Inspection on 20/01/10 for Harewood Court Nursing Home

This inspection was carried out on 20th January 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harewood Court Nursing Home 21/01/09

Harewood Court Nursing Home 29/01/08

Harewood Court Nursing Home 22/02/07

Harewood Court Nursing Home 15/09/06

Harewood Court Nursing Home 07/03/06

Harewood Court Nursing Home 21/04/05

Harewood Court Nursing Home 13/10/04

Harewood Court Nursing Home 08/07/04

Harewood Court Nursing Home 24/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Harewood Court Nursing Home 89 Harehills Lane Leeds Yorkshire LS7 4HA     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: Carol Haj-Najafi     Date: 2 0 0 1 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 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Harewood Court Nursing Home 89 Harehills Lane Leeds Yorkshire LS7 4HA 01132269380 01132285697 scouserdumont@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Solutions (Yorkshire) Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 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, maximum number of places: 20 Dementia - Code DE, maximum number of places: 20 Date of last inspection Brief description of the care home The home is registered to provide care with nursing for up to forty older people, this includes up to twenty people with dementia. It is situated in a busy residential area of Leeds, which is well served by public transport. There is a range of local amenities nearby. The home is on 3 floors, accommodation is on the first and second floor, and the ancillary services are on the ground floor. All the bedrooms are single rooms with en-suite facilities. Each floor has a separate lounge and dining room, with a kitchenette available for making snacks and drinks. A passenger lift allows access to all floors and Care Homes for Older People Page 4 of 34 Over 65 0 20 20 0 Brief description of the care home the home is accessible to people with disabilities. Information about the services provided by the home in the form of a Statement of Purpose and Service User Guide is available at the home. In January 2010 the weekly fees ranged from £439.42 to £589.42. Additional services such as chiropody and hairdressing are available for an additional charge. Care Homes for Older People Page 5 of 34 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 Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in January 2009. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Older People Page 6 of 34 Surveys were sent out to people who use the service, their relatives, healthcare professionals and staff. Six surveys were returned, two from people who live at the home, three from staff and one healthcare professional. Information from the surveys has been included in the report. Two inspectors were at the home for one day from 9:30 to 18:00. We spoke to five people who live at the home, two visitors and seven staff and the manager. Some people have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met so we also observed interaction between staff and people who live at the home. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the manager at the end of our visit. After our site visit we met with a senior manager and the home manager to discuss staffing levels. The senior manager reassured us that the home is being appropriately staffed and agreed to send written confirmation of the staffing levels that would be provided. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? At the last inspection we found that the home provided care to people with a wide range of needs but some people were living at the home and had needs that did not fall within the categories of care the home is registered to provide. The home applied to change their registration and they are now registered to provide care to people with dementia. The home is introducing a significant event tracker, which is additional to the life history diaries. They are completing these with people who live at the home and their relatives. This project is in the early stages but they are hoping to have these for each person who lives at Harewood Court. The activity organiser is co-ordinating the project Care Homes for Older People Page 8 of 34 and has been collecting information, which will then be used to plan activities and provide other staff with valuable information. What they could do better: Care plans and assessments contain some good information but some peoples needs have not been fully identified. The care plans could provide more detail about peoples wishes and how their needs should be met. People who live at the home could be more involved in the care planning process. This will help make sure people are receiving the care they want and their wishes are taken into account. Daily records could provide more information about how peoples needs have been met. This will make sure their health and welfare can be properly monitored. Hand written medication administration record entries could be checked more carefully for completeness and accuracy. This will make sure prescribed medication is administered correctly as directed by the prescribers instructions. People who live at the home could be offered more activity on a daily basis. People said they enjoy the activities that are provided but they generally thought there should be more to do. One person who lives at the home said, Its very seldom there are any activities. Sometimes there are entertainers but only very occasionally. I need something to keep my mind alive. A visitor said, I have no concerns about the home but there is not a lot going on. Menus that are displayed in the home could match the meals that are provided. On the first day of our site visit, people had braised steak or corned beef hash and blackberry and pear crumble for lunch. The menu said they should have been eating yorkshire puddings and beef goulash or corned beef hash and blackberry and apple pie. There is no record of meals when they differ from the menu so it is difficult to accurately monitor whether meals are varied and nutritious. Safeguarding processes could be more robust. We found that the home has not reported some important events to CQC. A serious incident took place a week before the inspection where a person who lives at the home was injured by another person who lives at the home. The home had telephoned an ambulance and people who were involved in the incident received support from healthcare professionals. The incident was not reported to the local authority. The environment in the unit for people with dementia could to be further developed to meet the needs of people with dementia. We observed that some people were not receiving support at the right time because staff were not available. Some people did not receive appropriate support to eat their lunch. There should be enough staff to meet peoples needs in a timely way. The manager could submit a registered managers application. This will make sure the home has a registered person that is in day to day control of the service. Care Homes for Older People Page 9 of 34 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 34 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 34 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. Peoples needs are properly assessed before they move into the home, which makes sure their needs are known and could be met. Evidence: We talked to two people who recently moved into the home. They told us they had settled in reasonably well and were satisfied with the admission process. One person said they couldnt manage to visit the home before they moved in but they got information about the home and someone talked to them about the home and told them where it is. In the AQAA the responsible individual said, We have improved all documents used in the pre-admission process. The assessments are more detailed and the format improved to cover the information handed or given, visual information is now available. Care Homes for Older People Page 12 of 34 Evidence: We looked at two peoples assessment records that have moved in since the last inspection. They had detailed assessments that were completed before the person moved into the home. The assessments contained good information about the type of support they required. At the inspection in January 2009 we found that people experience adequate outcomes in this area and said peoples needs are assessed before they move in. We found that the home provided care to people with a wide range of needs but some people were living at the home and had needs that did not fall within the categories of care the home is registered to provide. The home applied to change their registration and they are now registered to provide care to people with dementia. At the last inspection we also found that the home was providing a service to people from different ethnic groups. For example, the home had ten people from Afro Caribbean backgrounds and four people from Eastern European backgrounds. In the last report we said, That while staff have a good level of awareness of Afro Caribbean culture there is less awareness of Eastern European culture. At this inspection we also found that the home could improve how it meets peoples diverse needs and have covered this in more detail in the next section of the report. Care Homes for Older People Page 13 of 34 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 identify some care needs well but other care needs have not been identified so we cannot be sure that peoples needs are being properly met. Evidence: We talked to people who live at the home and their relatives and received good feedback about the home. People said they are generally happy with the care they receive. When asked what the home does well, one person said, Taking care of us and that isnt easy with some people. Another person said, I like it immensely. If I didnt like it I wouldnt stay. People are generally happy with staff and the way they are treated. One person said, The staff know me and I know them and we have a laugh together. Another person said, Most of the staff are wonderful. Others are not bad just different to the really nice ones. We talked to five care staff and a nurse and received three staff surveys. Generally Care Homes for Older People Page 14 of 34 Evidence: they thought people who live at the home receive good care. Some staff said the staffing levels were satisfactory; others said they are busy and sometimes they do not have enough time to do everything on time. We have covered staffing in more detail in the staffing section of this report. Staff talked about promoting privacy and dignity and gave us examples of how they do this. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. Staff treated people with respect and they were kind and courteous. We saw some good practice, which included staff supporting people with their meal. Staff asked people what they wanted to eat, gave them time to respond and listened to what they said. We also observed some practices where staff did not have sufficient time to support people with their lunch. The general appearance of people who live at the home was good, they were dressed appropriately and attention had been given to their personal care. For example, peoples hair had been brushed and their glasses, shoes and clothing were clean. In the AQAA the manager said, The care plans are visually detailed, individual and cover a range of assessments. Our efforts are to make them person centred to cover all aspects of care in a positive way. We seek the views of other professionals in support of care. We looked at four peoples care plans and assessments. These were well organised. Some information in the care plans was good and gave sufficient information about potential risks and how individual needs should be met. One care plan stated that the person can only say odd words like yes/no. However, knows how to express self and communicates by actions. We spoke to the person and observed them communicating with staff. The care plan accurately reflects how the person communicates. One person told us they have their food cut up small, they like to have moisturising cream applied to their body and a weekly manicure. All this information is recorded in their care plan. Some information was inaccurate. For example, one person told us they had a recent visit from a close relative but their care plan said they do not have contact with them. Information about decision making and peoples wishes was limited in some care plans. One person smokes and they said they cannot always smoke when they want to. The person has a plan for smoking and this has been changed from having a Care Homes for Older People Page 15 of 34 Evidence: cigarette after meals to having two cigarettes a day. Staff said the decision was made in consultation with others but it was not clear from the plan why or who had made the decision about the reduction in cigarettes. One person talked about good health improvements in recent months and said they wanted to become more independent. Staff confirmed this. Their plan did not reflect most of the health improvements or make any reference to supporting the persons independence. Reference to a mental capacity assessment was recorded in the persons file in July 2009 but this does not appear to have been followed up. The care files of two people that have a different cultural background made no reference to their cultural identity and their cultural needs. One of these people has dementia and spent the day sat in a chair in their room with the television on to provide stimulation. We were unable to identify whether this person wished to spend his day listening to and watching the television. It was also unclear whether he understood the English language. A range of risk assessments have been completed, and these identify the level of risk. Each assessment has been regularly reviewed. Regular health checks are carried out. Peoples weight, blood pressure and pulse are checked every month. The care plans and assessments are completed by qualified staff. Care staff said they read the care plans and pass on important information to the qualified staff. They said they receive information at handovers and are kept up to date with important information. Staff record some important information about peoples health and welfare. The records have good information about healthcare appointments and show people are receiving regular input from healthcare professionals. People who live at the home said they get good support with healthcare and always see a GP if they are unwell. A healthcare survey said the service always seeks advice and acts on it to meet peoples social and healthcare needs. Under what the home does well a visiting healthcare professional told us, I am very impressed by their positive person centred approach. Staff are enthusiastic. They are proactive to find solutions to challenging situations. They are happy to provide flexible respite care. We looked through peoples daily records. Often the notes are repetitive and dont say much about the person. For example they say medication given, assisted to bed, safety checks maintained. Daily records of how people spend their day in the dementia unit were up to date but Care Homes for Older People Page 16 of 34 Evidence: they did not inform the reader of how they actually spend their day and what activities they were involved in. The daily record just referred to their personal care needs and how they were met. We did not see any evidence that people who live at the home or people that are important to them are involved in their care planning process. We asked people about care planning but they were not familiar with their care plans. We looked at the systems the home adopts for ensuring the safe administration, recording and storage of medication. We found that there are systems in place to record the medications that are brought into and stored at the home. These systems are also audited to make sure the medication levels are correct. Regular monthly audits take place and any irregularities are dealt with. However, we identified some concerns in relation to medication administration and recording when we looked at the Medication Administration Record sheets. There were several gaps identified in three peoples medication charts. We found evidence that showed staff were not keeping an accurate record of the reasons why a person did not receive their medication. One person who had been admitted to hospital the previous night at 8pm had her 10pm medication signed for by the nurse on duty. Care Homes for Older People Page 17 of 34 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. Choice is promoted and peoples routines are flexible. People enjoy planned activities but would benefit from more stimulation on a day to day basis. This would help make sure people have a more varied lifestyle. Evidence: People who live at the home told us they choose where to spend their time, and decide when they go to bed and when they get up. One person said, I like to go to bed around 9:30 to 10 but choose to go earlier if Im tired. Another person said, I get a call about 8 and thats the right time for me. Another person who lives at the home said they like to spend time in their room and staff regularly call to see them. We spoke to two visitors. They told us they visit regularly and can spend time in communal areas or in peoples rooms if they prefer. They said they can visit at anytime. One person said, Its fantastic, really good. They also said they are always made to feel welcome, can make a drink anytime, and sometimes stay for lunch. The activity organiser showed us some significant event trackers, which is additional to the life history diaries. They are completing these with people who live at the home and their relatives. This project is in the early stages but they are hoping to have Care Homes for Older People Page 18 of 34 Evidence: these for each person who lives at Harewood Court. The activity organiser is coordinating the project and has been collecting information, which will then be used to plan activities and provide other staff with valuable information. The home has a programme of activity that includes group sessions and one to one sessions although there was not a programme in place for the week of our inspection because the activity organiser was absent at the beginning of the week. Occasionally entertainers visit the home. People said they enjoy the activities that are provided but they generally thought there should be more to do on a daily basis. One person who lives at the home said, Its very seldom there are any activities. Sometimes there are entertainers but only very occasionally. I need something to keep my mind alive. A visitor said, I have no concerns about the home but there is not a lot going on. We looked at daily records but these did not show that people are involved in regular activities. The activity records for the first floor could not be located. In the AQAA the manager told us they have improved daily life in the last twelve months and said, We have a regular support worker who leads the social service and provides one to one stimulation as well as structured group sessions including more reminiscence. We talked to the new manager during our visit who agreed that the level of activity could be further improved. People told us they always have enough to eat and said the food is generally good. We observed regular drinks being offered to people. Lunch on the first floor unit was well organised. At lunch time staff appropriately assisted people who needed support with their meal. People were asked at the time of serving what they would like to eat, which is good practice because people can choose what they want at the time they are eating. Everyone appeared to enjoy the food. We observed lunch on the specialist dementia unit. At the start of lunch there were three care staff involved with the whole process of plating up food and providing the meals to people. However, two staff had to leave the area to get involved with other tasks leaving one person to support nine people to eat their meal. This left people in positions where their dignity was compromised. Two people really struggled to eat their meals and had to start eating with their fingers because they had no support. They dropped food on their clothes and ate out of their laps. Other staff did eventually arrive to support people to eat. However, the evidence seen showed that there are Care Homes for Older People Page 19 of 34 Evidence: issues with providing suitable numbers of staff to ensure peoples needs are met. The food is taken from the kitchen and placed in a hot trolley so care staff can serve it when people are ready to eat. The food was placed in the hot trolley at 12:00 and uncovered plates of liquidised meals were placed in the trolley at 12:20. The meal was served at 13:30, which is well over an hour after the food was placed in the hot trolley. The menus that are displayed in the home do not match what meals are being provided. On the day of our site visit, people had braised steak or corned beef hash and blackberry and pear crumble for lunch. The menu said they should have been eating yorkshire puddings and beef goulash or corned beef hash and blackberry and apple pie. The teatime menu gave people an option which included omelettes but these were not available and scrambled egg was being provided instead. There is no record of meals that are provided even when they differ from the menu so nutrition and variety of meals cannot be properly monitored. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and the service will handle these appropriately however the safeguarding procedure is not always followed which could put people at potential risk. Evidence: In the AQAA the manager said, We are approachable and act on minor issues as soon as they occur. Log and deal with complaints in a prompt manner accepting criticism. People who live at the home told us they talk to their relatives or staff if they are unhappy. Relatives said they know how to make a complaint about the care provided by the care service. Staff said they would report any concerns to the management team and they are confident they would deal with them promptly and appropriately. We looked at the complaints procedure and it contained good information as to how a person should make a complaint and how that complaint would be dealt with. Five complaints were recorded in the complaints records. The most recent one occurred on New Years Eve. The evidence seen showed that the complaint was recorded and investigated according to the complaints procedure. Staff we spoke to said they have received adult protection training, and said they would report any concerns to the management team if they suspected abuse or had an allegation of abuse made to them. Care Homes for Older People Page 21 of 34 Evidence: The manager and staff told us about a serious incident that took place a week before the inspection where a person who lives at the home was seriously injured. The home had telephoned an ambulance and people who were involved in the incident received support from healthcare professionals. The incident should have been reported to the local authority because it was a safeguarding incident. CQC (Care Quality Commission) received a notification of the incident but it did not contain enough detail about what had happened. Another safeguarding incident took place in November 2009. This was reported to the local authority but it was not received by CQC. It should have been reported to CQC because it was an event that affected the health and welfare of a person living at the home. The manager produced a list of incidents that had been reported to CQC. The safeguarding incident in November 2009 was not on the list. We identified two other incidents that occurred in the home that should have been reported to the Care Quality Commission due to the serious consequences that they had for people living in the home. Care Homes for Older People Page 22 of 34 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 a pleasant, comfortable and clean environment. The environment for people with dementia should continue to be developed to enhance service provision. Evidence: People who live at the home and visitors told us the home is comfortable, clean, tidy and doesnt have unpleasant odours. One person said they have made an effort to give it that homely feel. When we looked around the home it was clean, tidy and well organised. People were walking freely around the home. Some people spent time in the communal areas; others chose to spend time in their room. The home is divided into two units. There is a dining room and communal areas on each unit. There is a passenger lift and a staircase that allows access to all floors. Assisted bathrooms and toilets are situated near to peoples bedrooms and communal areas on all floors. The home has recently been registered to provide dementia care. The second floor unit has been identified to provide a service to people with dementia. They are developing the environment to meet good practice standards. For example, they have displayed some nostalgic pictures and photographs. Appropriate signage is important Care Homes for Older People Page 23 of 34 Evidence: for helping people with dementia find their way around but the home does not have much signage in place. The manager said they are developing this service. They also discussed plans to change the location of the dementia unit to enable people to have access to an enclosed garden. The home is reasonably well decorated and furnished. All rooms seen were clean, free of odour and maintained to a reasonable standard. People have been able to furnish their rooms with pictures and photographs. One person said they decided they wanted their own TV from home and some large ornaments and got help to sort it out. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. The home had a good supply of protective clothing and staff said they always have access to the supplies. Hand cleaning facilities are situated throughout the home. In October 2010, a food hygiene inspection was carried out by the local authority. The home was awarded a 4* rating which means the level of compliance with food hygiene standards is very good. Care Homes for Older People Page 24 of 34 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 are supported by staff who are trained and properly recruited. Staff do not always have sufficient time to meet peoples needs at the appropriate time or spend quality time with them. Evidence: People who live at the home and visitors were generally complimentary about the staff that work at the home. People described staff as friendly and good carers. Some concerns were raised about staffing levels. The home is divided into two units. Care staff are allocated to work on a specific unit. If there is only one nurse on duty they will work in both units. On the day of our inspection one nurse was working on shift. The manager who is a qualified nurse was also on duty and said she helps out when only one nurse is on shift but acknowledged that she also has management tasks that she has to attend to. Two care staff and a student on placement were allocated to the dementia unit and three care staff were allocated to the nursing unit. Staff were very busy and lunch was delayed because of an emergency earlier in the day. Care Homes for Older People Page 25 of 34 Evidence: At the time of our visit twelve people were staying in the dementia unit and twenty people were staying in the nursing unit. Most people need two staff to support them with personal care. When only two care staff are working in a unit they are often working together to meet peoples personal care needs which means the unit does not have staff available to monitor the other people who live in the unit. There has recently been a high level of staff sickness which has caused difficulties with staffing levels. The manager said they are increasing the number of bank staff so they have a larger pool of staff to use when regular staff are off and looking at increasing the staffing numbers. Some people said staffing levels are ok; others thought staffing levels should be higher. One person said, Its sometimes hard to do everything because we dont have enough staff to do all the work. After our site visit we met with a senior manager and the home manager to discuss staffing levels. The manager confirmed that since the inspection three staff had been recruited and three more staff were waiting to start work. The senior manager acknowledged that the staffing levels were short on the day of the inspection but reassured us that the home is being appropriately staffed. The senior manager said the staffing levels are as follows: Between 8am and 2pm, one nurse covers both units and four care staff work in each unit. Between 2pm and 8pm, one nurse covers both units and four care staff work in one unit and three care staff in the other unit. The manager said she helps with the morning medication round Monday to Friday. The senior manager agreed to send written confirmation of the staffing levels that will be provided. We received some positive feedback from staff about what the service does well. Staff told us the team generally works well together although some staff felt frustrated that staff sickness has been exceptionally high. One staff said, Team work is good. Another staff said, Staff get on well. Staff told us they receive good training and receive training that is relevant to their role. The training records provided good evidence that showed over 50 of staff have been trained to at least NVQ level 2. Four staff have also attained level 3. The training records showed all staff have been provided with training in dementia. Necessary training in areas such as safeguarding, control of substances harmful to Care Homes for Older People Page 26 of 34 Evidence: health (COSHH), fire training, moving and handling and infection control are updated regularly. The manager said that training in broader areas such as diabetes, continence care, pressure area care and nutrition are not provided at present but there are plans in place to give this training. In the AQAA the manager said, all the people, who have started work in your home in the last 12 months have satisfactory pre-employment checks. We looked at the recruitment process for people who have recently started working at the home and found that all necessary pre employment checks had been completed. Care Homes for Older People Page 27 of 34 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 has not had a consistent management approach although the new manager is planning to register shortly and provide continuity at the home. The home has effective health and safety systems in place. Evidence: The home has had two managers since the last inspection, which includes a very recent change of management. The new manager said there were plans to have a gradual change over of the management arrangements but due to unforeseen circumstances the planned handover did not take place. The manager said she has had very regular support from senior management. Although the manager had only been at the home for a short period of time she has become familiar with many of the systems and has good ideas about how she is wanting to develop the service. She has identified that the homes staffing levels Care Homes for Older People Page 28 of 34 Evidence: should be addressed and was recruiting staff at the time of our site visit. People said they thought the home was well managed and we received some good feedback about the new manager. The manager said she is preparing her registered managers application and is hoping to submit this shortly. At the last inspection we found that people experience adequate outcomes in the area of management and administration. We made a judgement that the manager provided clear leadership; guidance and direction to staff. But overall staffing levels are such that there are some practices that do not always promote the health, safety and well being of the people using the service. As stated in other sections of the report, at this inspection we found that there are not always enough staff to meet peoples needs in a timely way. At the key inspection in February 2007, January 2008 and January 2009 we found that there were not enough staff working at the home and made a requirement that, There must be enough staff available at all times to meet the assessed needs of the people living in the home taking into account the size, the layout and purpose of the home. This is to ensure that peoples health; personal care and social care needs will be met. At the inspection in January 2008 we extended the timescale to give a new manager time to address the staffing issues. We have not made a requirement this time because when we met with the manager and senior manager on this specific matter, we were assured that the home had the willingness and the capacity to improve staffing and some actions were already underway. We will monitor this. In the AQAA, the manager said, We have increased staffing and improved both the activity and laundry support services in response to feedback given. At the inspection we were unable to look at some information because the manager could not access it. For example she could not access several weeks staffing rotas or some information about how peoples cultural and social needs should be met. At the meeting the manager confirmed that she now had access to all the information at the home. We found good evidence that showed there are systems in place to review the quality of the care in the service. The home has recently been audited by the organisation and recommendations have been made as a result of this and timescales provided to make sure they are met. Areas that were included in this audit included; care plans; Care Homes for Older People Page 29 of 34 Evidence: food; falls, staff and professionals views; recruitment and internal environment. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us information about the service but in some sections it did not give us much information. It gave us some examples of what they do well, what they could do better and how they plan to improve. The manager said generally they do not hold monies on behalf of people who live at the home. Sometimes families leave a small amount of cash. Purchases are recorded and receipts are obtained. Staff said they received appropriate support from the management team and have regular supervision and staff meetings. In the AQAA the responsible individual told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. We looked at the records kept in the home to monitor the health and safety equipment and systems. These were regularly checked by the maintenance man. Clear evidence was seen that showed where a concern was identified action was taken to ensure the fault was put right. We looked at some accident and incident records. These had sufficient detail about incidents that had occurred and action points to help prevent a similar incident occurring again. We did not observe any unsafe working practices during our visit. Staff were confident when they used lifting equipment. They explained to people what they were doing and checked they were comfortable. Care Homes for Older People Page 30 of 34 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 31 of 34 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 18 13 Any allegations of abuse must be reported to the relevant agencies which are identified in the homes safeguarding procedure. This will make sure people are protected. 30/03/2010 2 18 13 The Care Quality 30/03/2010 Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at the home. Care Homes for Older People Page 32 of 34 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 7 Daily records should provide more information about how peoples needs have been met. This will make sure their health and welfare can be properly monitored. The care planning process should be developed to make sure people who use the service have a care plan that identifies their individual needs and wishes and how they should be met. This should include the different needs of people which relate to race and ethnicity. This will make sure peoples needs are met. People who live at the home should be more involved in the care planning process. This will help make sure people are receiving the care they want. Hand written medication administration record entries should be checked for completeness and accuracy.This will make sure prescribed medication is administered correctly as directed by the prescribers instructions. People who live at the home should be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. Meals that are served to people who use the service should be recorded. This will make sure nutrition and variety of meals can be monitored. The environment should continue to be developed to meet the needs of people with dementia. There should be enough staff to meet the needs of the people living at the home, taking into account the size and layout and purpose of the home. The manager should submit a registered managers application. This will make sure the home has a registered person that is in day to day control of the service. 2 7 3 7 4 9 5 12 6 15 7 8 19 27 9 31 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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