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Inspection on 04/03/10 for Lickey Hills Nursing Home (2 Units)

Also see our care home review for Lickey Hills Nursing Home (2 Units) for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We looked at the care of two people who use the service. We saw they had care plans that had been reviewed and re-written since the last inspection. The care plans were very informative and they were much more person centred. We spoke to staff about the care these people needed and we found these staff had a satisfactory understanding of their individual care needs. We spoke to the people whose care we tracked and we saw they were receiving the care they needed. For example, one person was spending most of their time in bed due to sore skin. We saw pressure ulcer care plans and wound assessments were in place and the nurses were changing the dressing at the frequency stated in the care plan. We saw the wound was re-assessed each time it was redressed. We saw from these documents and the photographs taken of the pressure ulcers that they had improved considerably. We saw that it stated in the care plan the person`s position needed to be changed every three hours to reduce the risk of the person`s skin becoming sore. We looked at the charts completed by care staff each time the person`s position was changed. These charts showed the staff have been moving this person at the designated frequency to prevent their skin deteriorating. We saw assessments for each person identifying if they may be at risk of malnourishment. We saw people`s weight was being checked and recorded on a regular basis to ensure they were not losing weight. We saw people at risk of losing weight were receiving specialist high protein diets and they were being given high protein food supplements as prescribed by their Doctor. We spoke to the chef and she told us the nurses tell them which people need specialist diets, such as high protein, a reducing dietor a diet for people who have diabetes. The chef produces specialist food for these people to ensure their dietary needs are met by the home. We saw that people who are at risk of losing weight are offered snacks in between meals. On the morning of the inspection people were being offered pieces of fruit and `bite size` egg sandwiches with their midmorning drink to encourage them to eat little and often to maintain their weight. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean cloths and their hair and nails were well looked after. We saw much more interaction with people by staff on the dementia unit than we had at previous inspections. We saw people watching the television in the corner of the lounge. We saw a group of people playing sensory games with the activity person in another part of the lounge. The people were smiling and interacting with the staff. We saw staff asking people where they would like to sit in the lounge and if they would like to join in with the activities. We saw staff sitting next to people whilst they were completing paperwork, but at the same time they were engaging in meaningful conversation with people using the service. We spoke to a dementia care specialist employed by the organisation who own the home. She told us she is now visiting the home once a week to offer guidance and support to the staff to enable them to develop the care and make the environment more suitable to people with dementia on Rednal Unit. The pharmacist inspector visited the home on 4th March 2010 to check the management of medicines within the service and found that there was an overall improvement in the management and control of medication, particularly on Rednal Unit. We saw that all medication was stored securely including the provision of a new air conditioning unit in the treatment room for Rednal unit. We saw that peoples medication were stored neatly which means that medication is safe and therefore the people who live in the service are protected from harm. We looked at the medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts and we saw clear directions recorded for the application of any external preparations such as creams or ointments. This ensured that staff knew when to give medicines. When MAR charts were changed or a new medicine started then two members of staff checked the records for accuracy and detailed the reason for the change directly onto the MAR chart. This helped to ensure that accurate medicine records were available for people living in the home. This means that there are arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. The date of opening of boxes and bottles of medicines were usually recorded and balances of medication were carried forward from old records to new records. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner.Overall we saw better documentation, records and checks made on peoples medicines and therefore the requirements for medication from the previous inspection had been met. The staffing levels provided have been reviewed and the staffing numbers have been increased since the last inspection. They have had a high turnover of staff due to many reasons and at the moment there is a high usage of agency staff in the home. The impact of this is being reduced through continuity of agency staff. The service has recruited and continue to recruit new nurses and care staff and a more robust induction programme is provided before staff start work in the home to ensure staff have the skills and knowledge to enable them to provide the care needed by the people who use the service. Two full time nurses are currently leading each unit and their time is supernumerary to the staff rota. Staff spoken with told us the morale in the home is much better and they told us about the improvements that had taken place since the last inspection. For example, the staffing levels have increased, food is better presented and there is more food available including `finger food` and snacks in between meals. St

What the care home could do better:

The overall quality of the care records we looked at was good. The following are examples of areas where further improvement could be made. Staff need to spend more time reading the care plans to ensure they have a greater knowledge of the health and social care needs of the people who use the service. The home need to ensure where the care plan states the gender of carer chosen and required for personal care at all times, that this is adhered to by the staff, or if this need has changed to ensure the care plan is updated. Staff need to ensure they offer people drinks in the evening and throughout the night when they are giving personal care and that this information is recorded on the fluid chart provided. Staff need to ensure they record on the charts provided all continence care given to an identified person. Staff need to ensure if a setting for an air mattress changes due to weight loss or increase, that this information is reflected consistently throughout the care plan.

Random inspection report Care homes for older people Name: Address: Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sandra Bromige Date: 0 4 0 3 2 0 1 0 Information about the care home Name of care home: Address: Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER 01214455532 01214477835 lickey.hills@craegmoor.co.uk www.craegmoor.co.uk 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) : Parkcare Homes (No.2) Ltd care home 97 Number of places (if applicable): Under 65 Over 65 0 97 47 dementia old age, not falling within any other category physical disability Conditions of registration: Age: Dementia (DE) age 55 and above. 47 0 0 The maximum number of service users who can be accommodated is: 97 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: Physical disability - over 65 years of age (PD(E)) 47 Old age, not falling within any other category (OP) 97 Dementia (DE) 47 Date of last inspection Care Homes for Older People Page 2 of 9 Brief description of the care home Lickey Hills Nursing Home is situated in a picturesque area of Barnt Green close to the Lickey Hills visitor s centre. It comprises of two units, one catering for the elderly physically frail Cofton Unit and the other for people who have care needs arising from dementia related illnesses Rednal Unit. Both units offer facilities for male & female residents who require nursing care. Both units are on two floors and all rooms, single and shared have en-suite facilities. This report reflects inspections of both of the units in the home as it is registered as one service.Up-to-date information relating to the fees charged for this service is available on request from the home. Care Homes for Older People Page 3 of 9 What we found: This was an unannounced visit by one Inspector and a specialist Pharmacist Inspector, which took place over one day. The purpose of the visit was to see if the service had complied with the three Statutory Requirement Notices served on the 9th November 2009 following the random inspection in October 2009. We also checked to see if the home had complied with the additional requirement made following the key inspection on 1st December 2009. Following the last key inspection we asked the Provider for an improvement plan showing us what they were going to do to improve the service, how they were going to achieve this and by what date. This information was received by us on the 8th February 2010. The improvement plan told us they had achieved compliance with the Statutory Requirement Notices. The outcome of the inspection showed the service had complied with the Statutory Requirement Notices and the seven outstanding requirements thus ensuring good outcomes of care for the people who use the service. Due to the poor outcomes of care for the people who use the service following the inspection in October 2009, the Provider made a voluntary agreement with us not to admit any further people to the home until the standards of care had been improved. We have now agreed with the Provider that they can start admitting people to the dementia unit in the home at a maximum of one per week. The Provider has advised us they do not wish to start admitting to the other unit at the present time. This will be reviewed by the Provider in discussion with us in one month. What the care home does well: We looked at the care of two people who use the service. We saw they had care plans that had been reviewed and re-written since the last inspection. The care plans were very informative and they were much more person centred. We spoke to staff about the care these people needed and we found these staff had a satisfactory understanding of their individual care needs. We spoke to the people whose care we tracked and we saw they were receiving the care they needed. For example, one person was spending most of their time in bed due to sore skin. We saw pressure ulcer care plans and wound assessments were in place and the nurses were changing the dressing at the frequency stated in the care plan. We saw the wound was re-assessed each time it was redressed. We saw from these documents and the photographs taken of the pressure ulcers that they had improved considerably. We saw that it stated in the care plan the persons position needed to be changed every three hours to reduce the risk of the persons skin becoming sore. We looked at the charts completed by care staff each time the persons position was changed. These charts showed the staff have been moving this person at the designated frequency to prevent their skin deteriorating. We saw assessments for each person identifying if they may be at risk of malnourishment. We saw peoples weight was being checked and recorded on a regular basis to ensure they were not losing weight. We saw people at risk of losing weight were receiving specialist high protein diets and they were being given high protein food supplements as prescribed by their Doctor. We spoke to the chef and she told us the nurses tell them which people need specialist diets, such as high protein, a reducing diet Care Homes for Older People Page 4 of 9 or a diet for people who have diabetes. The chef produces specialist food for these people to ensure their dietary needs are met by the home. We saw that people who are at risk of losing weight are offered snacks in between meals. On the morning of the inspection people were being offered pieces of fruit and bite size egg sandwiches with their midmorning drink to encourage them to eat little and often to maintain their weight. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean cloths and their hair and nails were well looked after. We saw much more interaction with people by staff on the dementia unit than we had at previous inspections. We saw people watching the television in the corner of the lounge. We saw a group of people playing sensory games with the activity person in another part of the lounge. The people were smiling and interacting with the staff. We saw staff asking people where they would like to sit in the lounge and if they would like to join in with the activities. We saw staff sitting next to people whilst they were completing paperwork, but at the same time they were engaging in meaningful conversation with people using the service. We spoke to a dementia care specialist employed by the organisation who own the home. She told us she is now visiting the home once a week to offer guidance and support to the staff to enable them to develop the care and make the environment more suitable to people with dementia on Rednal Unit. The pharmacist inspector visited the home on 4th March 2010 to check the management of medicines within the service and found that there was an overall improvement in the management and control of medication, particularly on Rednal Unit. We saw that all medication was stored securely including the provision of a new air conditioning unit in the treatment room for Rednal unit. We saw that peoples medication were stored neatly which means that medication is safe and therefore the people who live in the service are protected from harm. We looked at the medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts and we saw clear directions recorded for the application of any external preparations such as creams or ointments. This ensured that staff knew when to give medicines. When MAR charts were changed or a new medicine started then two members of staff checked the records for accuracy and detailed the reason for the change directly onto the MAR chart. This helped to ensure that accurate medicine records were available for people living in the home. This means that there are arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. The date of opening of boxes and bottles of medicines were usually recorded and balances of medication were carried forward from old records to new records. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner. Care Homes for Older People Page 5 of 9 Overall we saw better documentation, records and checks made on peoples medicines and therefore the requirements for medication from the previous inspection had been met. The staffing levels provided have been reviewed and the staffing numbers have been increased since the last inspection. They have had a high turnover of staff due to many reasons and at the moment there is a high usage of agency staff in the home. The impact of this is being reduced through continuity of agency staff. The service has recruited and continue to recruit new nurses and care staff and a more robust induction programme is provided before staff start work in the home to ensure staff have the skills and knowledge to enable them to provide the care needed by the people who use the service. Two full time nurses are currently leading each unit and their time is supernumerary to the staff rota. Staff spoken with told us the morale in the home is much better and they told us about the improvements that had taken place since the last inspection. For example, the staffing levels have increased, food is better presented and there is more food available including finger food and snacks in between meals. Staff told us the people love the new sofas on Rednal. New staff are starting. Staff are working well together and everything runs smoothly. Residents seem happier. We are able to do eight to ten baths a day now. The home have reviewed their procedures for reporting incidents to us to ensure we receive them without delay. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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, 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 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 Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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