Inspection on 27/01/09 for Ivy House Care Home

This inspection was carried out on 27th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ivy House Care Home 10/08/09

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Ivy House Care Home 50 Ivy House Road West Heath Birmingham West Midlands B38 8JZ Lead Inspector Lisa Evitts Unannounced Inspection 27th January 2009 09:15 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ivy House Care Home DS0000068295.V373904.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 (wholly owned subsidiary of Four Seasons Healthcare Limited) Manager post vacant Care Home 76 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) Category(ies) of Dementia (18), Dementia - over 65 years of age registration, with number (18), Old age, not falling within any other of places category (76) Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 76 persons - 40 for general nursing care, 36 in need of residential care for reasons of old age or dementia. To continue to provide care to two named residents who have a learning disability. 26th September 2008 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 area 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 easily 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. 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 were not available on the day of our visit but should be available from the home on request. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 5 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 Commission for Social Care Inspection (CSCI) 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. This is the second key inspection at the home for the year 2008-2009 and it is recommended that this report is read in conjunction with the previous report for the home. At the time of the last visit to the home in September 2008, there was a suspension on placements by Adults and Communities, which meant that no more people could be admitted into the home. This was following concerns raised during an adult protection investigation. This suspension is still in place and will be reviewed by Adults and Communities in the near future. Due to the previous concerns raised around healthcare, medication management, complaints and protection of the people living at the home We, the commission focused our inspection visit around these areas. The visit to the home was undertaken by two inspectors over one full day, and a pharmacy inspector over four hours. The manager assisted us throughout. The home did not know that we were visiting on that day, when there were 54 people living there. Three people were receiving hospital treatment. Information was gathered from speaking to and observing people who lived at the home. Four 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 outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and complaints records were also reviewed. It is difficult to get peoples views about the home due to differing levels of dementia however three people who live at the home, two visitors and three staff were spoken to. Reports about accidents and incidents in the home were reviewed in the planning of this visit. An Annual Quality Assurance Assessment (AQAA) was not requested for this visit as has been requested prior to the last inspection. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 6 Following this visit we sent the home a warning letter regarding concerns around the management of medication. This is an outstanding requirement and the medicine management must improve as we may consider taking further action to make the home improve. A further inspection will be carried out to monitor progress of this to safeguard the health and wellbeing of the people who live in the home. What the service does well: What has improved since the last inspection? There is information about the home made available and this is in the process of being updated so that it is a current reflection of the service offered. Some care plans have improved so that staff have information about how to meet peoples needs. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 7 A temporary activity coordinator has been employed so that people are assisted to lead an interesting and stimulating lifestyle. Complaints are being recorded and responded to so that people are more confident that they are being taken seriously and listened to. Some bedrooms have been decorated and a range of furniture and equipment has been purchased in order to enhance the living environment. One person told us Cleanliness has improved recently. This means that people live in a clean environment. The recruitment procedure has improved so that people are safeguarded from harm. Staff have received training so that they have the knowledge and skills to meet peoples needs. A new home manager has been recruited and systems have been set up so that people know who is in charge when the manager is not there. One person said, Staff communication has improved recently. What they could do better: Care plans must reflect the current care needs of individual people living at the home. Plans should provide information about personal preferences so that people receive their care in a way they prefer. The medicine management must improve to safeguard the health and wellbeing of the people who live in the home. Low-level concerns should have the outcome recorded so that any themes or trends can be monitored. Minutes of any meetings held should be recorded and made available to people so that they know what is happening at the home. The manager should submit an application to become the registered manager, as this will show a commitment to the home. Please contact the provider for advice of actions taken in response to this Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ivy House Care Home DS0000068295.V373904.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.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have some information about the home and the opportunity to visit so that they can make an informed decision about whether they would like to live there. EVIDENCE: The statement of purpose was available in the reception area of the home. The service users guide was not displayed however the manager told us that this was being updated and will be available in each persons room so that they can refer to information as they want to. The updated guides will mean that people have access to current information about the home. It is recommended that when the information is updated the fee rates for the home are also included so that people will know how much they will have to pay to live at the home. It was not possible to review how people are assessed before they come to the home as Adults and Communities had placed a suspension on admissions into Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 11 the home. This meant that there had been no new people come to live at the home since our last visit. People are able to come to the home for trial visits and this gives them the opportunity to sample what it would be like to live at the home before they make a decision about whether they want to live there. One person who had come to live at the home just before our last visit told us I came for a trial visit, I felt rough from the journey but the staff made me feel so comfortable, I decided I wanted to come here because it was so quiet, no traffic outside of my window. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with some information but are not consistent and may mean that some people do not get the care that they need. People may not receive their medication as prescribed. 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 four peoples care plans. A project manager had been at the home to help staff reassess people and write care plans so that staff knew how to meet peoples needs. One person had detailed care plans in relation to sore skin and there was evidence that specialist advice had been sought from the tissue viability nurse and the GP. There were photographs of the wounds and sizes had been recorded so that staff could monitor the progress of the wound. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 13 Each person who requires monitoring for fluid or food intake, behavioural needs or position changes has a folder with the records in which are taken with them wherever they go in the home. This means that charts are updated when staff assist people so that there is an accurate record for staff to monitor. One file had not had the care plans evaluated since August 2008. It was clear from talking to the manager and from the daily records that the care plans had not been updated to reflect the deterioration in this persons condition and their current care needs. The manager told us that they had tried to prioritise which care plans they reviewed and that this one would be addressed immediately. One person had been treated for an infection with antibiotics but no short-term care plan had been written so that staff could monitor progress. A care plan for a person who needed thickened fluids and pureed meals due to swallowing problems was really detailed and provided staff with good information. There were also good details about how to care for a feeding tube so that the risk of infection was reduced. The plans provided some details of peoples individual needs, likes and dislikes but this was not consistent. Some plans were based around tasks rather than about the person. Staff are receiving training in person centred care and this should help them to plan peoples care in a way that meets their individual needs. The manager has started to complete care plan audits so that any omissions or changes can be rectified to provide staff with current information. There was evidence that people and their relatives are involved in the planning of their care so that they receive care in a way that they prefer. A relative told us that he was happy with the care provided and a person who lives at the home told us the manager spent a lot of time talking to me about my pain and the tablets, she sorted out the GP and got me some patches. Documentation includes a number of risk assessments including, risk of sore skin, nutritional needs and moving and handling. Moving and handling assessments were detailed with the type of equipment that should be used to assist people safely. The medication room was warm and the manager is currently monitoring the room temperature to ensure the medicines are stored in compliance with their product licences. One medicine - a patch used to alleviate severe chronic pain had not been ordered in time and it was not recognised until the day of application. This had still had not been received and applied six days later. Another pain alleviating patch was applied one day too late according to the records. Staff are not following the prescribed instructions from the doctor, which may result in unnecessary pain for the person concerned. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 14 Some medicines had been administered but not recorded as such, others signed as administered but not. Reasons for non administration were not always accurate. Some medicines were unaccounted for. The medicine administration record (MAR) charts listed many medicines, which were no longer needed. In one instance a duplicate MAR chart was seen where the medicine had been printed twice. This may lead to potential errors as the medicine may be administered twice. Allergies were incomplete for one person. This may result in the administration of a medicine that someone is allergic to. This was to be addressed immediately by the manager. Medicines were found in the trolley that had not been recorded on the medicine chart. If a medicine is no longer prescribed it should be removed from the premises so that people are not given the drug in error. A medicine prescribed to treat the symptoms of angina was found in the cupboard. No record was seen on the MAR chart. This is of concern as nursing staff may be unaware of its presence to treat an angina attack. One medicine was found where the label had been removed. All medicines must be administered from the pharmacist labelled box to ensure they are administered to the person they are currently prescribed and dispensed to and at the correct dose. A bottle of lotion had the name of the person removed but still available to use. It could not be demonstrated who it was dispensed for. Many medicines had been prescribed, As directed. Staff had not confirmed with the doctor the dose actually required. The dose of one medicine had been changed following discharge from hospital but staff were still administering the medicine at the old dose. All people had been offered the influenza vaccine; consent forms were not always fully completed. Consent must be obtained before any vaccination takes place. No quality assurance system was used to assess individual staff practices in the safe handling of medicines. The manager was keen to implement this to improve practice to a safe level. Due to the non-compliance with the previous reports requirements regarding medication a warning letter was issued. Further breaches in the requirements may lead to enforcement action being taken by the commission. 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. Staff were observed to assist people discreetly in order to maintain their dignity. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose the activities that they participate in which promotes their individuality and independence. People are offered a choice of meals to meet their dietary, cultural needs or preferences. EVIDENCE: Since our last visit an activity coordinator was working full time at the home on a temporary basis, she had previously worked as a carer at the home and therefore knew the people who lived there. The home provides activities such as music, games, knitting, nail care and one to one time for people who cannot or do not wish to participate in group activities. External entertainers come into the home and there had been a Cinderella pantomime at Christmas. Someone comes into the home to do exercise to music should people choose to join in. One person who chooses to stay in their room told us the activity lady came in and we had a sing a long. I also have story tapes and we sat and listened to that together A monthly church service is held and people can receive Holy Communion if they choose to. This means that people can continue to follow in their chosen Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 16 religion. There was no one of any other religions living at the home at the time of our visit. The hairdresser visits each week and the home has its own hair salon. 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. We did not review the meals on this visit; the manager said that the only change to the menus was that the amount of fish had been reduced following requests from people who lived at the home. One person said, Im supposed to have a choice of food but I didnt know until today that I have a choice of breakfast. I had a lovely breakfast today for the first time, sausage, bacon and tomato. It went down as sweet as a nut. This was brought to the managers attention and it is recommended that people are informed that they can have a choice of all meals. The home is able to cater for diets for medical or cultural reasons and for personal preferences. One relative said, I have my lunch here with my husband, and I feed him liquidised meals. This assists people to maintain relationships that are important to them. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is available to people should they need to make a complaint. 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 four complaints regarding cleanliness, healthcare appointments and medication. Records were available about how the home had investigated the complaints, and outcomes were recorded. We had received two complaints, which had been referred back to the provider to investigate regarding staffing levels in the home. A number of concerns and complaints were recorded in the senior person file. The manager was able to tell us verbally what action had been taken in response to these concerns but there was no written evidence. Some of the concerns should have been recorded as formal complaints and the manager told us that they had discussed how to formalise this more so that outcomes were recorded and people knew what had been done to resolve the concerns. This will be reviewed at the next visit to the home. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 18 People told us: If I wasnt happy about anything I would get hold of the three managers Ive not really had to complain here At the time of our last visit there was a safeguarding case open in which the police were taking the lead, this case has now been closed. There have been two further safeguarding referrals made, one raised by the home and one by an outside professional agency. The outcome of these is not yet known. 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. Some staff have received training in Protection Of Vulnerable Adults and further training is planned so that all staff will have received this training so that they have the knowledge to safeguard people from harm. The recruitment procedure has improved so that people are protected from harm. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a clean and comfortable environment in which to live that meets their needs. EVIDENCE: There have been a number of improvements to the environment since our last visit and the home has further plans to enhance the living environment for the people who live there. 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. Work had started on the kitchenette areas and new work surfaces had been installed, one unit had new cupboards and there were plans to put new tiles around so that the area could be kept clean. Fridges and microwaves were clean with the exception of Rose unit, however Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 20 staff addressed this immediately. One relative said, Cleanliness has improved recently. Communal areas are well decorated and homely and there are a variety of chairs for people to sit in. It was pleasing that the activity equipment had been removed from Rose unit lounge and there are plans in place to turn this area into a sensory room, which will provide a relaxing place for people to sit. People told us: Im ok watching television, I can see it well as its big I enjoy being here in the lounge with other people, mixing is good 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 four 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. The bathrooms still required some remedial work and the manager told us that they were planning to refurbish all of the bathrooms hopefully within the next three months. Call bells had been untied so that people could use them if they needed to call for help. 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 manager told us that seven bedrooms had been decorated and a further three were identified for redecoration. One relative told us that he had asked for his relative to be moved to a quieter room. This request was granted and he had been involved in the layout of the room and this shows that people are listened to and are encouraged to be involved in decisions. The home has brought new commodes, pillows, dining tables, chairs, carpets, crockery, shower chairs, televisions and tea trolleys. While we were at the home new dining chairs and mattresses were delivered and the manager told us about other things that they had ordered such as curtains, coffee tables and chairs. All of these things will enhance the environment in which people live. On the dementia unit, work had begun to make themed corridors, for example one of the corridors had a musical theme and there were instruments that people could use. A number of dolls and rummage bags had been introduced which provide stimulation for people with dementia. Items with different textures were also on shelves in the corridors to provide things, which people could touch and feel. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by staff who receive some training to ensure they have the knowledge to meet peoples needs. The recruitment process should ensure that people are protected from harm. EVIDENCE: There are two trained nurses and five carers on duty throughout the day on the general nursing unit, with one trained nurse and three carers at night. One senior carer and two carers are on duty in the day with one senior and one carer on duty at night on the residential unit. On the dementia unit there is one trained nurse and two carers in the day and one trained nurse and one carer at night. Care staff numbers are a minimum and the manager said that often there were more staff on duty and this should ensure that peoples needs are met in a timely manner. In addition to the nursing and care staff the home also have laundry, domestic, kitchen, maintenance and administrative staff to meet all the needs of the people who live in the home. There are currently two nurse vacancies and a housekeeper vacancy to be appointed to. The amount of agency staff has been reduced so that people know who will be assisting them to meet their needs. Since our last visit to the home, two senior nurses have been appointed to the nursing unit and senior carer roles have been introduced on the ground floor. One relative said, Staff communication has improved recently. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 22 People told us: The staff come and help me when they can, I use my buzzer. They come quite quickly The staff made me feel so comfortable The staff were wonderful 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. 17 of staff have completed a National Vocational Qualification (NVQ) in care. It is recommended that at least 50 of staff have this qualification so that a knowledgeable and skilled workforce can meet people’s needs individually and collectively. The manager told us that staff were keen to start this training and that they were planning to get people onto a course in the near future. We looked at two 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 training matrix had not been updated but showed that some staff had received training in moving and handling, first aid, food hygiene, infection control, fire and protection of vulnerable adults. The manager showed us plans for a rolling programme of training so that all staff receive the training they require so that they have the knowledge and skills to meet peoples needs. It is recommended that the training matrix is updated so that the manager knows what training is required and when, as this will assist in planning. Trained nurses have received care plan training and care assistants were to have tissue viability training (sore skin) in February 2009. Ivy House Care Home DS0000068295.V373904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and organisation are keen to make and sustain improvements so that the home is run in the best interests of the people who live there. EVIDENCE: Following our last visit, a manager was brought in to help manage and make the improvements that were needed at the home. She has now taken up the full time position as the homes manager and should submit an application to become registered to us. The manager is a Registered Nurse who has experience in home management and care of older people. The manager has qualifications in training, quality and management, which will assist her to move the home forward in the best interests of the people who live there. One staff member said, The management are very supportive. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 24 It is clear that a number of improvements are in place. The home now needs time to sustain these and work on other areas that still need improving. The manager had prioritised the most important areas and was clear where the home would next focus on in order to improve the outcomes for people who live at the home. Records could be located when requested and were organised in a way that meant information could be easily retrieved. There had been no formal meetings with people who at the home and the manager told us that she had spoken with people individually to gain their views about the home. There were no records of these conversations and these should be recorded. There was evidence that staff had attended meetings but there were no minutes written up following these. These meetings are important so that people have the opportunity to raise concerns or ideas about the home and how it can be improved and have some input into decisions about home. Two project managers had supported the home manager to make the improvements to the home. The Regional Manager continues to visit once or twice a week and is available by phone at other times. A regulation 26 report, which tells us about the quality of the home, was seen for December 2008. The manager stated that these were completed monthly as required but the Regional Manager had these written up on her laptop, which had broken. These should be available at the home for us to see. A report on the results of the satisfaction surveys was in reception for people to look at and the manager is completing a number of audits to ensure that peoples needs are being met. One staff member said, They are trying their hardest. We did not review peoples personal money on this visit, as there was a robust system in place at the time of our last visit, which meant that peoples money was held safely. Fire records showed that the fire alarm is checked on a weekly basis to ensure that it is in full working order. We did not review any other maintenance records at this visit, as these were all satisfactory at the last inspection. Ivy House Care Home DS0000068295.V373904.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 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 3 X X 3 X 3 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 3 X X X 3 3 Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 14 (2) Requirement Timescale for action 20/03/09 2. OP9 13(2) Care plans must be updated to reflect current care needs so that staff have information about how to assist people to meet their needs. The medicine chart must record 23/02/09 the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice All prescribed medicines must be 23/02/09 available for administration and must be administered to the service user they are prescribed to only from a pharmacy labelled box. The practice of administering medicines dispensed to one service user to another must cease immediately. DS0000068295.V373904.R01.S.doc Version 5.2 3. OP9 12(1)(a) Ivy House Care Home Page 27 4. OP9 13(2) This is to ensure that the service user is administered their prescribed medication at all times. A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice. 23/02/09 5. OP9 13(2) This is to ensure that all medicines are administered as prescribed and this can be demonstrated. All medicines must be stored in a 23/02/09 locked cabinet at all times. This is to ensure medicines are not mishandled. All staff must be trained to adhere to the medication policies and procedures and also the indications and side effects of the medicines they handle This is to ensure that the staff understand the medicines they administer to be able to fully support the clinical needs of the service users and handle medicines safely. 6. OP9 13(2) 23/02/09 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. Refer to Standard OP1 Good Practice Recommendations Fee rates should be available to people so that they know DS0000068295.V373904.R01.S.doc Version 5.2 Page 28 Ivy House Care Home 2. OP3 3. 4. 5. 6. 7. OP7 OP15 OP16 OP19 OP28 8. 9. 10. OP30 OP31 OP32 how much they will have to pay if they want to live at the home. Pre admission assessments should contain enough details so that people know their needs can be met prior to moving in. (Unable to assess) Care plans should provide details about personal preferences so that people receive care in a way that they prefer. People should be informed that they can have a choice of all meals so that they can choose what they would like to eat. Low-level concerns should be recorded so that trends and outcomes can be monitored. Remedial works should be undertaken in the bathroom and toilets to ensure that people’s safety is maintained. (Previous recommendation) Staff should receive National Vocational Qualification training in care to ensure they have the knowledge and skills to care for people. (Previous recommendation) The training matrix should be updated to assist with planning and easy retrieval of information. The manager should submit an application for registration, as this will show a commitment to the home. Minutes of meetings held should be made available to people so that they are kept informed about the home and issues discussed. Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ivy House Care Home DS0000068295.V373904.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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