Inspection on 16/03/09 for Oldbury Grange Nursing Home

This inspection was carried out on 16th March 2009.

CSCI 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

Oldbury Grange Nursing Home 12/02/08

Oldbury Grange Nursing Home 29/06/07

Oldbury Grange Nursing Home 26/02/07

Oldbury Grange Nursing Home 07/12/05

Oldbury Grange Nursing Home 23/06/05

Oldbury Grange Nursing Home 27/01/05

Oldbury Grange Nursing Home 06/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oldbury Grange Nursing Home Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ     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: Yvette Delaney     Date: 1 6 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 30 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 30 Information about the care home Name of care home: Address: Oldbury Grange Nursing Home Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ 02476398889 02476398881 shroprivatecare@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr B Sidhu,Mrs C Sidhu Name of registered manager (if applicable) Charan Kanwal Sidhu Type of registration: Number of places registered: 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: 44 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 44 Date of last inspection Brief description of the care home Oldbury Grange Nursing Home is situated in the Warwickshire countryside a short distance from Hartshill. Dr and Mrs Sidhu currently own the home. The home is registered to provide nursing care for 44 elderly people. The accommodation is purpose built with service user accommodation provided on two floors. Access to each floor is possible via passenger lift or stairs. Garden and patio areas are easily accessible to service users, including those that use wheelchairs. The accommodation Care Homes for Older People Page 4 of 30 care home 44 Over 65 44 0 Brief description of the care home provides excellent views over the local countryside. At the time of the inspection the fees charged range from 460.00 - 500.00 pounds per week and payable usually in advance by either cheque, direct debit or standing order. The fees do not include newspapers, toiletries, and the services of a chiropodist, dentist, optician or hairdresser. Care Homes for Older People Page 5 of 30 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: The quality rating for this home is 1 Star; this means that the home overall provides adequate outcomes for the people who use the service. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. The manager for the care home was asked to complete and return an Annual Quality Assurance Assessment (AQAA). The assessment requests further information related to the quality of the service provided by the agency. The AQAA contained limited information about the services provided by the home. As far as possible some of the information has been used in assessing actions taken by the home to meet the care standards. Care Homes for Older People Page 6 of 30 The focus upon outcomes and the information contained in the AQAA provides information, which considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The inspection focused on checking that systems and procedures are in place. Information was gathered from reviewing two staff files and a range of policies and procedures. Discussions with the Manager, Deputy Manager, nurses and care staff helped to inform this report. Five residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health, and safety were examined. Conversations were held with a number of residents who were able to make active contributions during the inspection visit. Information in this report is also gained from observing interaction between residents, residents and staff and visitors to the home. The manager was asked to give questionnaires to residents and relatives including those followed through the case tracking process and their relatives. Case tracking involves looking at peoples care plans and health records and checking how their needs are met in practice. Five members of staff were also asked to complete questionnaires. Five questionnaires were returned by residents, four from relatives and a member of staff returned their questionnaire. The inspection included meeting some of the people living at the home, including the five people whose care was being examined. Discussions took place with residents, their family plus care staff and managers for the service. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Residents and relatives expressed a number of concerns in respect of the areas where they felt the home could do better. Their concerns varied and relate to poor staffing levels, cleanliness of the home and standards of care. They told us, I feel they could do with more carers. Cleaning More staff on duty to spend more time with clients instead of clients having to wait. Often there is a strong smell of urine and faeces in the lounge. I think that could be improved, perhaps by fitting an extractor fan. Also the downstairs lounge French door is very difficult to open. This could be fatal in case of a fire! The door is in need of repair and should be treated as urgent. Hygiene could be better. Room needs to be cleaned more often. Fresh water not always supplied. Do not respond when call button is used. Care Homes for Older People Page 8 of 30 Other areas of concern that relatives and residents discussed with us, some through responses in their questionnaires are written into this report. Requirements we have made at this inspection include: The home must make sure that they are able to promote and make proper provision to meet and maintain the individual personal care needs of people. This will help to promote the health and welfare of people living in the home. The home must make sure that controlled drug records are accurately and legibly maintained at all times. This will help to make sure that drugs are accurate, safe and appropriately managed and stored in the home. Eye drops should be dated when they are opened to make sure that they are used within 28 days of opening. This will make sure that the eye drops are active and their stability maintained. The home must make sure that they are able to treat people with dignity and respect by meeting their individual care needs in a timely manner. The home must be able to demonstrate that they have sufficient staff on each shift. This will make sure that residents have their care needs met consistently and in a timely manner. 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 30 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 30 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. Information in the Statement of Purpose needs to be updated to ensure people are given current information. People receive a comprehensive assessment of their care needs to make sure they can be met before admission to the home. Evidence: Copies of the Statement of Purpose and Service User Guide were seen and copies taken to read following the inspection visit. Both documents are available to people living in the home. We were told that they had been reviewed and updated. Reading the Service User Guide showed that the information had been updated. However, the Statement of Purpose shows that it needs further review so that it gives people who use the home current information. For example the document still refers to The National Care Standards Commission. Relatives and residents spoken with said that they were well informed when making a choice about moving into Oldbury Grange Nursing Home. One relative said that Information arrived after move to care home Care Homes for Older People Page 11 of 30 Evidence: had taken place. Three residents care files were chosen for closer examination and to support the case tracking process. Care files were chosen for three of the most recent people admitted to the home. All residents had been assessed before admission to the home. This will help to make sure that the home is able to meet their needs. Care files showed that residents referred by Social Services had a Care Management Assessment and the Primary Care Trust assess the needs of people requiring nursing care. Information considered in the assessment of people considering using the home includes previous and current medical history, social and health care needs. Other information available includes the persons next of kin, GP and advocacy arrangements. A relative visiting their family told us that a member of staff from the home visited them in the hospital. At this visit they were asked questions about their health and information gathered about what would be needed to help the home meet their relatives needs. This relative and other members of their family said that they visited the home before making the decision to move in. Two other residents also told us that they had a visit from staff and were asked a number of questions before they moved into the home. The availability of this information should ensure that the specific care needs of each person would be identified and be used to complete a plan of care. Care Homes for Older People Page 12 of 30 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 show improvement and should provide staff with clear guidance on meeting residents care needs when completed. Planning and changes in residents care needs are not always shared or discussed with their representative. Improvements are needed to make sure controlled drugs are safely stored and managed. Evidence: It was pleasing to note at this inspection visit that people living in the home looked better cared for. At previous visits residents would be seen to have dirty mouths, finger nails, and their clothing in need of changing due mainly to spillage of food. Five residents, which include residents seen and spoken to at previous visits, had clean mouths and hands. However concerns were raised by residents and relatives in their questionnaires. Responses made told us that Sometimes personal hygiene could be a bit of a problem, hair not washed often. Residents and relatives told us that they felt that staff could meet some care needs better. Comments made in response to the question, do you receive the care and support you need? Include: Care Homes for Older People Page 13 of 30 Evidence: I think some needs could be met better such as change bed sheets, cleaning could be improved upon. (Sometimes found dirty sheets on bed.) I think it could improve, when my family are not with me I am left for long periods of time on my own where I could have been sick or wet. Following the last inspection nursing staff had started to review residents care plans. These were being organised to make sure they contained details to guide staff on the action they need to take to meet the care needs of people living in the home safely and appropriately. The home has started to implement new care plan documentation based on their local health and social services supportive care paperwork. However, a mix of the old care plan documentation was being used with the new paper work. The old documentation did not fit into the new system making care file documentation incomplete and difficult to follow the delivery of care. The care plans are linked to risk assessments. For example assessments for maintaining a safe environment for individual residents had been carried out. A detailed care plan telling staff how to meet a persons needs, care delivered is evaluated and staff write daily reports. Staff told us that the New style of care plan has improved individuality of care. Following our random visit in July care plans developed for caring for residents with compromised skin integrity showed that they had improved. Care plans contained statements made to advise staff on the action required to care for the residents include Nurse on airwave mattress and pressure relieving cushion (special equipment used to alleviate pressure on areas of the body when sitting or lying down). Observation of the residents showed that they were being nursed on an airwave mattress and a cushion was on the chair. Separate records are maintained for wound care and information was cross referenced in care plans making it easier to follow the care given. Photographs and diagrams were available to show how the wound was healing and progress made with the treatment. There are some inconsistencies in the risk assessment tools used to assess the level of risk to residents. The care files do not make it clear what risk assessment tool was in use as two different tools were being used. Staff told us that they are given a daily report on each person with any changes or special requirements at each change over of shift. This helps to keep staff up to date on changes in residents care. Each persons care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, Dietician, Optician, Chiropodist and Tissue Viability Nurse Specialist. Relatives said that they are usually kept up to date with any changes Care Homes for Older People Page 14 of 30 Evidence: in their relatives care. One relative said This is usually good verbally. Another relative said that they are not always kept up to date with important issues affecting their family member. They told us But not always sometimes when I notice bruises etc. I have to ask the staff as to what happened. But they usually tell me. It is good practice and important for the home to make sure that identified family members are kept up to date with any changes in their relatives well being. We examined the systems for the management of medicines in the home. A monitored dosage (blister packed) system is used. Medication is safely stored in locked trolleys, which are kept in a locked clinical room. A medicines fridge is available in the treatment room with daily recordings of the temperature, which were within recommended limits. The facility for storing controlled drugs (CD) is satisfactory. There is one CD cupboard to store CDs. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. However, clear and legible records were not always maintained, balances were not clearly written and different coloured inks were used to make entries. Nursing staff had undertaken daily audits of the contents of the CD cupboard. Maintaining accurate records helps to ensure that medicines are maintained to comply with legislation and protect people from the risk of potential medicine administration errors. An audit of the medication prescribed for people demonstrated that medicines had been administered as prescribed. Appropriate systems for the safe disposal of medicines are in place. Unused medicines are checked and returned to the pharmacy. Eye drops were not labelled with the date of opening to ensure that they were disposed of twenty eight days after they were opened. The stability and effective of the eye drops after this time cannot be guaranteed. The home manager advised us following the inspection that all eye drops are commenced on the day they are received into the home. This then fits into their 28 day medication cycle of receiving medicines into home and appropriate disposal of unused medicines. It would be good practice to label eyedrops with the date of opening to ensure that they are not used for more than 28 days. Care Homes for Older People Page 15 of 30 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. Open visiting arrangements encourage regular contact with relatives and friends and food is nutritious. Social and recreational activities do not meet the full needs of all residents. Evidence: The activities coordinator maintains a record of her daily interactions with people living in the home. This information is intended to show what activity the resident was involved in and their response. This would be good practice but the information was not very informative to demonstrate how the person responded, how much effort was given to make the activity stimulating and meaningful for the residents. Residents and relatives told us that residents Could be more stimulated. The activities coordinator continues to provide two hours in the morning between the hours of 9.00 and 11.00 am, four days per week, occasionally doing some additional time. This does not offer much flexibility for all residents as not all residents will be available to take part either because they have just been helped out of bed or just eaten their breakfast. This means that people could feel rushed and not so enthusiastic to take part. We did not observe any activities taking place at the time of our visit. Care Homes for Older People Page 16 of 30 Evidence: Staff said that the home could do better if they Provide more activities during the day. A resident said in their questionnaire that There are activities arranged but because of sight and hearing problems I am unable to join in. Care plans examined showed that information regarding peoples preferences for their daily routine had been documented, such as the time they like to get up in the morning and foods that they like eating. Posters were seen advertising planned outings for a mothers day tea and a pub meal or garden centre. Residents said that activities take place in the home and they have a choice whether they join in. On the day of the inspection, most residents were up sitting in the lounges. In the lounge on the ground floor of the home residents were either listening to music or the television. There was no obvious social interaction seen to take place between residents in this lounge. Relatives, friends and other visitors were seen visiting the home throughout the day. Staff told us that people are encouraged to visit and maintain contact and involvement in the care of their relative. People visiting told us that they are made to feel welcome. We observed the lunch time meal service in the dining room/lounge on the ground floor of the home. Residents were supported to sit around the dining tables. A two course meal was offered at lunch time. The main meal choices for the day were sausage, bolognaise and pasta, corn beef, which was served cold as this was how staff said residents liked it, with potatoes and carrots. Desert was bananas and custard, ice cream or yoghurt. Residents and relatives made positive comments about the food provided in the home. Residents said that the food in the home was Ok There was concern that there was not sufficient staff in the first floor lounge to observe and support residents during the lunch time. Two residents were calling out and a further two residents had eaten very little of their meal. Care Homes for Older People Page 17 of 30 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. People have access to the information they need to complain and know who to talk to if they have any concerns. However, complaints are not always handled objectively and in a sensitive manner. The adult protection procedure and staff awareness of the procedures reduces the risk of abuse. Evidence: A copy of the complaints procedure is displayed and a copy included in the Statement of Purpose. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. We have received three complaints about the home since our last Key inspection February 2008. Complaints received were related to the care of people with pressure sores, general care and not enough staff to meet residents care needs. As a result we carried out a random visit in July 2008. Our visit showed shortfalls in the way that the service manages people who are at risk of developing or have pressure sores. An immediate requirement was issued following this inspection visit. The registered manager/owner was asked to forward to us her plans for ensuring improvements in the management and care of residents identified with compromised skin integrity. At this inspection visit a designated nurse had started to review and update care plans on the management and treatment of people with or at risk of developing pressure sores. Care Homes for Older People Page 18 of 30 Evidence: Discussions with the manager, information in the AQAA and records examined confirmed that six complaints have been received by the home since the last inspection. Two of these complaints have been resolved to the satisfaction of the complainants and the remaining four are still being investigated. Residents and relatives told us I always go to the matron or manager if I have any issues. Other comments made in questionnaires include: Report to matron or care manager or report to CSCI. Everything we have asked has been seen to quite promptly. I have on file the names and addresses of the Commission for Social Care Inspection in Birmingham and the name of the Inspector to contact and phone no. My mother would tell the carers if something was not right. My mother would not be able to make a complaint but would tell me if something was wrong so that I could do something about it. A number of concerns were expressed by residents and relatives in their questionnaires. These raise questions as to whether complaints made by people who use the service are responded to promptly, sensitively and in an objective manner. In complaints received by us complainants have said that their complaints are sometimes not listened to and responded to appropriately. This does not make service users feel confident that their concerns will be taken seriously and dealt with appropriately by the home. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Training records examined indicates that protection of vulnerable adults training had been received by staff during the homes internal 2008/09 training programme. There have been no safeguarding incidents referred to the adult protection team for investigation. There was no evidence of abuse, verbal or otherwise seen on the day of inspection. Care and consideration by members of staff towards residents was evident at all times. Care Homes for Older People Page 19 of 30 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. Although improvements have been made to the environment, feedback from residents and relative show that standards in the home to provide a warm, clean, safe and homely environment are not consistently maintained. Evidence: Looking around the home during this inspection visit showed that improvements had been made to present a homely environment. The home looked clean at this visit. Bedrooms are located on the ground and first floor of the home. Residents with the support of their relatives have personalised their bedrooms with some of their own possessions. The bedrooms of the residents followed through the case tracking process were observed to be individual, homely and looked comfortable. Comments received from residents and relatives through conversation and in completed questionnaires said that better cleaning and housekeeping was needed. Some rooms in need of redecoration. A relative expressed their concern that: During the very cold parts of the winter the temperature was below what it should be for elderly people. The heating system has been almost non-existent during the Care Homes for Older People Page 20 of 30 Evidence: coldest parts of the winter and is in urgent need of repair and regular maintenance. The manager/owner told us that the heating had been fixed in the home, which should improve the temperature in all areas during cold periods. Lounges are available on both floors and there is a separate large dining room on the ground floor next to the kitchen. Residents were sitting in both lounges in suitable chairs and they looked comfortable. The home provides equipment necessary to assist residents to maintain their mobility and independent access around the home. Corridors in the home were not obstructed as noted at previous inspections and grab rails are positioned throughout the home. The laundry room was organised, clean and safe working practices were seen. Chemicals, namely washing products were appropriately stored and locked in cupboards. Care staff used appropriate procedures to dispose of soiled linen and clothing. In the laundry these items were washed in special bags that dissolve to prevent cross contamination and the spread of infection. The food fridge held a number of items that were appropriately covered. A cleaning schedule was looked at and records held showed they were signed by the kitchen staff to show cleaning tasks had been completed. Observations in the kitchen showed it was clean. Kitchen surfaces and equipment were clean. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are not always on duty to ensure the needs of people living in the home are met. Staff have received up to date training to make sure people are cared for by competent staff. Staff recruitment procedures have improved to support making sure people living in the home are protected from the risk of harm. Evidence: The home aims to provide two nurses and five carers on an early shift, two nurses and five carers on a late shift and one nurse and two carers on a night shift. There are dedicated staff to provide cooking, laundry and cleaning services to the home. An advocate for a resident told us that they had concerns about staffing levels in the home saying X (Resident) feels there is an issue with the number of staff available. Further comments were received from relatives and residents expressing their concerns about staffing levels in the home these include: One relative told us that staff need to Check on client more often when visitors not there. Sometimes during shift change the communal lounge is left unattended for up to 20 minutes, and some of the patients tend to start wandering about. I feel there should always be someone present. Care Homes for Older People Page 22 of 30 Evidence: When asked the question Are staff available when you need them? residents and relatives said that their care Could improve if had more staff on duty. We observed during the inspection that the first floor lounge was left unattended for periods during the lunch time. Training records show that 16 out of 30 care staff permanently employed in the home has a qualification in care at NVQ (National Vocational Qualification) level two or above. Information in the AQAA told us that a further six care staff are currently working towards the award. This means that 53 percent of care staff in the home are qualified at NVQ level two. Once all care staff have completed the course, the home will have 73 percent of care staff employed with an NVQ in care this should mean that people are cared for by competent staff. The personnel files of five recently recruited staff were examined. The files showed that they contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. Two references were obtained for all staff. However steps were not always taken to ensure that references were being requested from the most suitable person. Ensuring consistent and robust recruitment procedures are followed before staff start working in the home safeguard people living in the home from the risk of abuse. New staff have an induction period when they first start working in the home. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. The records showed that the level of training attended by staff had improved since the last inspection in February 2008. Staff spoken with said that they had attended fire training, moving and handling, cross infection. Mandatory training is supported by video training packs. Other training attended by staff includes palliative care, dementia, pressure ulcer prevention and PoVA. The cook for the home has completed a NVQ level 2 food processing and cooking course. Staff said that they are able to attend training courses relevant to their role. Care Homes for Older People Page 23 of 30 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 person who has the required experience and qualifications manages the home. Comments made show that the welfare and well being of people living in the home are not consistently protected to ensure they feel valued and respected. Evidence: The Registered Manager and a senior nurse were present at the inspection. The registered manager takes care of the administration side of the management of the home. She is supported in running the home by a care manager who is responsible for the care practices in the home and a deputy manager. There are clear lines of accountability within the home with the care manager and deputy manager reporting to the manager. Staff spoken with said that the management team are approachable. The manager told us in the AQAA for the home that questionnaires are sent out to residents. The feedback from questionnaires is collated; the registered manager told us that the information is used to support improvements in the home. Although copies Care Homes for Older People Page 24 of 30 Evidence: of completed questionnaires were seen by us, the information was not collated to produce a report or plan of action to show how peoples responses and concerns would be adressed. The number of concerns raised and written into this report suggests that the views of people who use the service are not always listened to so that they are consistently promoted and incorporated into the running of the home. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of the personal monies of residents followed through the case tracking process were was checked and found to be correct. Information sent to us in the AQAA tells us that equipment used in the home is serviced or tested as recommended. For example, annual checks had been carried out on hoists and electrical appliances. A fire risk assessment and checking of fire equipment was made in. The fire alarm is tested weekly. Health and safety concerns identified at previous inspections had been addressed for example; staff were seen to use appropriate moving and handling techniques. Wheelchairs seen had appropriate foot plates fitted. Chemical based products are being stored safely and staff have received COSHH (Control of Substances Hazardous to Health) training. This training covers the safe storage, risk assessments and safe handling of chemicals such as cleaning products used in the home. Moving and handling practices were seen to have improved. Corridors in the home were free from obstruction and fire doors were not blocked. Alarms were fitted to fire doors so that staff were aware when one had been opened and could investigate. Magnetic door closures have been fitted to bedroom doors. These are linked to the fire alarm system. Fitting the door closures lets residents keep their door open safely as they will automatically close in the event of a fire. At our last visit to the home a number of residents were seen with small tables in front of them, which restricts their movement it was the same at this inspection. In response to our last visit when this was seen the owner/manager asked relatives and obtained signed permission to continue using the tables in this way. There was no information to show what discussion had taken place or that a risk assessment had been carried out. Care Homes for Older People Page 25 of 30 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 26 of 30 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 8 12 The home must make sure that they are able to promote and make proper provision to meet and maintain the individual personal care needs of people. This will help to promote the health and welfare of people living in the home. 30/05/2009 2 9 13 The home must make sure that controlled drug records are accurately and legibly maintained at all times. This will help to make sure that drugs are accurate, safe and appropriately managed and stored in the home. 30/05/2009 3 10 12 The home must make sure that they are able to treat people with dignity and respect by meeting their individual care needs in a timely manner. 30/05/2009 Care Homes for Older People Page 27 of 30 This will make sure the care needs of people living in the home are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be updated and available in alternative formats. This will ensure prospective residents have current information to enable them to make an informed decision about using the home. The home should make sure that a residents family or representative are kept informed of any changes in their health and well being. Eye drops must be dated when they are opened to make sure that they are used within 28 days of opening. This will make sure that the eye drops are active and their stability maintained. The time allocated to support activities in the home should be reviewed to ensure that all residents in the home can benefit from appropriate social, mental and physical stimulation. The home should make sure that all complaints are managed appropriately in line with their complaint procedure. This will make sure that residents know that their complaints will be taken seriously and investigated by the home. The heating in the home should always be working and maintained at a temperature which is appropriate for the time of the year and suitable to the needs of people living in the home. A good standard of cleanliness should be maintained in the home at all times. This will make sure that the home is always fresh and clean, standards of hygiene maintained and residents cared for in an environment which keeps them free from the risk of infection and able to live in a pleasant environment. The home should make sure that appropriate quality systems are in place to monitor the quality of the services provided to people living in the home. This will make sure 2 7 3 9 4 12 5 16 6 25 7 26 8 33 Care Homes for Older People Page 28 of 30 that people are happy with the services they are receiving and can be assured that the home is being run in their best interests. Care Homes for Older People Page 29 of 30 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 30 of 30 - 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!