Inspection on 10/08/09 for Ivy House Care Home

This inspection was carried out on 10th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ivy House Care Home 27/01/09

Ivy House Care Home 26/09/08

Ivy House Care Home 18/07/07

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 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Ivy House Care Home 50 Ivy House Road West Heath Birmingham West Midlands B38 8JZ Lead Inspector Lisa Evitts Key Unannounced Inspection 09:25 10 & 13th August 2009 th DS0000068295.V377045.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 2 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 Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivy House Care Home Address 50 Ivy House Road West Heath Birmingham West Midlands B38 8JZ 0121 459 6260 0121 459 6328 ivyhouse@fshc.co.uk www.fshc.co.uk Four Seasons Homes No.4 Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care Home 76 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (76) of places Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 (OP) 76, Dementia (DE) 36 The maximum number of service users who can be accommodated is: 76 The minimum age on admission for the service user category of Dementia will be from 60 years. 27th January 2009 2. 3. Date of last inspection Brief Description of the Service: Ivy House is a purpose built home situated in a residential area of West Heath, South Birmingham. The home offers nursing and residential care for up to 76 people who may also have dementia care needs. All bedrooms are for single occupancy with an en-suite facility consisting of toilet and hand basin. The home is divided into two floors. Two units upstairs are dedicated to nursing care and on the ground floor there is one residential and one nursing dementia care unit. Within each unit there is a lounge/dining area and assisted bathing and toileting facilities. Corridors are wide to enable people who need adaptations to move around the home. The home has a range of equipment to assist people to move around the home and pressure relieving equipment for those who are prone to developing sore skin. The enclosed, well laid out rear garden is accessible to people living at the home. There is off road parking to the front of the property, which is sufficient for the home, one of these spaces is for disabled people to park closer to the home in a larger space. The home is situated close to a number of bus links. There are a range of local shops and community facilities nearby. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 5 In the reception area there are leaflets of interest for anyone who wishes to read them. The last inspection reports and information about the home are available should people choose to read this. Current fee rates for living at the home range from £450 - £575 per week depending on individual needs. The fee rates were correct at the time of our visit but are subject to change and should be checked with the home. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Following our last visit in January 2009, the home was sent a warning letter so that medication management was improved and that people received their medication safely and as prescribed. A pharmacist inspection was undertaken on the 2nd March 2009 to check that the home had complied with requirements about the management of medication. We found at this visit that the medicine management had improved. At the visit in January the home had a suspension on placements by Adults and Communities which meant that no more people could be admitted. This was following concerns about the care that people received. This suspension had been partially lifted and the home had been able to take four admissions per week, however a full suspension was placed on the home again in June, following further concerns being raised. This suspension was due to be reviewed the week after our visit. The visit to the home was undertaken on two different days by four inspectors. On the first day a pharmacist inspector reviewed the management of medication. A second inspector completed a Short Observational Framework for Inspection (SOFI) on two different units. We completed a SOFI because some of the people in the home are unable to verbally tell us about their experiences, we use a formal way to observe people to help us understand. The SOFI involved us observing five people who use the services for two hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff members, other people who use the service and the environment. The results of this observation are included within the report. On the second day, two inspectors visited the home for a full day. The home did not know that we would be visiting that day. There were 67 people living at the home and one person was in hospital. Information was gathered from speaking to and observing people who live at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 7 outcomes. Case tracking helps us to understand the experiences of people who use the service. We partially looked at three other files. Staff files, training records, maintenance and complaints records were also reviewed. We spoke to two people who live at the home, three relatives and six staff. Reports about accidents and incidents in the home were reviewed in the planning of this visit. Prior to the inspection a manager had completed the Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about how well the home thinks they are performing. It tells us about the home, staff and people who live there, what the home do well and where they need to improve. What the service does well: People are seen by external healthcare professionals so that that they receive specialist advice to meet their individual needs. The home offers a choice of meals that can meet personal preferences, dietary and cultural needs, so that people receive food they like and require. The accommodation is spacious so people have a choice of areas where they can spend their time or see their visitors. People are encouraged to personalise their rooms with items that are familiar to them so that they live in an environment, which they prefer. There is a robust system in place for the safekeeping of small amounts of personal money should people choose to use this facility. People told us: I couldnt leave my husband before but its ok here I am always made welcome I dont like red meat so they give me a pork pie salad if red meat is on the menu or something similar The staff are alright What has improved since the last inspection? The management of medication has improved so that people receive their medication as prescribed. A number of improvements have been made to the environment. These include new chairs and sofas, new carpets and redecoration. New quiet areas and a sensory room have been developed. Signage has improved on the dementia unit to help people find their way around. These improvements enhance the environment for people to live in. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 8 Another nurse is now on duty throughout the day to meet the needs of the people living at the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People using the 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 have some information to enable them to make an informed decision about whether they would like to live at the home. Pre admission assessments ensure people know their needs can be met prior to moving in. EVIDENCE: The statement of purpose was available in the reception area of the home and included the fee rates so that people know how much they have to pay if they decide to live at the home. The home has a brochure which gives some information about the home. The manager was not able to show us a copy of the service users guide and confirmed that no one had this document in their room. The service users guide should be available to people so that they have information about the home in a format that they can understand. Our last Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 11 inspection report was displayed in reception so that people can read this if they want to. Due to the suspension on placements there had not been any recent admissions into the home. We looked at the assessments for the last two people who had come to live at the home and found that they were detailed. This means that the person knows their needs can be met before they move into the home. The AQAA told us that people can visit the home before they move in to look around and spend time at the home, so that they can sample what it would be like to live there before they move in. We were not able to confirm this with the people we case tracked during our visit. One person said I couldnt leave my husband before but its ok here. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the 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 provide staff with some information but they are not consistent which may mean that some people do not get the care that they need. EVIDENCE: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to meet their needs. We looked at three peoples care plans in detail and partly reviewed three other files. There were some good details recorded so that staff knew how to meet peoples needs in a way that they preferred for example uses nivea cream on her face twice a day and needs food cut up. There were some good details recorded for someone who had depression and staff were given good indicators of what to look for such as decreased appetite and decreased engagement with staff. This should ensure that staff recognise any changes Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 13 and seek further guidance. Short term care plans were written for specific illnesses such as chest infections. One person had a nutritional assessment completed which said that they were diabetic but there were no other records or care plans for this. The manager was not aware that the person was diabetic and was to confirm with the GP as this may have an impact on the persons well being. One person had a skin wound and there was a detailed plan in place for staff to alter their position and change wound dressings. There was an assessment form completed each time the wound was redressed. It was disappointing that the care plan had not been updated when the type of dressing was changed as this may mean that some people would not use the right dressing on the wound. We saw that a number of people had long or dirty fingernails. A relative said I saw the manager about three weeks ago about fingernails but they need doing again. Staff should ensure that people have clean nails so that their dignity is maintained. One person had care plans which said that they should wear their glasses and hearing aid. We visited this person who was not wearing the glasses or the aid and this does not enable people to communicate effectively. One person was displaying some difficult to manage behaviour. There was no care plan in place for staff to follow and tell them how to manage this behaviour. Records stated that a behaviour chart was in place, however when two different staff were asked about the chart we were told that the person didnt have one. This means that the behaviour was not being monitored. Moving and handling plans gave good details so that staff would know what equipment to use to move people safely. Food and fluid charts were completed so that staff could monitor their dietary intake. One person should have had their weight checked each week but there were gaps in the recording and this does not ensure that people are being monitored. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. External healthcare professionals such as opticians, speech and language therapists, social workers, dentists and GP visit people so that they receive specialist advice. A pharmacist inspection had taken place in March 2009, following the visit in January. This showed that the management of medication had improved. The pharmacist inspection took place on a different day to the main inspection. The medicine trolleys were kept in a dedicated medication room. This was too hot to safely store the medication within. All medicine should be stored below 25C at all times to maintain their stability. Medicines requiring refrigeration were stored in a dedicated refrigerator. The temperature was unknown as all three thermometers read a different temperature. It was also unlocked. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 14 Surplus medication was kept in separate cabinets. None were locked. In addition medication awaiting return to the clinical waste company was also kept in open bins. Anyone gaining access to the medication room would also have free access to many of the medicines held within. The home sees some of the prescriptions before they are dispensed and checks these to ensure that all the medicines they require are prescribed. Problems had arisen where staff had failed to order these prescriptions in time. This had resulted in some people not receiving all their prescribed medication until a new prescription was written. We were assured that all the prescriptions had been ordered and received earlier for the next cycle so these problems should not happen again. Copies of some prescriptions were available to check the medicines and Medication Administration Records (MAR) charts against. Without all the copies of prescriptions the medicines cannot be adequately checked in. This had resulted in problems identifying the correct dose of one medication. Staff were unaware of the latest dose that had been prescribed and had also failed to record any doctors visits so it was not possible to demonstrate exactly what the correct dose was. Even though the nursing staff had recorded that 40mg should be administered they were routinely recording and administering only 20mg for the last 11 days. This matter was to be addressed immediately after the inspection. The quantities of the medicines had been recorded enabling audits to take place. These indicated that the majority of medicines had been administered as prescribed and records reflected practice. A few errors were seen where one medicine had been signed as administered when it had not been and one gap on the MAR chart was seen where an agency nurse had failed to record exactly what had taken place. The nurse in charge had already recognised this and addressed the problem. All staff spoken with had a good understanding of what the medicines were for and the clinical indications of the people they looked after. We observed that one person signed for medication when another person administered the medication. The person giving the medication should sign the chart. All controlled drug (CD) balances were correct and the entries in the CD register matched those on the MAR chart indicating further good practice. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the 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 able to choose the activities that they participate in so that they experience a lifestyle that is meaningful and meets their needs or expectations. People are offered a choice of meals to meet their cultural, dietary needs or preferences. EVIDENCE: The home has a full time activity coordinator. Activities include manicures, quizzes, board games, bingo, reminiscence and theme days. People are involved in sing a longs, movement to music, foot massage and arts and crafts. Some people have one to one time; however the coordinator confirmed that she was only able to see people in their rooms about once a week. Care staff should assist with activities but due to staffing problems, they had been taken off activities to help with personal care needs. This may mean that not all people receive as much stimulation as they require. One person said there are not many activities organised but there are a lot of people and only one activity staff. Consideration should be given to the number of hours for activities offered to ensure that people receive enough stimulation. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 16 During the day we observed people to go out into the garden and in the afternoon a game of bingo was played. Other people were seen to stay in their rooms and watch their own televisions. People are able to go out of the home with their families. The home does not have any transport to take people out and the coordinator was hoping to register people with the ring and ride service so that they could go out of the home. A monthly church service is held and people can receive Holy Communion if they choose to. This means that people can continue to follow their chosen religion. The home has its own hair salon and the hairdresser visits each week so that people can have their hair styled in a way they prefer. Life history books were being produced and these included photographs and information about peoples lives and interests. This gives staff information about people and gives them something to talk to people about which is meaningful to them. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. One person said I am always made welcome. There is a four week rotating menu in place. There is a choice of cereals or cooked breakfast. There is a choice of two hot meals at lunchtime and soup and sandwiches or a lighter hot meal in the evening. Snacks are available throughout the day and there are alternatives to meals available such as jacket potatoes or salads. The cook told us that they ask people what they want to eat each day and that they have a comments book for the food. Staff were able to tell us about people who needed special diets for medical reasons and knew who needed liquidised foods because they had difficulty swallowing. When the home organise themed days a menu is produced. For example we saw a Caribbean day menu. People told us: I dont like red meat so they give me a pork pie salad if red meat is on the menu or something similar The food is alright Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the 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 not always confident that their complaints are listened to and acted upon. There are systems in place which should protect people from harm. EVIDENCE: The complaints procedure is displayed in the home and is included in the statement of purpose. This procedure includes our contact details so that people know how to make a complaint if they need to. Since our last visit to the home, they have received twelve complaints regarding care delivery, staff attitude, laundry and meals. Records were available to show how they had been investigated and what the outcomes were. We had received three complaints which had been referred back to the organisation to investigate using their own procedure. As at the previous inspection, we found that some concerns were recorded in the senior person file and were not recorded as a concern or complaint so that the home can monitor any low level concerns and trends. The senior person file is for the person in charge of the home to record information to pass onto the home manager. One relative had made a complaint about the food and the records said to see the complaints form. No form had been written and Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 18 therefore neither the complaint nor the outcome was recorded and this does not ensure that people are being listened to and complaints acted upon. People told us: I have spoken to the manager about three times with concerns but he just laughs I spoke to the manager with concerns about Moms fingernails, it was wrote down and addressed but now they are long and dirty again At the time of our visit there were three safeguarding cases open which were being investigated and the outcome is not yet known. Two of these were raised by external professionals visiting the home and one was raised directly by the home. The home has a copy of the Birmingham Multi Agency Guidelines and this should ensure that staff have guidelines to follow in the event of any allegations of abuse. Staff have received training in Protection Of Vulnerable Adults so that they have the knowledge to safeguard people from harm. Staff that we spoke to were able to tell us the procedure they would follow in the event of an allegation being made to protect people from harm. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25 & 26 People using the 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 provided with a home to live in which to live that meets their needs. Offensive odours in some areas of the home do not provide a pleasant environment for people to live in. EVIDENCE: The home is purpose built and each floor consists of two units, which have a communal area and dining room. Each unit has a kitchenette area where refreshments can be made. Since our last visit, further improvements have been made to enhance the environment for the people who live at the home. New chairs and sofas have been purchased for people to sit in and large flat screen televisions have been purchased so that people can see these and watch programmes that they Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 20 enjoy. A sensory room has been created on Rose unit and this had soft and fibre optic lights, soft music and items with various textures for people to feel. This room provides a relaxing area for people to sit but also provides stimulation for other people. New signs had been introduced on the dementia unit to help people find their way around. The corridors are wide and spacious and allow people at the home freedom to move around with any equipment they are assessed as needing. The home has hoists to assist people to change their position and have special mattresses for people who are at risk of developing sore skin. The home has both walk in showers and assisted baths so that people can choose what they prefer. Some of the bathrooms had been decorated but some still needed redecoration as the walls were scuffed. This redecoration was planned. We looked at the bedrooms of the people we case tracked and found that these were personalised with items that reflected individual choices and preferences. People had the equipment that they had been assessed as needing. The AQAA told us that several rooms had been upgraded with new carpets, curtains and furniture and there was a plan in place to continue with redecoration in the home. One room had a radiator which was dripping water into a bowl which had been placed on the floor. This was brought to the attention of the manager at the time of our visit so that it could be addressed. On the ground floor, there was an offensive odour in the corridor, between the two units. The manager told us that they were trying to address this. A new carpet had been laid and new cleaning products were being used, however the odour remained due to the incontinence of a person living at the home. We looked at a report about the home written by an external manager at the beginning of July which noted that an odour was being investigated. It was disappointing that this was still the same four weeks later as it does not provide a pleasant environment for people to live in. The home has a large, well maintained garden area which numerous people were seen to use throughout the day. A relative said I like to take him for a walk in the garden; its nice to spend time out there. The manager told us that people on the dementia unit were only able to access the garden if they had someone with them as it was not safe for people to wander in. The home are looking at ways to make this area safer so that people can go out into the garden. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the 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 supported by staff who receive training to ensure they have the knowledge to meet peoples needs. The recruitment process should ensure that people are protected from harm. EVIDENCE: During the day there is one nurse and three carers on each unit, except the residential unit which has one senior carer and two carers. At night each floor has one nurse and three carers. Since our last visit another nurse is on duty to meet the needs of the people living in the home. In addition to the nursing and care staff the home also has laundry, domestic, kitchen, maintenance and administrative staff to meet all the needs of the people who live in the home. There is currently one nurse vacancy to be appointed to. The home has needed to use agency staff while recruiting permanent staff. They have tried to use the same staff so that people know who will be assisting them to meet their needs. One person said The staff are alright We observed good interactions between staff and people who live at the home during our visit and there was a pleasant atmosphere in the home. During the Short Observational Framework Inspection (SOFI) we saw staff interacting well Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 22 with people. 65 of interactions for the group of people observed on the residential unit were positive, 30 were neutral and 5 were negative. People were generally in a positive or passive mood and no one was seen to be in a negative state. On the nursing unit 40 of interactions were positive, 33 were neutral, with 27 being negative, for the group of people observed. People were observed to be in a passive mood state on this unit. On this unit staff tended to be task orientated and we discussed with the manager how staff could be more involved with people. 22 of staff have completed a National Vocational Qualification (NVQ) in care. At least 50 of staff should have this qualification so that a knowledgeable and skilled workforce can meet peoples needs individually and collectively. We looked at three staff files and these were found to have all the required checks prior to employment beginning to ensure that people were safeguarded from harm. The home did not have a training matrix and this is recommended as this will easily identify peoples training needs. We saw records that some staff had received training in health and safety, infection control, safeguarding, care planning, tissue viability (care of skin), dementia and person centred care. Staff who had recently started to work at the home confirmed that they had received training and one person said I had induction for two weeks and I did not work as part of the shift. This means that people have the time to get to know the home and the people who live there so that they know how to meet their needs. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 People using the 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 is in need of a stable management team to ensure that it is run in the best interests of the people who live there. EVIDENCE: Since our last visit to the home in January, there have been four different managers at the home. A new peripatetic manager had started at the home the week of this visit. (Peripatetic managers are temporary managers who work at homes until permanent managers are appointed). The new manager is a registered general nurse and a registered mental nurse and has experience in management of homes. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 24 The home has been without a stable management team for some considerable time and there has not been any continuity for the people who live at the home. Relatives and staff told us: Changes of managers has been a nightmare In seventeen months we had five managers, it makes things difficult and we need some stability We don’t know if we are coming or going with the change of managers No manager seems to stick it here, which means our mums suffer. We raise things with managers and we dont get anywhere and its going downhill. Following our visit, the Regional Enforcement Team has written to the home regarding the appointment of a Registered Manager. We have been advised that the current manager will apply for registration with us and progress with this will be monitored. Residents/relatives and staff meetings are held so that people have the opportunity to discuss any concerns or ideas about the home. External managers visit the home each month and write reports about the quality of service being provided. Not all of these reports were available in the home and they should be available for us to see when we visit. The home sends out surveys to people who live at the home and to staff twice a year to gain feedback about the home and what it could do better. This information is then collated and an action plan is written to address any areas that need to be improved. There is a robust system in place for the safekeeping of peoples personal money. Maintenance records were sampled and show that equipment is checked and serviced to ensure it is in full and safe working order. The fire alarm system is checked by an external company quarterly. We were unable to find any recent records of the weekly fire checks and the manager sent us copies of these following the visit. During the day we saw that a number of bedroom doors were propped open with wedges, chairs and tables. The manager removed all of these at the time of our visit as the doors would not shut in the event of a fire. We told West Midlands Fire Service about our concerns. They have visited the home and found that most of the doors now had self closing devices flitted. This means that people can have their doors open but are safe in the event of a fire as the doors would close. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X 3 3 2 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 2 Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 Requirement Staff must have enough information about peoples needs. Timescale for action 22/10/09 2. OP9 13 (2) So that they have the knowledge to meet peoples individual needs in a way that they prefer. All medicines must be stored in 08/10/09 a locked facility at all times and in compliance with their product licences. This is to ensure that all medicines stability is guaranteed and are held safely on the premise to reduce the risk of any mishandling. Offensive odours in the home must be resolved. So that people live in a pleasant environment. Staff should receive National Vocational Qualification training in care. So that they have the knowledge and skills to care for people. 3. OP26 23 (2) 30/09/09 4. OP28 18(1) 31/12/09 Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Refer to Standard OP1 OP8 OP8 OP9 OP9 OP12 OP16 OP30 OP31 OP33 OP38 Good Practice Recommendations Information about the home should be available for people. Systems should be in place to ensure that people receive nail care. People should be assisted to wear any aids that will help with communication. It is advised that the prescriptions are ordered in a timely fashion to ensure that service users have a continual supply of medication at all times. It is advised that only the member of staff responsible for preparing and administering the medication actually signs the MAR chart. Consideration should be given to the hours available for activities, given the size of the home. Low-level concerns should be recorded so that trends and outcomes can be monitored. (Previous recommendation) The training matrix should be updated to assist with planning and easy retrieval of information. (Previous recommendation) The manager should submit an application for registration, so this will show a commitment to the home. (Previous recommendation) Monthly reports about the quality of service provided by the home should be available in the home for people to see. Doors should not be wedged open so that people should be safe in the event of a fire. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 28 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Ivy House Care Home DS0000068295.V377045.R01.S.doc Version 5.2 Page 29 - 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!