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Inspection on 20/05/09 for Perry Locks Nursing Home

Also see our care home review for Perry Locks Nursing Home for more information

This inspection was carried out on 20th May 2009.

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

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

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

What has improved since the last inspection?

Since January 2009 we could see the home was making improvements and below is the list of improvements that have occurred since the last key inspection in November 2008. These improvements need to be maintained so that the home can demonstrate its commitment to providing a quality service to people living in the home. The medicine management had improved since the last pharmacist inspections. The home has now met all the requirements from the statutory requirement notice issued on 24th October 2009 regarding the unsafe medicine management practices. Staff had been trained in a number of areas which has given them confidence and knowledge to meet the needs of people living at the home. A wide range of equipment had been obtained to promote and maintain the well being of people living at the home such as wheelchairs and pressure relieving equipment. A refurbishment programme had occurred across the whole of the home, which has improved the facilities for people living in the home and include a new call bell system to summon staff, to give one example. New furniture has also been purchased for people`s bedrooms, making their personal space fresh and clean looking. All staff roles have been reviewed ensuring the home is run in an efficient manner and people`s needs are being met effectively. Information provided to people living in the home has improved, so they are able to make informed choices. Care planning and risk assessment documentation has improved, which also reflects the care being provided to people living at the home. These recordsPerry Locks Nursing HomeDS0000024879.V375501.R01.S.doc Version 5.2 Page 8give staff instructions on how to care for someone, but also allow care to be assessed, monitored and reviewed. This process ensures people`s needs are fully meet. Systems for meeting the health care needs of people living in the home have been reviewed in conjunction with the PCT, so ensuring people`s needs are being met appropriately and in a timely manner. Record keeping for the home has improved and information is easily retrievable, which ensures the smooth running of the home and ultimately benefits the care provided to people living in the home. The meal time experience for people living at the home has improved ensuring they have their meals at the appropriate time. The ethos of the home has improved, meaning both people living in the home and staff were observed to be happy and fulfilled.

What the care home could do better:

The garden area for Perrywell unit needs to be landscaped so that people living on this unit can enjoy a safe outdoor space. The catering has improved but further work is required in menu format for people with dementia so that active choice is gained. The preparation of scrambled egg needs to be reviewed to ensure that it has taste and texture. Training is needed in areas such as the Mental Capacity Act, Deprivation of Liberty, End of Life Care and Bedrail safety. This will provide staff with an all round knowledge bases to maintain the rights, dignity and promote the wellbeing of people living in the home. A comprehensive set of training records need to be kept to demonstrate staff have received training in a variety of fields such as diabetes and epilepsy.

Key inspection report CARE HOMES FOR OLDER PEOPLE Perry Locks Nursing Home 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG Lead Inspector Karen Thompson Key Unannounced Inspection 20th May 2009 07:40 DS0000024879.V375501.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Perry Locks Nursing Home Address 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG 0121 356 0598 0121 331 1261 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.com BUPA Care Homes (CFHCare) Ltd Manager post vacant Care Home 120 Category(ies) of Dementia (120), Mental disorder, excluding registration, with number learning disability or dementia (120), Old age, of places not falling within any other category (120), Physical disability (120) Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 120 Old age not falling within any other category (OP) 120 Physical Disability (PD) 120 Mental Disorder (MD) 120 The maximum number of service users to be accommodated is 120. 2. Date of last inspection 25th November 2008 Brief Description of the Service: Perry Locks is a purpose built Nursing Home and is part of the BUPA organisation. The home comprises of four separate units, each with thirty beds and is registered to care for people with a number of health care needs including: dementia, physical disability, mental health problems and conditions relating to older age. The home is situated beside a canal in a residential area, four miles from Birmingham City Centre and has a perimeter fence that enables security and safety of people living in the home. There is off road parking facilities at the front of the home. It is situated close to a local bus route and local shops are a reasonable distance away. The home has recently completed building work on a new extension to increase the number of beds to Perrywell Unit, these rooms need to be registered with us prior to use. Four units have access to a garden area plus a lounge/dining room and a quiet room available for people who live in the home. All bedrooms are single occupancy with a wash hand basin and a call bell system to summon assistance when required. Fees vary and are dependent on the needs of people who require the service. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 5 Items not covered by the fees include toiletries, visitor’s meals, and continence products, private treatments such as physiotherapy and chiropody, escort by a member of staff outside the home, hairdressings and newspapers. The current scales of charges for the home range from £491 to £1299 per week. The home retains the nursing element of the fee, which is paid by the Primary Care Trust. For up to date fee information the public are advised to contact the home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on in November 2008 when it was found that people using the service received poor quality outcomes and Statutory Notices were issued in respect of medication and care planning. A random inspection was undertaken in January 2009 to check compliancy with the notices and it was found that the Statutory Notice for care planning had been met indicating that care planning was satisfactory. The Statutory Notice for medication was not met and this resulted in the providers receiving a formal caution from us. Staff have been working hard and have been supported by the Primary Care Trust (PCT) since then and there have been in number of improvements and the home is now providing good quality outcomes for people living in the home. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. Two inspectors undertook the fieldwork visit over one day and the manager was available for the inspection. The home did not know that we were visiting. The pharmacy inspector also carried out an inspection on 14th May 2009 in order to check the homes compliance with the statutory notice in respect of the medication and their findings are included in within the report. At the time of inspection three units were in use, which were visited and information was gathered by speaking to and observing people who lived at the home. Six people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 7 The inspector would like to thank the manager, people who live in the home and the staff for their hospitality throughout this inspection. What the service does well: Visiting to the home is open and people living within the home can maintain relationships that are important to them. . What has improved since the last inspection? Since January 2009 we could see the home was making improvements and below is the list of improvements that have occurred since the last key inspection in November 2008. These improvements need to be maintained so that the home can demonstrate its commitment to providing a quality service to people living in the home. The medicine management had improved since the last pharmacist inspections. The home has now met all the requirements from the statutory requirement notice issued on 24th October 2009 regarding the unsafe medicine management practices. Staff had been trained in a number of areas which has given them confidence and knowledge to meet the needs of people living at the home. A wide range of equipment had been obtained to promote and maintain the well being of people living at the home such as wheelchairs and pressure relieving equipment. A refurbishment programme had occurred across the whole of the home, which has improved the facilities for people living in the home and include a new call bell system to summon staff, to give one example. New furniture has also been purchased for peoples bedrooms, making their personal space fresh and clean looking. All staff roles have been reviewed ensuring the home is run in an efficient manner and peoples needs are being met effectively. Information provided to people living in the home has improved, so they are able to make informed choices. Care planning and risk assessment documentation has improved, which also reflects the care being provided to people living at the home. These records Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 8 give staff instructions on how to care for someone, but also allow care to be assessed, monitored and reviewed. This process ensures peoples needs are fully meet. Systems for meeting the health care needs of people living in the home have been reviewed in conjunction with the PCT, so ensuring peoples needs are being met appropriately and in a timely manner. Record keeping for the home has improved and information is easily retrievable, which ensures the smooth running of the home and ultimately benefits the care provided to people living in the home. The meal time experience for people living at the home has improved ensuring they have their meals at the appropriate time. The ethos of the home has improved, meaning both people living in the home and staff were observed to be happy and fulfilled. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 9 order line – 0870 240 7535. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1.3.6 People using the service experience good quality outcomes in this area. There have been no new admissions to the home. Where people have been re-admitted from hospital the assessment was found to meet the standard. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since 11 September 2008 there have been no new admissions to the home as part of the agreement with BUPA. We looked at the assessment of a person who had recently returned from hospital. The assessment documentation used by the home had been updated to show the changes in their needs. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 12 During the inspection we were able to talk to staff about the care they gave people. Staff told us they had received training in dementia care and challenging behaviour. They also told us they were supported by the Primary Care Trust (PCT) and other visiting professionals. On the day of the inspection we met an external health professional who told us “the staff have tried very hard to improve and have been working well with the PCT”. We discussed plans for future admissions to the home with the management. They advised us this would be done slowly and they aimed to admit only one person every two weeks to each unit, so that people could be integrated into the units effectively. At present only three units are open and we were informed that following refurbishment those people previously living on Brooklynn would be offered the opportunity to return to the unit or remain on the one they were presently on. We were also advised that the practice of moving people from Perrywell unit to another unit when their primary care needs became physical, which previously occurred, would also cease. The Service User Guide had recently been reviewed and meets the standard, so people have information about the services and facilities available in the home.. Service User Guides were seen in the bedrooms of people living in the home so they could refer to them if they wished. No intermediate care is provided at this home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7.9.8.10 People using the service experience good quality outcomes in this area. The arrangements for meeting people’s health and personal care needs are being met by a trained, motivated and supported workforce. The medicine management has improved to a safe standard. Good systems have been installed and implemented to ensure that this is maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living at the home have a care plan, which outlines their needs and the actions required by staff to meet their needs. Each person case tracked had their own care plan. The care planning documentation was being reviewed regularly and was found to reflect the care being provided to people living in the home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 14 There was also a range of risk assessments that highlighted potential risks and the action required to minimise them. All the risk assessments we saw had been regularly updated and amended to show the changing needs of people living in the home. Pressure area care management had improved so people were protected from developing pressure sores. Skin integrity assessments had been reviewed on a regular basis and reflected changes in the person’s condition. Pressure relieving equipment was available and was based on the person’s individual needs. There was evidence that the home had been working with the tissue viability nursing service of the PCT to ensure needs were met. Wound care plans had enough information to guide staff in meeting needs. People deemed at risk had records to demonstrate that pressure relieving was occurring on a regular basis. Kirton chairs were in use for a number of people living at the home. These chairs place high pressure on the sacrum and can also be used as a form of restraint. The staff at the home had carried out a risk assessment for these chairs and could demonstrate they were being used in the best interest of people living at the home. Pressure relieving cushions were also observed to be in place in these chairs to reduce the risks of pressure on the sacrum. Wheelchairs have been obtained for people living at the home since the last key inspection. This allows people to go out and about if they wish. We were also informed by one member of staff that one person living at the home was now able to visit the hairdressing salon. The number of General Practitioners now looking after peoples health needs at the home has significantly reduced. Each unit now has one G.P allocated to it; people can retain their own G.P if they wish. Trained staff spoke very positively about only having to liaise with one G.P practice; they felt this had enhanced the care provided to people living in the home. Staff told us G.P’s visited the home weekly and would visit more frequently if needed. Staff were able to demonstrate through records and by talking to us that they would and were acting in a proactive manner to meet people’s needs. For example peoples weight was monitored regularly and this is linked to the nutritional care plans. Staff were able to tell us what care they were giving in relation to meeting nutritional needs and this matched the care planning records. Food diaries and fluid charts were in place for people who are deemed at nutritional risk; these had been completed, and demonstrated monitoring was taking place. Diabetic care for one person living on Lawrence unit was looked at. Staff were again able to demonstrate a good understanding of meeting this particular persons health needs and were liaising with a number of health professionals. The home has one hypoglycaemic emergency kit; this is kept on the Calthorpe Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 15 unit. It is recommended that a hypoglycaemic kit is kept on each unit or on units where it is known that people are liable to hypoglycaemic attacks, so no unnecessary delays are experienced in obtaining the emergency equipment. A care plan for a person with behaviour that challenges on the Perrywell unit was reviewed and this contained good information. Staff also informed us that they had received training in behaviour that challenged and felt supported. Perrywell has a new unit manager and there has been a change of culture within the unit with a shift from task orientation to person centred care. A number of external health professionals have supported staff to meet the needs of people living at the home. Staff spoken to us demonstrated awareness of needs and confidence in meeting them. They felt supported in meeting the health needs, were able to talk with confidence about the training they had received and how this had influenced the practice and the care given to people living in the home. They were able to demonstrate a good understanding of specific health care needs such as diabetes, epilepsy, PEG feeding. Staff told us “we have had training from the PCT it has been very good”. Trained staff spoken to informed us they had recently read the Nursing and Midwifery Council Standards of Medicine Management and Record Keeping documents. Staff also told us they were due to attend a training session for record keeping management. A large number of beds had been replaced with profiling beds which are more appropriate for meeting the health needs of people living in the home. These profiling beds have bedrails built into them and are available for use. This ensures that the bedrail matches the bed although they do not have to be used. Bedrail risk assessments were being carried out when they were in use, but records could not demonstrate that staff had considered any alternatives. Staff need to look at the bedrail safety training package that BUPA and the Health and Safety Executive to ensure they are exploring all possibilities for maintaining a person’s safety. The pharmacist inspection lasted four hours. Medicine management was inspected on the three units that remained opened. Five people’s medicines were looked at, together with the care plans and daily records. Three nurses were spoken with and all feedback was given to the acting manager at the end of the inspection. The medicine management had improved since the last pharmacist inspection. On 24th October 2008 a statutory requirement notice was issued requiring the home by 10th November 2008 to: 1. Put in place arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 16 This was breached on inspections’ that followed on 26th November 2008 and 15th January 2009. The home was offered and accepted a caution due to this serious breach of the Regulations’. The statutory requirement notice and all four requirements and two recommendations left at the last inspection have now been fully complied with. The medicine management is good and no longer puts the health and well being of the people who live in the home at risk. The acting manager has worked had to install and implement good systems to ensure that the nurses administer the medication as prescribed. All prescriptions are seen, checked and a copy is used to check the dispensed medication and Medicine Administration Record (MAR) charts received into the home for accuracy. All quantities of medicines are recorded together with any balances carried over from the previous month. This enables audits to be undertaken to demonstrate that the medicines are administered as prescribed. Audits undertaken during the inspection indicated that the medicines had been administered as prescribed and records reflected practice. The nursing staff spoken with had a good understanding of the clinical conditions of the people they looked after and the medicines they handled. One registered mental nurse (RMN) knowledge of medicines used to treat clinical conditions other than mental health conditions was poor, but he was keen to improve this. The home had medical information available to do this A few people are PEG fed and have their medicines administered via this route instead of orally. There were still no information textbooks available for staff to access information about the suitability of medicines administered this way, but we, the commission, were assured that further information was always requested from the pharmacist and doctor. All medicines prescribed on a “when required” basis had supporting protocols detailing their use for staff to follow to ensure they are only given as the doctor intended. All variable doses had been accurately recorded so it was possible to see exactly whether one or two tablets had been administered and when. All medicines that had not been administered had the clear reason recorded so it was possible to see what had occurred. The care plans regarding medication were very good and detailed all external healthcare professional visits together with their outcome and also the underlying clinical conditions of the people that lived in the home. These were reviewed on a regular basis and in time the person’s family was also to be consulted regarding their care. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 17 Storage of medicines was good and new medicine refrigerators had been purchased. Their temperatures were monitored on a daily basis together with the medication room temperatures to ensure that all medicines had been stored correctly to maintain their stability. Staff informed us they were due to attend training in end of life care. The Service User Guide also contain information about end of life care which had been supplied by the PCT. This standard was not fully assessed. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 People using the service experience good quality outcomes in this area. People are supported to maintain contact with family and friends, so they are able to maintain relationships that are important to them. People living at the home have the opportunity to take part in a range of activities to enable them to lead a stimulating and fulfilling life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Arrangements for visiting the home were flexible for relatives enabling them to visit at time that suited them and the person living in the home. The lounge areas on all three units have been refurbished. We were told that people living on three of the units had chosen to have a large screen television Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 19 which was linked to free satellite channels. The people living on Perrywell unit and or their representatives have opted for a large summer house. There are four activities co-ordinators working at the home. The senior activities co-ordinator and activities co-ordinator were observed assisting people with breakfast on Calthorpe and Perrywell unit. The senior activities coordinators role involves organizing activity events for people living in the home and organizing the activity co-ordinators working rota. We were informed that the senior activities co-ordinator would be covering reception that day. We observed breakfast taking place on these two units and lunch on the Perrywell unit. The inspectors were informed that some people remain in their bedrooms for breakfast. We were also informed that five carers are allocated to work on each unit for the morning and late shift. One carer in the morning is given the task of ensuring people receive their breakfast, whilst the other four carers are responsible for meeting peoples personal needs. Whilst the catering appears to have improved there still appears to be deficits in the quality. The scrambled egg was disliked by both inspectors, staff (who were asked by us to sample the food) and people living at the home. The texture was rubbery and it was luke warm. Further work is required to ensure the food prepared is both nutritionally and is a pleasant experience for people living at the home. The present menu offers a choice of meals and people make a choice from the menu the day before. The menu format is written which is inhibiting for people with dementia. We spoke to the catering manager in detail about the dietary needs of people with dementia and the presentation of the menu choices in a pictorial form. We were told this was something they would be introducing in the near future. Records demonstrated a range of activities were taking place on all three units in the home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 People using the service experience good quality outcomes in this area. The systems and arrangements in place to ensure peoples rights are promoted and protected are dealt with in an appropriate manner, to ensure they are listened to, taken seriously and acted upon. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure that is available enabling people to raise concerns where necessary. The homes complaint log contained two formal complaints since the previous key inspection in November 2008 and one compliment. Records demonstrated letters were sent to the complainants and records demonstrated an investigation had taken place, so peoples concerns were being addressed. Staff training records demonstrated that the majority of staff had received safeguarding training in the last seven months. Staff interviewed were able to tell us with confidence the action they would take if they became aware of any Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 21 safeguarding issues demonstrating they would protect and promote the wellbeing of people living in the home. Previously all safeguarding referrals have been made by the Care Manager. During this inspection we found the unit manager had made a referral, which ensures information is speedily referred and reduces the possibility of information being lost by being passed on third hand. The training matrix did not demonstrate whether staff had received training in the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. Staff interviewed were unaware of this important legislation. Staff need to be aware of their rights and responsibilities in relation to this important legislation, so they are aware of how to support people who lack capacity to make decisions. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.21.22.23.24.25.26 People using the service experience good quality outcomes in this area. People live in a safe, well maintained, clean and comfortable environment which meets their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The main block contains the kitchen, laundry and the administration area. All four units are linked to the main block by a covered access and they were all visited during the inspection. All four units are built to the same design with Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 23 bedrooms coming off an “H” shaped set of corridors. All bedrooms are singly occupied with wash hand basin and call bell facility to summon assistance if required. The communal area (sitting and dining areas) and the office are situated at one end of the unit and there is a fully equipped kitchen attached to the dining area. There is a small sitting room with chairs for private use by visitors, relatives and staff. Changes have occurred in all four units. Perrywell unit has been refurbished in consultation with the organisations own dementia care specialist. At the end of last year the unit was extended to provide a further six bedrooms with en-suite facilities. They are not in use yet as the provider withdrew the application for registration, whilst the home was closed to admissions. There is a significant outdoor space attached to the Perrywell unit that is not being used at present as it needs to be landscaped to make it an enjoyable and useable space for people. A large summer house had been purchased for this garden and staff informed us they hoped to put it to use in the future. Brooklynn unit has been refurbished, and no one was living in the unit at the time of the inspection. The nurses station and telephone lines on Lawrence unit has been moved into the lounge/dining areas, which ensures staff are visible to people living at the home and staff can observe this area. However, some telephone calls will need to be made in confidence and this area would not be appropriate for such calls. The provider needs to review the telephone facilities for each unit. On the day we visited the home we observed a number of decorators in the process of removing wall paper from the lounge area in Calthorpe as part of this refurbishment programme, which the provider has undertaken for the whole home. The call bell system has been renewed and enables staff to monitor the length of time it takes for a call to be responded to. The call bell system is linked into the fire alarm system, so that all staff are alerted when an alarm goes off. Bedrooms are personalised and people are able to bring in their own possessions to reflect their tastes and interests. Bedrooms visited were clean and tidy and a number of bedrooms were observed to have new bedroom furniture. We also observed new bedroom furniture in the corridor of Lawrence unit, we were told this was to be redistributed to bedrooms in the home. Bathrooms and toilets are positioned conveniently around the units and have special equipment to support people with their mobility. The provider has reviewed the housekeeping systems within the home. The home was found to be clean and with no malodours. Staff were observed wearing gloves and aprons for the various tasks they need to carry out. Alcohol Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 24 hand gel was available though out the home. This ensures that risks of cross infection are reduced. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 People using the service experience good quality outcomes in this area. People living at the home are supported by staff that are motivated and trained to met their needs We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has had no new admissions since September 08. Staff levels are currently at the level required to meet the standard. Since the number of people living at the home has been stable for some time and therefore well known to the staff, this allows the home to provide the required levels of care. Any increase in the number of people living in the home, however, or significant change in health care needs may well result in care being compromised or may result in staffing levels becoming inadequate for peoples care needs to be met. This will need to be monitored and action taken where necessary to address changes. We talked to the Acting Care Manager about the admission of new people to the home and how this would be managed. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 26 We were informed that no more than one person would be admitted to each unit every two weeks. Brooklyn unit has been closed since February 09 and staff have been redeployed around the site. The reopening of this unit will require a number of new staff to be employed to allow the unit to function effectively. The home has lost a number of staff but has also recruited new staff. A sample of staff recruitment files were inspected and they were found to meet the standard with one exception. Information was missing in one instance and this was forwarded to us after the inspection once the home had retrieved the information from head office. All records relating to the running of the home should be available for inspection. There was an induction training programme available and this meets the standards of the Social Skills Council. Carers and nurses undertake a three day induction programme where they are supernumerary for a minimum of one day when the commence employment and they gradually work through a training booklet over a 12 week period. New nurses also undergone a medication competence test during their induction to ensure they are safe to administer medication. Staff confirmed this induction took place. The training matrix demonstrated staff had undergone training recently in fire, safeguarding and have commenced dementia care training. A number of staff have received training in manual handling as part of an ongoing rolling programme. The training matrix given to use did not evidence specialist training such as diabetes and end of life care. Staff informed us they had attended such training/awareness sessions. Records need to be kept of this so the home can demonstrate that it is providing staff with a range of skills to meet the needs of people living in the home. The AQAA supplied to us stated 42 of care staff had completed National Vocational Qualification (NVQ) level 2 or above in care. The AQAA also stated they hope to improve on the number of people with this qualification. The NVQ level 2 in care demonstrates a certain level of skill and competence has been achieved by staff working at the home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.35.38 People using the service experience good quality outcomes in this area. The home is being run in the best interest of people living there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There has been no Registered Manager in the home since June 08. Since January 2009 we have been aware of a change in the day to day running of the home. The current Acting Care Manager is in the process of submitting their application for registration with the Commission. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 28 Staff, spoke to during the inspection felt supported by the new management team. Comments included, “change is good but continuity is needed for residents”, “feel new as well”, “try and motivate and support each other”, “previously…. knowledge not passed on, stagnant, the new management is approachable”. Staff were being encouraged to take ownership of their practice e.g. of these could be seen in unit manager making safeguarding referrals, unit manager meeting to discuss each other rotas and how they can help each other meet the needs of people living in the home, the sharing of knowledge. At the last two key inspections management of peoples money met the standard. The system has not altered since the previous inspection. Money is held in a bank account which has sub accounts for each individual person’s money. The providers audits these accounts and the administrator is not aware of when these will take place. Individual finances were not looked at this inspection. The provider carries out an annual quality assurance audit, where questionnaires are sent out to people living in the home and or their representatives. The surveys for this annual quality assurance audit had not been sent out. We were given the annual quality assurance survey results for 2008. The 2008 results are compared to the 2007 and overall they demonstrate a decline in the service provided for people living at the home during 2008. This reflects some of our findings for this year. During this period the providers submitted improvement plans to us on a regular basis. They also had their own Quality and Compliance teaming working in the home. We were informed the Quality and Compliance team report directly to the board of directors and are not part of the operational branch of the running of the home. The care provider to people living at the home has improved by the home working with professionals outside the organisation and experts employed by the provider. A sample of records in relation to servicing and checking of equipment were sent to us by the home following the inspection to determine the health and safety systems in the home. Records sampled were in relation fire, hoists and hot water, these were found to be satisfactory. The home has a folder containing personal evacuation fire plans for people living at the home, staff were able to demonstrate they were familiar with its contents. This demonstrates that fire safety is being taken seriously to protect everyone at the home. Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The home should ensure that it collects pre-admission information in a comprehensive and individualised manner so that it provides a person centred approach to meeting peoples needs once living in the home. The home should purchase hypoglycaemic kits for all units on the site where people are at risk of hypoglycaemic attacks. All staff must receive end of life care training that is appropriate to their position to ensure peoples and relative needs are meet in an appropriate manner. (not implemented fully on 26.11.08 and 20.05.09) It is recommended that the home obtain a copy of the Dept of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training, so that staff are aware of their responsibility DS0000024879.V375501.R01.S.doc Version 5.2 Page 31 2 3 OP8 OP11 4 OP14 Perry Locks Nursing Home and peoples rights are protected. 5 6 7 8 OP15 OP15 OP19 OP30 (not implemented on 26.11.08 and 20.05.09) The home should review the formats of menus for people with dementia. Food sampling should take place to find out whether the food being presented to people living at the home is of a quality that the sampling panel would be happy to eat. The garden for people living on Perrywell should be landscaped so that people living on this unit have a safe secure outside space Training/awareness should be provided to staff in Deprivation of liberty to ensure they are aware of their responsibility in promoting the well being of people living at the home. BUPA training package in relation to bedrails should be shown to all staff working at the home. (not implemented on 20.05.09) 9 OP38 Perry Locks Nursing Home DS0000024879.V375501.R01.S.doc Version 5.2 Page 32 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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