Random inspection report
Care homes for older people
Name: Address: Perry Locks Nursing Home 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lisa Evitts Date: 2 6 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Perry Locks Nursing Home 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG 01213560598 01213311261 Telephone number: Fax number: Email address: Provider web address: www.bupa.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFHCare) Ltd care home 128 Number of places (if applicable): Under 65 Over 65 0 0 128 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 128 128 0 128 The maximum number of service users to be accommodated is 128. 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) maximum number of places: 128 Old age not falling within any other category (OP) maximum number of places: 128 Physical Disability (PD) maximum number of places: 128 Mental Disorder (MD) maximum number of places: 128 Date of last inspection
Care Homes for Older People Page 2 of 11 Brief description of the care home Perry Locks is a purpose built Nursing Home and is part of the BUPA organisation. The home comprises of four separate units. Calthorpe and Brooklyn have 30 beds, Lawrence has 32 beds. Perrywell has 36 beds and this unit is for people who have dementia healthcare needs. 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. Each unit has 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. Eight of these rooms have ensuite toilet and handwash facility. Fees vary and are dependent on the needs of people who require the service. Items not covered by the fees include toiletries, visitors meals, continence products, private treatments such as physiotherapy and chiropody, escort by a member of staff outside the home, hairdressings and newspapers. Current fee rates are available from the home. Care Homes for Older People Page 3 of 11 What we found:
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 regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of this service was completed on the 20th May 2009. This random visit was undertaken by three inspectors over six hours. We visited Perrywell unit only, where 27 people were living. The home did not know that we would be visiting that day. The reason for this visit was to review the Dementia unit as there had been an increase in the number of incidents and safeguarding referrals made. During this visit we looked at three care files in detail and partially looked at one other. We looked at complaints records and staff training records. We spoke to three visitors and three staff. We completed a Short Observational Framework for Inspection (SOFI). We completed a SOFI because due to their dementia needs, many of the people living on the unit are unable to verbally tell us about their experiences. We use a formal way to observe people to help us understand what it is like to live at the home. The SOFI involved us observing three people who live at the home for two hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff members and other people living at the home and the environment. Following the visit we spoke to the Responsible Individual for the home by telephone to provide feedback about our observations. These are our findings: We looked at four peoples care plans. These are plans which give staff information about what people are able to do independently. They also say when staff need to support people to meet their individual needs and how they should do this. We found that most of the care plans contained detailed information for staff to follow so that peoples needs were met in a way they preferred. We found that staff did not always follow planned actions or take action when changes were observed, for example; One persons plan for eating and drinking said that the person should be weighed weekly due to poor dietary intake. On the day of our visit there were no records of the weight, since admission, and it was concerning that an entry in the daily records said that supplements had been discontinued as the persons appetite had improved. The care plan had not been updated to reflect this. We were sent a copy of a weekly weight chart following our visit. In another persons file staff had recorded that the person had had several incidents of diarrhoea. The care plan evaluation said that the person remained incontinent but did not refer to the diarrhoea. We could not see that any action had been taken to find the cause of this. We looked at the file of one person who was observed during the SOFI observation. Their
Care Homes for Older People Page 4 of 11 activity plan said that they liked to watch TV, 1940s music and chatting to staff. The person was not able to see the TV where they were sitting and there was no interaction from staff. During the observation this person was coughing after taking a drink, there was no mention of this person being at risk in their file and no mention that thickeners may be required. We brought this to the attention of the general manager on the day of our visit, so that this could be monitored. We looked at the complaints records since our last visit in May 2009. The home had recorded six complaints and two concerns. None of these were in relation to Perrywell unit. There was good documentation about how the complaints had been investigated and actions taken as a result in order to minimise the potential for the same complaint to happen again. We spoke to three relatives who were visiting the home and they commented: I am pleased with the care he gets I can go to staff and talk to them they are very helpful They know what he likes Yes there are enough staff on duty and they seem fine and helpful I am completely satisfied with the home Some of the young staff in particular are wonderful, really good to mom and will do what ever you want Her personal care is very good I come around mealtimes so I can sit with my relative and help them have their dinner, I am not sure if there would be enough staff to sit with my relative at mealtimes There had been some incidents that had happened at the home that had been raised as safeguarding, to ensure the safety of the people living at the home. There had been concerns that on some occasions we had been informed but Adults and Communities had not and vice versa. We discussed this with the home manager who told us that this had happened because staff did not have access to the fax machine at the weekend as it was in the office. This meant that information was not always sent in a timely manner. At the end of our visit the manager told us that a new BT line was to be installed and a fax machine installed so that staff could access this at all times. Staff spoken to were able to demonstrate a good knowledge of what they should do in the event of an allegation being made. The training matrix showed that training in safeguarding was ongoing and had been completed by all staff. We looked at staff training records and the majority of staff have completed BUPA training in Dementia. This is in the form of a workbook and the manager told us that staff would now do this as part of the induction programme. The training matrix did not show if staff have had training in the Mental Capacity Act or Deprivation of Liberty Safeguarding. The manager confirmed that staff had not yet had training in this area. Staff need to understand the importance of this so that they know how to support people
Care Homes for Older People Page 5 of 11 who are unable to make their own decisions due to lack of capacity. The manager also confirmed that staff had not received training in challenging behaviour but were hoping to set up this training in the near future. Training in this topic may assist staff to diffuse situations where people are displaying difficult to manage behaviour and minimise the risk of harm to others. During the SOFI observation we saw some good interactions but the majority of them were neutral or poor. The overall percentage for the group observation was 33 good, 36 poor and 31 was neutral. Neutral means that the person had neither a good or bad experience. We saw that when staff were hoisting people into chairs they were talking to them and telling them what they were doing. We also saw staff move people in chairs from behind without telling them what they were doing. The conservatory was draughty and cold as the windows were open and the radiators were not on, one member of staff eventually noticed this and closed the window where people were sitting. There was music playing and some staff had musical instruments. This appeared to be a music session but did not appear to be planned and no one was taking the lead so it became quite chaotic. The lounge became very noisy with music playing loudly, the TV was on at the same time and staff were shaking musical instruments. We saw that the morning medication was still being administered at 11:30 and this does not ensure that people are receiving medication in a timely manner. It does also not ensure that there is enough time gap before the next medication is given. We were concerned that blister packs were left on top of the trolley while the nurse went to administer medication. There are some mobile people on the unit with dementia and the tablets could place them at risk of harm if swallowed by accident. This was brought to the attention of the manager on the day of our visit. One person had a table in front of them for the whole of the observation. They were given a plate of biscuits which were put on the table and they had to reach out for them. The person moved some of the biscuits onto the table. A staff member approached and moved the plate out of their reach. Another staff member came over and took the plate and biscuits away and took the cup the person was holding out of their hand but didnt tell them what they were doing. The person responded to noise and voices, and tried to engage with staff by reaching out and trying to touch them as they walked by. Some staff did speak to the person but didnt wait for a response from the person living at the home before walking away. This person appeared withdrawn at times and in total, for the two hours had negative interaction of 48 with only 17 being positive. Staff were seen to rub peoples faces and stroke their hair which at times appeared inappropriate. One person was observed to have lunch at the dining table. The meal was not cut into manageable pieces and the person had to cram a large piece of fish into their mouth. Only a quarter of the meal was eaten and the person told staff it was cold. Staff took the meal away and brought the person a pudding instead. We observed another person sitting far away from the table and was having to stretch forward to reach their food. Several staff walked past without noticing and one staff member pushed them nearer to the table after fifteen minutes. Another person started to cough persistently after taking a drink. Three staff came to the person but they were all doing something different and talking to each other not the person who was coughing. It appeared to be chaotic and staff were unsure of what to do. Care Homes for Older People Page 6 of 11 Staff appeared to be task orientated for example making drinks and wiping tables but not interacting with people. The environment was clean and had been refurbished recently. There are some pictures around the home and a small room which has some sensory items. Toilet doors are painted red so the facilities are easy to identify. Bedroom doors did not have any memory boxes or pictures to help people identify their rooms. The manager told us that they were hoping to get some rummage boxes in place and start an allotment so that people would have things that interested them. Six new beds have been registered and the rooms were seen to be pleasantly decorated, with flat screen TV and en suite included. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 12 Systems must be in place to ensure that staff follow guidance and act upon changes in health care needs. So that peoples healthcare needs are monitored and acted upon. 02/04/2010 2 9 13 Arrangements must be in place for the safe management of medication administration. To ensure that people receive their medication in a timely manner. 25/03/2010 3 30 18 Suitably qualified and competent staff must be available. So that peoples individual needs can be met. 21/05/2010 4 30 12 Staff must have the knowledge and skills to interact with people living at the home. 21/05/2010 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So that peoples individual needs can be met. 5 30 18 Staff must receive relevant training. So that they know how to support people with difficult behaviour and those that lack capacity. 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 21/05/2010 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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!
