Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright
Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home
Name of care home: Address: Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ 08453455746 01451861179 gillian.hughes@blanchworth.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Sally Anne Manby Roberts,Mr Jeremy Walsh care home 60 Number of places (if applicable): Under 65 Over 65 60 dementia Additional conditions: 0 Temporary variation to client categories OP (Old Age) for 1 (one) named service user. The Home will revert to the original client categories when this service user no longer resides at the home. To accommodate one named service user under 65 years of age with Dementia Date of last inspection Brief description of the care home Northleach Court is situated close to the centre of Northleach, which is about 12 miles from Cheltenham and 10 miles from Cirencester. The Home is a registered Care Home with nursing and has 60 beds with a category of dementia care for predominately older people. Accommodation is on two floors; on the ground floor there are a number of communal rooms including a conservatory, dining areas and lounges. The home has grounds comprising of a number of enclosed courtyard areas and small lawns. People are able to ask the home for a copy of their Statement of Purpose and Service Users Guide. The fee ranges for this service are 502.50 pounds to 750 pounds per week. The home Care Homes for Older People
Page 4 of 32 Brief description of the care home can provide information to people about the Funded Nursing Care Contribution (FNC) and how they manage this payment. 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 inspection was carried out by two inspectors over two days in March 2009. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service and the staff. We received one back from a person who uses the service. The results from this have been used in the report. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection. However it was not returned on time and we had to send a further letter requesting it. We found that parts of the AQAA were very detailed and contained information about how the service is meeting the needs of people and areas they wish to improve on. Some of the DataSet information however was incorrect and did not relate to this service. We looked at other information we have received from or about the service Care Homes for Older People
Page 6 of 32 from other stakeholders. This includes where the home notifies us of any incidents that affect the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision, recruitment and training, complaints, medication and maintenance records. Since the last inspection the home has had two managers in post. An acting manager is now running the home whilst the Registered Provider recruits a new manager. What the care home does well: What has improved since the last inspection? What they could do better: The home does have systems in place to make sure peoples needs are assessed prior to admission, however we were concerned that one person was admitted to the home due to their ongoing medical condition. We could not discuss the admission of this person as the manager who admitted this person has left the home. The service must make sure that people are having their needs met as directed in their care plans. We observed that two people had not been toileted or had their position changed for the majority of the day which is not acceptable. Care plans for medication prescribed as when required need to contain more detail Care Homes for Older People Page 8 of 32 about how and when it should be used. A number of environmental issues were identified during the inspection as Northleach Court is not a purpose built care home. The home has had three managers in the last three years and one who left in a short period of time. This has prevented the service from improving as staff and people who use the service need the stability of a competent manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a system in place to make sure that prospective people are assessed prior to admission to ensure their needs can be met. However despite available information some people have been admitted to the home whose needs cannot be met within this environment. Evidence: The pre admission assessments of two people who have been admitted to the home since the last inspection were examined. In both cases Social Workers were involved in their care. The previous home manager had undertaken an assessment of their needs prior to their admissions and had obtained copies of other assessments completed by health or social care professionals. We had concerns about the admission of one of these people to the service and whether this home was the right environment to meet their needs. We were not able
Care Homes for Older People Page 11 of 32 Evidence: to discuss the admission process of this person, as the manager that completed this assessment has left the home. The family of one of these people knew about the home and they had contacted the home regarding possible admission. 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. The health and personal care that the majority of people receive is based on their individual needs. However a review of the staffing arrangements will help to make sure that all peoples needs are met. The principles of respect, dignity and privacy are put into practice the majority of the time. Evidence: We looked in detail at the care of two people who use the service. This included examining care records, speaking to the person if able, speaking to staff and observing this person and any interactions between them and the staff. Several other peoples care records were also examined to look at specific information. Since the last key inspection the Registered Provider has reviewed and updated their care planning format and both people had their care records transfered onto this format. Both people had detailed care plans in place for all assessed needs. Care plans are linked with other care plans and with risk assessments which is good practice. Ongoing reviews were in place. One person was found to have some conflicting information about how often staff should be monitoring their whereabouts, however their care needs had
Care Homes for Older People Page 13 of 32 Evidence: changed very recently and therefore the documentation was due to be updated. Staff need to be mindful about when more than one care plan mentions an assessed need, as they must all state the same instructions. The other person had detailed care plans and risk assessments in place, however some of the instructions for staff were not always taking place for example, the risk assessment for eating and drinking said to use a fluid and food intake record but when staff were asked to show us this form they said this person was not on one. It also mentions half hourly snacks when wandering but it appeared that not all staff were aware of this. This person was found to be losing weight but staff had identified this on the evaluation of the care plan. Consideration should be given to the terminology used in care plans as words like adequate and regular are not descriptive enough and staff need clear directions to follow. We also found statements in care plans that were not descriptive enough for example, ensure stair safety. This does not tell staff exactly what they would have to do or observe for. One person was observed to be sat in a specialist chair but they appeared to be sliding out of it and their ankles were resting on the footplate causing redness. This was relayed to one of the Representatives of the Registered Provider who was present at the inspection. Fluid and food charts and continence charts were examined. It was found that there were inconsistencies with completing these and a large number of these had limited entries. It is very important that these are completed especially for people who are deemed to be nutritionally at risk and to monitor when people are taken to the toilet. Two people who were sat in one of the communal lounges had only one entry on their continence charts for the morning to state they had been taken to the toilet, when we looked at them early evening. We asked the staff on duty with one of the Representatives from the Registered Provider if they had assisted these two people to the toilet. None of the staff were able to say they had done it; therefore we can conclude that these two people had not been toileted or moved for the majority of the day. This is poor practice. The Representative from the Registered Provider said they were going to discuss allocating staff to make sure this does not happen again. During the tour of the environment we observed one member of staff about to assist one person to have a drink. At this point the person was led on their side we reported this to the Representative from the Registered Provider and they said the member of staff had pressed the call bell for help from other staff. A Representative from the Registered Provider has recently audited all the accident records and from this some peoples care plans and risk assessments have been
Care Homes for Older People Page 14 of 32 Evidence: amended. A random inspection with the Health and Safety Executive took place last October where we looked at the systems the home has in place for the management of bed rails. At this inspection a Representative from the Registered Provider said they have no bed rails in use the present time and people who are assessed as being at risk of falling out of bed have crash mats in place. This is good practice. During the tour of the environment two alternating pressure relieving mattresses were checked to make sure they were set at the correct weight setting for each person. We found that both mattresses were set at incorrect settings for both peoples weight. This was reported to one of the Representatives for the Registered Provider. They said a form is in place to make sure the alternating pressure relieving mattresses are set to the correct weight setting, however they were not on this occasion. It is important that these mattresses are set to the correct weight settings as per the manufactures instructions to prevent people from being place at risk of damage to their skin. During the inspection we observed staff having to manage one person with challenging behavior, we felt they managed one particular incident that we observed very well especially as the person was lashing out at them. They quickly moved away from the situation but made sure the person was safe until the situation was calm. This is excellent practice. People who use the service have access to external health and social care professionals to include GP, Community Psychiatric Nurse (CPN), Psychiatrists, Dietitians and Social Workers. Records are maintained of these visits. We received a survey back from a person who uses the service and we asked them do you receive the care and support you need and they had replied sometimes. We also asked them if they received the medical support they need and they replied usually. We spoke to a number of relatives and they were happy with the level of care their relative was receiving. We also had feedback prior to the inspection from one relative who was not happy with the level of care their relative received. Some of the medication systems used by the staff in the home were examined. Only qualified nurses administer medication. Due to the medical condition of people who use the service they would be unable to self medicate safely and at the time of this inspection staff were administering all peoples medication. We observe staff administering medication safely and making sure that the medication trolley was secure during administration. We did find during a tour of the home a tablet on the
Care Homes for Older People Page 15 of 32 Evidence: floor in room 6 and this was given to the staff. Staff administering medication need to make sure that people have taken their medication. We looked at a number of Medication Administration Records (MAR) especially those of people who had their care examined in detail. One of these people was prescribed a medication that was written up as twice a day and as required. Times had been added to the MAR by the Pharmacy of 8am and 6pm and it appeared that this medication was being given on a frequent basis at these times. When we asked how the staff had decided on the timings, we were told that the staff in the home would have informed the pharmacy but no evidence could be found that this had been done. As this medication was prescribed to be taken as required a care plan was in place but it didnt mention this medication specifically and there was not enough instructions on when to use this medication and how the staff came to decide on the timings. A new system was being introduced during the inspection to monitor wound dressings to make sure they did not run out. One person was having covert medication, this is where medication is concealed in food or drink and the best interest decision had been documented and the home had obtained the consent of the family and GP, although the GP had not signed the documentation. Another person was having medication in a patch form and the staff were completing a record to make sure they were not being put in the same place, which is good practice. A medication reference book was seen in the nurses office. A temperature gauge is on the medication fridge to monitor the temperature. We observed staff treating people with respect during the inspection and they spoke to people in a kind way. Prior to the inspection we received feedback from a visitor to the home who felt that the staff did not respect peoples belongings as they were upset to find their relatives clothing that had been returned from the laundry in a heap on the bed in their room. This relative also expressed concerns about the appearance of their relative, as their clothing was untidy and their shoe laces were not done up. We spoke to a number of visitors and asked them if they were happy with the appearance of their relative they all said yes. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make some decisions about their daily life but this is dependent on their needs. A selection of social and recreational activities are provided to meet peoples choices, abilities and needs. Evidence: We looked at the arrangements the service had in place to provide people with activities. The activities coordinator works Monday to Friday but they were off sick on the second day of the inspection. A poster is displayed each week listing what activities are taking place. Group and one to one sessions take place. The activities record listed a number sessions that have taken place recently and these include Church Services, haggis tasting, visits from the local school children and quizzes. An external entertainer visited prior to the inspection to provide music and movement for people. We observed some one to one activities taking place on one of the days of the inspection. The Registered Provider has plans to increase the activities hours which is excellent due to the number and medical condition of people who use the service. We saw photographs of a birthday party for one person who was 100 years old and the email from this persons relatives thanking the home for the party. Care Homes for Older People Page 17 of 32 Evidence: We spoke to a number of visitors to the home and they all confirmed that no restrictions are placed on when they can visit. During the tour of the home we saw in a number of rooms belonging to people who use the service their personal possessions on display. Due to the medical condition of the people who use the service they are not able to manage their own finances. We observed staff assisting people to make choices for example when offering people drinks staff gave people a choice. We observed one person telling the staff they did not want the meal they were given and they were offered something else. The records for meal provision showed that alternatives are offered to people but we were unsure if this is done on peoples likes and dislikes or if the staff offer people a choice of meals. We observed a mealtime in one of the communal rooms, whilst on the whole the staff were very attentive some people had to wait longer than others for their meal and drinks and one person became distressed that other people were eating and not them. We observed that some people were sat with food in front of them for a while and were not always offered any help and one person had difficulty eating part of their meal but this was not picked up by staff. In this room a large number of people require assistance from staff and a review of the staffing arrangements should be considered to address this. We visited the kitchen and spoke to the cook. We saw evidence of health and safety checks being undertaken. Records are in place for alternatives to the menu. The cook was able to tell us that she was aware of people who required pureed diets and peoples nutritional assessments scores. Milkshakes that are high in calories and protein are offered to people as well as fruit. At the last inspection snacks were seen in the communal areas but we did not see any at this inspection and this was fed back to the Representatives from the Registered Provider. The cook said that she has seen some people eating bags of crisps. The kitchen has been awarded 4 stars from the local Environmental Health Department (EHO) which is excellent. We did observe many people enjoying the meals provided. In the survey we had returned to us we asked do you like the meals at the home and they had replied sometimes. We observed that people who spend all day in their rooms did have jugs of drink for staff to assist them with. Since the last inspection two hot trolleys have been purchased to help maintain the food temperature. Care Homes for Older People Page 18 of 32 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their Representatives have access to a complaints procedure so they can voice any concerns. Improvements are planned to existing safeguarding systems and these will continue to help safeguard people from possible risk of harm or abuse. Evidence: We looked at the systems the service has in place to manage complaints. At the time of the inspection no complaints had been received for 2009. One complaint was received in June 2008 and we examined the records for this. An acknowledgment letter was sent to the complainant and a final response was sent in August 2008. Therefore the response was longer that the 28 days as required by the Care Home Regulations 2001. The homes Annual Quality Assurance Assessment (AQAA) was received after the inspection and it stated they had received 2 complaints. We only saw records for one complaint and the AQAA also states both complaints were responded to in the 28 day time scale. The service is aware that records of all complaints must be stored at the home. We received one concern since the last inspection regarding the care of one person. They did not want to make a formal complaint but wanted us to know of their concerns. A copy of the homes complaint procedure is displayed on the notice board by the main entrance. The homes AQAA says that in the last 12 months they have changed their complaints procedure and now the Manager respond to any complaints directly and not the Registered Provider.
Care Homes for Older People Page 19 of 32 Evidence: The AQAA also lists the plans the service has to improve their complaints system in the next 12 months by reviewing its procedure to make it more user friendly. In the survey we received we asked people if they knew who to speak to if they were unhappy and they said sometimes. We also asked them if they knew how to make a complaint and they said no. The Registered Provider has procedures and policies in place in relation to the protection of vulnerable people from abuse. Staff have access to a whistle blowing policy as well. As part of the induction programme staff receive in-house training in challenging behaviour and about abuse. Some staff have attend the local County Council training for the protection of vulnerable peoples called the Alerters guide training and the AQAA states they plan to continue to send all staff on this. Another plan is to send the manager on the Enhanced training. Some members of staff spoken with confirmed they have attended the Alerters guide training.They also confirmed that if they had any concerns or suspicions that a person was being subjected to abuse they would report it immediately to the acting manager. Regarding the plans for Mental Capacity Act 2005 and Deprivations of Liberty guidance a Representative from the Registered Provider said they have plans to send staff on the training provided by the local County Council. The AQAA states that from April 2009 they plan to introduce a Deprivation of Liberty screening tool for people who use the service and a policy and procedure for staff. Recently two people who used the service were referred to the Adult Protection Unit at the local County Council due to concerns regarding the management of their medical condition. Both have been fully investigated and both cases have been closed. Care Homes for Older People Page 20 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 physical design of this home is not purpose built but with the continued ongoing improvements this will help to make sure people live in a clean and pleasant environment. Evidence: Northleach Court is not a purpose built care home and due to the age of the building it requires continuous maintenance and ongoing redecoration. Some new floorings and repainting of a number of areas of the home have taken place since the last inspection. We toured the environment with a Representative from the Registered Provider and we viewed the majority of rooms belonging to people who use the service. We identified a number of issues and our feedback in relation to the environment was; Room 6 the quilt was very thin, the bed was not made properly and the bedding was very creased. The lamp shade was torn and battered looking. Room 5 felt cold but it appeared that the thermostat on the radiator had been turned down and once it was adjusted the room warmed up. Room 47 the window was very drafty but the room did feel warm as the radiator was turned up to maximum. Room 48 was cold as the valve on the radiator was stuck and this was repaired during the inspection. The electric socket had been pushed into the wall and this was reported
Care Homes for Older People Page 21 of 32 Evidence: to the maintenance team who were at the home. Room 52 was very cold and it was found that one of the windows would not close and the other window frame was rotten. It was found that an aerosol nozzle was stopping the window from shutting and this was removed and the room started to warm up. Room 51 was cold and dark as the curtains were closed. On opening them we found that top pane of glass was missing and a board was in place that had tissues around it to stop the drafts. A new pane of glass needs to be fitted as soon a possible but the drafts were addressed during the inspection. Dried excrement was found on the armchair in this room. Room 50 no handle on the window. Room 43 the armchair did not have a cushion on the base. Room 27 strong odour. Room 32 is a shared room but the bed not being used had a stained divan base. Room 31 The floor covering in places was coming away from the floor in the en suite. Room 29 is also a shared room but the privacy curtain only reached half the room and must be changed to make sure peoples privacy and dignity are maintained. One window had a handle missing. Room 16 the window sill was rotten. One persons room was flooded by the room above and a dehumidifier was in place. Plans to redecorate this room following the inspection were seen. The dining room in the garden room was not being used during the inspection and when we asked staff they said it was because it was cold. A number of boxes containing incontinence pads was also being stored in this room and a chair and box was in front of the fire escape. This was relayed to a Representatives from the Registered Provider. We also noticed that earlier in the day a fire escape route opposite the downstairs shower room was blocked but we did observed that the obstruction was moved later in the day. During the tour of the home we noticed that a number of crash mats were soiled and one of the Representatives asked for them to be cleaned. Changes have been made to the garden outside the garden lounge as raised flower beds have been put for people to use. The laundry area was inspected and a number of bags of linen were waiting to be washed. A system is in place to manage soiled linen. We did observe the laundry assistant using the iron press on damp towels. Staff have access to protective clothing to include gloves and aprons and we observed staff using them when required. Care Homes for Older People Page 22 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. The care home is confident that the staff are skilled and in sufficient numbers to meet the needs of people who use the service. Evidence: The duty rotas were examined and discussed with the deputy manager, she was confident that the number of staff on duty were meeting the needs of people who use the service. Ancillary staff are available to assist the care staff. At the time of the inspection the home was using long term agency staff. One person was receiving one to one care. Staff spoken with said they enjoy working at the home. In the survey we received back from a person who uses the service, we asked them if the staff listen and act on what they say and they replied no. We also asked are staff available when you need them and they said sometimes. We spoke to a number of relatives and they praised the staff for their hard work. A Representative from the Registered Provider provided us with the number of staff that have an NVQ 2 or above in health and social care and the number of staff that are undertaking this qualification. The home exceeds the recommended 50 of care staff with this qualification which is excellent. The recruitment files of two staff recruited since the last inspection were examined on
Care Homes for Older People Page 23 of 32 Evidence: the homes computer system. Both members of staff had the required recruitment checks in place except one member of staff did not have a full employment history. A Representative from the Registered Provider said that this has been mentioned in a recent managers meeting. Both members of staff had full Criminal Records Bureau disclosures (CRB) in place prior to starting work at the home. A Representative from the Registered Provider said that no changes have been made to the induction programme since the last key inspection but they have plans to review this. Each member of staff receives a booklet and attends several in house awareness training sessions. Since the last inspection the homes manager must now arrange training for staff both in house and with external training agencies. A training matrix is in place and an ongoing training programme includes both mandatory subjects and other training to include dementia, bed rails, medication (for qualified nurses) and end of life care. Training specific for qualified nurses includes first aider training which the care staff receive an awareness training, venepuncture and syringe driver. The Care Home Support team are also providing some training for all staff. Staff spoken with confirmed they have access to training and several told us about the courses and training they have recently undertaken. The AQAA dataset information said that no staff have done training in malnutrition and only 2 staff have done infection control training. Following the inspection the Registered Provider said that 1 member of staff have compelted training in malnutrition and 14 staff have undertaken training in infection control. Care Homes for Older People Page 24 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. The management and administration of the home is not always run in the best interest of people who use the service as there is a lack of a consistent manager. Evidence: Since the last key inspection in March 2008 the home has had 2 managers in post. One manager did apply to us to be considered for registration but withdraw her application and left the home. The current deputy manager is also leaving. At the time of the inspection an acting manager was in post who has previously worked at Northleach Court. To be able to improve the care people receive and maintain this the home needs a permanent manager in post. The Registered Provider must now appoint another manager and that person must apply to us to be considered for registration. The Annual Quality Assurance Assessment (AQAA) was not received on time and we had to send a further letter requesting it. The information provided about the outcome areas for people who use the service was very detailed. However the Dataset
Care Homes for Older People Page 25 of 32 Evidence: information appeared to be incorrect for example when we asked how many people have a diagnosis of dementia they had put none, but the home is registered to care for people with dementia. They had also put that only one person required assistance to go to the toilet but we found this was not the case. We also asked for other numerical information, but we found they were not always correct when we compared them to the numbers of people who were using the service at the time the AQAA was completed. The home has a number of quality assurance systems in place to include audits done by the Registered Provider. As the acting manager has only been at the home for a short period of time she has not undertaken many audits. Templates are in place for the acting manager to complete audits examples being peoples rooms, daily care plan checks and where personal care charts are randomly selected and checked that people are receiving mouth care. Regulation 26 visits are taking place and these are where the Registered Provider or a Representative on their behalf visits the home and conducts unannounced visit and completes a report. These reports must continue to be sent to us on a monthly basis. The Registered Provider sends out questionnaires on a yearly basis and this was last done in June 2008. The AQAA states that meetings for people take place and we saw minutes of staff meetings. The Registered Provider is working on Equality and Diversity policies for their services. The home has a system in place to manage peoples monies. The amounts of monies matched the records however the recording of what peoples monies are being spent on needs to be more specific. For safety reasons two members of staff should always sign and date any entries on these records. We looked at the records for staff supervision. Not all care staff are receiving the recommended six sessions per year and some staff had not had a supervision session this year. Supervision sessions for ancillary staff are taking place. We did see records of a group supervision session which took place in January 2009. Records were examined for ongoing maintenance and servicing of equipment used in the home. The AQAA states that portable appliance testing was last done in January 2008, a lift service was December 2006 and heating and gas checks in July 2007. Following the inspection the Registered Provider was able to provide us with up to information regarding checks on the above equipment and services. Records for fire equipment checks were all in place. A number of false fire alarm trigger records were seen and the names of staff who attend these are documented and these are recorded as fire training. Monthly water temperature checks are in place and all hot water outlets are regulated except for the kitchen.
Care Homes for Older People Page 26 of 32 Evidence: The arrangements the home has in place for managing the risk of Legionella were examined at the random inspection in October 2008 by the Health and Safety Executive. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8&9 The home must appoint a 01/09/2008 suitably qualified and competent person to manage the home and apply to us to be considered for registration. This will help to make sure that the home is run in the best interests of the people who use the service. This requirement remains outstanding since the last inspection. 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 7 15 The registered person must 01/06/2009 make sure that if a persons care plan requires fluid and food charts to be maintained to monitor their wellbeing, that these are completed. This will help the staff to monitor peoples food and fluid intake especially if they are deemed as being nutritionally at risk. 2 7 12 The registered person must make sure that people who use the service have their needs met as detailed in their care plans. This relates to people being taken to the toilet and having their position changed. This will help to make sure that people are having their needs met and are not being put at unnecessary risk. 01/06/2009 Care Homes for Older People Page 29 of 32 3 8 13 The registered person must make sure that pressure relieving mattresses are set at the correct level for each person. This will help to prevent people from being put at unnecessary risk 15/06/2009 4 9 13 The registered person must make sure that people who need as required or PRN medication have a care plan in place that provides staff with clear instruction for its use. This will help to make sure people receive the correct levels of medication according to their needs. 30/06/2009 5 31 8 The registered person must appoint a suitably qualified and competent person to mange this home. This will help to make sure that the service is run in the best interests of people who use the service. 31/08/2009 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 15 Due to the large number of people who require assistance with eating and drinking a review of the staffing and mealtime arrangements should be considered. This will help to make sure people are not left with food in front of them to go cold and all people are offered assistance who need it. Care Homes for Older People Page 30 of 32 2 18 The service should make sure that all staff continue with the Alerters guide, Mental Capacity Act and Deprivation of Liberty training. The home needs to review the system they have in place for the recording of peoples monies and any transactions to make it more transparent. 3 35 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!