to the home needs to be updated to ensure that it provides information for anyone thinking of moving into the home. Consideration now needs to be given to ensuring that the care planning process is consistently completed for all people living at the home. All the Registered Nurses now Care Homes for Older People Page 7 of 28 need to be completing these to the high standard seen in some of the plans. This should include ensuring that all are completed with a person centered approach in mind. Social and recreational opportunities are currently limited although it is hoped that this will improve in the very near future. Some areas of the home were did not smell fresh and clean during this inspection. The management need to ensure that all areas of the home smell fresh at all times. The home has not had a consistent manager for some time. We have been unable to assess any skills any manager may have as no manager has been registered with us for a significant period. We have been told by Southern Cross that a new manager has been recruited and should be starting employment in the very near future. Southern Cross must ensure that the manager submits an application to become registered with us as soon as possible. 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 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. Some aspects of this documentation requires updating The home will ensure that people are appropriately assessed before a placement is offered. All people living at the home have been provided with a copy of the terms and conditions of their stay. Trial visits are offered. Evidence: The home has developed a statement of purpose and information for people thinking of moving into the home. A copy of this information was viewed. This document requires some updating with regard to the facilities offered. The current information states that the home has four baths and no showers available for use. However it was noted that the home has at least one shower. In addition the home manager details and that of the wider company managerial arrangements have recently changed. The Care Homes for Older People Page 10 of 28 Evidence: documents also therefore require updating in this area. The Care Quality Commission was previously known as the Commission For Social Care Inspection and the our contact details have also recently changed. The documentation available for people needs to be altered to reflect this change. New placements at the home have been limited due to previous poor rating to enable improvements to be made. As such it was difficult to assess any preadmission assessments made by the home. The documentation for the assessments however was viewed and this contains all necessary information. This assessment will ensure that the home can meet the needs of the individual prior to moving in. In addition to the preadmission assessment the homes asks the individual (if possible) and or a family member to come to visit the home to ensure that all parties are happy for the placement to proceed. Assessments are also sought by the staff at the home from other health care professionals or social worker. The home provides each individual with the terms and conditions of their stay (contract). The contract viewed clearly sets out the fees payable, payment terms, notice periods and any additional charges. Fees stated in the contract do not include any Registered Nurse Care Contribution (RNCC). This is a sum of money paid by the government for anyone with a nursing need. Fees do not include hairdressing, visitors meals, newspapers, alcohol, private treatments such as physiotherapy or chiropody, taxi fares, toiletries, dry cleaning and escort duties. Charges for these items are invoiced monthly and Notification is given when the monies are used up. The contract states that a trial period of four weeks is in place. Care Homes for Older People Page 11 of 28 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. Improvements in the standard of care planning has been seen although some additional developments are still required. Staff were observed to treat people with dignity and respect at all times and people feel well cared for.Staff were observed to treat people with dignity and respect at all times and people feel well cared for. Improvements in the mamagement of medication has been seen Evidence: At the last inspection it was reported that the care planning process was inadequate as the plans did not give clear guidance to staff on the needs of the individuals living at the home. Since the last inspection the staff have commenced work to review and develop the care planning process. Some of the plans viewed however require ongoing and additional development. Information in the plans and assessments needs to be consistent to ensure that staff Care Homes for Older People Page 12 of 28 Evidence: deliver the care and support to the individual in a consistent way and to ensure that care needs are met appropriately. The care plans for individuals were not always specific and were ambiguous in places. For example one individual was immobile and required staff support to move or change position. The assessments and associated care plans for this area did not tell staff the equipment to be used nor the frequency that a positional change would be required. Nutritional assessments were not seen in all the plans viewed. These assessments are used to assess the risk of weight loss. Weight loss in older people can be significant and can be used to signify that the individual is becoming frailer and can also impact on the increase the risk of sustaining such things as pressure ulcers (also known as bed sores). We found that for people with swallowing difficulties that when a thickener is prescribed, that the use of this is included in the care plan and staff giving out drinks were aware of the need to use the thickener. This means that people will receive drinks that they are able to cope with. The bedroom for one individual at risk of weight loss and development of pressure ulcers was viewed during the inspection. This showed that appropriate pressure reliving equipment was in place. The equipment in use was in line with the care plan. During the course of this inspection this individual was supported to change position on a regular basis in line with the care plan. A change of position is required to help in the prevention and the healing of any pressure damage. The staff had commenced charts to record the frequency of positional change and the amount of fluids taken these had been completed consistently by staff. Charts such as these are used to assess if the care and support provided by staff is effective and adequate. The plan for another individual who had diabetes was viewed. Again this was ambiguous in places. The care plan did not state what the normal blood sugar was for this individual nor did the plan state what action the staff should take if the bloods were outside this normal range. The individual had a medical condition which causes the retention of fluid in the legs. This is called oedema. The plan stated that staff should monitor the oedema in the legs. The plan however did not state how this should be completed. The care plans for another individuals were viewed. These plans had been subject to recent updating . These contained a range of assessments and associated care plans. These contained more information and reflected the care needs of the individual in more detail than the documentation for the other individuals. Care Homes for Older People Page 13 of 28 Evidence: The Mental Capacity Act Deprivation of Liberty safeguards (formerly known as the Bournewood safeguards) were introduced through the Mental Health Act 2007 (which received Royal Assent in July 2007). The safeguards are designed to protect the interests of an extremely vulnerable group of service users and to: - ensure people can be given the care they need in the least restrictive regimes - prevent arbitrary decisions that deprive vulnerable people of their liberty - provide safeguards for vulnerable people - provide them with rights of challenge against unlawful detention avoid unnecessary bureaucracy It is expected that staff in care homes consider this act when providing care and support to people. Care plans to address the guidance in the act however has yet to be completed. The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GPs, Social workers & palliative care specialists. At the last inspection it was reported that One visiting health professional commented The staff were very good at linking with the GP and informing relatives of changing needs. Another told us that the home were very positive and supportive in their management and had promoted Independence . We spent time observing the care being given and noted that the members of staff treated people using the service with dignity and respect at all times. People using the service appeared relaxed in the company of the staff and the atmosphere was happy and calm. Surveys from people living at the home confirmed this. The home employ both male and female staff to support any gender preferences for care. The homes AQAA states that, We have conducted an annual review of our Policy on equality and diversity to ensure that it continues to be pertinent to needs of present and prospective service users. We found that a new medication room and fridge has been provided at the home. Since these have been in use the temperature has been well controlled. This means that people can be assured that their medicines will be suitable for use when given to them. We found that when people need to have blood sugars monitored that the devices used to obtain the blood sample were not recommended by the manufacturer for the purpose they were being used. As the members of staff were obtaining the samples this increased the risk of an needle stick injury occurring and also increaed the risk of cross infection. It was agreed during the inspection that replacement suppplies of suitable devices would be obtained. This means that people will be protected by suitable infection control measures. Care Homes for Older People Page 14 of 28 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 provision of activities is currently restricted although improvements are anticipated in the near future. People are able to maintain contact with friends and family. Meals and mealtimes are on the whole adequate although some improvements are required. Evidence: The feedback received from people living at the home was very mixed with regard to the provision of activities. Out of the five feedback forms received three people stated that the home only sometimes arranged activities, one person stated that this usually happened and one person stated activities were always arranged. This supported the findings of the inspection when no activities were on offer. Documentation with regard to activities undertaken by individuals was seen to be spasmodic. Staff need to ensure therefore that the range of activities is increased (including those seen for 1 to 1 time) to include those who are less able. The management of the home told us that they were aware that activities at the current time were limited due to the lack of activities organiser. They hope that this will be Care Homes for Older People Page 15 of 28 Evidence: rectified in the very near future as they have now employed an activities coordinator. The management need to continue to review the activities available and ensure that these meet the expectations of people living at the home. Activities documented as being on offer included games, crafts, concerts, gardening and some trips to the local shops. A number of visitors were seen during the day of the inspection. People spoken to confirmed the finding of the feedback forms returned by relatives. Visitors to the home are welcome at any time. The staff service breakfast each morning to the people in their bedrooms or in dining room. The main meal of the day is at lunchtime and there is a l dining room available. Some people choose eat in their rooms or in the communal lounges. The tables were laid however condiments were not available. Drinks were served for people to have with their meal. People with specific dietary needs and preferences were catered for and contact with the Community Dietitian is made as and when required. When asked if they liked the meals three people stated that they always like them and two people stated that they usually like them. People using the service who were able to give an opinion confirmed that choice is made available. We observed lunch being served both in the dining room and in bedrooms and it appeared to be enjoyed by all. Staff were observed to give choices to people at the home. This included showing the plate of the menu choices available to those who would have difficulty in making a choice or with communication issues. People who required assistance were helped in a dignified and discreet manner. A menu was not on display during this inspection. The management told us that this was due to a recent breakdown of the kitchen freezer. As a result of this the cook was shopping and deciding on a daily basis what to cook. This resulted in a change from the usual planned menu system. On the day of inspection lunch was a choice of Cornish pastie or cheese and onion quiche. Both of these products were shop bought and not made on the premise. This may have been due to the breakdown of the freezer but the management need to keep this under review to ensure that nutritional value of the meals served is adequate. Chips or mashed potato were available as well as swede and carrots. Omelettes and salad were also available although this was not chosen by anyone living at the home. Care Homes for Older People Page 16 of 28 Evidence: Tinned fruit salad with cream and/or ice cream was then available. The evening meal is the lighter meal of the day. Drinks were served throughout the day. It was noted that some of the cups that cold drinks were served in were very stained. These need to be replaced. Biscuits were available with the morning and afternoon drinks. It is recommended that the range of snacks available be reviewed to ensure that snacks are available for those with swallowing difficulties or those at risk of loosing weight. Foods such as yoghurts, milk shakes fruit etc should be made available. Staff need to ensure that the snacks are actively offered to people living at the home. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that they are listened to and their requests acted upon. Staff demonstrated good knowledge and understanding of their role to ensure that people using the service are protected from abuse. Evidence: This inspection was conducted to review outstanding requirements. At the last inspection the outcome for complaints and protection was assessed as good. The standards therefore were not fully assessed on this occasion. At the last key inspection it was reported The home has updated the complaints policy to include the correct contact details and is displayed in the home to enable access to all. It is also available in the homes Statement of Purpose/ Service user Guide provided in each persons bedroom. Both people using the service and staff told us that if they had any concerns they would raise them with he manager designate and would be confident that appropriate action would be taken. The homes AQAA states, All complaints whether verbal or written are recorded in the complaints log. A holding letter is sent within 24 hours of the complaint being received and is dealt with within 28 days and signed off by the Manager when resolved. The home has received two complaints which have been appropriately investigated Care Homes for Older People Page 18 of 28 Evidence: and responded to.The complaints log is recommended to be updated to ensure that all responses and outcomes are recorded. All people using the service are registered to vote in any forthcoming elections and an independent advocacy service is accessed for people who require this service. The home displays prominently its policy on abuse awareness and most staff have received abuse awareness training. The home has copies of the Safeguarding Vulnerable Adults Policy for Somerset (September 2008) and has company policies for staff on whistle blowing and abuse awareness. Staff spoken with were clear of the actions to take should an allegation or suspicion of abuse be raised. Care Homes for Older People Page 19 of 28 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 provides people with a homely place to live, it is comfortable and suited to the needs of the people who live there. Equipment is provided where there is an assessed need. The standard of hygiene must be reviewed to ensure that an appopriate standard is achieved in all areas of the home. Evidence: At the last key inspection it was reported that The home is a large older building, which has been converted and extended. There is a communal lounge, smaller lounge and dining area, these areas are adequately furnished and decorated. Personal accommodation is located on each of the 3 floors of the home and is accessible to people with all levels of mobility. Lift access is available to each floor. All bedrooms seen varied in size and were comfortably furnished and had been personalized to reflect the tastes of the individual person. People are able to bring personal effects and small items of furniture with them when they move to the home, which gives rooms an individual homely feel. Care Homes for Older People Page 20 of 28 Evidence: Various aids and adaptations have been put in place to assist people to maintain their independence. Specialist pressure relieving cushions and mattresses were seen were there was an assessed need. Profile beds have been provided for people with nursing needs. The Expert by Experience noted There is a lack of storage space around the Home; a small lounge on the ground floor would have been much nicer had not a large supply of incontinence pads been stored along one wall. The homes AQAA states that, We are planning to redesign our lounge and dining areas in order to make them more user friendly. Redecoration of the large lounge has made the space brighter and a pleasant space. Repairs to the heating have been completed and hot water is accessible to all areas of the home. Some areas of the home were noted to have a malodour of urine and the ground floor bathroom and toilets are in need of repair/refurbishment to ensure they have a good standard of appearance and hygiene. The home is currently advertising for a cleaner and on the day of inspection only one cleaner was working. Some areas of the home were observed to be cluttered with equipment and incontinence aids. These areas must remain clear to ensure there is no risk of falls or fire risk in the home. The home has developed a wet room which is now in use for people using the service to have a shower. At this inspection it was noted that a programme of refurbishment and decoration was being completed. This will improve the overall appearance of the home and ensure that it is a pleasant place to live. On this inspection it was noted that there were some odours in some areas of the home. We received some conflicting information with regard to this issue. One relative stated that the home no longer smelt and that her family member had been at the home for a seven years and this was the first time the home had not smelt. Another relative told us that the home often smelt when she visited. The management need to keep this under review and ensure that all areas of the home are kept clean and free from offensive odours. This may include researching alternative floor coverings for some areas. As stated previously the development of the wet room/shower should be reflected in the homes statement of purpose. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs enough staff to meet the needs of the people using the service and to ensure the safety, comfort and maintenance of the premises. Recruitment procedures are mostly robust in protecting people using the service. People benefit from having experienced staff who have a good understanding of their needs. Evidence: As previously stated as the home was assessed as poor 0 stars at the last key inspection the home has not had a recent admissions. Due to this the occupancy at the home has been relatively low. Southern Cross health care have not reduced the staffing numbers in line with this reduced occupancy. This has given the staff time to address some of the shortfalls previously identified. On the day of the inspection 22 people were living at the home. Staffing numbers included one registered nurse and five care staff in the mornings and one registered nurse and four care staff in the afternoon and evenings. In addition a range of other staff such as cooks cleaners, managerial support and maintainance personnel were available. Given the current occupancy these numbers were sufficient to meet the needs of the people living at the home. Comments at previous inspection have identified that the numbers of staff available is not always adequate. The management therefore need to ensure that as the occupancy increases that staffing numbers are reviewed in line with peoples Care Homes for Older People Page 22 of 28 Evidence: assessed needs. Two staff recruitment files were viewed as part of this inspection. These demonstrated that robust recruitment checks are completed for all staff prior to the staff member commencing work at the home. Staff training was reviewed. A copy of the training matrix was provided by the home. This demonstrated that the majority of staff have undertaken all necessary mandatory training. The home has staff who have achieved an National Vocational Qualification in care and also staff working to wards this qualification. Staff told us that they had undertaken an induction process which was in line with the Skills for Care Common Induction Standards. Staff felt the induction provided them with the information they needed to start work at the home. This was confirmed by viewing the induction records of two staff who had recently started employment at the home. Staff records and staff comments confirmed that they receive regular one to one supervision to discuss further training needs and any ongoing concerns in the home. This takes place no less than 6 times each year and is in place to support and develop good practice in the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes residents involvement in the life of the home and promotes by health and safety monitoring prevention from the risk of harm. Financial systems for people using the service personal monies are managed in an auditable manner and the storage of records is secure and in line with the Data Protection Act. Evidence: The home has been without a stable manager for a significant period of time. (for this reason standards 31 and 32 have not been assessed) This has not allowed the home to maintain consistent improvements. As a result of this we met with the providers southern cross health care following the concerns raised at the last key inspection. In addition we requested that the company send us regular monthly updates with regard to the progress being made at the home. These monthly updates have confirmed that Southern Cross health care have been supporting the home during the current period the home has been without a manager. During this inspection we were told that a new manager had been recruited and was due to commence employment once all Care Homes for Older People Page 24 of 28 Evidence: necessary checks had been completed. The current managerial support to the home would continue to enable the new manager to have a period of induction. It is now hoped that this will enable the home to maintain and sustain the improvements seen at this inspection and that the home will continue to develop. At the last key inspection it was reported The home implemented a quality assurance audit in August 2008 and the results have been made available in the front hallway of the home. These include comments about the provision of activities. The management of the home also undertakes audits of the home to improve service delivery. The home has been delays in forwarding Regulation 37 notifications to the Commission and is reminded to ensure that all notifications are forwarded promptly for our information. Records stored at the home are stored securely and in line with the Data Protection Act. Staff are aware of the need for security of confidential documentation and all records are maintained individually. There are established systems in place for dealing with people using the service personal finances. We evidenced that each persons personal monies were recorded and receipts checked. All accounts are held by the companys accounts and a float of accessible cash maintained for people using the service to access should they need any money. An invoice of cash flow by each person was sent with the fee request each month. Accident records are maintained and a regular audit of accidents is undertaken to promote accident prevention. Records were examined with reference to safe working practices. Most records were well maintained and documented. Maintenance certificates were up to date. Some routine checks had been ticked as undertaken but not signed and dated, these included, the fire alarm checks and emergency lighting checks. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 12 The responsible individual is 08/05/2009 required to ensure that each person has been risk assessed and has a suitably detailed supporting care plan in place to ensure all identified needs are met. This is required to ensure that staff can provide the care needed and the person using the service is not placed at risk. 2 26 16(2)(j)(k) The registered provider is required to ensure that all areas of the home have a satisfactory standard of hygiene and ensuring that there is no malodour. The responsible individual is required to ensure that a manager is registered with the Commission. This is required to promote the stable management of the service. 01/10/2008 3 31 8 08/04/2009 Care Homes for Older People Page 26 of 28 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 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 2 12 15 It is recommended that consideration is given to developing the range of activities. It is recommended that the snacks that are available at the home are actively offered and available to all people living at the home. It is recommended that some of the stained cups and beakers are replaced. It is recommended that the menu is on display as soon as possible to ensure that people are informed of the food to served and enable them to make an active choice about the meals they would like. The management need to keep under review the amount of ready made or shop prepared food to ensure the nutritional value of the meals served. It is recommended that as the occuapncy levels at the home increase that the staffing numbers are kept under review. 3 4 15 15 5 15 6 27 Care Homes for Older People Page 27 of 28 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 28 of 28 - 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!