Inspection on 07/04/09 for Lickhill Manor Nursing Home

This inspection was carried out on 7th April 2009.

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

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

Other inspections for this house

Lickhill Manor Nursing Home 14/06/10

Lickhill Manor Nursing Home 09/02/10

Lickhill Manor Nursing Home 07/10/08

Lickhill Manor Nursing Home 25/01/08

Lickhill Manor Nursing Home 04/05/07

Lickhill Manor Nursing Home 25/01/06

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 Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL Lead Inspector Emily White Unannounced Inspection 7th April 2009 09:00 DS0000064419.V375007.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. DS0000064419.V375007.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address DS0000064419.V375007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lickhill Manor Nursing Home Address Lower Lickhill Road Stourport on Severn Worcs DY13 8RL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01299 827789 01299 878065 Gentle Care Services Limited Mrs Lynda Ann Mason Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places DS0000064419.V375007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 40 Physical Disability (PD) 40 The maximum number of service users to accommodated is 40 2. Date of last inspection 7th October 2008 Brief Description of the Service: Lickhill Manor Nursing Home is a large grade II listed building, which has recently been extended to provide nursing and personal care for 40 people. The majority of people in the home are older people, but the home accommodates some younger people with debilitating illnesses for example multiple sclerosis. The home is located on the outskirts of Stourport-on-Severn next to Lickhill caravan park. It is situated in over an acre of landscaped gardens providing pleasant views from the rooms. The home is difficult to access on public transport but is within short distance of the town with the shops and the river Severn. The home provides plenty of car parking for visitors within the grounds. Accommodation is provided on three floors in both single and shared rooms. The home provides a range of aids and equipment to assist them in meeting the needs of people using the service. A passenger lift is available to assist people using the service to access all three floors of the home. Communal areas are available with three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. The home is owned by Gentle care services limited. The registered manager for the home is Lyn Mason who is a first level registered nurse with many years experience having worked at the home for 15 years. Lyn is responsible for the DS0000064419.V375007.R01.S.doc Version 5.2 Page 5 day to day running of the home. Information regarding the home can be obtained from the statement of purpose and the service users’ guide which are available from the home. A copy of our most recent inspection report can be viewed at the home. Information about the fees is available on request from the home. DS0000064419.V375007.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. We carried out this key inspection without telling the home we were going. During the inspection we looked at aspects of the service that are important to people using it and checked the quality of the support provided. Before visiting the service we looked at the Annual Quality Assurance Assessment which the manager had sent us. This tells us what the service has been doing and how it plans to improve. We also reviewed all of the information we have gathered since the last key inspection. During the inspection, we met and spoke with a number of people who live in the home, some privately in their rooms and others in a small group. We had a discussion with the manager and service provider and met several staff. During the day we observed the daily life of the service and how staff assist people living there. We also looked at records which included care records, staff files and documentation to do with the running and upkeep of the building and equipment. What the service does well: The home provides a warm and friendly environment for people to live in and to visit. Written information is available to help people decide if they wish to move to Lickhill Manor. Residents are able to bring some of their own personal possessions into the home so that they are able to create a more homely room. Staff are kind and respectful in the way they care for people. The grounds are well maintained and provide pleasant areas for the residents to use when the weather permits. The home has been extended to provide more single en suite bedrooms for people to use so that they do not have to share a room unless they choose to. DS0000064419.V375007.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our DS0000064419.V375007.R01.S.doc Version 5.2 Page 8 order line – 0870 240 7535. DS0000064419.V375007.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064419.V375007.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made so that people moving to the service have a detailed assessment of their healthcare needs before they move in. This makes sure the service can meet these needs. The process for people moving to the home is not personalised which means peoples interests, likes and dislikes are not always considered before someone moves in. EVIDENCE: The last key inspection report recommended that the service review and update the information it provides to people so that it accurately reflects the services and facilities available, and that information be provided in other formats to make it easier for people to understand the information provided. The Annual Quality Assurance Assessment tells us that the service still needs to improve how often it reviews the statement of purpose and service guide. DS0000064419.V375007.R01.S.doc Version 5.2 Page 11 We saw the guide and note that it has not been updated and is not available in an alternative format. However we spoke to four people who use the service and their relatives who had recently moved there. Everyones relatives said that they had enough information and knew what to expect when they moved there. Two people said they had chosen the service from a recommendation from people who had lived there. The last key inspection report also recommended that everyone using the service be provided with a statement of terms and conditions or a contract to assist them in ensuring that their rights are protected, and so that they know what they can expect from the service. The administration manager, who had been away from work at the last key inspection, now ensures that people have written contracts. We saw a contract for one person who was paying for their own care. The last key inspection report required that the service have systems in place to ensure that peoples needs can be met prior to them moving in. This includes having a detailed assessment of their needs. We looked at the assessments carried out for the two newest people living at the home. One person had a detailed long term needs assessment on their file which was dated before they moved in. This assessment covers all the health related topics required by the National Minimum Standards but contains very little background or personal information about the person, such as their likes and dislikes, hobbies or interests. Another new person had not had a long term needs assessment, as they had been admitted on temporary basis, but a pre assessment form had been completed on the day before admission to the service. This has a dependency profile and covers all areas of the National Minimum Standards. This person had become a permanent resident at the service a few days before our inspection but a long term needs assessment had not been completed. The service does have a key worker system which is usually the staff member responsible for co-ordinating the persons care plan, monitoring its progress and staying in regular contact with the person and everyone involved. We spoke to staff members who are key workers who did not say that supporting new people was part of their role. Improvements could be made to this system to make sure that new residents are supported when they first move to the home, and that their individual abilities and preferences are considered. DS0000064419.V375007.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to care plans and recording so staff have enough information to meet peoples care needs. People are treated with dignity and respect but the service is not personalised to peoples individual preferences. EVIDENCE: Following the last key inspection a requirement was made that people using the service must be consulted about their care plan. The care plan must be kept under continual review and revised at any time when it is necessary to ensure that their care needs are identified, and a clear action plan must be put into place for staff to follow. The Annual Quality Assurance Assessment tells us that there is now detailed information provided in the care plans and the daily records which are completed quickly and without delay. Increased discussion between staff members of changes in the Care Plans ensures that any changes are implemented as required. DS0000064419.V375007.R01.S.doc Version 5.2 Page 13 We looked in detail at three plans for people using the service. Each plan has a summary with important contact details and the date the person moved to the home. There are sections called Life Story and Personal History which are left blank. There is very little information within the plans which tells staff about a persons likes, dislikes, hobbies and interests - the plans are not individual to the person they are for. It is important that the service gathers this personalised information about people using the service so that staff can provide the best support for that person. From the long term needs assessment, the plan has individual sections for each of the persons identified health care need. This explains what the need is and what staff need to do. For example, one person needs regular blood taken and monitoring for changes following a stroke. Daily records show that these are being done and changes in the care plan are being followed up. One person who had become a permanent resident a few days before our visit had not had a full care plan set up, although important sections relating to pressure care, moving and handling, falls and nutrition had been completed. The service should ensure that people have care plans completed in a timely way so that staff are aware of exactly how to support that person. The manager and deputy are now carrying out monthly reviews of care plans which are being recorded. Peoples needs are set out on separate pages so they are easy to update, and we saw that changes have been made, for example one person whose health has deteriorated has had a regular update to their plan. There is an overview of the care plan which does not show whether changes have been made as a result of review. It would be good practice to show whether changes have been made so that staff can look at the relevant section for an update. The last key inspection identified that staff were not recording details about peoples health needs as they did not have enough time. People using the service were at risk of missing out on important health information and care. During our inspection there were only 28 out of a potential 38 people living at the service, and only five of these people needed a high level of support in bed. From the records we saw, staff are able to manage the support and recording for this number of people. Staff are recording when people have personal care assistance, health checks such as pulse and blood pressure, and peoples weight is being recorded and monitored. We looked at records for one person at the end of their life, which show that staff are regularly monitoring changes in appetite, mood and other health related information. Peoples health care is also monitored through individual risk assessments for pressure care, pain management, moving and handling, falls and nutrition. One person who had ongoing concerns with their nutrition had been regularly monitored, as they were identified as highly at risk. A nutrition assessment had been completed ten days before our visit which recorded refer to GP and DS0000064419.V375007.R01.S.doc Version 5.2 Page 14 dietician for high protein diet. We saw from food charts and by speaking to the kitchen staff that this person was receiving the right fortified drinks, however the plan did not record whether the GP or dietician had visited. It is important that actions in a care plan are followed up and recorded so that everyone involved in that persons care is kept up to date. The last key inspection report required that systems must be in place to record all medication administered so that people receive their prescribed medication safely and in accordance with prescribed instructions. The Annual Quality Assurance Assessment tells us that that the service has improved its medications storage and training for staff. We saw two treatment rooms, with medications trolleys secured to the wall, appropriate storage for all medications including controlled drugs. We looked at the medications for three people, which showed updates following recent doctors reviews, and the majority of medications given and signed for appropriately. One person had not been given their medications on two occasions, although they had been signed for by the manager. From staff records we could see that these were the dates that the manager had been covering nursing staff shifts. It is likely that she had been called away during the medication round and is a good example of why the manager should always be supernumerary. The service has been working with the local authoritys care services quality team to improve some areas of their service. This has included staff attending two training sessions on Dignity in Care. The quality officer who carried out this training tells us that the training was well received and staff were open and honest about some of the care practices they had used and had good recognition and awareness of changes they could make. In addition the service now provides a relatives room to ensure privacy. Our observations during our visit show staff offering reassurance to people, addressing people appropriately and discreetly. In discussion and from records staff show a good understanding of how to respect privacy and dignity, for example daily notes are recorded sensitively using peoples names, and one staff member said you put yourself in their place, think about how you would like to be treated. Comments about their care from people using the service and their relatives include: Staff are kind and sensitive Their health is managed well, they eat what they like X has put on weight, talking more, seems happy They always phone if X is ill, get the doctor straight away if needed I know X is very well looked after, I know they would call me when needed I am very happy with the care, the staff are lovely. DS0000064419.V375007.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14. 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made and the service is starting to support people to keep up their interests and activities and to be part of their local community. People are able to keep in touch with family, friends and representatives. They have nutritious and attractive meals and snacks, at a time and place to suit them. EVIDENCE: The last key inspection report required that systems be put in place to ensure that the recreational and social needs of residents are met and their wellbeing promoted. Since the last key inspection the service has employed an activities coordinator for 21 hours per week, who we met during our visit. Although care plans are not personalised and do not record peoples preferences or interests, the activities coordinator shows a good understanding of how to personalise the service she provides. She has had training in dementia care as part of a previous role and plans to join the National Association for Providers of Activities for Older People. She understands the importance of one to one work DS0000064419.V375007.R01.S.doc Version 5.2 Page 16 and working with people who do not like to or who arent able to socialise. She is able to describe what individual people using the service enjoy, for example magazines, looking at bright objects or doing the crossword. The service should consider gathering this information and using it to inform their care planning. The activities coordinator tries to visit everyone in their room for at least a chat during the week, and organises other group and individual activities. We met people using the service and relatives who confirm that she comes to their room nearly every day, and everyone said there are a variety of activities available to them. Examples given by people using the service include making Easter hats and cards, singing, music entertainments, exercise for hands, bingo, art, films, quizzes, craft clubs, film clubs, relaxation and massage, reminiscence, walks and church services. There is a basic recording chart in peoples care plans which is completed by the activities coordinator. These charts show people have some contact several times a month, including people who stay in bed. We saw visitors throughout the day, and they were made welcome by staff. One relative told us “I visit every day and they always make me welcome”. Visitors can visit the home at any time, and can request a meal to have at the home. The Annual Quality Assurance Assessment tells us that there are sometimes opportunities for people to go out with the activities coordinator. People using the service tell us that they have access to church services, entertainers, and visits from the local school. The last key inspection recommended that the service should be able to evidence that food preferences and choices are being respected. Peoples care plans do not document their individual choices, unless there is a particular health need related to food. However the cook tells us that when someone is new she meets them with a staff member and asks them about their preferences for food. The cook shows a good understanding of diabetes, and tells us a lot of the food is sugar free. The cook says she does not have a budget or restrictions, and is able to get good quality fresh meat, fruit and vegetables as needed. People are offered choices for breakfast, lunch and dinner as well as snacks. We observed a meal time and saw good staff interactions for example asking people for their choice of location to eat dinner, offering choices of food, explaining to people what is on their plate. There is a relaxed atmosphere in the dining room, with music playing. Comments from people during lunch time include we get a choice of food, I cant grumble about the food, I have porridge and prunes, which is what I had at home, the food is always on the menu board, the food is good here. We also note that peoples religious beliefs are respected, for example one person using the service was on a 40 day fast and not eating meat. DS0000064419.V375007.R01.S.doc Version 5.2 Page 17 We note that the service has recently had a four star environmental health inspection food hygiene inspection, and that all health and safety and food hygiene practices are recorded, such as fridge and food temperature checks. DS0000064419.V375007.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Staff have not been trained to recognise signs of abuse or neglect which means it is difficult for people to be confident that they will be safeguarded while they use the service. EVIDENCE: The last key inspection identified concerns that people did not know whether their complaints would be followed up properly due to staff shortages. The Annual Quality Assurance Assessment tells us that the service has improved by having regular meetings with staff, people who use the service and relatives to discuss any issues which may arise. It also says that they have regular discussion of the complaints procedure with people who are new to the service. During the past six months since the last inspection we have not received any complaints about the service. The manager operates and complaints file but has not received any complaints either. We met several people using the service and their relatives who all know how to complain. Comments include: I cannot fault the staff, I have no concerns, no bad words, if there are any concerns I see the manager and they are dealt with, the manager is really helpful. DS0000064419.V375007.R01.S.doc Version 5.2 Page 19 During the last key inspection we were unable to identify how many staff had received training in the protection of vulnerable adults, and no training record was available. We were told that training in protection of vulnerable adults was planned in October 2008. During this key inspection we were still not able to identify training records showing that staff had had training in the protection of vulnerable adults. We spoke to staff who confirmed they had not had recent training but were able to talk about the process for raising concerns. One member of staff was not very clear about spotting different signs of abuse. Although there are clear policies and procedures in place, and the manager shows a good understanding of recent developments concerning deprivation of liberty and safeguarding, it is important that staff are trained in this area so that they are able to keep the people they support safe from abuse or neglect. DS0000064419.V375007.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. The older part of the house does not support the needs of people with cognitive or sensory impairment. EVIDENCE: The house is a large grade II listed building, which has recently been extended to provide some modern rooms with en suite bathrooms. The house has over an acre of landscaped gardens providing pleasant views from the rooms. There are bedrooms over three floors and a passenger lift is available to assist people using the service to access all three floors of the home. There are three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. DS0000064419.V375007.R01.S.doc Version 5.2 Page 21 We saw some peoples bedrooms which are very personalised to their own tastes. Some improvements have been made to the house since the last key inspection, for example there are now two washing machines and two dryers in the laundry, and shelves with individually named baskets for peoples laundry. A path to the patio has been finished to provide easy access to the garden for wheelchair users, and raised flower beds are currently being built to provide a sensory garden or opportunities for gardening for those who wish to. The last key inspection identified that orientation for people with cognitive or sensory impairment could be improved. The house is spread over a large area, particularly since the recent extensions and could be disorientating for people using the service. In considering improvements to the older part of the house, the service should consider current good practice in setting up an environment suitable for those with cognitive or sensory impairment, such as appropriate signage, colour schemes and fabrics. The Annual Quality Assurance Assessment tells us that the service plans to provide more domestic staff to ensure high standards of cleanliness and tidiness in the home. During our visit we noted that there are no unpleasant odours and that staff observe good hygiene practices. We were not able to establish whether staff training in infection control and hygiene had been updated recently, as the manager does not keep and up to date record of staff training. DS0000064419.V375007.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices have improved so people can be confident staff have had the right background checks. As more people move to the service, and as their needs increase, they cannot be confident that there will be enough well qualified and trained staff available to meet those needs. EVIDENCE: Following the last key inspection an immediate requirement was made that there are suitably qualified and competent staff available in sufficient numbers to ensure that the health and welfare needs of people are met. The service sent us some copies of rotas and told us in their Annual Quality Assurance Assessment that there is increased levels of staff and less use of agency staff with a good skills mix at all times. On the day of our inspection we could see that recent staff rotas showed a sufficient number of staff for the number of people using the service. During the day we observed staff working and there appeared to be enough staff. For example, we observed staff working carefully with people using a hoist, taking time to explain what they were doing. There was a calm relaxed atmosphere in the home. DS0000064419.V375007.R01.S.doc Version 5.2 Page 23 However at the time of our inspection we noted that there were ten vacancies which is a quarter of the number of spaces available at the service. We discussed this with the manager, a nursing staff member and two care staff members. Everyone said that while there are enough staff at the moment, when more people move in or more dependent people move in, it is harder to work effectively. Staff say they feel very busy, especially when there are people who need to be cared for in bed. Staff say they try not to rush but time is often short and people do wait for assistance. Staff say that at busy times it is difficult to fit in the bathing and breakfast routine. In particular staff said that one member of nursing staff is not enough. Occasionally the manager has covered a nursing shift which is poor practice, leaving less time for management tasks and increasing the likelihood of mistakes being made with medications and other nursing tasks. Comments from people using the service confirm that while the staff very caring, at busy times their work can be affected. Staff are lovely, Most of the staff seem happy, The girls are very good, They don’t employ enough of them, They always come quick when I ring the bell but sometimes two in the morning are always rushing. While the requirement for staffing has been met at the time of this inspection, staffing is an area that the service should continue to develop as more people move to the home. The service has been working with the local authoritys Care Services Quality Team and has plans to review staffing levels and criteria for assessing the dependency of people using the service. A further requirement was made following the last key inspection, to ensure that the recruitment procedure is robust so suitable people are recruited. The Annual Quality Assurance Assessment tells us that the service now has a more rigorous and safer recruitment process. The staff we met confirmed that they had all had recruitment checks before starting work. We checked four staff files, which had all the relevant checks for all staff. One reference was missing but this had been misfiled and was sent to us following the inspection. The Annual Quality Assurance Assessment tells us that there are 22 staff members and eight of these have an NVQ qualification. The staff training matrix shows six staff with NVQ qualifications. This is below the target for 50 of the staff group recommended in the National Minimum Standards. The last key inspection recommended that the service develop a system to monitor and ensure that staff have the relevant training and skills to meet the needs of people using the service. The service has started to put together a training matrix which shows the staff training that happened in 2008. This shows that not all staff have had the mandatory health and safety training. Previous dates of training are not available so the manager is not able to monitor whether training is out of date. The matrix does not cover other important training such as medications, protection of vulnerable adults or specialist training such as dementia care, palliative care diabetes or basic nursing tasks. While staff confirmed that they had had a good induction when they started, they also DS0000064419.V375007.R01.S.doc Version 5.2 Page 24 said that they had not had very much training since working at the home. With only one qualified member of nursing staff on shift, the service must develop a system which will promote the development of competent, qualified and skilled care staff to meet the needs of people using the service. DS0000064419.V375007.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has made some improvements to the quality of life for people using the service. The service provider and manager do not regularly monitor the standard of the service which means people cannot be confident that improvements will always be addressed. EVIDENCE: Since the last key inspection there have been some improvements to the service, particularly in the areas of health and care planning. Staff tell us that there have been improvements in record keeping and in communication between staff, so important information about health and personal care is not DS0000064419.V375007.R01.S.doc Version 5.2 Page 26 missed. Staff say that it is a happy home and believe they work in a good team. The service has started to work with the local authoritys Care Services Quality Team and has undertaken training in Dignity in Care and has started to look at staffing and training. The service provider tells us that they will be engaging a consultant to work to improve staffing practices and training. The provider is considering undertaking NVQ level 4 in care work and is planning to be present at the service to support the manager alongside the administration manager. The last key inspection report recommended that the service formalise their supervision program for the staff to assist in monitoring performance and ensuring that they have the opportunity to voice their opinions. The Annual Quality Assurance Assessment tells us that the service has increased the use of appraisals and supervision. Staff tell us that they have a mentor who they are able to go to for support. New staff tell us they feel very supported by the manager. Senior staff are carrying out supervision of junior staff, but say that this is not happening as often as it should. Nursing staff tell us they have not had supervision from the manager. While some supervision records were available in staff files, these did not show us that supervision is being carried out at regular intervals for staff. Following the last key inspection a recommendation was made that the service develop effective quality assurance audits and include the views of people using the service and professionals. The manager tells us that she is carrying out some audits such as medications; however nursing staff were not aware that this happens. The service provider tells us that the quality monitoring will be reviews of the Annual Quality Assurance Assessment, surveys and meetings with people who use the service, and staff meetings. The full system has not yet been set up and the provider informed us that the required monthly reviews of the service had not been carried out but would be starting in April. Since the last key inspection the service has been operating without alarms to three external doors, which meant that people could leave through these doors without staff being aware. Although the service had met a requirement to secure the doors from the outside, the doors were still not alarmed from the inside at this inspection. Since the inspection the service provider has fitted these doors with alarms. The service tells us it has also improved health and safety practices through setting up an evacuation folder in the hall for fire, and appointing one member of night staff to monitor accidents. We saw that health and safety checks include clinical waste, electrical testing, hoists, sluice, water temperatures, lifts, sewerage, gas, cooker, tumble dryer, nurse call and laundry. The service does not manage money for people using the service and sends and invoice for any charges such as hairdressing. DS0000064419.V375007.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 2 x 2 DS0000064419.V375007.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation Requirement Timescale for action 07/07/09 Regulation The registered person must 12 ensure that there is a system in (1)(a)(b) place to monitor staff training and development. The service must be able to demonstrate mandatory training, training in the protection of vulnerable adults and specialist training is being planned for and provided to staff. This will ensure staff fulfil the aims of the home and meet the changing needs of people using the service. 2. OP33 Regulation The provider of the service or 07/07/09 26 their appropriate representative must visit the service at least once a month, and prepare a written report on the conduct of the service. This ensures that the quality of the service is being monitored for the benefit of people using the service. DS0000064419.V375007.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 OP2 Good Practice Recommendations The service should review its admission procedure so that it is more personal for individuals. This includes providing information in alternative formats and using the assessment to find out peoples interests, likes and dislikes. This will assist in providing the right service for people and settling in when they first move. The service should ensure that people have care plans completed in a timely way so that staff are aware of exactly how to support that person. Care plans should provide personalised information as well as health care needs so that all aspects of peoples well being is considered. The outcome of suggested actions in care plans should be recorded so that the service can show how decisions relating to peoples care have been made. This will ensure that people using the service are getting the most appropriate support. In considering improvements to the older part of the house, the service should consider current good practice in setting up an environment suitable for those with cognitive or sensory impairment, such as appropriate signage, colour schemes and fabrics. The service should consider a system for continually reviewing staffing levels and criteria for assessing the dependency of people using the service. This will ensure that there is the right number and skill mix of staff available at busy times, so that people always receive the support they need. To assist the service in meeting the needs of the residents, the service should develop effective quality assurance audits and include the views of people using the service and professionals. DS0000064419.V375007.R01.S.doc Version 5.2 Page 30 3. OP7 4. OP8 5. OP19 6. OP27 7. OP33 8. OP36 The service should be able to show that regular supervision is taking place. This will help the service to monitor training and development needs and ensure the quality of the support being provided to people. DS0000064419.V375007.R01.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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