Inspection on 17/03/10 for Meadow Lodge Care Home

This inspection was carried out on 17th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Lodge Care Home 07/06/10

Meadow Lodge Care Home 04/02/10

Meadow Lodge Care Home 14/09/09

Meadow Lodge Care Home 01/04/09

Meadow Lodge Care Home 02/04/08

Meadow Lodge Care Home 08/10/07

Meadow Lodge Care Home 24/04/07

Meadow Lodge Care Home 27/09/06

Meadow Lodge Care Home 16/06/06

Meadow Lodge Care Home 03/02/06

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Ashcroft Hollow Nursing Home

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Breme

Ravenhurst

Bank House

Inspirations

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Meadow Lodge Care Home 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 1 7 0 3 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Meadow Lodge Care Home 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 01214202004 01212468279 info@meadowlodgecarehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Coseley Systems Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 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: 22 The registered person may provide the following category of service only: Care Home Only (Code PC) 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) 22 Date of last inspection Brief description of the care home Meadow Lodge is situated on the Hagley Road a short distance from Bearwood shopping centre. Bearwood has a variety of facilities including banks and public houses, shops and a library. Public transport into the City Centre is available directly outside of the home. The home was originally two dwellings and has been converted to provide accommodation for up to 22 older people. The home has four shared and Care Homes for Older People Page 4 of 32 Over 65 22 0 2 4 0 9 2 0 0 9 Brief description of the care home fourteen single bedrooms. The home has two lounges and two dining areas. Shower and toilet facilities are provided on the first and ground floors. On the first floor there are two bathrooms with bath seat lifts. There is a stair lift in the home. To the rear of the home there is a large garden that people living in the home can use. To the front of the home is a forecourt that provides some car parking. The home has a ramped access available. The service user guide/welcome pack states that the fees at the home are per regional Social Service/Council body contracts and the fee for people who are paying privately is 365 pounds per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out over one day by two inspectors. The pharmacist inspector looked at the management of medicines in the home on the same day. A lady called Spiwe Takura also visited the home. She is known as an expert by experience. This means that she has used care services and she visited the home to provide an independent view on the home and the service it provides. During her visit she spoke to 8 people who were living in the home, sampled the food, looked around the home and observed interactions. She wrote a report about her visit and her comments have been included within this report. The focus of 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, standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 32 Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included 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. The Annual Quality Assurance Assessment AQAA for this inspection was not received before the inspection but was received within the required timescales. The AQAA is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Two other files were also looked at. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with four of the people living in the home, the manager, and three staff to get their views on the home. We spoke to six relatives of people living in the home before the inspection. We sent out 20 surveys to staff and one completed survey was returned to us. Following the key inspection of September 2009 we carried out a random inspection on 4th February 2010 to check on the homes compliance with the requirements. Findings of that inspection are included in this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The lawn has been mowed and some slabs have been relaid. This means that the garden is more accessible to the people living in the home. The kitchen roof has been replaced ensuring that the building is kept maintained. Several carpets in the home have been cleaned. This means that the environment presents as more homely and looked after. New menus have been put in place. This means that the people living in the home will have more variety in the meals being provided. The mould in the bedroom identified at the random inspection has been attended to making the bedroom more comfortable. The issues identified in the laundry at the random inspection have been attended to minimising the risks of cross infection. Care Homes for Older People Page 8 of 32 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 order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Processes ensure that the needs of people moving into the home are known and people can be assured that their needs will be met. Evidence: Following the key inspection of 24.9.09 a random inspection was carried out on 4.2.10. At the random inspection it was found that the service user guide had been updated to include a range of fees charged in the home and the people who had not received a contract in September 2009 had been given one. This ensured that the people living in the home, and those thinking about moving into the home had information available to them telling them what services were available, how much it would cost and what their rights and responsibilities were. At this key inspection we looked at the admission process for one person who had moved into the home recently. We saw that due to the difficult circumstances in which the individual moved into the home an assessment was carried out on the individuals Care Homes for Older People Page 11 of 32 Evidence: needs at the time of moving into the home. The admission assessment was found to cover lots of areas of need including: medical history, eating and drinking, mobility, independent living skills, personal hygiene and daily living skills such as care of the environment, laundry, kitchen, communication, social and medication skills. This ensured that the home were aware of the individuals needs and able to plan how their needs were to be met. It was recommended that a record is made following individuals assessments of the reasons why the home felt they could meet their needs or not. This will enable any queries to be readily responded to. The expert by experience spoke to the people living in the home and her comments about the home and care provided were: On the whole the environment appeared to be welcoming for visitors and conducive for the residents. There appeared to be a relaxed work environment. I also thought that the residents seemed to get adequate care based on their responses to questions and staff involvement with residents. Interaction was evident in the downstairs lounge. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans include information about the needs of the people living in the home but care is not always provided according to them. The medical needs of the people living in the home are met. The home is not able to maintain safe medication administration to ensure the heatlh and well being of the people in the home. Evidence: We looked at the care plans for four people living in the home. These are documents that tell the staff how people are to be assisted to meet their needs in a person centred way. The care plans include lots of sheets giving information on areas such as routines during the day, personal care, mobility, general health and other professionals involved in peoples care. The information recorded in these sheets are then put onto the care plan continuation sheets which cover personal care, dietary needs, daily Care Homes for Older People Page 13 of 32 Evidence: living, family or friends contacts, religion and general health. These are the working documents for the staff to know how to assist people to meet their needs. The plans need to be clearer for people who are unable to make their wishes known. For example, the plans should tell the staff what might indicate that people with dementia want to go out and this should be planned into their daily routines. Staff do not always follow the care plans as evidenced the records and staff spoken with. For example, the toiletting regime for one person indicated that they should be assisted to the toilet every two hours however discussions with staff and examination of the records did not confirm that this was happening. This would indicate that people did not always receive their care as planned and this could have a deterimental affect on their dignity. There are risk assessments in place for issues such as leaving the home, pressure ulcer prevention and poor nutrition. In some instances where daily records record agitation, restlessness or aggression there is no management plan in place. This could put the people living in the home and the staff at risk of injury or the needs of the people living in the home not being met in the way they want. Daily records were generally informative however they did not always evidence what had actually happened for example, for one individual the GP had been called regarding aggressive behaviour but there was nothing regarding this behaviour in the daily records reflecting this. The manager was not aware of this behaviour and felt staff could have been referring to restlessness during a particular time of the day. Daily recordings must be accurate as inaccurate recording could potentially lead to someone being inappropriately prescribed medication to manage behaviours that are not there. There was evidence in the records we saw that people were receiving their medical needs via access to the local GP, district nursing services, dentist, chiropodist and also specialist facilities such as hospital and mental health teams. The expert by experience spent time in the home speaking to some of the people living there and she said: Generally, every resident I spoke to had great things to say about the carers they said: The staff are wonderful The staff are excellent! They help me with all my needs Care Homes for Older People Page 14 of 32 Evidence: They are friendly and polite There is sufficient number of staff They will dance along with me...you see I, like ballroom dancing The pharmacist inspector looked at the management of medicines in the home. The pharmacist inspection lasted two hours. Three peoples medicines were looked at, together with their Medicine Administration Record (MAR) charts. Two senior care assistants were spoken with and all feedback was given to the manager. The home saw all the prescriptions before they were dispensed and used a copy of these to check the dispensed medicines and MAR charts received into the home. The quantities of all medicines had been recorded enabling audits to take place, to demonstrate whether the medicines had been administered as prescribed and records reflect practice. The majority of medicines had been administered as prescribed. Problems were seen when one person went to hospital and the care staff gave all his medicines to the ambulance crew. The care staff did not check in any of the medicines that had been returned from the hospital, so it was not possible to demonstrate in these instances whether they had been administered as prescribed. This had been recognized by the manager and she had devised a system to check the medicines received back into the home to enable her to assess her staff who administered medicines to ensure they are administered as prescribed at all times. Additional problems were also seen where a dose of one medicine had been changed by the doctor. The new dose had been written on the MAR chart but not all staff had administered the new dose. This was cause for concern as one medicine prescribed to prevent blood clots, had not been administered as prescribed. A second medicines dose had been increased but only three out of the five doses had been administered at the increased dose. The manager has not ensured that clear directions had been written on the MAR chart to prevent the mal-administration of medicines seen. One senior care assistant had a very good knowledge of the medicines she handled, enabling her to support the peoples clinical needs in the home. The lunchtime medicine round was observed. The senior care assistant prepared two peoples medicines and put them in individual medicine tots. These were then stacked on top of each other and taken to the people in the home. The MAR chart was also signed before the actual administration. This is considered bad practice as he could give the incorrect medicine to the person and also the record may not be a true reflection of what actually occurred. The manager was to address this issue after the inspection. Care Homes for Older People Page 15 of 32 Evidence: We did not observe anything during the inspection to indicate that the dignity of the people living in the home was not being promoted however comments we received showed some dissatisfaction about the promotion of dignity as peoples clothing was either being lost or misplaced and individuals being dressed in other peoples clothing. Other comments made included marvellous staff, cannot be faulted and staff will do everything you ask them to. At the random inspection of 4th February 2010 we found that one bedroom on the ground floor did not have a lock in place which meant that the individual living there was unable to lock their door, another bedroom had a strong odour and in another bedroom the curtains and window were dirty, there was mould and damp in the room and it had not been generally well cleaned. At this inspection we were unable to check if the lock on the bedroom door had been fixed, however, another bedroom we looked at was not able to be locked, there was still an odour in the bedroom identified earlier and although the damp had been attended to by the window in the other bedroom there was still damp by the wash hand basin which had not been attended to. The furniture audit of bedrooms carried out in the home in December 2009 also identified the two bedrooms where the locks did not function. The lack of functional locks on bedroom doors, poor cleaning and lack of attention to the upkeep of the building means that peoplesprivacy and dignity could be affected. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities in the home but they could be improved to be more stimulating. People receive adequate nutrition and some choices are available. Evidence: The people living in the home were able to make choices such as where they sat, what they wore and some choices at meal times were evident. Choices such as whether they preferred a bath or shower were recorded in care plans but these were not always shown as being translated into practice. The activities documented in the files we looked at were in the main watching television, listening to music, chatting to staff, sing a longs and occasionally things such as exercise, colouring books and dancing. A more varied and individual activities plan should be put in place for each person to show how the individuals are being assisted to lead meaningful and stimulating lifestyles. Comments we received about activities included: No activities, sometimes exercise and singers. Care Homes for Older People Page 17 of 32 Evidence: Never any activities when Ive visited. Nothing to occupy X, listens to music. X doesnt have enough activity/stimulation just watching TV. X sitting around usually. Occasionally skittles, told party at Christmas and some entertainment. Told X will dance if music on but usually sitting. The expert by experience spoke to the people living in the home and found that: I was made to understand that there were no organised activities, however someone came to do some choral singing once in a while; darts and video games but the main activities seemed centred around TV. The residents said it would be great to have trips or other organised activities. We received somel comments about the food. These included: X looks healthy, has put on weight. Food looks good, have a set menu, not aware of any choices but X happy with the food. Food ok.... Would like some ..... but doesnt always get them. Maybe cost or not available. Good food Would be good if quality of food better. Basic food. We sampled some food records and looked at the menus. The menus show choices are available and we were told that people are asked which choice they want each day and they sign to say what they want. One person indicated that they had not been offered a choice at lunch but had been offered a choice at tea time. New menus have been put in place over the past couple of weeks and we were told that people had been asked their opinions of what they wanted on them. The success of the menus should be monitored for success. The expert by experience talked to the people living in the home about the food and Care Homes for Older People Page 18 of 32 Evidence: she said that: Although I did not sit at table with some of the residents, I managed to sample their food. My view is that the food is adequate, no trimmings. Really basic and the chips were a bit greasy...but presentation was good. The dining room had a warm open environment for residents and visitors. During individual discussions I managed to check with all residents about their meals. They were NOT happy with the meals except for one who said it was adequate. The majority thought that: It was basic Sheer boredom Awful, no choice menu, presentation not the greatest Unacceptable No variety. Same frozen vegetables The manager told us that the last meeting for the people living in the home to discuss the home was held in September 2009 but that she regularly spoke to people and used these comments to determine satisfaction. These comments were not recorded anywhere and it was advised to record them so that they can be used to develop the service and evidence that the views of people are taken into consideration. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not follow up all matters of concern to ensure people in the home are listened to and appropriate action taken. Evidence: No complaints have been raised about the service with us since the last key inspection. One person living in the home was able to leave the building without the staffs knowledge and this put the individual at risk. Since the incident we have been assured that systems have been put in place to prevent, as far as possible, a similar incident occuring again. We were told by staff, relatives and the people living in the home that comments had been made in respect of heating, laundry and food. These comments have not been recorded as complaints however, they were expressions of dissatisfaction and should have been recorded and treated as such. This would show that the views of the people living in the home and their relatives were being listened to and acted upon to the satisfaction of the individuals. The expert by experience spoke to the people living in the home about raising issues in the home and she said: Care Homes for Older People Page 20 of 32 Evidence: Of the residents that I interviewed 2 of them said they had raised the food issue, another one said they had encouraged management to put flowers in the garden. At the time of the random inspection of February 2010 the previous requirements in respect of the management of medicines had been met. At this inspection some incidents of people not getting their medication as prescribed have been identified by the pharmacist inspector during an audit of medicines. This could put the individuals health at risk. Also at the random inspection of 4th February 2010 it was found that soiled laundry was being mixed with other laundry increasing the risks of cross infection. Good infection control practices were not being implemented as the wash hand basin in the laundry could not be used, there was no soap, paper towels or gloves available for handling soiled laundry. These issues were found to have been addressed at this key inspection. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation met its stated purpose. Some areas of the home and furnishings do not fully meet residnets needs. Evidence: We looked at some communal areas of the home and four bedrooms. The lounges and dining areas were suited for their purpose although some of the seating could be cleaned as it has become stained on the armrests. We were told that the lawn had been mowed and paving relaid. The garden could be developed further to make it more welcoming and attractive and tidied up to make it safer. We were also told that some bedroom carpets had been cleaned and the kitchen roof repaired. The bedrooms we looked at were adequately furnished. Two were found to have been personalised to the needs of the occupants, one was currently not in use and had had the mould and damp that had been identified at the random inspection of February 2010 addressed. The cleaning of this room could be improved and there was still damp around the wash hand basin that needed addressing. The bedroom in which an odour had been identified at the random inspection still had Care Homes for Older People Page 22 of 32 Evidence: an odour evident and the cleanliness could be improved. The furniture audit carried out by the home in December 2009 identified furniture that needed replacing and bedrooms where the locks were not functioning. These issues should be addressed. An ongoing refurbishment plan should be put in place to ensure that the furniture and fittings are updated and replaced as needed. There had been some problems with the heating, which the home had addressed but it had resulted in some people needing additional heaters. The manager and proprietor were unaware of this. The assisted bathroom was still out of use as some work was needed to the ceiling following a leak. There were showering facilities available which were adequate but would be better if they were updated to enhance their presentation. Disposable gloves were found with normal household rubbish. They should always be disposed of in clinical waste bins in line with good infection control practices. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff on duty with the skills and knowledge needed to care for the people living in the home. The recruitment process was robust and ensured that only suitable people were employed to work with the people living in the home. Evidence: The staffing rota showed that there were enough staff on duty to meet the needs of the people living in the home. The training matrix showed that the majority of staff had attained NVQ level 2 or 3 training. This ensured that there were sufficient staff on duty with the appropriate skills and knowledge to meet the needs of the people living in the home. We spoke to some staff during the inspection and this showed that the people living in the home were assisted to make choices. The four staff files we looked at showed that the appropriate checks had been made before people were employed in the home. The recruitment procedure needed to be made more robust by ensuring that at least one reference is from the last employer so that the applicants current competencies are commented on. Staff should have a development plan in place indicating how they are going to Care Homes for Older People Page 24 of 32 Evidence: enhance their skills. This could be discussed at individual supervision sessions which should be taking place a minimum 6 times in any 12 month period. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people living in the home do not receive a consistently improving service and the quality assurance systems in the home are not fully developed to ensure that this happens. Evidence: The registered manager has many years experience of managing a care home and has been managing this home for some time. The home has found it difficult to maintain a consistent and sustained level of improvement of the quality of care provided in the home and improvements are generally based on requirements made through the inspection programme. Issues such as the poor management of medicines and infection control practices are raised in inspection reports on a regular basis and although improvements are generally made they are not maintained or sustained on a long term basis. Care Homes for Older People Page 26 of 32 Evidence: Since the last inspection the quality assurance system has improved in that many more audits are being carried out. It is not always possible to evidence where the information has been gathered from as it is not recorded eg views of the people living in the home on the services being provided. Although audits of medications were being carried out the pharmacist inspector found that there some people were not always receiving their medicines as prescribed. We were told that the home felt that people were happy with the choices and food available in the home however, we were told that this was not always the case. This has been an ongoing issue within the home. We were told that a report was to be prepared to include the results of the audits and the action plans to be put in place to improve the service. The AQAA we received indicated that the home has not been able to increase overall occupancy levels in the home and therefore the investment in the home has been curtailed but that the service has not suffered as a result. An outside agency visits the home on a regular basis and advises them on how they are meeting the standards. We looked at the supervision levels of staff and found that they were not meeting the required standards of 6 sessions a year. The records of the supervision sessions we saw were brief indicating that these could be improved to include reviews of policies and practices within the home. We looked at the records of monies held within in the home for the people living in the home and found them to be satisfactory. We found that the equipment in the home was safe and well maintained ensuring that the staff and people living in the home were safe from harm. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All medication dose regimes 17/04/2010 must be clearly written on the medicine chart, checked by a second member of staff for accuracy. This is to ensure that the staff have clear directions to follow. The medicine chart must 17/04/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 2 9 13 Care Homes for Older People Page 29 of 32 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 3 26 13 Practices in the home should 30/04/2010 follow good infection control policies. This will ensure that that cross infection is minimised. 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 4 The reasons as to whether and individuals needs can or cannot be met at the home should be recorded. This would enable individuals to understand how the decision to offer a place or not has been made. Management plans should be in place for all risks identified. This will ensure that the people living in the home and staff are safeguarded. People should receive their care as identified in their care plans. This will ensure that person centered care is provided. Peoples dignity and choices should be promoted in areas of life. The social and emotional needs of people living in the home should be planned for on an individual basis. This will ensure that people live meaningful and fulifilled lives. Systems should be put in place to ensure that people are given the choices available on the menus and to gather feedback on the choices available. This will enable people living in the home to input into the development of the menus. All comments about the quality of the service should be recorded and acted on where needed. All areas of the home should be kept in a good state of repair and decoration. This will ensure that the environment is homely and well maintained. 2 7 3 7 4 5 10 12 6 15 7 8 16 19 Care Homes for Older People Page 30 of 32 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 9 19 A plan for the cleaning and replacement of furniture and furnishings should be in place to ensure that the replacement of items is planned. The garden area should be tidied and developed to make it more attractive to use. All areas of the home should be adequately heated to meet the needs of the people living in the home. All areas of the home should be maintained odour free and clean. This will ensure that the environment is fresh and clean. A development plan should be in place to ensure that staff continue to remain up to date with current good practice developments. A report and action plan based on the findings of the quality assurance system should be made available to people with an interest in the home. This will ensure that people can see that issues are identfied and improved as required. Staff should receive the required supervision to ensure that they are working in line with current good practices. 10 11 12 20 25 26 13 30 14 33 15 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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). 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