Inspection on 12/01/10 for Kingfisher House

This inspection was carried out on 12th January 2010.

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

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

Other inspections for this house

Kingfisher House 22/05/07

Kingfisher House 17/05/06

Kingfisher House 25/11/05

Kingfisher House 02/08/05

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 08/06/2011.

Key inspection report Care homes for older people Name: Address: Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU     The quality rating for this care home is:   zero star poor 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: Amanda Lyndon     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU 01217530333 01217714190 kathryn.rafter@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 38 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: 38 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 38 Date of last inspection Brief description of the care home Kingfisher House provides general nursing care for up to thirty eight older people. It is managed by Methodist Homes for the Aged, which is a nationwide charity. The aim of the home is to improve the quality of life for older people based on Christian values. However their services are open to all older people assessed as needing them regardless of their cultural background or faith. Care Homes for Older People Page 4 of 35 Over 65 38 0 Brief description of the care home The home is located in a residential area within the boundary of Heartlands Hospital. It is close to shops and public transport links. Ample off road parking is provided for vehicles at the front of the home. There is a secure garden that is suitable for all people to use. The home is a non-smoking environment. The home is purpose built and all bedrooms are located on the ground floor. They all offer single accommodation and all but two have en suite bathroom facilities consisting of a toilet, wash basin, and walk in shower facility. In addition, assisted baths and showers are available for all people to use. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists to meet the assessed needs of people living there. The home offers communal dining and lounge areas. A separate room is allocated as a hair dressing salon. There is also a separate multi faith/prayer room. Kitchen and laundry facilities are based on site. The home employs one activity coordinator who works on a part time basis. In the reception area there is information that may be of interest. This includes our last inspection report, the statement of purpose, and service user guide. Details of fees charged to live at the home are not included in the service user guide and this will prevent people from having this information. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing, and newspapers. Care Homes for Older People Page 5 of 35 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: zero star poor 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 focus of our inspections 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 areas that need further development. The inspection was carried out over one day by one inspector. The home did not know we were going to visit. There were thirty five people living at the home and no one was in hospital. Prior to the visit taking place we looked at all of the information we had received, or asked for. This included any notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We received an Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. Care Homes for Older People Page 6 of 35 It also gives us some numerical information about staff and people living at the home. We had to send a chaser letter to the home as they had not completed and returned the AQAA within the given time scale. This was completed by the manager and returned to us within the extended deadline. We sent out random surveys to eight people who live at the home, eight relatives and eight staff members, in order to obtain their views about the service provided. Prior to our visit one person who lives at the home, two relatives, and two staff members returned surveys to us. Their comments are included in this report. Following the visit we received completed surveys from a relative, a person living at the home and a staff member. Three people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to six staff members and one volunteer about the care and support they provided to these people. We sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean and comfortable for them. We gave all people living at the home the opportunity to be involved in the inspection. We spoke with six of these people. We also spoke with five relatives and friends and one health professional that was visiting the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Prior to coming to stay there people cannot be confident that the home will be suitable to meet their needs. Care Homes for Older People Page 8 of 35 People cannot be confident that they consistently receive the care, support, and supervision at the times that they require. People cannot always be confident that care and support will be provided in a respectful and dignified manner. Activities on offer do not always meet peoples needs and expectations. This means that some people are not supported to lead fulfilling and stimulating lives. People cannot always be confident that their concerns have been taken seriously and that actions have been taken in response to all complaints made. People living at the home cannot be confident that they are protected from harm. Staff must receive all the training they need to meet peoples individual and collective needs. People cannot be confident that their health and safety is maintained whilst living at the home. People should be able to benefit from the home being well managed. Any shortfalls within the service provided should be identified and rectified for the benefit of the people living there. People told us: Communication between the carers and the nurses sometimes is very hit and miss. They need to keep the family updated more. Myself and another lady specifically requested not to be cared for by a male carer but there was three men on duty last night so there was no option. We dont have much entertainment lately. It would be better if residents went on more outings and more activities needed in the home. They dont give me my call bell and my television is on all night and the staff dont switch it off. Sometimes the staff come quickly and sometimes they say I have to wait a bit. It takes the staff a long time to come. We have regular staff but others have left. You have to tell the night staff what to do. The staff are normally doing their job but no one in house checks. I shall not bother going to the next meeting. Things that we discussed at the last meeting and the one before that we are still waiting for things to happen. Care Homes for Older People Page 9 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 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. Systems are in place so that people can make informed decisions about whether to live at the home or not. Prior to admission people cannot always be confident that their care and support needs will be met at the home. Evidence: Information in a survey completed by a person living at the home said that they had received enough information before they moved in to decide if the home was the right place for them. A statement of purpose and service user guide had been produced and these were available on display in the home for people to read. We saw that these had been produced in a large print format. The manager stated that these could be produced in other formats and languages on request. However information about this was not included within the documents. This means that people will not be aware of this. Care Homes for Older People Page 12 of 35 Evidence: The documents included information about the majority of the services and facilities provided at the home. However details about the fees charged to live there, and details about arrangements for people that choose to smoke were not included within these documents. This will prevent people from having this information when deciding whether to live there or not. We saw that a service user guide called Welcome To Your New Home had been distributed to people living at the home. People told us that they had found the guide to be informative. We saw that assessments of peoples care needs are undertaken prior to coming to live at the home. However a number of assessments sampled had been poorly completed in parts. This will prevent staff from making an accurate assessment of whether a persons individual care needs could be met at the home. We spoke to people about the pre admission process. They told us that they had the opportunity to view the home prior to coming to live there. This is in order to sample what life would be like to live there. Intermediate care is not provided at the home. Care Homes for Older People Page 13 of 35 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. Systems in place ensure that the health and personal care needs of the majority of people living at the home are met. People cannot be confident that they will always be supported in a respectful manner. Evidence: The majority of people told us that they were happy with the level of personal and health care provided by the home. One person living at the home said They support me with my disability. Care records identified that staff support people to have regular baths and showers based on their preferences. People told us Everyone is kept lovely and clean. My mom is washed and showered every morning and The carers do keep my dad clean. We saw that people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture, and the time of year. Relatives told us I am more than happy with everything here. To see my mom smile and relax is wonderful and They give my mother the best possible care she needs to relieve her pain. We did, however receive a number of negative comments regarding the time taken for staff to attend to people on a number of occasions. (as discussed in the staffing section of this report). Care Homes for Older People Page 14 of 35 Evidence: We saw that assessments of peoples individual physical, emotional, and social care needs are undertaken on admission to the home, and are reviewed periodically throughout their time there. Care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves, and in what areas they require support. We found that the vast majority of care plans were personalised, included peoples preferences regarding their daily lives and identified what the person could and couldnt do for themselves. They also gave instructions for staff about the support to be provided. It was evident from our discussions with people living at the home and their visitors that some people were involved in writing and reviewing these. This is important so that people are encouraged to maintain their independence and means that their preferred routines can be maintained whilst living at the home. People told us that care reviews are undertaken so that they have the opportunity to discuss their care in order to ensure that their needs were being met. However one relative met during the visit said We have individual meetings for care reviews but the last time the named nurse and named carer didnt turn up. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks, and promote their independence. We saw that moving and handling assessments identified the specific support and equipment required for each person. In addition the majority of staff had undertaken recent training in this area. This should mean that people are supported to transfer in a safe manner. From information received in surveys, records sampled during the visit, and from discussions with people living at the home and their visitors, we identified that there was a longstanding issue about poor communication between the staff team. People said Communication between the carers and the nurses sometimes is very hit and miss, One nurse says one thing and another says something else. There is not enough information being passed on between nurses. and They only contact me if my father has fallen out of bed. They never contact me if the doctor is called to my father. They need to keep the family updated more. Staff told us that they use diaries to communicate information to the rest of the staff team. However it was evident that the system for this was ineffective at times. This may result in people not receiving the care and support that they require. We saw that people can retain their own doctor on admission to the home, if the Care Homes for Older People Page 15 of 35 Evidence: doctor is in agreement. In addition we saw that advice can be sought as needed from a range of other health and social care professionals. We saw that staff follow instructions made by professionals and this promotes peoples health. We spoke with the chiropodist who was visiting the home. He said There are no problems whatsoever here. Staff are consistent. The home employs a private physiotherapist two days a week for the benefit of the people living at the home. There is a good system in place for the management of medication and we saw that records in relation to this were well maintained. An exception to this was that staff had failed to record whether medication had been given to two people on two occasions. This means that there is not an accurate record of all medication administered. Throughout our visit we observed staff supporting people in a respectful manner, and this will ensure that their dignity is maintained. The manager told us that she complies the staffing rota based on the gender of staff so that people have a choice of staff attending to their care needs. We saw that this was the case however, people told us that in practice this did not always happen. One person said Myself and another lady specifically requested not to be cared for by a male carer but there was three men on duty last night, so there was no option. The manager told us that this was due to a female carer not being available for work at short notice. However ,the manager said that the female nurse on duty should have attended to the people who specifically requested a female worker. This had not happened. It was of concern that a comment received from a person living at the home who had completed a service satisfaction questionnaire indicated that they had not been supported in a respectful manner. We could not evidence that actions had been taken about this and this does not uphold peoples dignity. Care Homes for Older People Page 16 of 35 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. Opportunities for social stimulation do not meet the needs and expectations of all people living at the home. Evidence: We saw that there were activity boards throughout the home displaying photographs of recent celebrations, and a copy of the homes newsletter was on display. This was produced in large print so that it was accessible to more people. It included information of interest to people living at the home, for example the outcome of a recent care quality inspection, staff training updates, the success of recent events, and birthday greetings. The home employs one activity person for fourteen hours a week, covering a Monday and a Tuesday. Care staff told us that they are responsible for arranging activities at other times. One staff member We could do with extra activity support. In addition to a weekly music and movement class and reflexology, the activity plan identified that activities to be provided included ball games, arts and crafts and quizzes. However from speaking with people living at the home, sampling records, and our observations on the day, it was evident that further work was required to ensure that all people at the home had opportunities to be socially stimulated. People said We Care Homes for Older People Page 17 of 35 Evidence: dont have much entertainment lately, I wish there was more activities on a daily basis not only on special occasions such as Halloween and Christmas and It would be better if residents went on more outings, and more activities needed in the home. We only have a church service on a Tuesday. When we first came there was games bingo and handicrafts. People told us that suggestions for activities put forward by people living at the home during group meetings had not been arranged. The activity plan on display on the day of the visit identified that there was Christian Praise in the morning and Arts and Crafts in the afternoon. We saw that a number of people took part in the morning activity, however the afternoon activity did not go ahead at the arranged time as the person organising it was running late. Activities for people unable to participate in group events were limited despite the statement of purpose stating that support would be provided for all people in this area. It was of concern that the activity plan of one person stated that they were Too frail to do any activities so unable to participate in any recreations. This may result in the person not being offered opportunities to participate in activities. One person who completed a survey said My relative is bed bound and could do with more social stimulation in room. It was pleasing however, to observe that as reflected as their choice within their care plan, classical music was being played in the bedroom of a person who was unable to join in with group activities on the day of our visit. People told us that there are limited opportunities to participate in activities outside of the home. They said They need to take them out on more day trips in the summer. However, one person said that he went out regularly with a carer. People told us that the home is sensitive to their religious and cultural needs which means that support is provided in an understanding manner. Religious worship services are held at least weekly at the home. The statement of purpose states that the home aims to improve the quality of life of older people based on Christian concern and that people of all faiths are welcomed. There is a multi faith/prayer room at the home. In addition, staff can help make arrangements for people to worship at a local place of their own choice if preferred. This means that people have the opportunity to worship and practice their own faith, and pursue what is important to them. People told us There are services for their religious needs, and I dont agree with them forcing religious things to my relative. We did not see any evidence of this during our visit. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Care Homes for Older People Page 18 of 35 Evidence: People are encouraged to maintain contact with their family and other people important to them. People told that there is an open visiting policy and that they can meet with their visitors in private if they wish. One person met during the visit said I have two visitors who come and see me. We meet in my room. In addition, we saw that some people go outside of the home with their friends and family, at any time that they choose. One relative met with during the visit said We are made to feel welcome here. We can make drinks whenever we choose. I come for a meal on a Sunday and on special occasions. From discussions with people living at the home and from our observations, we saw that people have a choice of how they spend their time, where they are served their meals, and the time that they are served their breakfast. Menus identified a variety of nutritious meals and special diets are prepared for reasons of health, culture, and religion. A choice of meals is always available and in addition people have the option of choosing snacks at other times. The menu choices available on the day of the visit were on display in large print and reflected the meals prepared. We saw that staff speak to people about what is on the menu so that they can choose which they would like to eat. Information in a staff survey said Sometimes there is a complete lack of communication from nurses and manager to kitchen. However we saw that people living at the home are involved in menu planning and that suggestions put forward are added onto the menu. We saw that lunchtime was relaxed and both visitors and staff were assisting people with their meals in a respectful manner ,as required. One person living at the home said The food is very nice thank you. Care Homes for Older People Page 19 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be confident that outcomes will improve as a result of raising concerns. Systems in place do not protect people from harm. Evidence: An easy to read complaints procedure was on display in the home and was included in the service user guide. This should mean that people know how to make a complaint. One person living at the home met with during the visit said I would tell the manager if I wasnt happy about anything but I dont see her much. The manager however told us that this was not the case. Since our last visit, we have not received any complaints about the service provided at the home. Information on the AQAA told us that the home had received eight complaints in the last twelve months. We looked at the complaints register held at the home and found that it did not include a large number of the concerns raised by people living at the home and their families that we had identified during our inspection. We could not evidence that actions had always been taken to address the concerns raised. This means that people cannot be confident that their concerns are taken seriously. We did, however, identify that satisfactory investigations had been undertaken regarding the complaints recorded in the complaint register held at the home. We saw that some actions had been taken as a result of these for the benefit of the people living there. Care Homes for Older People Page 20 of 35 Evidence: Since our last visit we have been aware of three safeguarding referrals made involving people living at the home. One of these was regarding care afforded to a person whilst in hospital, and we await the outcome of this. The outcome of the other two referrals were not upheld. However despite a comprehensive safeguarding policy being in place, it was evident that the home had not followed local multi agency guidelines about how to manage the investigation into one of these. It was of concern that from records held at the home reviewed during our visit we found that the home had failed to raise safeguarding alerts regarding two incidents involving people living there. In addition, shortly after our visit social services alerted us to a further incident of a safeguarding nature. This was raised by the relative of a person living at the home that had occurred at the home shortly prior to our visit. The home had failed to report this to social services or to us during our visit. The outcome of this was that there was no deliberate harm on the part of the home, and social services were satisfied with the support plan put in place by the home for this person. However the homes failure to report this to the relevant agencies had resulted in a delay into the incident being investigated. The staff training matrix identified that the majority of staff required refresher training about safeguarding. On the day of our visit we saw that the manager was providing staff training regarding this. This is of concern as it was evident that her knowledge in this area was limited. We have already evidenced that this has resulted in the correct procedures not being followed in order to safeguard people living at the home. As discussed in the staffing section of this report, new worker recruitment checks are not always robust, and do not always safeguard people living at the home. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean and homely living environment however inaccessible call facilities place people at risk of harm. Evidence: We saw that a number of areas of the home were in need of redecoration and refurbishment, and the manager told us that plans were in place for this. People told us that a refurbishment had been promised for a long time however they had not had an update about this recently. We sampled the areas of the home relevant to the people case tracked. The home is divided into three self contained units however people are able to move freely around the home as they wish. All accommodation is located on the ground floor for ease of access for the people living there. Each unit has its own lounge and dining areas and we found that these had been decorated and furnished in homely styles. People told us that they had requested a larger television in one of the lounges. They said that this request had not been granted so a number of relatives had recently donated money and had bought a new television for people to enjoy. All bedrooms offer single occupancy and all but two of these has an en suite toilet and walk in shower facility. In addition communal assisted toilet, bathing and shower facilities are accessible to all people living at the home. We looked at the bedrooms of Care Homes for Older People Page 22 of 35 Evidence: people case tracked and saw that they have personalised their bedrooms to reflect their age, gender, interests and culture. People met during the visit stated that they were happy with their rooms. One person told us that he is looking forward to being involved in redecorating his room. People have the option of having a key for their bedroom door so that they can keep their personal items private and secure. We saw that a number of people choose to use this facility. There is equipment available to assist staff to deliver personal care to people living at the home in a safe manner. We saw that there is a rolling programme of replacing specialist equipment, including beds in order to improve the quality of peoples lives. It was of concern that people met during the visit told us that they had no means of summoning assistance from staff whilst in the communal lounge and dining areas. It was evident that this was an ongoing situation and no immediate actions had been taken to address this, placing people at risk of harm. We saw evidence that a person had experienced a choking episode whilst in this area of the home. Relatives and staff had to shout for assistance and on this occasion the emergency was resolved. The manager told us that plans were in place within the refurbishment of the home to install a pendant style nurse call facility. However no indication of a time scale of when this would be achieved was given. This means that people are not protected in the short term. In addition to this, one person spoken with during the visit said They dont give me my call bell and my television is on all night. The staff dont switch it off. We found that the home was clean and fresh throughout our visit, and effective and hygienic laundry systems were in place. We saw that an excellent award had been granted as a result of a recent environmental health inspection. This should mean that people can be confident that food is prepared in a hygienic manner. Care Homes for Older People Page 23 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that their care needs will be met by current staffing arrangements. Evidence: In addition to care staff, administration, cleaning, maintenance, laundry, and catering staff are employed so that people living at the home receive some support in these areas. In addition there is a team of dedicated volunteers who spend their time improving the quality of the lives of people living at the home. Positive comments were received about the staff team including In my opinion the home runs smoothly under a very friendly atmosphere. It is one big family unit and The nurses do a good job and they are always friendly. In addition we found that staff were welcoming and helpful during our visit. However from discussions with people living at the home, their visitors, and from sampling records, we identified that there had been a number of occasions when staff had not been available to provide supervision and support at the times that people required. This had resulted in peoples personal care needs, dignity, and safety not being maintained. It was of concern that despite this being raised as an issue on a number of occasions, the situation continued especially during the evening. One person had complained that their relative had to wait for an unacceptable length of Care Homes for Older People Page 24 of 35 Evidence: time for his personal care needs to be attended to. This does not uphold the persons well being or dignity. People said Sometimes there does not seem enough staff to cope with the demands of the residents and many are very frail. I think that the staff do a good job but could do with extra staff, Sometimes the staff come quickly and sometimes they say I have to wait a bit and It takes the staff a long time to come. One staff member said Staffing levels are okay but can be stretched if people need more attention and family need more attention. They do ask people to work extra time or put a relief worker on. One person met with during the visit said We have regular staff but others have left. You have to tell the night staff what to do. We also identified a concern of a similar nature recorded within the minutes of a recent resident/relative meeting. We discussed this with the manager who explained that the number of staff on duty reduced at 8pm during the handover period from day to night staff. It was evident that due to the frailty and complex care needs of a large number of people living at the home, this continued to be a busy time as large number of people required staff attention and support at this time. Current arrangements place people at risk of harm. We sampled the recruitment files of two staff members who had recently come to work at the home. These included the majority of information required. However we saw that two suitable references had not always been obtained. This is despite the persons application being approved by the management team. This means that people cannot always be confident that people employed by the home are suitable to work with them. We saw that staff do not start working for the agency until satisfactory vulnerable adults checks have been obtained in order to protect people living there. We saw that new workers complete induction training including an introduction into health and safety matters, and practical work. This is in order to gain the skills and knowledge in preparation for providing care and support to people living at the home. Staff met during the visit told us that they were generally satisfied with the training provided for them. However, the training matrix identified that a high number of staff required refresher training in mandatory areas, for example health and safety, food hygiene and infection control. We could not evidence that training in these areas had been planned. This means that people cannot be confident that they will receive care and support in a safe and competent manner. Information on the AQAA identified that the majority of staff employed at the home are trained to a National Vocational Qualification Level 2 in care (NVQ 2) and most are Care Homes for Older People Page 25 of 35 Evidence: working towards NVQ 3. This should mean that they have some of the skills and knowledge required to provide care and support in a competent manner. Staff told us that they were looking forward to the dementia care training that was planned for later in the week. They also said that they had enjoyed the recent training about epilepsy. Records identified that staff meetings are held regularly. This should mean that staff have the opportunity to be involved in the running of the home and be made aware of training opportunities. This should result in improved outcomes for people living at the home. Care Homes for Older People Page 26 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the home is run in the best interests of the people living there, or ensure their safety and well being. Evidence: Prior to and during our visit negative comments were made by a number of people living at the home and their visitors about the managerial arrangements in place at the home. People said The staff are normally doing their job but no one in house checks and We need to see more of the manager she never seems to be there. Evidence at this inspection indicates that managerial arrangements at the home need to improve. It was also evident that the management team had failed to identify a number of shortfalls regarding the service being provided to people living there. The home manager has been in post for the past two years and is registered with us. She is a registered general nurse and has completed a nationally recognised management qualification. From our discussions with her she appeared to have good Care Homes for Older People Page 27 of 35 Evidence: knowledge of the care and support needs of the people living at the home. Positive comments were made by the staff team about the support provided to them by the manager. One staff member said The manager supports us in all directions that she can. Shortly after our visit we were informed that the home manager had resigned from her post and was completing her notice period at the time of our inspection. We had not been aware of this during our visit however alternative managerial arrangements are now in place until the new manager commences employment at the home in March 2010. Prior to the inspection, we had to send a reminder letter to the home as they had not completed and returned the Annual Quality Assurance Assessment (AQAA) within the given time scale. This was completed and returned to us within the extended deadlines. It included details about the home, staff, and people who live there, and what the service hoped to achieve for the benefit of the people living there. We did evidence, however, that some of the information included within the AQAA did not reflect our findings during our visit. This means that it doesnt give us a reliable picture of the service provided at the home. Senior external managers undertake regular quality monitoring visits at the home, and there was evidence that some people living there are involved in these visits. Some people met with during the visit told us that they had not had the opportunity to meet anyone from head office. It was of concern that shortfalls regarding the service provided identified during our visit had not been identified during these visits. This means that actions had not been taken to improve the quality of the service for people living there There are some systems in place to capture the view of people living at the home and those people important to them. Group meetings are arranged and we sampled the minutes of a recent meeting. However these were not on display and this will prevent people who did not attend the meeting from having this information. One relative met with during the visit said They send letters out so we know when relatives meetings are going to be held but I shall not bother going to the next one. Things that we discussed at the last meeting and the one before that we are still waiting for things to happen. For example, the refurbishment hasnt started, the film nights, fish and chip suppers and pantomime trip havent happened. We saw that service satisfaction questionnaires had recently been sent out to people living at the home in order to seek their views about the service provided there. Information about the results of these had been sent to the home so that they were aware of peoples views. The vast majority of feedback was negative including Care Homes for Older People Page 28 of 35 Evidence: comments of a safeguarding nature. Comments included a number of concerns that peoples dignity had not being maintained and staff not always being available at the times that people required them. It was of concern that we could not evidence that actions had been taken to address the issues raised in order to protect people living at the home. There is a robust system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Receipts were available and this means that it was possible to establish what peoples money had been spent on. From records sampled we identified that regular checks are taken on equipment to ensure that it is safe to use. We saw that a fire drill had been undertaken recently so that people were aware of the actions to be taken in the event of a fire. We saw that accident forms are completed and that the manager regularly audits these. It was of concern however that safeguarding alerts had not been raised by the home following two accidents of concern involving people living at the home. We have identified throughout this report areas of concern relating to the management of services provided at the home. Systems should ensure that the appropriate actions are taken in response to accidents, incidents and other events affecting the health and welfare of people living there. It was evident that there had been failings regarding these systems and this had compromised the health and welfare of people living at the home. Ways in which to manage these concerns must be implemented in order to improve the outcomes for, and maintain the safety of the people living at the home. Care Homes for Older People Page 29 of 35 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 30 of 35 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 3 14 Comprehensive assessments 28/02/2010 of peoples care and support needs must be completed prior to coming to stay at the home. This is in order to determine the suitability of the home to meet peoples individual needs. 2 8 12 Systems must be in place in order to improve communication between the staff team. This is in order that people recieve the care and support that they require. 28/02/2010 3 9 13 Medication administration 28/02/2010 charts must be completed at all times. This is in order that all people receive their medication as prescribed. Care Homes for Older People Page 31 of 35 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 4 10 12 Arrangements must be in place so that people receive care and support in a respectful and dignified manner at all times. 28/02/2010 5 12 16 Arrangements must be in 30/04/2010 place so that people have the opportunity to engage in meaningful and stimulating activities. This is in order to enhance the quality of life for people living in the home. 6 16 22 A system must be in place 28/02/2010 for recording and acting upon all complaints recieved about the service provided at the home. This is to ensure that people can be confident that actions are taken in response to their complaints. 7 18 13 Systems must be in place so 28/02/2010 that people are always protected from harm. 8 19 13 Arrangements must be in place so that staff can be summoned when needed. This is in order to protect people from harm. 28/02/2010 Care Homes for Older People Page 32 of 35 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 9 27 18 Arrangements must be made so that staff are available at the times that people require care and support. This is in order to protect people from harm. 28/02/2010 10 29 19 Robust recruitment practices 28/02/2010 must be in place. So that staff are fit to work with vulnerable people. 11 30 18 Arrangements must be made so that the staff providing care and support to people living at the home have the necessary skills and knowledge to do so in a safe and competent manner. 30/04/2010 12 33 24 Systems must be in place so that shortfalls regarding the service provided to people living at the home are identified. 31/03/2010 13 38 13 Systems must be in place so 28/02/2010 that staff adhere to the correct procedures following accidents involving people living at the home. This is in order to protect people living there. Care Homes for Older People Page 33 of 35 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 statement of purpose and service user guide should identify all facilities provided at the home and the fees charged to live there, so that people have this information when choosing a care home. Arrangements should be in place so that people know that the service user guide and statement of purpose can be produced in different formats and languages so that more people can access the information. Systems should be in place so that all people involved in a persons care are involved in the reviewing of their needs. This is in order to determine if current care regimes are effective. To maintain peoples dignity, arrangements should be in place so that people are supported by the gender of care staff of their choice. Minutes of group meetings should be accessible to all people including those unable to attend. This is so that people are aware of matters discussed and any actions to be taken as a result of this. A report based on the findings of service satisfaction questionnaires and actions taken as a result of these should be produced, in order for people to be confident that their suggestions have been acted upon. 2 1 3 8 4 10 5 32 6 32 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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