Inspection on 19/01/09 for Hollycroft Nursing Home

This inspection was carried out on 19th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollycroft Nursing Home 8-10 Redhill Stourbridge West Midlands DY8 1ND     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: Yvette Delaney     Date: 1 9 0 1 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 34 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 34 Information about the care home Name of care home: Address: Hollycroft Nursing Home 8-10 Redhill Stourbridge West Midlands DY8 1ND 01384394341 01384375901 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) : Leyton Healthcare (No 7) Limited care home 37 Number of places (if applicable): Under 65 Over 65 0 37 0 dementia old age, not falling within any other category physical disability Additional conditions: 37 0 37 The maximum number of users who can be accommodated is: 37 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, 37 Dementia - Code DE, maximum number of places, 37 Physical disability - Code PD, maximum number of place, 37 Date of last inspection Brief description of the care home Hollycroft Nursing Home is now owned by Leyton Healthcare (No.7) Limited. The home is a converted house, which has been converted to provide accommodation for up to 37 residents who may require nursing care. The home is situated on Red Hill, close to the centre of Stourbridge. The home provides accommodation in 25 single and six shared bedrooms on two floors for elderly people who wish to use the service. Eleven of the single occupancy rooms offer en suite facilities, these consist of a toilet and Care Homes for Older People Page 4 of 34 Brief description of the care home hand basin. The home has a passenger lift for access to the first floor. There are three communal lounges and two dining areas. To the rear of the home there is a large enclosed garden. Access at the front of the home provides an area for off road car parking. Information provided confirmed the fees for living in the home to range from £447 to £500. Residents pay additional variable charges for the services of a hairdresser, chiropodist and newspapers. 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 quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main Key Standards. As part of the inspection process we reviewed information about the home that is held on file by us, such as notifications of accidents, complaints, allegations and incidents. Care Homes for Older People Page 6 of 34 An annual quality assurance assessment (AQAA) was completed and returned by the manager in time for the inspection. Information provided in the annual assessment by the home manager has been used to inform this report. The manager was asked to give questionnaires to ten residents and their relatives, this includes the residents followed through the case tracking process. Case tracking involves looking at peoples care plans and health records and checking how their needs are met in practice. Four questionnaires were returned by people living in the home and four questionnaires from relatives.Only one completed questionnaire was returned by a resident giving their views of the service they receive. The inspection included meeting some of the people living at the home, including the three people whose care was being examined. Other peoples files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and managers for the service. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: As a result of this visit we have made a number of requirements: All persons living in the home must have a care plan, which clearly identifies all their health and personal care needs. This must include people who are admitted for short term care. This will help to make sure staff know what they need to do to meet the individual needs of people in their care. Risk assessments must be completed for residents who chose or refuse to use wheelchairs without footplates. This will make sure that people living in the home are moved around the home safely. Moving and handling risk assessments should be completed for all residents. A proactive care plan should then be developed so that care staff know how individual residents should be transferred or moved safely round the home and when attending to residents care needs. Care Homes for Older People Page 8 of 34 Staff must use safe and appropriate moving and handling practices when moving and transferring people in their care. This will ensure that residents are supported to move safely around the home and protect them from the risk of harm. Doors in the home must not be wedged open. This will ensure that people living in the home are protected from the risk of harm particularly in the event of a fire. Wheelchairs used by people living in the home must be fitted with appropriate footplates. This will help to make sure that residents are moved safely around the home. Sufficient staff must be on duty to make sure that residents are not left unattended. This will help to make sure that residents can be supervised at all times and not left at risk from harm. Checks must be made to make sure that staff are using wheel chairs correctly at all times. This will ensure that a safe and appropriate mode of transport has been considered for all residents. The use of electrical heaters in the home must be reviewed and a risk assessment carried out. This will make sure that the electrical heaters are used safely and will protect residents from the risk of harm. A number of recommendations have also been made, these are included in this report. 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 and 3 were assessed. Information about the home gives details on the services the home provides but is not up to date. Updating the information will help people make an informed decision about moving into the home. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. Evidence: The home has a statement of purpose and service user guide. Both documents have been put together in a folder as a welcome pack for people who choose to use the home. The welcome pack was seen to be available in residents bedrooms. Residents and their families also receive a brochure, which provides them with further information about the home and the services provided. It was noted and discussed with the manager that some of the information in these documents needs updating. Care Homes for Older People Page 11 of 34 Evidence: This includes providing the contact details of the current Commission of Social Care and Inspection (CSCI) office and updating the provider and manager details for the home. The admission process was assessed at this inspection. Evidence showed that potential residents are assessed by the manager or one of her deputies. The assessment carried out helps to identify the individual care needs of people before they are offered a place in the home. One of the residents was able to tell us that they had a visit from a member of staff, before they moved into the home. They told us that they were asked a number of questions about their health, medical history and interests. People are admitted to the home for respite care. One of the care files reviewed showed that the GP had completed and sent a comprehensive assessment of the residents medical history and care needs. This information supports the home to complete comprehensive care plan. Information in the AQAA and residents spoken with told us that they were encouraged to visit the home before they moved in. A family member told us that they visited the home on behalf of their relative and said that their impression was that The home seemed friendly and welcoming. Care Homes for Older People Page 12 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. Standards 7, 8, 9 and 10 were assessed. Healthcare needs and risk assessments are not always fully identified for all residents this means that people living in the home could receive inappropriate care. Evidence: At this inspection we examined the care files for three people who have recently moved into the home. Two of the residents had high dependency needs. We asked some of the residents about their experiences of living in the home. To support our evidence on the care people received the interaction between staff and residents were observed. Two residents told us that the care they received was good. The home uses generic care plans to plan the ongoing care of people admitted to the home. Generic care plans provide staff with a prescribed plan of care that they can follow. This format then leaves gaps for staff to individualise the plan of care to the specific resident. Care Homes for Older People Page 13 of 34 Evidence: The care plan file for a resident identified the persons needs using activities of daily living. These cover areas such as safety, communication, eating and drinking and personal hygiene. Two of the care plans examined for this resident identified one of the residents care needs as Service User has reduced mobility, risking pressure sore development. Information in the care plan said that a risk assessment should be completed for moving and handling the person and pressure development. A risk assessment was completed for reducing the risk of pressure sores but a risk assessment was not available for moving and handling. The absence of risk assessments would mean that staff had not given consideration to the best way of maintaining this persons safety. The care plan lacked details about how many staff were needed when moving the resident. A decision had been made not to use foot rests when using a wheelchair but there was no information to show how staff should transport the resident in a wheelchair safely. A visit to the resident showed that they were using an airwave mattress, this is a special mattress used to alleviate the pressure on a persons body, which should help to reduce the risk of the person developing pressure sores. This information was not updated in the persons care plan. Care plans were not completed to demonstrate that they had been personalised to show the individual care required by each resident. For example a care plan titled Service User is unable to maintain hygiene needs independently said Offer Service User the choice of a bath, assisted wash or bed bath. There was no indication that a discussion had taken place to identify the persons preference. The care files for another resident showed that there were only two care plans completed these were related to Personal Hygiene and Catheter Care. The referral assessment by the GP and the initial assessment by staff working in the home showed that there were other care needs to be considered. For example the resident was assessed as having a poor appetite and problems sleeping. The assessments also identified that the resident had a swollen abdomen. Information written in the care file said that the abdomen should be monitored for any increase or decrease in swelling. A care plan had not been developed and there was no indication of how the persons abdomen would be monitored to ensure consistency and reliability of reporting from staff. Information in care files and talking to residents confirmed that people were visited by a Chiropodist, Dentist and Specialist Nurse. The home has access to a GP surgery, which provides a service to the home. Residents are encouraged to keep their own GP if they wish. A physiotherapist visiting the home told us that the home is well Care Homes for Older People Page 14 of 34 Evidence: managed. She told us that the staff are always approachable and carry out any instructions she leaves to continue residents care. Daily reports in one of the care files showed that they were written in a logical order and entries were dated and signed. However the time of making the entry is not always entered, some staff writing PM, AM or Nocte (Night). This does not help when trying to follow the day to day care given to residents. It was also noted that staff review the care plans daily as well as writing a daily report. The daily reports were informative and provided details of a persons health and wellbeing. Reviewing the care plans daily showed that they were repetitive for example in an Activity of Daily Living - Hygiene plan staff wrote daily Bed bathed by care staff or Personal hygiene needs met fully by staff. The same information would also be written in the daily report. We discussed how the home review their care plans with the manager and one of her deputies. The manager has told us that they plan to review how the care plans are written with a view to carrying out monthly reviews and only reviewing the plans more often if needed. We examined the systems for the management of medicines in the home. The medication charts for the three residents were looked at together with their care plans and daily records. The medicines had been accurately checked in this cycle against copies of the original prescription to check them in against. Storage of medicines was good. Medication charts examined showed that they were completed and signed. The nurse spoken with during the inspection had a good knowledge of the residents clinical needs. Staff had a kind and caring attitude towards the people living in the home. Personal care was provided in private and residents spoken with said that staff were respectful towards them and addressed them by their preferred names. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15 were assessed. The lifestyle and activities offered to people living in the home is limited this means that residents do not always experience varied stimulation to enhance their daily quality of life. Residents benefit from a nutritious and varied diet. Evidence: Information in the homes AQAA told us that activities are provided five days per week and that details of activities that have taken place are maintained. The home employs an activities co-ordinator, posters and limited records showed details of some of the activities and events, which have taken place in and outside the home. Activities that have recently taken place include residents making Christmas cards, which are sold and the monies put into the residents funds. Other activities include darts, jigsaws and other crafts. One resident said I enjoy doing jigsaw puzzles, reading, listening to my radio, playing DVDs and videos in my own room. Information in the AQAA told us that the home could do better by offering more outdoor and external activities. The manager told us that the activitys co-ordinator is Care Homes for Older People Page 16 of 34 Evidence: currently on sick leave. As a result any social activities that currently take place are dependent on the availability of care staff in the home. Designated care staff, separate to those providing care were not identified on the duty rota this leaves the risk of the number of staff being available to provide care being depleted. At this visit there were no activities seen to take place. At the time of this inspection visit most of the residents were sitting in the lounges watching television or listening to the radio. Other residents chose to stay in their bedrooms or due to their health were nursed in their bedroom. Residents said that they are encouraged to take part in activities but they make the choice. A comment made in a relatives questionnaire told us that The television in the residents lounge often the reception is very poor and residents are generally hard of hearing or poor vision which makes this activity more difficult to start with. Both TVs in the main lounge were observed to be showing poor quality pictures. Support is given to help meeting the religious needs of people living in the home. The home is visited by a catholic priest weekly and a vicar visits the home monthly. Information in the AQAA told us that the home has no restriction on visiting. However further information gained at the inspection told us that visitors are asked to avoid mealtimes, early morning and late visits are made with prior arrangements with the home. Families and friends were seen visiting the home throughout the day. One of the visitors we met at the time of the inspection said that they are made to feel welcome. A resident told us I have lots of visitors. Separate dining rooms are provided for residents to eat their meals. Some residents sat in the small dining room for their lunch. The dining room did not present as a warm, inviting and homely area to encourage residents to eat their meals comfortably and in a social setting. The meals for the day offered a choice of starter, main course and desert. A conversation with the cook and menus for a four week period showed that meals were varied and offered residents a two course lunch each day. The cook told us that she makes homemade soups and cakes and that all meals are prepared in the home from fresh foods. Residents told us that they enjoyed the food provided by the home. Meals were delivered to people who chose to eat in their room and discreet support was given to residents who needed help to eat. We were also told that special diets can be prepared in the home. There are no residents of different cultural backgrounds and residents told us that they prefer old fashioned cooking. We observed that special meals were prepared for residents due to health reasons for example residents that have diabetes and supplement drinks were available for residents who had a poor Care Homes for Older People Page 17 of 34 Evidence: appetite. A lighter meal choice is offered at the evening meal, this is usually sandwiches, soup or something on toast. Care Homes for Older People Page 18 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. Standards 16 and 18 were assessed. People living in the home can be confident that their concerns will be listened to. The standard of care delivery in the home does not show that people living in the home are protected from harm at all times. Evidence: A copy of the complaints procedure is displayed in the home this makes sure that it is accessible to people living in the home, their families and staff. In questionnaires returned to us residents and their families told us that they would know who to speak to if they were not happy. People spoken with in the home said that they would raise concerns with the manager or senior staff on duty. People using the services of the home felt that generally their complaints are listened to. We have not received any complaints about services offered by the home since their registration. A record of complaints and concerns received by the home is maintained along with the action taken by the home regarding each issue raised. Evidence showed that complaints were responded to in a timely manner. The home has received one complaint, where concerns were raised by a resident about the banging and squeaking of doors especially at night, this was again brought up at a residents meeting. The manager has taken action to resolve the concern. Care Homes for Older People Page 19 of 34 Evidence: The home has an adult protection policy. The document gives staff direction in how to respond to any suspicion, allegations or incidents of abuse. Training records show that staff have received training in recognising signs and symptoms of abuse. In conversation staff working in the home showed an awareness of the role the local Social Services take in the event of receiving allegations of abuse. As discussed in the management and administration section of this report concerns were discussed with the home manager when staff were observed using poor moving and handling techniques. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 21, 22, 24, 25 and 26 were assessed. The home is being maintained, however some practices do not ensure that a safe, attractive and homely environment is provided for residents at all times. Evidence: Hollycroft nursing home provides accommodation for up to 37 older men and women. The manager showed us around the home and told us about the new owners plans for the refurbishment of the home. It was noted that in some areas the home there is a need for decoration and repair. Residents have access to three lounge areas, one of which provides a quiet area for people to sit. However this lounge was not well decorated to promote a comfortable, homely and relaxing environment for people to relax. The bedrooms of the three residents were viewed, residents said that they liked their bedrooms. One resident saying My room is comfortable. These bedrooms and others visited showed that some of them were personalised by residents and their families. A number of bedrooms did not look homely or well presented. The manager told us in the AQAA that there are plans to update and refurbish residents bedrooms. There are Care Homes for Older People Page 21 of 34 Evidence: now three shared bedrooms, which would give the home the capacity to accommodate 34 residents. Shared bedrooms in use showed that they were arranged to provide two separate living areas and privacy was provided by curtains. People were observed moving around the home in wheelchairs and using walking sticks. Wheelchairs seen did not all have footplates fitted and as discussed under management and administration staff were observed using the wheelchairs without footplates. Hand rails along the walls provide support for residents able to move around the home. Other support aids and equipment in the home are available to support residents living in the home. These include for example nursing beds, pressure relieving mattresses and cushions and hoists. A new walk in shower facility has been provided on the first floor of the home, this is not yet in use. Other assisted bathing and shower facilities are available in the home, some of these are in need of refurbishment. An example of this is the toilet facilities provided for staff use on the ground floor of the home where there is damage to the walls and ceiling. Lighting in some areas of the home does not provide a good level of light to help residents move around the home safely. The manager has told us that a review of the lighting is part of the refurbishment plans for the home. It was noted that the home was using electrical heaters around the home, we asked the reason for this. The home manager told us that the heating in the lounge area was not working properly. This had been reported and engineers would be visiting to remedy the problem. The room was warm at the time of the visit and residents looked comfortable. However the electrical heaters were not being used safely and this is further discussed under the management and administration section of this report. The standard of hygiene in the home was good. The home was clean and fresh at the time of this inspection visit. Good practice was observed in the laundry in the home. The area was kept clean and separate clean and dirty areas were identified. Systems in the laundry and the knowledge of laundry staff helps to support good infection control procedures in the home. It was noted that the iron board cover and the cover and padding on the roller for ironing sheets was worn. Walking around the home it was noted that some residents liked to keep their bedroom door open. Observation showed that not all the doors had fire door closures fitted this meant that staff were using wedges, which is not safe in the event of a fire. This was addressed by the home manager and maintenance man at the time of inspection and a door closure was fitted to a residents door. Care was taken by staff to dispose of soiled laundry safely to prevent cross infection. Care Homes for Older People Page 22 of 34 Evidence: Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. The standard of food hygiene and cleanliness in the kitchen area was good and the kitchen staff should be commended for this. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30 were assessed. Staffing levels in the home appear sufficient but not organised to make sure that residents are not left unattended for long periods of time. Residents benefit from being cared for by trained staff. People living in the home can be confident that appropriate checks have been done to make sure that staff are suitable to care for them. Evidence: There were 30 people living in the home at the time of the inspection. We were able to examine four weeks working duty rotas. The duty rotas showed us that the number of staff on duty for each shift was maintained. The manager told us that there are two nurses on and five to six carers on an early shift, one nurse and three or four carers on a late shift and one nurse and two or three carers on a night shift. The number of carers would be increased depending on the needs of the residents. The home also employs a handyman, administrator, laundry staff and kitchen staff to support the running of the home. The duty rotas examined did not make it clear who was on duty and what shift the person was working. Some shifts are indicated by a tick and others show the number of hours to be worked by the member of staff. This makes it difficult to confirm that Care Homes for Older People Page 24 of 34 Evidence: shifts were covered over a 24-hour period and confirm who worked the shift without some form of code. During the visit it was noted that there were periods of time when residents were unsupervised in one of the lounges. This would mean that vulnerable people are not supervised at all times. This is also of concern when electric heaters were in use in the lounge. Information in the minutes following a residents and relatives meeting, detailed a relatives concerns about the lounge being unattended telling us Sometimes the residents need help and there is no one around to help them. Speaking in their questionnaires a relative said At times supervision in the lounge seems less than adequate, particularly when residents who have dementia and remain mobile are present. Training records show that 86 per cent of care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. Ongoing regular training is organised for staff. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. Staff were able to confirm that they had attended training. This should mean that staff are updated in safe working practice. Staff have also attended training in dementia care, infection control, palliative care and end of life care. New employees are given an induction period to make sure they have a working knowledge of residents in their care. The induction also covers health and safety issues to support staff to work in a safe manner. Staff told us that training includes health and safety and fire safety. During this time staff are also made aware of the policies and procedures followed in the home. The personnel files of two recently recruited staff were examined and both contained evidence to show that pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references were requested before staff started working in the home. Robust recruitment practices support the safety of people living in the home from the risk of abuse. Care Homes for Older People Page 25 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. Standards 31, 33, 35 and 38 were assessed. The home is managed by an experienced, competent person. Practices carried out in the home do not always ensure that the service is run in the best interests of people living in the home. Evidence: The home has recently changed providers and is currently owned by Leyton Healthcare (No.7) Limited. The change of owners does not appear to have had a negative effect on the running of the home. Both residents and staff were happy with the way the home is run. The manager has a lot of experience of working with older people. She has completed a NVQ level 4 leadership qualification. The manager is supported by two deputy managers. The duty rotas examined show that the managers hours are not Care Homes for Older People Page 26 of 34 Evidence: supernumerary. This is not good practice as there is no dedicated time for the manager to monitor and audit the services and practices provided by the home. Providing this time will support the manager to make sure that the home is being run well and staff are always practising safely. Quality monitoring is undertaken by external managers and reports of their findings are available. Action plans are developed for making improvements and these are reviewed to monitor progress made by the home. Staff meetings are held and staff are given the opportunity to discuss areas to improve the running of the home. Residents and relatives meetings are held regularly discussions include the planned new shower and a free discussion of any concerns residents and relatives have. Systems are in place for the safe keeping of residents monies. Records show that audits are carried out to ensure that transactions are completed appropriately. Examination of one residents personal monies was found to be correct. Incidents and accidents that happen in the home are recorded and were available for examination. Systems in the home makes sure that equipment used for the benefit of residents is serviced or tested as recommended by the manufacturer and is kept up to date. Evidence was sampled at random to confirm this. For example, labels on fire extinguishes and hoists show the date they were checked and the date they are next due to be checked. Other servicing and checks carried out in the home include portable electrical appliances before they are used and water temperatures. Records examined show that the fire alarm is serviced and is tested weekly. Concerns were raised and discussed with the home manager about practices in the home that put residents at the risk of harm. It was observed in the lounge that electric heaters were being used these did not have a cool surface and were hot to touch. They were not guarded to protect residents from being burned if they walked near to them. We also noted that the wiring from the heaters and the television were not securely placed so that they did not present as a trip hazard. This was remedied at the time of the inspection. The manager for the home actioned the purchase of a fire guard and the larger electric heater was placed on the unused fire surround. The electrical wires were also made safe. A second concern was the poor practice observed by two members of staff. One member of staff was using a wheelchair without foot rests, the resident was dragging their feet along the floor. This practice could result in injury to residents. We also observed staff at the time of the inspection using poor moving and handling Care Homes for Older People Page 27 of 34 Evidence: techniques when transferring the resident to a wheelchair with foot rests by holding the person under their arms. Both practices put the residents at the risk of harm. It was noted when checking staff records that the moving and handling training given to staff is very comprehensive and gives full explanation of the correct and up to date procedures to follow. Information is also given to staff on the dangers of poor practice when moving or transferring residents. These concerns were discussed with the home manager. Care Homes for Older People Page 28 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 29 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 7 15 All persons living in the home must have a care plan, which clearly identifies all their health and personal care needs. This must include people who are admitted for for short term care. Staff will know what they need to do to meet the individual needs of people in their care. 31/03/2009 2 8 13 Moving and handling risk assessments must be completed for all residents. A proactive care plan should then be developed. This will make sure that care staff know how individual residents must be transferred or moved safely. 31/03/2009 3 8 13 Risk assessments must be completed for residents who chose or refuse to use wheelchairs without footplates. 31/03/2009 Care Homes for Older People Page 30 of 34 This will make sure that people living in the home are moved around the home safely. 4 18 13 Staff must use safe and appropriate moving and handling practices when moving and transferring people in their care. This will ensure that residents are supported to move safely around the harm and protect them from the risk of harm. 5 22 13 Wheelchairs used by people living in the home must be fitted with appropriate footplates. This will help to make sure that residents are moved safely around the home. 6 27 18 Sufficient staff must be on duty to make sure that residents are not left unattended. This will help to make sure that residents can be supervised at all times and left at risk from harm. 7 38 13 Checks must be made to make sure that staff are using wheel chairs correctly at all times. This will ensure that a safe and appropriate mode of transport has been considered for all residents. 31/03/2009 31/03/2009 31/03/2009 31/03/2009 Care Homes for Older People Page 31 of 34 8 38 13 The use of electrical heaters in the home must be reviewed and a risk assessment carried. This will make sure that the electrical heaters are used safely and will protect residents from the risk of harm. 31/03/2009 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. No. Refer to Standard Good Practice Recommendations 1 1 The home should update the Statement of Purpose and Service User Guide so that people have accurate information available to them. This will help to support peoples decision on whether to use the home. Written entries in residents care files should be dated, timed and signed with the signature of the person making the entry. This will help to ensure that a legible and effective audit trail is available to track the care given to people living in the home. The time allocated for care staff to undertake activities with residents should be identified clearly on duty rotas. This will show that the involvement of care staff in activities does not impact on the care delivery for residents. Work should continue on developing a proactive activity plan, which considers the interests of people living in the home. This will help to promote and stimulate the wellbeing and quality of life of residents. Televisions provided for the benefit of residents should be reviewed to make sure they are suitable and provide good quality viewing for people living in the home. Accurate information on visiting hours should be available for visitors wishing to visit people living in the home. The small dining room should be decorated to present an environment where residents can eat their meals in a comfortable, social and homely atmosphere. Doors in the home should not be wedged open. This will 2 7 3 12 4 12 5 12 6 7 13 15 8 19 Care Homes for Older People Page 32 of 34 ensure that people living in the home are protected from the risk of harm particularly in the event of a fire. 9 19 Plans should be available to show what and when refurbishments and repairs will be carried out in the home to ensure that a well maintained, homely and safe environment is provided for the people who chose to live there. Residents bedrooms should be furnished, equipped and maintained to provide a comfortable and homely environment. This will help to meet the residents assessed needs, increase their self-esteem and promote a good quality of life. The heating system in the home should be reviewed to make sure that it has the capacity to heat the home appropriately and meet the needs of people living in the home. Lighting in the home should be reviewed to ensure that the level of lighting is suitable for residents to walk around the home safely. The duty rotas should clearly show the time of shifts to be worked by staff. This will provide information to show that the home is covered to provide care and support for people living in the home over each 24 hour period. The managers hours should be supernumerary to support the effective running and management of the home. This will help to make sure the home is run for the benefit and well being of people who chose to live in the home. 10 24 11 25 12 25 13 27 14 31 Care Homes for Older People Page 33 of 34 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. 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!