Inspection on 18/11/09 for Ivybank

This inspection was carried out on 18th November 2009.

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

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

Other inspections for this house

Ivybank 28/11/08

Ivybank 24/01/08

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 16/02/2010.

Key inspection report Care homes for older people Name: Address: Ivybank 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Bennett     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Ivybank 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG 01216243006 01216243581 ivybank@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd care home 58 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 58 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 category: Old Age, not falling within any other category, Code OP - maximum number of places 58 Date of last inspection Brief description of the care home Ivybank Nursing Home is a large traditional property, which has been further extended to provide accommodation for 58 older people who require nursing care. However, several bedrooms are not accessible to people who have mobility difficulties so until this can be achieved only 35 people can be accommodated there. The home is located in a residential area of South Birmingham and is close to local amenities. The home is conveniently situated for public transport and off road car parking is available for several cars. Care Homes for Older People Page 4 of 32 Over 65 58 0 2 8 1 1 2 0 0 8 Brief description of the care home The home has been established for a number of years however was acquired by Southern Cross Healthcare in November 2007. Accommodation is provided in both single and double rooms. En-suite toilets are provided in 24 rooms, and two en-suite shared rooms are available. The bedrooms are on two floors and a passenger lift is available to all floors. Sufficient communal space is provided with lounges and dining rooms and there is a large garden to the rear of the home, which is accessible to people via a ramp. The home has a number of hoists and pressure relieving equipment available to meet the assessed needs of the people living at the home. There are assisted toilets and bathrooms available and corridors are wide and spacious to enable people to move around the home freely with any aids they require. Inside the home, there are various notice boards, which display information about forthcoming events and other articles that may be of interest. The last inspection report is available in the reception area and this enables people living at the home or visitors to the home to access this information easily. The current scale of charges for the home were included in the service user guide and updated information on these can be obtained directly from the home. Additional costs include, hairdressing, toiletries, chiropody and newspapers. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake 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 provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered including notifications received from the home. The home is required to tell us about incidents Care Homes for Older People Page 6 of 32 and accidents that happen there. The Annual Quality Assurance Assessment (AQAA) was completed by the acting manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by four people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, relatives visiting, the project manager, the operations manager and staff on duty were spoken with. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Assessments before people move in should be more detailed so the home is sure that they can meet the persons needs. Care plans should clearly state how staff are to support people to meet all their needs. More activities should be provided so that people can lead an interesting and stimulating lifestyle. Food records should show that people are getting the nutrition they need so ensuring their well being. All complaints should be logged to ensure that action is taken and peoples views are listened to. A smoking area inside the home should be considered so that people who choose to smoke can do so inside their home. Staffing levels should be regularly reviewed to ensure that peoples needs are met in a timely manner. Adequate numbers of staff must have training in how to give first aid so they can respond where needed in an emergency. A registered manager must be in place to ensure that the home is well run in the interests of the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to help them make a choice as to whether or not they want to live there. Before people move in their needs are assessed but it is not always clear that they can be met there. Evidence: The statement of purpose was not dated so it was not clear when it was last updated. It included the relevant information to help people make a choice as to whether or not they want to live there. It is available in large print if requested and the project manager said they are looking at producing it in DVD format to help make it easier to understand. The service users guide included the relevant information that people would need about the home. It stated the fees charged to live there. These ranged from £377.24 to £700 pounds plus, depending on the individuals needs and the type of accommodation provided. It stated that the fees include accommodation, full board, in Care Homes for Older People Page 11 of 32 Evidence: house laundry of personal items and provision of care. The service users guide was not dated so it was not clear when it was last updated. Records sampled included a pre admission assessment completed by the home. These included little detail and it was not clear how or whether a decision had been made that the persons needs could be met at the home. Records sampled showed that the person or their relative had visited the home before they moved in to help them make a choice as to whether or not they wanted to live there. The AQAA stated all prospective residents are offered a four week trial at the home then a review meeting is held to ensure that the persons needs can be met there. Records sampled showed that these meetings were held and involved the person and their relatives or friends. The home does not provide an intermediate care service. Therefore, standard 6 that relates to this was not assessed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not always met, which could affect their health and well being. Evidence: We looked at the records for four of the people living there. These included individual care plans that stated how staff are to support the person. One persons care plan stated that staff are to monitor the persons blood pressure and notify the persons GP if it is too high. However, it did not state what was too high for that person so staff may not be clear when to notify the GP for medical advice, which could impact on the persons health. One person had a care plan for depression, as this was something they suffered from. It stated what medication they needed to help with alleviating the symptoms. It did not state what staff are to look for so they can monitor for signs of the person being depressed to ensure they get the support they need. This was important as other records for this person indicated they may be depressed, such as reduced appetite and refusing to talk and so could impact on the persons well being. Care Homes for Older People Page 13 of 32 Evidence: Where a person had been prescribed antibiotics, a short term care plan had been put in place so that staff were aware of what they needed to do to help the person recover from an infection. Records sampled included information about the persons life, where they had lived and worked, their family and what things they enjoy doing. This gives staff a picture of the person before they came to live in a care home so that people can be treated as individuals. Records included individual risk assessments. These stated how staff are to support people to be as independent as possible while ensuring the risks to their health and safety are minimised. Some people need to be moved regularly to reduce the risk of them developing a pressure sore. Records for one person showed that on the day of our visit they were moved four times into different positions in bed but we observed the person sitting in the lounge during this time. Records sampled for the other people indicated that they had been moved regularly. Since we last visited staffing levels had been increased however, staff were observed to be very busy. We observed that one person had to wait twelve minutes from the first time they asked to be supported to use the toilet. Staff did not ignore their request but had other people to support and did not seem to have the time to respond to people when needed. When the person apologised for taking their time staff reassured them that they were not a nuisance and were sorry for the time it had taken. A visitor said that staff sometimes answer when people press the call bell but sometimes people have to wait. They said that staff do not ignore them but they are busy. Staffing levels should be kept under review to ensure they meet the needs of the people living there. Records sampled showed that when people were unwell staff contacted the GP immediately and where needed medication was prescribed to help the person. Staff support people to attend health appointments and other professionals are involved in individuals health care. Records showed that staff had followed the advice of health professionals to ensure that peoples health needs are met. Some people living there have dementia which may cause them to behave in a way that can be aggressive to others. One persons records included a management plan so that staff know how to support them when they can become aggressive either Care Homes for Older People Page 14 of 32 Evidence: physically or verbally. Their records indicated that staff did not always follow this, as it stated to leave the person, tell them you will be coming back and then return to them after five minutes. There was no evidence in the records to show that staff did go back to them. This could affect the persons safety and well being. Evaluation of the persons care plan stated that no violent behaviour had been noted. However, their records indicated an incident where the person had behaved in an aggressive way. Care plans should be fully evaluated so that it is clear whether or not the person is being supported appropriately to meet their needs. Medication administration records (MARS) sampled included a photograph of the individual so that unfamiliar nurses would know who to give the medication to. One nurse works on each floor and gives the medication to the people living on that floor. We found that people had been given their medication as prescribed. However, one persons MAR on the top floor was confusing as the date at the top had been changed. It looked like the balance of the amount of tablets kept in stock had been recorded on the MAR but it was actually the date given. This made the MAR confusing, which could result in errors being made. When we last visited we were concerned that there was not a long enough gap between doses of medication given, which could affect peoples health. We found that this had improved and that nurses were given enough time to concentrate on the medication round so that there were sufficient gaps. Copies of all prescriptions are kept so that nurses can check that the medication delivered for each person matches what the GP has prescribed. One person had their blood checked regularly so that the doctor could adjust the dose of one of the tablets they were prescribed if needed. This was recorded appropriately and the dose changed if prescribed. When we last visited we found that the medication fridge temperatures were not at the right temperature and the room where medication was kept on the ground floor was too hot. This could affect how effective the medication is. We found that an air conditioning unit has been provided and staff check the room temperature. These and the fridge temperatures were within the recommended level to ensure that medication is stored appropriately. The people living there and visitors said the staff are good and look after people well. Staff were generally observed to interact well with the people living there and talk to them in a way that respected their dignity. Care Homes for Older People Page 15 of 32 Evidence: People were observed to have individual styles of dress and looked well cared for. Care plans stated how staff are to support the individual with their personal care. They did not all state what peoples personal preferences are, for example whether or not the person prefers a bath or shower or whether they have their own teeth or wear dentures. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do not always experience a meaningful lifestyle, which could impact on their well being. People are generally offered a choice of meals to meet their dietary and cultural needs or preferences. Evidence: The AQAA stated that a new activity coordinator was in post and was meeting with people to discuss what activities they want to do. Unfortunately when we visited we found that this person was off sick so activities were not being planned or did not happen as often as people wanted. Some people said they were bored and there was not anything to do. One person said, You could die with boredom here. They said that an entertainer had recently visited, which they had enjoyed. Staff were observed sitting talking to people, giving them a manicure and giving people magazines to look at. Staff turned off the TV in the ground floor lounge as none of the people living there were watching it. They put some music on which people seemed to be enjoying. Interaction between staff and the people living there was good but the time that staff had to spend with individuals was limited as they had care tasks to do. A fish tank had been provided in the ground floor lounge and staff were talking to people about this. One person said, A couple of weeks ago carers took us to feed ducks, it was lovely, Care Homes for Older People Page 17 of 32 Evidence: would like to do more often. Another person said, The activities lady is away but no one has taken her place, when she was here she came up every day, read the paper to us or played cards. Care plans sampled included how staff are to meet the persons social needs and what activities they enjoy. Activity records sampled showed that people did some activities but they were not that often. For example, one persons records showed that in October they watched TV twice and did a reminiscence activity three times. This person told us that there is little to do in the home. Records of activities did not state whether or not the person had enjoyed it. This would be useful so that activities which the person enjoys can be planned for them to ensure their well being. The AQAA stated that a minibus had been provided to benefit the people living there. One member of staff can drive this and they told us they sometimes take people to visit their families or to the park. People said they had been out in the minibus to visit their family. Records sampled showed that people are supported to keep in contact with their family and friends. Visitors said they can visit when they want to and were observed to be made welcome by staff. People told us that they can bring their personal possessions into the home, if practical to do so and this made their room more homely. People said they can make choices about what they do and what they eat and drink. We observed lunch being served in each of the two dining rooms. On the ground floor there were small tables that were well presented with cloths, table mats, serviettes and small flower vases. People wore aprons to protect their clothes if needed. Menus were provided on each table. People had a choice of a cooked meal if they wanted it. This was well presented and condiments were provided on the table. Where people needed assistance staff sat to support them and did this appropriately so respecting their dignity. A relative of one person who was in hospital came to update staff as to how the person was. While there they had their lunch and staff ensured they had what they wanted before they went to the hospital. People were given a choice of hot or cold drinks. One person said they preferred to have sandwiches and were given these. People had a choice of what they wanted for pudding. On the top floor the menus on the tables were for the previous day and people did not know what was for lunch. One person said they had a cooked breakfast which they enjoy and can always have this if they want to. They said that they do not get a choice at lunchtime. One person said the food is very nice but they get too much, which puts them off eating sometimes. Staff seemed rushed as they had six people Care Homes for Older People Page 18 of 32 Evidence: who needed support to eat and there were only two staff. However, another staff member came up to assist but staff said this is not usual. The food looked appetising and people said it was nice. Pudding was served to people in the dining room before they had finished their main course. Food records sampled did not state what people had eaten, they stated main or pudding. The operations manager said this cross references to the menu and the choices list. This makes it more difficult to assess whether or not an individual who may be at risk of malnutrition is receiving a nutritious diet. It is recommended that where people are at risk clearer records of what people have eaten are kept to ensure that the person is getting the nutrition they need. Records stated how much the person had eaten. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: The AQAA stated that the complaints procedures have been updated and were available in the home. The complaints procedures showed people how to complain if they were unhappy and how this would be responded to. The complaints log said that three complaints had been made in the last 12 months. Two of these complaints had been made to us and had been passed to the operations manager to investigate. Records showed that these had been investigated appropriately and action taken to resolve the issues raised. When looking at peoples records we found that a complaint had been made by a relative. Action had been taken to resolve this but this was not recorded in the complaints log. All complaints should be recorded in the log so it is clear what action is taken. It also makes it easier to track how many complaints are made and if there are any similar complaints made, which could indicate that action taken is not effective. We received a complaint the week before we visited about deteriorating standards within the home particularly relating to hygiene. We investigated this during our visit and found no breaches in regulations. Care Homes for Older People Page 20 of 32 Evidence: Staff training records showed that the majority of staff had received training in abuse and the protection of vulnerable adults. The AQAA stated that this training is updated every year for all staff so they can ensure that staff know how to safeguard the people living there from harm. The policy on protecting vulnerable adults from abuse is comprehensive and there are details of who to contact if abuse is suspected. Staff records sampled included evidence that a Criminal Records Bureau (CRB) check had been completed. Evidence that the staff have not been excluded from working with vulnerable adults has been checked to ensure people are safeguarded. The project manager said that none of the people living there have a Deprivation of Liberty Safeguard authorisation. This legislation is part of the Mental Capacity Act and ensures that people living in a care home are not deprived of their liberty unless it is in their best interests to do so. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable, clean and safe environment that generally meets their individual needs. Evidence: The home was well decorated and maintained. Maintenance staff are employed and regular checks are completed of all equipment in the home to ensure it is safe to use. At the last inspection there was a smoking area inside the home which did not impinge on the well being of people who did not smoke. However, we observed that one person who smoked had to go outside to do so. The person and staff said that smoking is no longer allowed in the home so that people who choose to smoke have to do so outside. The person was supported to keep as warm as possible. A smoking area inside the home should be considered so that people living there who choose to smoke can do so in their home. Some of the bedrooms are inaccessible to people who have mobility difficulties. Therefore, there are less people living in the home than it is registered for. The project manager said that quotes have been submitted to provide ramped access to some of these bedrooms so they can be used. Bedrooms seen were personalised to individual tastes and interests. The AQAA stated Care Homes for Older People Page 22 of 32 Evidence: and people said that they are encouraged to bring their personal possessions with them to make their bedrooms more homely. The AQAA stated that there is a rolling programme of redecoration of the bedrooms to ensure these are well maintained. Bedroom doors had locks on them that could be locked from inside. The project manager said that none of the people living there would be able to put the latch down on the doors to lock themselves in their bedrooms. There is a master key system so that staff would be able to unlock doors if needed. It was not clear if this had been risk assessed for each individual to ensure that people are not at risk of staff not being able to help them in an emergency. The home was clean and there were no offensive odours present throughout the day making it pleasant for people to live in. The AQAA and training records showed that the majority of staff had received training in infection control so they know how to reduce the risk of cross infection. The AQAA stated that a new spin dryer had been provided in the laundry and the flooring had been replaced so to help reduce risks of cross infection. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development are variable, which could impact on the well being of the people living there. Evidence: There were two nurses and seven care staff on in the morning and from 2pm this reduced to six care staff and two nurses. This has increased since we last visited. Cleaning, cooking, laundry, administrative and maintenance staff are also employed. As stated earlier in this report we observed that staff were very busy and did not always have time to spend with people or were not able to respond to meet peoples needs when required. Staffing levels should be kept under review to ensure that they are sufficient to meet peoples needs. The AQAA stated that 50 per cent of care staff have National Vocational Qualification (NVQ) level 2 or 3 in Care and other care staff are now registered to do this. This meets the standard to ensure that staff have the skills and knowledge to meet the needs of the people living there. We looked at the records of three of the staff that work there. These showed that a satisfactory Criminal Records Bureau (CRB) had been returned. There was evidence that it had been checked that the staff are not excluded from working with vulnerable adults so helping to ensure that the people living there are safeguarded from harm. Care Homes for Older People Page 24 of 32 Evidence: References were available on file but these were not all from the persons previous employer. One record showed on the application form that the person had gaps in their employment. This had obviously been noted as the form was highlighted but it was not clear what had been done to explore why there were gaps to ensure that all staff are suitable to work with the people living there. Staff said that they have an induction when they first start working at the home that covers what they need to know to meet peoples needs and keep them safe from harm. They have an opportunity to shadow other staff during their induction and are an extra person on shift so not counted in as part of the rota. The training matrix showed that the majority of staff had received training in fire safety, infection control, food hygiene, abuse, health and safety and moving and handling. Half of the staff had received training in pressure area care, care planning, challenging behaviour, nutrition and dementia awareness. No staff had received further training in dementia. Given the needs of some of the people living there more staff need training in dementia awareness. Only ten staff out of forty three had received first aid training and this must be improved. We noted in staff records sampled that some staff did training in four different areas in one day. The project manager said that some training is done by watching videos but some is done by input from a trainer. A senior care staff is responsible for overseeing staff training and ensuring that staff do the training that is needed. They also observe staff when on duty and identify any training needs they have. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements do not help to ensure that the home is run in the best interests of the people who live there. Evidence: The manager was off sick at the time of the visit. The manager is not registered with us and had recently withdrawn their registration application. There has not been a registered manager in post since the organisation took over the home in November 2007. An acting manager was in post but unfortunately was also off sick that week. The project manager was present for the inspection and was overseeing the home. They have previously managed the home and have worked for the organisation for a number of years so are aware of the policies and procedures. Staff said that a stable manager is needed however, they felt that recently positive changes had been made. There is not a deputy manager in post but the project manager said that this post is being recruited to. A representative of the organisation visits monthly as required to ensure that the Care Homes for Older People Page 26 of 32 Evidence: home is meeting the standards and regulations set. A report of their visit is made so that it is clear what needs to be done to improve the running of the home. Surveys had recently been sent by the home to the people living there, their relatives and friends and professionals that visit the home. Generally comments received were that the home provided a good or excellent service. Comments made in these surveys are used to make improvements to the home and help to ensure that the views of the people living there are listened to. The money belonging to the people living there was not looked at during this visit. The operations manager said there had recently been a financial audit and all systems were assessed as being good. The managers are not responsible for managing the financial affairs of the people living there but small sums of money are kept safely in the home for people who want this. Systems are in place to ensure that peoples money is safeguarded and used appropriately. A fire risk assessment was in place and we saw that actions needed to improve fire safety had been completed. Fire records showed that the fire equipment is tested regularly to make sure it is working and serviced regularly by an engineer. Regular fire drills are held and comments about these made to show where improvements are needed. This helps to ensure that all staff and the people living there would know what to do if there was a fire. Records sampled showed that all equipment in the home is regularly tested to ensure it is safe to use. Regular health and safety meetings are held to ensure that the home is safe for people to live and work in. Minutes of these showed that where action was needed to improve safety this was done. Several of the people living there need assistance to move. Equipment is provided to help staff to do this safely and staff have training in how to do this. Staff were observed to support people safely, telling them what they are doing so to reduce their anxieties. One hoist kept stopping and staff reassured people who were being hoisted when it stopped. Staff took action to report this fault to ensure it was rectified and people could be moved safely. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 13 Adequate numbers of staff must have training in first aid. To ensure they know how to support the people living there in an emergency. 31/03/2010 2 31 8 A registered manager must be in place. To ensure the home is well run and benefits the people living there. 30/04/2010 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 service users guide and statement of purpose should be dated. This will make it clear when it was last updated so that people know how current the information is. Pre admission assessments should be more detailed to ensure that the persons needs can be met at the home. Care plans should be fully evaluated so that it is clear whether or not the person is being supported appropriately Page 29 of 32 2 3 3 7 Care Homes for Older People 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 to meet their needs. 4 7 Care plans should clearly state how staff are to support the individual so their needs are met and to ensure their well being. Staffing levels should be kept under review to ensure they meet the needs of the people living there. Medication Administration Records (MARS) should be clear to ensure that errors in giving medication are reduced to ensure peoples well being. Care plans should state how staff are to support the individual with their personal care and individuals preferences to ensure people are supported in the way they want. Activity records should include comments about whether or not the person enjoyed it so that people can do things they enjoy so ensuring their well being. More activities should be provided so that people can experience a meaningful lifestyle and do the things they enjoy. Where people are at risk of malnutrition clearer records of what people have eaten should be kept to ensure that the person is getting the nutrition they need. There should be sufficient staff to support all the people living there at mealtimes so they can get the support they need. All complaints should be recorded in the complaints log so it is clear what action is taken. It also makes it easier to track how many complaints are made and if there are any similar complaints made, which could indicate that action taken is not effective. The locks on bedroom doors should be risk assessed to ensure that staff can support people if needed in an emergency. A smoking area inside the home should be considered so that people living there who choose to smoke can do so in their home. Records should be kept of how any gaps noted in Page 30 of 32 5 8 6 9 7 10 8 12 9 12 10 15 11 15 12 16 13 19 14 19 15 29 Care Homes for Older People 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 employment are explored to ensure that the people living there are safeguarded from harm. 16 30 Staff should have sufficient training to ensure they know how to support the people living there so ensuring their well being. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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