Inspection on 17/06/09 for Grassmere Residential Care Home

This inspection was carried out on 17th June 2009.

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

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

Other inspections for this house

Grassmere Residential Care Home 02/07/08

Grassmere Residential Care Home 12/07/07

Grassmere Residential Care Home 07/12/06

Grassmere Residential Care Home 28/09/05

Grassmere Residential Care Home 24/05/05

Grassmere Residential Care Home 26/01/05

Grassmere Residential Care Home 21/07/04

Grassmere Residential Care Home 20/01/04

Grassmere Residential Care Home 25/09/03

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grassmere Residential Care Home 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2XL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 1 7 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Grassmere Residential Care Home 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2XL 01213273140 01213273949 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) : United Care Ltd care home 26 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Additional conditions: 21 0 The maximum number of service users to be accommodated is 26. The registered person may provide the following category of service only: Care Home only (Code PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Older People (OP) 26 Dementia (DE) 21 Date of last inspection Brief description of the care home Grassmere Residential Care Home is situated on Washwood Heath Road, close to shops, pubs, churches and Ward End Park. It is well served by public transport. The Home provides residential care for up to 26 older people and this may include people in need of care for reasons of dementia. All rooms are for single occupancy and seventeen of these have en suite facilities. There are three linked sitting areas for the people living in the home, together with a Care Homes for Older People Page 4 of 32 Brief description of the care home dining room on the ground floor of the home. Also located on the ground floor are the main kitchen, a small office and staff facilities. The laundry for the home is situated away from the main building at the end of the garden. The home has two passenger lifts for access to the upstairs and a newer annexe. There are some assisted toilet and bathing facilities in the home and emergency call facilities are available. At the rear of the home is a small garden for the people living in the home to use. There are also some car parking facilities available. The fees at the home were detailed in the service user guide and ranged from three hundred and sixty one pounds to four hundred and seventeen pounds per week at the time of the inspection. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was July 2nd 2008. This inspection was carried out by two inspectors over one day. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we had received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that Care Homes for Older People Page 6 of 32 have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing three people who live in the home for 2 hours and recording their experiences at regular intervals. We sent eight Have your Say surveys to the people who live in the home, ten to staff and nine to health care professionals. Eight completed surveys were returned to us, six from the people who live in the home and two from staff. These views have been included in this report. What the care home does well: What has improved since the last inspection? Medication management had improved ensuring people received their medication as prescribed. Staff were recording what people were having to eat so it could be seen they received a varied diet. There was a system in place to monitor the quality of the service offered and show any shortfalls which were then addressed by the manager of the home. This should ensure the service continues to improve. There had been several improvements made since the last inspection to enhance the home and make it more comfortable for the people living there. Care Homes for Older People Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for people wanting to live in the home to enable them to decide if the home was suitable. The pre admission assessment procedure ensured the needs of people being admitted to the home were known to staff. Prospective users of the service or their representatives were able to visit the home prior to admission to assess the facilities. Evidence: The statement of purpose and the service user guide for the home had been updated recently. The documents included all the information people would need to help them decide if the home could meet their needs. Both documents were on display in the home and the people living in the home received a copy of the service user guide. The files for two people admitted to the home since the last inspection were sampled. These showed that the manager of the home had undertaken pre admission Care Homes for Older People Page 11 of 32 Evidence: assessments to establish if the home could meet the individuals needs. The assessments covered numerous areas of the individuals lives. Although the form used was mainly tick boxes there were spaces for additional comments if needs were identified. The location of the assessments had been added to the forms as recommended at the last inspection. We were told people were offered a pre admission visit to the home but these were sometimes declined and at other times were felt to be too unsettling for people with dementia. There was evidence on one of the files seen that the family of the individual had visited on their behalf. The family of this person was spoken with and confirmed they had visited and stated how impressed they were with the staff and how welcoming they had been. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans needed to be updated as peoples needs changed and be more personalised to ensure people were cared for as they wanted to be. The lack of up to date risk management plans could put people at risk. The system in place for medication administration had improved and ensured people received their medication as prescribed. Evidence: The care for three of the people living in the home was tracked during the inspection. This included looking at care plans and risk assessments for the individuals, speaking to staff about how they care for them and observing the care delivered. All three people had care plans on file. On the front of the care plans were a list of desired outcomes which included to live full and happy lives, maintain independence and dignity, continue with hobbies and interests. These were not person centred as they were the same for everyone. It is unlikely that everyone would want to achieve the same in their lives. The outcome should reflect what people have said they want to Care Homes for Older People Page 13 of 32 Evidence: do. The care plans covered numerous areas including personal care, oral hygiene, nutrition, mobility, safety and activities. The plans in place generally detailed what people were able to do for themselves, where they were able to make choices and what staff were to do to meet their needs. Some areas of the care plans included some very good information for staff. For example, there was a very good description of one persons oral hygiene regime which detailed that staff should prepare the toothbrush and then the person could brush their own teeth. Some other areas gave limited details. For example, the details for how people wanted their personal care delivered could have included more detail about personal preferences, whether they were shaved with electric or wet shaver, what toiletries they preferred and so on. This was of particular importance for people with dementia as they will not be able to direct how they want their care delivered on an ongoing basis. Some areas of the care plans were not up to date. For example, one person had very detailed instructions on the care plan about the use of hearing aids and how staff would know which one went in each ear. The person was not wearing any hearing aids and we were told they would not wear them. This needed to be updated so that all staff had the correct information and knew the person did not wear the aids. Other areas of the plans showed that peoples choices were to be respected, for example, one detailed the person had dentures and was to be encouraged to wear them but if they declined this was to be respected. Staff spoken with knew some of the needs of the people living in the home and how they wanted to be cared for but there were some differences. One staff member told us one person would wash their hands and face but another said the person did nothing for themselves. Staff needed to ensure they followed the care plans and were consistent in the way they offered care to people to ensure there wishes were respected. It was concerning to see some of the information in relation to mobility and manual handling on care plans and risk assessments had not been updated leaving staff with conflicting information. For one person the care plan stated can transfer and walk short distances with his frame. If he insists he cannot stand use the hoist and detailed the sling size as medium. There was a manual handling equipment form that detailed the use of a handling belt to stand. When the person was seen in the lounge there was no zimmer frame available and he was being hoisted. We were told he he was no longer able to stand. Care Homes for Older People Page 14 of 32 Evidence: There were some risk assessments on the files seen for such things as falls which gave some details of how the risks were to be minimised. Risk assessments had been undertaken for nutrition and skin integrity however they did not always protect the individuals. For example, one person who was no longer mobile was not indicated as at risk on their assessment. Daily notes clearly indicated there had been some soreness in the past and the person had a pressure cushion. The care plan for pressure care stated check at least weekly sign chart and record and report any redness. The charts referred to were in place at the last inspection but were no longer being used. The charts detailed the most vulnerable areas and staff had to complete that skin was intact or otherwise. This individual was being observed for a period throughout the day and was heard to tell staff he was hurting and was trying to move his position in his chair as if uncomfortable. Staff were seen to transfer the person into a wheelchair but did not transfer the pressure cushion that was being used in the lounge. The manager must ensure there are pressure management plans in place for anyone who is at risk and ensure that staff follow them. Peoples nutritional likes, dislikes and preferences were detailed on their care plans and any specific dietary needs were generally detailed. For example low fat, low sugar diets for diabetics. Care plans also stated if people were at risk according to their nutritional assessment. People were being weighed monthly but there were some issues raised about how any information about any significant weight loss or gain was being passed on and monitored. Again if there were concerns about peoples dietary intake there needed to be specific management plans in place for this. One of the people living in the home was diabetic and there was a very detailed management plan for this on the individuals file. This indicated how staff would recognise if the persons blood sugar levels were not correct and what they should do about it. Staff were able to give us some information about the condition. The persons file also indicated that their family monitored their blood glucose levels and that they entered the results on the calendar in the persons room. This was seen however on one occasion the level was very high and this had been indicated by the family. However there was no indication of how this information was passed to staff or what had been done about it. If staff are to continue to monitor these levels there must be a system in place to ensure the senior staff oversee these levels and that they are kept within a safe level. This must be included in the management plan. Records showed that people had access to health care professionals such as G.P.s, district nurses, chiropodists, opticians and that they attended hospital appointments as necessary. Some of the outcomes of medical visits were difficult to track as they were being written on the daily records which quickly become lost with the build up of daily records. The manager at the home at the time had just changed this practice and staff Care Homes for Older People Page 15 of 32 Evidence: were recording all health care visits on separate sheets and the information was to include the reason for the visit and the outcome. Records did show that staff were identifying any health care issues and that these were being followed up appropriately. The management of the medication in the home had improved since the last inspection. All the requirements made following the last inspection had been met. The majority of medication was administered via a 28 day monitored dosage system. Staff administering medication had received the appropriate training. All medication was being acknowledged when received into the home and any balances held in the home at the end of the 28 day period were being carried forward to the next MAR (medication administration record). This made the system easy to audit. Several boxed medicines were audited and were generally correct. Only one minor discrepancy was found and this would not have had a profound effect on the individual. It was noted that one medicine stated 4 tablets daily which would indicate 4 tablets to be taken at once in the morning but staff had interpreted this as one tablet 4 times a day. The manager on duty was to contact the GP about this to clarify. The records being kept for the administration of controlled medication were appropriate. No issues were raised by the people living in the home in relation to their privacy or dignity. Staff were observed to be respectful in their terms of address and their interactions with the people living in the home. Assistance with personal care was offered discreetly. Some of the bedrooms remained without appropriate locks. All bedrooms had a lockable facility for the occupants to store any personal effects if they wished. The people living in the home could meet with their visitors in their bedrooms or one of the quieter areas of the home. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It could not be shown that the activities in the home met the needs of the people living there. People living in the home were able to exercise choice and control over their lives. People were satisfied with the meals being served to them. Some aspects of practice at meal times could be improved to make it a more enjoyable experience. Evidence: The home had a relaxed atmosphere throughout the course of the inspection and no rigid rules or routines were seen. People were observed wandering around freely, watching television, going outside for a cigarette, sitting chatting and taking part in activities. All the people living in the home that were spoken to seemed very content. The daily records did not give a general overview of how the people living in the home were spending their time. Many entries stated things such as ate well no concerns. This does not reflect what people are doing to pass their time. The care plans that were sampled all had activity and social sections. Some of these detailed quite specific hobbies and preferences. For example one stated the person had said he enjoyed cards, word searches, crosswords, gardening and cooking. One of Care Homes for Older People Page 17 of 32 Evidence: the outcomes detailed on the care plans was to continue with hobbies and interests. However there was no evidence to suggest these had been pursued by staff with the individual. There were some activities taking place in the home which were facilitated by the staff. Records showed these included darts, dominoes, board games, dancing and reminiscing. Staff were also recording in the activity records when they spent time with people on a 1 to 1 basis and if people declined to take part in an activity. The minutes of the meeting held with the people living in the home indicated there had been some entertainers visiting the home and people gave some very positive feed back about these. During the inspection we observed three people living in the home for a period of nearly 2 hours making recordings at five minute intervals to assess the state of being, level of interactions and engagement for them. For one of the people being observed the individual was in a positive state of being all of the time but the other two individuals were in a positive state of being for only fifty percent of the time. One person had more engagements overall than the other two. Indications were that overall staff interactions with people were generally positive. Staff needed to be mindful that quieter people were not forgotten. It was also noticed that staff often walk through the lounge areas without interacting with people at all. During the period of the observation staff were seen to facilitate two activities with some of the people in the lounge area. Those that were involved appeared to enjoy the activity. Visitors were seen to come and go throughout the day and all were made welcome by staff. We spoke with two of the visitors and they were very happy with the service offered to their relatives. They told us how happy they were with the staff team and that they thought staff were very dedicated. The people living in the home were able to exercise some choice and control over their lives. For example, what time to go to bed and get up, what to eat, how they spent their time and so on. People were encouraged to join in with activities but if they declined this was respected by staff. The people living in the home were encouraged to personalise their bedrooms and personal possessions were observed in all the bedrooms seen. The menus in the home were varied and offered choices at each meal. Since the last inspection menus for meals at tea times had been introduced. Staff had again started recording what food had been served to all the people living in the home. The records Care Homes for Older People Page 18 of 32 Evidence: needed to be further developed to show how any specific diets were being catered for. It was also recommended that where there were any concerns about peoples dietary intake staff recorded exactly what people had eaten rather than percentages. It would be very difficult to quantify what 50 was unless you knew exactly how much food had been started with. People told us they were happy with the meals served at the home saying food is great couldnt grumble at the food and food is lovely. Staff were heard asking people what they would like for lunch. Observations were made over lunch time and people seemed to enjoy their meal. Staff were available to give assistance where required. One person had full assistance from one member of staff who sat with her. Other staff were moving from table to table encouraging people. It is better if staff can sit with people throughout the meal when encouraging them to eat so that they can be assisted appropriately with dignity. It was also noticed that some people had to wait a long time for their meals which made some of them quite restless. Staff were seen talking to each other across the dining room about what shifts they would be working. They needed to be mindful that mealtimes were very important for the people living in the home and should be seen as a social time for them. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were systems in place to enable people to raise concerns should they have any. The majority of staff had received training in adult protection issues to ensure they were able to safe guard the people living in the home. Evidence: We had not received any complaints about the home since the last inspection. The homes complaint log showed they logged any complaints that came in and investigated them appropriately. The log showed that two complaints had been logged since the last inspection. Both had been resolved. The people living in the home had received a copy of the complaint procedure in the service user guide and there was a copy on display in the home. People seemed comfortable in the presence of the staff which would give them the confidence to raise any issues. Visitors that were spoken with were very happy with the service and had no concerns at all. One told us their relative would tell them if there was anything wrong as he had at previous homes he lived in. The minutes of the meeting held with the people living in the home showed they were asked if there were any issues they wished to raise and that if they wished to raise them in private rather than at the meeting they could speak to the manager. Care Homes for Older People Page 20 of 32 Evidence: As at the last inspection it was suggested to the acting manager that the staff record any minor grumbles that are made and how these are resolved to evidence they listen to people on an ongoing basis. The managers at the home have shown in the past that they are aware of when and who to report adult protection issues. The majority of care staff and some of the ancillary staff in the home had received training in adult protection issues. The training matrix indicated the training had been booked for more of the ancillary staff. Staff spoken with had a basic understanding on adult protection issues and did know when issues should be reported. It should be clarified with senior staff that they should not investigate adult protection issues before reporting to the local authority as this can interfere should a police investigation follow. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There had been some further improvements to the environment which was comfortable, well maintained and safe. Evidence: There had been no changes to the layout of the home which was suitable for its stated purpose. A tour of the home was undertaken and some bedrooms were seen. There had been several improvements made since the last inspection to enhance the home and make it more comfortable for the people living there. The improvements addressed the recommendations made following the last inspection. Several communal areas had been redecorated and had new curtains and flooring. The flooring had been replaced in the toilets as recommended at the last inspection. A new emergency call system had been installed and was accessible in the en-suite facilities. Work was under way to put the floor level shower into working order so that people had a choice of having a bath or shower. There was ample communal space in the home with two lounges a dining room and a sensory room which although quite small gave the people living in the home a quiet relaxing area to sit in. Care Homes for Older People Page 22 of 32 Evidence: People also had access to some outdoor space with seating for their use in fine weather. There were adequate bathing and toilet facilities available for the people living in the home and many of the bedrooms had en-suite facilities. As mentioned work was underway to have a working floor level shower. Several bedrooms were seen. Many had been redecorated and had some furnishings and fittings. Some bedrooms were still in need of redecoration and there was the odd carpet that needed to be replaced. This work was planned for. Bedrooms varied in size, were quite comfortable and personal possessions were evident in them. As stated earlier in this report not all had the appropriate locks fitted. There were some aids and adaptations around the home including, two shaft lifts, free standing hoist, emergency call system, assisted bathing facility and some hand and grab rails. The home was clean and odour free. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were being cared for by a generally well trained staff team that was able to meet their needs. Recruitment procedures were robust and ensured the people living in the home were safe guarded. Evidence: Staff turnover at the home is relatively low which is good for the continuity of care of the people living in the home. The relationships between the people living in the home and the staff group were good. Staff were described to us as helpful, good, lovely and dedicated by the people living in the home and visitors. Rotas at the home showed that there were four care staff on duty in the mornings, three afternoon and evenings and two at night. The home also employed cooks, domestic assistants and maintenance workers. The staffing levels were appropriate for the needs of the people living in the home and staff were seen to be available to the people living in the home. The recruitment files for two new staff were sampled. The files showed that all the required checks had been undertaken prior to people being employed including written references, POVA first and CRB checks. It was noted that for one person there was a POVA first check on file but the CRB check had not been returned. This person had Care Homes for Older People Page 24 of 32 Evidence: worked a night shift in the home which is not appropriate as until the CRB was returned the person should work with supervision at all times. This was addressed immediately by the manager on duty in the home at the time. She stated this is not usual practice for the company and had been arranged by another manager. There was evidence on the files sampled that the staff had undertaken some induction training. However for one person the Skills for Care common induction standards had all been covered in one day. This is not possible if done properly as they cover a big range of topics some of which require external training. For the other person a small amount had been covered on the first days employment and nothing since. The manager of the home needed to ensure staff undertook the appropriate induction training to ensure they had all the required skills and knowledge to care for the people living in the home. The training matrix for the home indicated that staff have undertaken a considerable amount of training including, moving and handling, food hygiene, first aid, fire and dementia. The training matrix did show some shortfalls for some staff that needed to be addressed. We were not able to determine when the training was undertaken as the matrix was not dated. The matrix needed to be dated so that it could be seen if staffs training was up to date and they were working to current good practice guidelines. The AQAA stated that of the 20 staff employed at the home 10 had an NVQ qualification. However the training matrix showed 20 staff but only seven with an NVQ qualification which is a little under the required 50 . It did indicate that another nine staff were undertaking the training. Staff that were spoken with were generally quite knowledgeable about the needs of the people living in the home. However as mentioned earlier in the report there were some inconsistencies in what staff thought the abilities of the people living in the home were. This could lead to peoples independence being undermined. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was running smoothly and the health and safety of the people living in the home and the staff were well managed. The home needed to have in place a development plan based on seeking the views of the people living in the home with a view to continuous improvement. Evidence: The manager was not on duty when we arrived at the home but there was a senior member of staff on duty. We were joined by the service manager for the home and a manager from one of the companys other homes. We were told that the manager for the home had recently resigned due to some issues being raised with him. He was working his notice at another of the companys homes. The manager from the other home was to provide management cover at Grassmere three days a week. Issues raised during this inspection included care plans and risk assessments not being up to date and reflecting the practice in the home. Also a need to ensure there were Care Homes for Older People Page 26 of 32 Evidence: management plans in place for all identified risks and that staff were aware of them. The manager covering was aware of the issues in the home and was very committed to ensuring things were improved. She had already started improving things by ensuring medical visit records were robust and easily tracked. There was a quality monitoring system in place that included internal audits being undertaken on such things as the records in the home for the people living there, financial systems, health and safety issues. Issues arising from the audits were highlighted and addressed by the manager. There was evidence that satisfaction surveys were issued to the people living in the home and their relatives. The outcomes from these were analysed and comments were made about the actions taken. There was evidence on site that meetings were held with the people living in the home and their relatives. Topics discussed included menus, activities and entertainment, forth coming events and how to raise concerns. It was strongly recommended that the home had a yearly development plan based on the views of the people living in the home and the outcome of the audits undertaken to show how the service was to be improved for the benefit of the people living in the home. There was a system in place for managing money on behalf of the people living in the home. The records for this were sampled and found to be appropriate. There were receipts available for all expenditure made on behalf of the people living in the home and two staff were signing the records. All balances checked were correct. The health and safety of the people living in the home and the staff were generally well managed. Staff had received training in safe working practices and were seen to work safely. There were records on site showing that equipment was regularly serviced. The in house checks on the fire system were up to date and fire drills were being undertaken regularly. It was noted that not all staff had been included in the fire drills. This should be addressed so that it can be assured all staff would know what to do in the event of a fire. Incident and accident recording were generally appropriate however it was noted that we were not always being notified appropriately of accidents in the home. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 There must be management plans in place for all risks identified for the people living in the home. These must be regularly reviewed and changed as necessary. This will ensure people are cared for safely and not exposed to any unnecessary risks. 31/07/2009 2 8 13 There must be a system in place to ensure that any significant weight loss or gain of the people living in the home is followed up. This will ensure peoples nutritional needs are being met. 31/07/2009 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. Care Homes for Older People Page 29 of 32 No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be further developed to include all the current needs of the people living in the home and how they are to be met by staff to ensure people receive person centred care. Staff should be familiar with care plans and follow them to ensure people receive their care as they want. To ensure the privacy of the people living in the home all bedroom doors should have appropriate locks fitted. There should be evidence that the social care plans of the people living in the home are being followed. This will ensure the social needs of the people living in the home are met. Staff should record how the people living in the home are spending their time to evidence their social needs are being met. Food records should show how specific diets are being catered for. This will show peoples nutritional needs are being met. Where there are any concerns about the dietary intake of the people living in the home the records of the amounts eaten should be specific. This will make it easier to identify if people are eating adequate amounts. Practice at meal times should be improved to ensure people get their meals in good time, peoples dignity is observed and that meal times are seen as important social occasions. Staff should record any minor grumbles that are made by the people living in the home and how these are resolved to evidence they listen to people on an ongoing basis. It should be clarified with senior staff that they should not investigate adult protection issues before reporting to the local authority as this can interfere should a police investigation follow. It is recommended that 50 of staff are qualified to NVQ level 2 or the equivalent. This will ensure staff have all the necessary skills and knowledge to care for the people living in the home. The training matrix should be dated to show staff have received recent training. Any shortfalls indicated on the matrix should be addressed so that staff are appropriately trained to care for people safely. There should be an annual development plan for the home. This will ensure the service is continually improved for the benefit of the people living in the home. Page 30 of 32 2 3 4 7 10 12 5 12 6 15 7 15 8 15 9 16 10 18 11 31 12 31 13 33 Care Homes for Older People 14 38 All staff should be included in fire drills over a period of time. This will ensure staff know what to do should there be a fire. The Commission should be notified of all accidents as necessary. This will show us that accidents are being managed in the best interests of the people living in the home. 15 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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