Inspection on 29/03/10 for Elm House

This inspection was carried out on 29th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm House 22/04/09

Elm House 17/04/07

Elm House 23/08/06

Elm House 25/10/05

Elm House 18/05/05

Elm House 12/10/04

Elm House 13/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Elm House 43 Cambridge Road Southport Merseyside PR9 9PR     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: Claire Lee     Date: 2 9 0 3 2 0 1 0 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Elm House 43 Cambridge Road Southport Merseyside PR9 9PR 01704228688 01704231940 elmhouse43@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Peter John Berry Name of registered manager (if applicable) Mrs Zena Carol Stretch Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Elm House is a privately owned care home that provides 30 single places for older people with nursing or personal care needs. Elm House is situated close to Southport town centre, local amenities and Hesketh Park. The home has 4 floors with a passenger lift to all areas. Extensive work has been carried out to improve the accommodation. There are now two lounges and all bedrooms have an ensuite facility. Wheelchair access is available at the main front entrance. The home has car parking space and a landscaped garden at the rear. Baths and a shower are suitably adapted Care Homes for Older People Page 4 of 33 Over 65 30 0 Brief description of the care home to assist those who are less able and residents are provided with a call bell system. Elm House is privately owned by Mr Berry and the manager is Ms Zena Carol Stretch. The weekly rate for accommodation is five hundred and ten pounds to six hundred and thirty five pounds. Care Homes for Older People Page 5 of 33 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: An unannounced visit took place as part of the inspection. This was carried out by two inspectors for one day and a pharmacy inspector on the second day. The pharmacy visit took place to check to see how medicines were being given to people. The visits lasted approximately fifteen hours in total. During the time spent at the home we looked at different areas and a number of care, staff and health records to assess what care the residents living there received. Discussion also took place with seven residents, seven staff, the manager and owner. The last unannounced visit took place on 22nd April 2009. Requirements and recommendations from that visit were inspected at this time along with all the key standards and other standards that we chose to look at. We conducted this inspection before the due date, as we had concerns as to how an incident, which affected people at the home, was managed. Care Homes for Older People Page 6 of 33 People accommodated at the home like to be called residents. Out of respect to them, this term is used in this report. During the inspection three residents were case tracked (their files were looked at and where possible their views obtained of the service). This was not carried out to the detriment of other residents who took part in the inspection. To find out more about the care provided at the home, survey forms called Have your Say About..... were distributed to a number of residents and staff prior to the site visit. A number of comments were received and some of them have been included in this report, along with comments we received at the time of our visit. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager completed this to a good standard. Some information from this document has been included in this report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We asked to look at residents contracts. These had not been given out to new residents, however the owner said he was in the process of sending them out. New residents should be given a contract stating terms and conditions of residency. This helps to ensure they are aware of their rights in respect of occupancy, the overall care and service to be provided for the fee charged. Care Homes for Older People Page 8 of 33 Following the advent of the Mental Capacity Act, we would recommend that peoples mental capacity is assessed at the point of moving into the home. The manager and staff should review this and ensure that such assessments are built into the admission and ongoing assessments. Residents care documents included risk assessments. These are completed by the staff when they have assessed a risk associated with a daily tasks or care need. We found that some of the risk assessments had not been reviewed following an incident, such as a fall, that had the potential to place a person at risk. The residents risk assessments must accurately record current risk in respect of falls and hazards to their safety. This helps to keep the person safe and make staff more aware of the increase in risk. We looked at the residents daily care records to ensure staff were recording the care they had given and any incident that had affected a residents welfare. The daily care records did not record details of a residents falls. The residents daily care records must be kept up to date to ensure their ongoing protection and for the staff to have the information they need to provide care and support according to individual need. This is especially important following an incident, such as a fall where the resident has subsequently suffered an ill effect. The pharmacy inspector issued requirements, as we had concerns over the management of the medicines in the home. Current practices are placing people at risk. The manager must oversee and monitor medicines administered by the staff to ensure medicines are given to residents in a safe manner and according to their prescription. A number of good practice recommendations were also made. The requirements and recommendations are stated within the report. We would recommend that a summary of the complaints procedure be displayed in the main hall. This is so that everyone knows who to speak with should they wish to raise a complaint and are aware of the timescales involved with responding to and investigating a complaint. Work is underway to provide a cover for the external fire escape. This needs to be completed to comply with building control and to help ensure the ongoing protection of the people in the home. The owner should advise us of this when completed. Daily checks of the hot water to the baths should be undertaken and then recorded. This helps to minimise any risks to the residents prior to them bathing. In the absence of the registered manager and/or owner, the nurse in charge of the home must be provided with the authority to manage the home effectively. In light of a recent incident that affected the welfare of people at the home, we would recommend a review of these procedures. This is to help ensure these arrangements are made explicit to the nurse in charge, so that he/she is left in no doubt as to the scope of their autonomy. In such circumstances there must be clear lines of accountability and decision making, which are essential in helping to ensure that the home is managed effectively. This will protect and ensure the heath and safety of people at all times. When requested or deemed necessary the staff offer assistance with managing pocket Care Homes for Older People Page 9 of 33 monies held on behalf of the residents. We found that there were no receipts for purchases or a financial record of expenditures for one resident. The way in which this was being managed was poor and and has the potential to place them at risk. 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 33 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 33 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. There is a good system to introduce people to the home, with information provided and needs assessments completed. This helps to ensure people know that their needs can be met by the staff. Evidence: Information was available about the home and the service the staff offer. These documents are called a Service User Guide and Statement of Purpose. These documents are provided for prospective and current residents and their families to view, the details of which are incorporated within the residents handbook. The information was clear and easy to follow to help residents decide whether the home is right for them. The AQAA gave details of the residents handbook and also reported, we give potential residents as much information as possible about the staff (skills and experience), specialised services such as palliative care (end of life care), physiotherapy and chiropody. A resident interviewed said they were greeted warmly when they arrived at the home and had settled in well. Care Homes for Older People Page 12 of 33 Evidence: Residents receive a contract with terms and conditions of residency and the owner said he is in the process of sending these details out for new residents. This should continue to help ensure they are aware of their rights in respect of occupancy and the overall care and service to be provided for the fee charged. Prior to admission to the home, the residents have their health and social care needs assessed by the manager to ensure the staff can provide the necessary care and support they need. The assessments look at different aspects of daily living, such as, nutrition, mobility, communication, medicines, social background, sleep and personal care. The AQAA told us that the staff also obtain information from external health professionals including social services and district nurses where appropriate. This helps the staff to plan the care according to need and preference. We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessments. Intermediate care is not provided at the home and therefore this standard was not assessed. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management of risks associated with the residents health and current medicine practices has the potential to place them at risk. Evidence: We looked at care files for three people and tracked aspects of their care. We found that work has been carried out to make care plans personalised, so that people have the care they need, given in the way they prefer. There are systems in place for reviewing and updating care plans regularly and in response to changes in a persons condition. This will help to ensure that people are receiving the level of support they need. We cross checked the falls and accidents recorded in peoples care files with the accident records. We found that staff are recording accidents clearly, however they need to take action in response to falls to ensure that individual risk assessments are kept up to date and hazards to peoples safety are identified and as far as possible, eliminated. Care Homes for Older People Page 14 of 33 Evidence: We looked at how peoples health is supported in the home and found clear records of medical interventions and treatment from visiting health professionals. Since our last visit, staff have written a specialist care plan format to be used for medical conditions such as diabetes. We recommend these plans be put into place for people who need them, to give staff clearer guidance about how to support their specialist health care needs properly and safely. We saw good evidence in the records that peoples choices are respected in care planning. Examples include choice of gender of carer, choice of rising and retiring times and choices and alternatives offered at meal times. People spoken with said their privacy is respected in their home and staff told us they have procedures to follow regarding respect for peoples privacy, dignity and confidentiality. As part of the inspection, a pharmacist inspector visited on 30th March 2010 to look at how medicines were being handled. Overall we found medicines were not being handled safely because they were not always given to people correctly. We found the records of medicines received into home were not always complete. None of the current stock had been dated on receipt and we found several examples of medicines not being recorded at all when they had been received into the home. Medicines that needed to be carried forward to a new monthly cycle were not properly recorded, so accounting for them was impossible. Records of medicines disposed of when they were no longer required were not accurate because staff did not properly witness and date them. Poor record keeping of medicines can lead to serious mistakes that can harm the health and wellbeing of people who live in the home. We looked at the times medicines were given and found some were not being given at the right and best time. Medicines that should have been given before food or after food were often given wrongly because the medicines rounds had not been properly organised. Giving medicines at the wrong time can harm the health and wellbeing of people who live in the home because it can stop them work properly. We checked a sample of boxed medicines and found some did not add up showing they had sometimes been missed because staff had forgotten to give them. One person missed their antidepressant medicine four times in the last month and another person missed six of their antihistamine tablets. We found liquid medicines difficult to account for and our checks showed several of them had been missed on numerous occasions. Of particular concern was an epileptic medicine that had been missed five times in the last two weeks. Missing medicines can seriously harm the health and wellbeing of people who live in the home. Care Homes for Older People Page 15 of 33 Evidence: Records of external medicines, such as creams, were not always completed by the care staff that handled them so we could not be sure they were being used properly. The manager showed us some new paperwork that was being developed and we gave some advice about how this could be further improved to help make sure these medicines are handled safely. We looked at how controlled drugs were handled and found they were not all stored according to the law because one of the cupboards was not correctly bolted to the wall. Records of administered controlled drugs were usually signed and complete but we found the records of them being received into the home were not always witnessed, so there was a risk of them being mishandled. Having secure storage and properly witnessed records help prevent the misuse and mishandling of controlled drugs. We checked the care plan of a person who often refused their medicines and found their mental capacity had not been properly considered. The manager and deputy manager said they had not carried out training about Mental Capacity and Deprivation of Liberty Safeguards and we saw no paperwork to support the assessment of mental capacity. This is important to help make sure the rights of people who live in the home are fully protected. We looked at how the managers made sure staff were competent and made sure medicines were being handled safely. Medicines checks were carried out monthly and although some problems had been identified, we found effective action had not been taken to help prevent mistakes happening again. We saw no formal assessments of staff competence, so we gave some advice about how these should be carried out, including watching nursing staff administer medicines to people. Having regular effective audits and thorough assessments of staff competency help make sure medicines are handled safely by suitably skilled staff. Although Standard 11 (Dying and Death) was not assessed, the staff provide end of life care and this is carried out with support from a local hospice. End of life care plans are completed at the appropriate time to evidence the specialist care needed at this time. There was no resident receiving this care when we were at the home. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide daily variation and interest for people living in the home. Evidence: There was a pleasant relaxed atmosphere in the home and good interaction was noted between the staff and residents, as they helped them with different tasks. For example, help with meals, which was given in a polite manner with time given to the residents to enjoy their lunch. Visitors arrived at different times of the day and were seen to be made welcome by the staff. Care files seen also showed that the staff contact the advocacy service if a resident does not have a person to act on their behalf. This helps to protect the residents best interests in respect of their daily affairs. Holy Communion is offered at the home so that residents can continue with their chosen faith. Care plans recorded information in respect of religion, culture and relationships, so that residents can continue where possible with their chosen lifestyle. Residents bedrooms seen were personalised with items from their own home to help Care Homes for Older People Page 17 of 33 Evidence: make the room feel more homely. A resident said, It helps bringing in bits and bobs and the staff helped me to arrange them. An activities organiser attends the home for approximately three hours a day during the week. The activities organsier has attended numerous courses to help her plan and implement a varied programme for the residents. The social arrangements are well managed and it was evident that time had been spent finding out what the residents like to take part in and what they enjoy. The care files seen contained this information within a well being chart and resident profile and also contact details of friends and family and religious requirements. This helps to ensure they can choose how to spend their day. A record was seen for activities undertaken by the residents and the activities organiser meets with them each day to discuss suggestions and ideas. During the visit residents were seen to take part in and enjoy a musical afternoon with a singer/guitarist and they were served wine, sherry and home made cakes. Other activities include, massage, foot spas, computer usage, quizzes, cinema afternoon, arts and crafts and outings to the park. A resident said, I love the music and the girls made sure I was ready to take part this afternoon. The staff were seen to invite people to attend and also the music afternoon was advertised for everyone to see. A resident said that the activities organiser visits everyone, including people in their own room. The main meal of the day is served at lunch time and a number of residents were seen to sit and enjoy their meal at the dining room tables in the conservatory and the main lounge/dining room. The tables were attractively laid with flower arrangements and table cloths. Some residents received their meals on coffee tables and other in their rooms if preferred. Lunch looked appetising and the residents were given a choice of two hot, freshly cooked meals. The menus offer good, wholesome meals and the cook was knowledgeable with regard to the residents food preferences. This helps to ensure they receive meals they like and enjoy. Special diets are catered for in respect of medical conditions following the advice of GPs or other health professionals. Nutritional assessments are completed by the staff and these help to monitor the residents intake to keep them in good health. The kitchen was organised and well stocked with plenty of fresh produce. Home baked cakes and soups are prepared regularly and the following comments were made, The food is very good, I can have what I want to eat and Good basic home cooking and acceptance of my small appetite. Environmental health records seen were current to maintain good standards of food control and hygiene in the kitchen. Care Homes for Older People Page 18 of 33 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 who use the service are protected by the homes complaints and safeguarding procedures, which are understood by the staff. Evidence: The AQAA reported that there is a complaints procedure. This is recorded in the residents handbook. It also stated that there had been eight complaints and one upheld. This was found to be the case and complaints received had been logged and investigated by the manager to the satisfaction of all parties. It is recommended that a summary of the complaints procedure be displayed in the main hall, so that everyone knows who to speak with and are aware of the timescales involved with responding to and investigating a complaint. Residents spoken with said they were happy with current arrangements in the home. The following comments were made, I can ask the matron anything and she gets it sorted for me and I have no worries at all. The home has a safeguarding policy to protect people and also Sefton and Liverpools Guide to the Protection of Vulnerable Adults. The AQAA reported that two safeguarding referrals were made to the relevant agencies including the Commission. One of these involved an incident that affected the health and safety of residents, staff and a number people visiting the home. External agencies, including the Commission, were involved as part of the investigation, as there were concerns as to the time it took to Care Homes for Older People Page 19 of 33 Evidence: resolve the issue. Clarification was provided by the owner with regard to the incident and this has now been resolved to the satisfaction of all parties. The management of the safeguarding referral is discussed further under Standard 32 (Management and Administration) of this report. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in suitably adapted, clean and comfortable pleasant surroundings. This helps to improve their quality of life. Evidence: The AQAA reported, the home has had a total facelift inside and out. The new extension is now complete and the home provides ensuite bedrooms throughout and a large lounge overlooking the rear garden. We conducted a tour of the home and looked at different areas to make sure they were clean, comfortable and well maintained. This was found to be the case. Communal areas comprise of two lounges, which also provide dining space and one lounge has a conservatory. Both rooms had comfortable armchairs and residents were seen to frequent both rooms during the day. The lounge at the level of the rear garden is used for activities and this is where the residents were enjoying musical entertainment at the time of our visit. The room is spacious to accommodate wheelchairs with ease. Residents have the use of a hairdressing room and therapy room where activities can be undertaken. Bedrooms seen were attractively decorated and had a good standard of furnishings and fittings. The rooms included a call bell with an alarm facility and some had special nursing beds for those residents who need extra support, as their health is frail. Residents interviewed said their beds were comfortable. Those residents being nursed in bed were attended to regularly by the staff to ensure they received good care. Care Homes for Older People Page 21 of 33 Evidence: Residents had brought items in from home to make their rooms feel special and homely. A resident said, I really like my room, it is nice and airy. Likewise another reported, I only have to ask and things are sorted for me, I always have my buzzer with me. Adapted baths and showers are available for the residents to enable them to use these facilities safely. The owner checks the hot water temperature to ensure it is at a safe temperature for people to use. We looked at the monthly records and these were found to be satisfactory. The manager said the staff check the hot water temperature each day before bathing the residents. These records had not been completed and it is recommended that a daily check also be undertaken and recorded to minimise any risks to them. Work is underway to provide a cover for the external fire escape. This needs to be completed to comply with building control to help protect people. The owner is aware of this and will advise us when the work has been completed. Areas seen appeared well maintained and clean. The laundry room was organised and staff receive infection control training to help ensure they have the skills and knowledge to minimise the risk of cross infection. The residents laundry is taken care of each day by laundry staff and their personal items returned promptly to them. A maintenance person ensures day to day jobs are completed to keep the home in good order. Any health and safety issues are reported to the manager to help ensure the safety of people in the home. A relative reported that the home provides, Nice, secure surroundings. Care Homes for Older People Page 22 of 33 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. People receive care and support from staff who are recruited safely and who are trained in their job role. Evidence: The residents receive care and support from a stable workforce, the majority of the staff have worked at the home for many years. We were advised that on the day of the inspection, two care staff had called in sick and this affected the overall number of staff on duty to care for twenty seven residents. The manager however, provided assurance that this number of staff could provide the necessary care and support to the residents. We were advised that normally shifts can be covered by the homes staff, however in this instance this could not be arranged. A member of staff was available to come in and help at 6pm prior to her night shift. Staff interviewed said it was a busy home and many of the residents need alot of help. No concerns were raised from the residents, with regard to not receiving the care they need. When the pharmacy inspection was conducted, there were five care staff on duty. We looked at recruitment procedures for two new staff and these were found to be robust to help protect people. The checks included obtaining police clearance and references prior to commencing employment. New staff receive an induction and for care staff this is given in accordance with the Skills for Care Induction Standards. These provide a formal introduction into care. Staff also receive a handbook, which Care Homes for Older People Page 23 of 33 Evidence: gives them information about the standards expected of them in the home. The AQAA advised us that all staff have achieved an NVQ (National Vocational Qualification) in Care at Level 2 and above. This is evidence of formal learning in care and assists the care staff with their development. Staff receive training in safe working, for example, moving and handling, infection control, food hygiene and first aid. Staff interviewed said that courses were made available and that training dates were in place on the training board for everyone to see. Staff also attend other courses relevant to the care of their residents and this includes safeguarding, diabetes, end of life care, bereavement and health and safety. It was evident that the staff have access to a training programme, that provides them with the skills and knowledge they need to care for the residents. A resident referred to the staff as being, Cheerful and friendly. Care Homes for Older People Page 24 of 33 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 management of the service must be improved, as existing practices may place people at risk. Evidence: The registered manager, Ms Stretch, is qualified and experienced in caring for older people and is employed in the home on a supernumerary basis. The owner, Mr Berry, also works in the home and both Mr Berry and Ms Stretch are qualified nurses. They advised us that they work with the staff to help deliver care and support to the residents. We discussed a recent incident that occurred in the home. This particular incident affected the health and safety of the residents, staff and a number of visitors to the home. It resulted in a safeguarding investigation. This is no reflection on the nurse who was left in charge and who had to deal with the situation in the absence of both the registered manager and the owner. Concerns were raised however by the agencies involved with the safeguarding referral, as to how the incident had been handled. In Care Homes for Older People Page 25 of 33 Evidence: the absence of the registered manager and/or owner, the nurse in charge of the home must be provided with the authority to manage the home effectively. We would recommend a review of these procedures. This is to help ensure these arrangements are made explicit to the nurse in charge, so that he/she is left in no doubt as to the scope of their autonomy, particularly when asked to make decisions that might involve additional expenditure. In such circumstances there must be clear lines of accountability and decision making, which are essential in helping to ensure that the home is managed effectively. This will protect and ensure the heath and safety of people at all times. This matter was discussed at length with the registered manager at the time of the inspection. The manager must oversee and monitor medicines administered by the staff to ensure medicines are given to residents in a safe manner and according to their prescription. Current practices are placing people at risk. The manager must ensure that the staff are aware of the need to take action in response to residents falls to ensure that individual risk assessments are kept up to date and hazards to peoples safety will be identified and as far as possible, eliminated. We looked at the residents daily records to ensure staff were recording the care they had given and any incident that had affected a residents welfare. The daily care records did not record details of a residents falls. The residents daily care records must be kept up to date to protect them and to ensure that the staff have the information they need to provide care and support according to individual need. This is especially important following an incident, such as a fall, where the resident has subsequently suffered an ill effect. Staff said they receive supervision of their job role and the AQAA told us they are also given questionnaires to complete. This and staff meetings give them opportunities to voice their opinions and make suggestions about the home. Residents and their representatives also attend meetings and the date of the next meeting was displayed. The manager compiles a newsletter, which gives information about the home and forthcoming events. When requested or deemed necessary the staff offer assistance with managing pocket monies held on behalf of the residents. We found that there were no receipts for purchases or a financial record of expenditures for one resident. The way in which this was being managed was poor and and has the potential to place them at risk. Care Homes for Older People Page 26 of 33 Evidence: A spot check was carried out of a number of certificates for services and equipment to the home. This included the gas, electric, moving and handling and fire detection equipment certificates. These were found to be in date. The AQAA also provided this information along with details of policy documents in safe working for the staff. The manager has recently reviewed all the homes policies and procedures to help ensure they are in accordance with current legislation and best practice. We looked at a number of these and they were available for staff referral. The staff had received fire training and fire drills take place as part of this. Regular tests had been made in respect of the the fire detection equipment to help ensure it was in good working order in the event of a fire. Care Homes for Older People Page 27 of 33 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 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The residents risk assessments must accurately record current risk in respect of falls and hazards to their safety. This is to help ensure the protection of the resident by identifying the risk and as far as possible eliminate. 07/05/2010 2 9 13 Medicines must be given to people as prescribed. This is important because receiving medicines at the wrong time, wrong dose, or not all all can seriously affect a persons health and well being. 06/05/2010 3 9 13 Records of medicines received into the home, given to people and disposed of must be clear, accurate and complete. 06/05/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help make sure all medicines can be fully accounted for. 4 9 13 Controlled drugs must be stored in a cupboard that meets the requirements of the law. This will help prevent mishandling and misuse. Financial records and receipts must be kept on behalf of the residents when staff are dealing with their monies. This will help to protect the residents financial interests. 6 37 17 Residents daily care records 07/05/2010 must be kept up to date. This is especially important following an incident, such as a fall where the resident has subsequently suffered an ill effect. This will help to protect the residents and to ensure that the staff have the information they need to provide care and support according to individual need. 06/07/2010 5 35 16 08/05/2010 Care Homes for Older People Page 30 of 33 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 New residents should be given a contract stating terms and conditions of residency. This helps to ensure they are aware of their rights in respect of occupancy and the overall care and service to be provided for the fee charged. Following the advent of the Mental Capacity Act we would recommend that peoples mental capacity is assessed at the point of moving into the home. The manager and staff should review this and ensure that such assessments are built into the admission and ongoing assessments. Can plans should be put into place for people who need them, to give staff clearer guidance about how to support their specialist health care needs properly and safely. Care plans should have detailed information about how peoples medicines should be handled including those used for seizures and pain relief and how people are to be safely supported to look after their own medicines. Managers and staff should have appropriate training about the Mental Capacity Act and the Deprivation of Liberty safeguards to help make sure the rights of people who live in the home are fully protected. The competency of nursing staff should be formally assessed to help make sure they have the necessary skills to handle medicines safely. Care plans should have detailed information about how peoples medicines should be handled including those used for seizures and pain relief and how people are to be safely supported to look after their own medicines. The competency of nursing staff should be formally assessed to help make sure they have the necessary skills to handle medicines safely. 2 3 3 7 4 9 5 16 A summary of the complaints procedure should be displayed in the main hall, so that everyone knows who to speak with should they wish to raise a complaint and are aware of the timescales involved with responding to and investigating a complaint. Care Homes for Older People Page 31 of 33 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 6 19 Work is underway to provide a cover for the external fire escape. This needs to be completed to comply with building control to help protect people. The owner should advise us of this when completed. Daily checks of the hot water to the baths should be undertaken and then recorded. This helps to minimise any risks to the residents. In the absence of the registered manager and/or owner, the nurse in charge of the home must be provided with the authority to manage the home effectively. We would recommend a a review of these procedures. This is to help ensure these arrangements are made explicit to the nurse in charge, so that he/she is left in no doubt as to the scope of their autonomy particularly when asked to make decisions that might involve additional expenditure. In such circumstances there must be clear lines of accountability and decision making, which are essential in helping to ensure that the home is managed effectively. This will protect and ensure the heath and safety of people at all times. 7 25 8 32 Care Homes for Older People Page 32 of 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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