Inspection on 18/03/09 for Robert Harvey House

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Robert Harvey House 11/04/07

Robert Harvey House 28/06/06

Robert Harvey House 14/03/06

Robert Harvey House 22/07/05

Robert Harvey House 06/01/05

Robert Harvey House 25/08/04

Robert Harvey House 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Robert Harvey House Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD Lead Inspector Jill Brown Unannounced Inspection 18th March 2009 08:30 DS0000024882.V375036.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. DS0000024882.V375036.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 DS0000024882.V375036.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Robert Harvey House Address Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD 0121 554 8964 0121 554 3351 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.bcop.org.uk Broadening Choices for Older People Mrs Anthea Reid Care Home 42 Category(ies) of Dementia (42), Old age, not falling within any registration, with number other category (42) of places DS0000024882.V375036.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2007 Brief Description of the Service: Robert Harvey House is registered to provide general nursing care for forty-two people aged 65 years and above for reasons of old age and or dementia. The purpose-built Home is set in a quiet residential area of Handsworth Wood, within easy access to bus routes. There is a car park to the front of the Home and a secure, well maintained private garden to the rear of the building. The Home is owned and operated by Broadening Choices for Older People, a local charity whose head office is based in Birmingham. Robert Harvey House offers 32 single en-suite rooms, 2 double en-suite rooms and a 6 bedded high dependency ward area. All bedrooms have a suitable shower facility and additional communal assisted bathing facilities are provided with staff available to provide assistance in these areas. Aids and adaptations are available in order to enhance the quality of the lives of people using the service. There is a communal lounge, dining area and smaller seating areas throughout the Home. There is a passenger lift for access to the upper level. Smoking is not permitted within the building. The range of weekly fees to live at Robert Harvey House was not available these are available on request. Items not covered by the weekly fee include newspapers, hairdressing, toiletries, private chiropody and staff escorts for routine hospital appointments. DS0000024882.V375036.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1Star. This means the people who use this service experience adequate quality outcomes. We visited the home without notice on a day in March 2009 and undertook a key inspection where we looked at the majority of the National Minimum Standards. The home had a thematic inspection in April 2008 when it was chosen for an inspection looking at Safeguarding of vulnerable people. The home gave us information in an Annual Quality Assurance Assessment (AQAA) in May 2008. The AQAA shows how the home rates their performance in the areas set out in this report and their plans for future improvement. During the inspection 3 peoples care was case tracked, this involves looking at all the records about this person and how the home manages their care and we looked at another 2 peoples care records. We spoke to 5 of the people whilst we were there. We spoke to two sets of representatives of people living in the home on the day. We looked around parts of the building and viewed the health and safety checks that had been undertaken. We spoke to 5 staff, and the head of care during the inspection We have received one concern about the home before we inspected but this appeared to be an isolated incident. Information about all of the above is contained in this report. What the service does well: People and their representatives are given information about the home before they are admitted and this helps them decide if the home would suit them. Information is collected about peoples health and personal care needs before they are admitted and this ensures that peoples needs identified are met. Relatives spoke of the good reputation of the home and we saw that senior staff worked well with relatives to ensure that they felt they could raise any issues. Complaints appear to be logged and dealt with appropriately. Medication administration was good and this helps to keep people well. DS0000024882.V375036.R01.S.doc Version 5.2 Page 6 People have access to health professionals such as GPs, chiropodists and opticians if needed. The home was clean and fresh on the day of the inspection and appeared warm and comfortable. People said Staff they look after us and that’s it, staff are pleasant. Staff have the appropriate checks before they are employed and this means that people are safe to work with vulnerable people. Staff talked to understood their responsibility to report any concerns they have about the welfare of people. Staff receive regular training and this helps to ensure that staffs care of people remains good. What has improved since the last inspection? What they could do better: Health and social care professionals have provided information and indicated where planning is needed and this has not been put in place in some cases. This means that for example their are gaps in the planning of the care needed. Although we have made requirements to ensure that the planning of care reflects the individual person, pre printed care plans are still in use for some people and progress in changing this is slow. The commission is considering what further action to take on this. The assessments of some risks such as nutrition, bed rails and use of lap belts was not thorough enough to ensure that all risks had been considered. Plans that following risk assessments were not followed. This could leave people at risk. People are not enabled to make real choices about their care, for example choosing what they would like to eat a week in advance is not appropriate for DS0000024882.V375036.R01.S.doc Version 5.2 Page 7 people with dementia and bulk bought toiletries do not allow people to choose fragrances they like or select toiletries they have always used. Space is limited in the six bedded “ward” area and this does not promote the comfort and dignity of the frail and vulnerable people in this area. Although the home had improved on the ironing of clothing and bedding at the last inspection this was raised as an issue at this inspection. There was evidence of care not being taken to ensure that bedding was coordinated and ironed. The staff files need to contain evidence that people are able to work in the country, qualifications and registrations where appropriate to the NMC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. DS0000024882.V375036.R01.S.doc Version 5.2 Page 8 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 DS0000024882.V375036.R01.S.doc Version 5.2 Page 9 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): 1,2,3 & 4 People using the 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 or their representatives are given information about the home before they are admitted and this assists them to decide whether this home will suit them. Information is collected about peoples health and personal care before they come into the home and this helps them make the decision whether they can meet the persons needs. Information received from all sources is not used and this means that not all care needed is planned for. EVIDENCE: We were supplied with a copy of the homes statement of purpose, which included the service user guide. The information in this had been recently updated. The home do not routinely record when information is given to people. However a person spoken to at this inspection said that they had DS0000024882.V375036.R01.S.doc Version 5.2 Page 10 received a pack of information from the home before their relative was admitted. We have been informed that this can be provided in large print or in different languages if needed. The information given includes a contract, complaint and fire procedures. A recommendation made at a previous inspection to include information about charges for escorts to hospital to be included in this document has not been acted upon. We found a copy of a contract on a persons care file including the fees that they were to be charged. The range of fees was not available on the day of the inspection but we were aware that the fee rate was likely to change at the beginning of April 2009. People are visited and information collected about them before they are admitted. The home collects information about peoples health difficulties, what they need help with and what risks there may be to the persons health and well-being. This information is then used to make a plan of care. People are visited to collect this information usually people are in hospital at the point of considering a placement. Information was found from other health and social care professionals but the home could not show that this had been used as part of their assessment of the persons needs. Information is recorded about peoples religion and there was evidence on the day to show that people had access to a Christian religious service. The home was not recording information about peoples ethnicity, and for the person sampled they did not have a cultural plan in place and the personal hygiene plan did not take account of a persons cultural needs. The homes Annual Quality Assurance Assessment showed that staff were from a diverse cultural background and this helps to ensure that people from a range of cultural backgrounds have people who know how to provide this care. As of May 2008 there was only one male staff member and this may mean that males living in the home do not have the benefit of conversations. Staff have recently received training in dementia care awareness and this assists in them understanding the needs of people with this condition. DS0000024882.V375036.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people do not have care plans that cover all their health conditions or show how they want the care to be delivered. This can lead to needs not being met, people not getting the care in the way they want and a consistently good standard of care not being maintained. Risks such as use of bedrails, use of lap belts and nutrition are not assessed well and measures are not in place to ensure the safety of people. People using the service receive their medication safely so that their health is promoted. EVIDENCE: People living in the home have care plans but these vary in the amount of information they give to staff and some do not cover all the needs identified. For example for one person the home identified a plan for nutrition was needed and this was not completed. A nursing fee assessor wrote to the home and DS0000024882.V375036.R01.S.doc Version 5.2 Page 12 advised that plans to encourage mental stimulation, maintaining a sitting balance and elevation of a persons legs and numerous risk assessments were needed and these were not in place. Some plans for some conditions and risks were pre printed and therefore the same for everybody (core care plans). These plans do not consider the persons lifestyle, routines and wishes, or behaviour and these should affect how care is given. There were gaps in plans where important information such as sling sizes was missed. We were made aware that the head of care was in the process of changing core care plans and people more recently admitted had plans that included more information about how the person would like their care to be given. This has been an outstanding requirement over a number of inspections and although there have been improvements recently the commission will be considering what further steps it will take to ensure compliance. People with poor appetite had nutritional risk assessments that indicated that they should be weighed weekly, have food charts, high protein diets and nutritional supplements. This did not happen for two people case tracked. (See standard 15) People who experience pain did not have a plan of care to minimise this. One person was found in pain during the inspection. They said the painkillers help but they dont get rid of it completely. I didnt think there was anything they could do. A member of staff confirmed that the person was always in pain. We found that there had been an intention to request stronger painkillers from the GP but we could not find where this had been done. In another situation pain relief for a person had been omitted without the reason being identified and recorded. Risk assessments and risk management plans were not sufficient or completed well enough to manage the risks for the provision of bedrails and we advised the head of care to look at the Health and Safety Executive website which had an appropriate assessment tool. We observed that a number of people spent their time in wheelchairs with lap belts on. We found that for two people this was not on their risk assessments. Although one person had had an injury from trying to get out of the wheelchair when they didnt have a lap belt in place, the risk assessment had not been reviewed or measures put in place to ensure that they were safe with a lap belt. For this person spending a long time in a wheelchair was contrary to advice about keeping the persons legs elevated. We noted at lunchtime only 5 people in the dining area were not in wheel chairs or reclining type chairs. The home were not showing that in all cases that people have freedom of movement or where the risks were too high that they had assisted time out of restrictive chairs. DS0000024882.V375036.R01.S.doc Version 5.2 Page 13 We spoke to two people that received the majority of their care in their rooms. Both people had their call bells available to summon help if they needed. One person said they (staff) pop in and out all the time, although I have been in bed for a long time Ive never had a sore back or bed sore they turn me and give my back a rub. The other person was found not to access to cold drinks and was thirsty. They said it can take up to half and hour to answer (the call bell). Another person said If I use the call bell it only takes a few minutes for them to come. Charts showing how often people are turned and what position they were in to relief pressure areas were not completed in some cases. Whilst peoples daily records were completed by the nurses, care staff were not completing their records daily as expected by the organisation. People looked as if they had had their personal hygiene needs met, peoples nails were clean and their clothes co-ordinated. \people had access to health professionals such as GPs, opticians and chiropodists when needed. The pharmacist inspection took place on a different day to the main inspection. It lasted just over three hours. Four people who live in the home medicines, Medicine Administration Record (MAR) charts, care plans and daily records were looked at. Two nurses were present throughout the inspection and all feedback was given to them and the registered manager - Andrea Reid at the end of the inspection. All the prescriptions are viewed online before they are dispensed to confirm with the community pharmacist that the doctor has prescribed all that is required. A copy of the prescription is printed to check the dispensed medicines and MAR chart received into the home. Staff had chased up any discrepancies or outstanding medication. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. A few errors were seen and the nursing staff were able to identify what had occurred for most of them. Good practice was seen. One medicine prescribed to be administered every three months had a separate sheet recording when it had been administered and when the next date was due. All boxes or bottles of medicines had the date of opening recorded on them. This reduced waste and made it easier to audit to confirm what has been administered. The care plans supported the service users clinical needs and it was easy for the nursing staff to access information surrounding the people who live in the homes clinical condition. Procedures detailing the administration of medicines not administered orally were good - for example the administration of nutritional supplements and medicines via a peg tube. Any allergies were recorded and all doctors visits documented. There were no separate protocols DS0000024882.V375036.R01.S.doc Version 5.2 Page 14 detailing the use of medicines prescribed when required and this was to be addressed after the inspection. The home had installed a quality assurance system. All medicines were checked and counted weekly and any discrepancies raised with the nurse involved. This had reduced the risk of errors and also identified the poor practice of one nurse in particular. The management team had suitably addressed the problems found at the nurses supervision meeting. The two nurses on duty had a good understanding of the medicines they administered and what they were for. This would enable them to support the people who live in the homes clinical needs. All Controlled drug balances were correct and checked daily to ensure there was no mishandling. People were generally happy with the care given to them. People said Staff they look after us and that’s it, staff are pleasant. DS0000024882.V375036.R01.S.doc Version 5.2 Page 15 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): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 12,13,14, &15 People living in this home are involved in activities and have friends and family to visit and this enhances their lives. Peoples dietary needs and choices are not always met and this means that people are unimpressed by the food. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) completed last year said: We have a wide range of activities during the week, mainly in the mornings. This is mainly because we have limited communal space and we have a lot of visitors in the afternoon. However we do still hold film afternoons and twice a week there is a music and movement class straight after lunch. Relatives sometimes come along and join in at these sessions. We have a bible study group once a month and a multi faith church service from the local church. The catholic priest visits every month to offer the Holy Communion to our catholic resident’s. DS0000024882.V375036.R01.S.doc Version 5.2 Page 16 There was some evidence that this had improved since then although the homes records did not reflect this. Staff interviewed told us that they had organised a come dancing night, bingo was arranged for Monday and Thursday, and on Tuesday, Weds and Friday the activities co-ordinator did painting, music and games with people. The home arranges for a church service to be held and bible study. There is an entertainer every 2 months and progressive mobility attends the home twice a week. People said: I cant leave my room, the activities coordinator doesnt come here but I have a physiotherapist who visits, if there a special tea they bring that and when they have singers 3 or 4 come down to my room to sing to me. They have tried to set up something so I can read books but nothing has worked. Just sit here, there is nothing for me to do, but sit and snuggle up, daughter visits, you could not grumble about the place. People appeared to be able to have visitors when they wanted and there seemed to be no undue restrictions. People visiting were observed coming in to the office to discuss issues with the head of care seemed relaxed about doing so. Relatives spoken with stated they were keen to get relatives in here due to the good reputation, they thought the care was good, staff were good and had no complaints. We were offered a test sample of the main meals of the day by the head of care these did not arrive. The options were fagots or a chop with vegetables. We later tried a test sample of the corn beef hash and salmon sandwich available to people at teatime and these were well prepared and tasty. People were given the choice of meals available a week in advance and this is not appropriate for people that have memory difficulties. The kitchen advised that if a person didnt like the choice they could add an option from some frozen foods held such as pie, fish or pasties. We noted on the day of the inspection a person did not want the option previously chosen and they were only offered sandwiches as an alternative. The person said Im fed up with sandwiches. People said about the meals: Meals are boring, we dont get much choice, there have been days when I have not eaten. Food is alright. The food – nothing to grumble about. Two of the homes surveys said about the food: Foods ok sometimes bland The sausages have been changed. DS0000024882.V375036.R01.S.doc Version 5.2 Page 17 People working in the kitchen were aware of people that had soft or diabetic diets, however those people that had a nutritional risk assessment advising a high protein diet they were unaware of. Records of what people had eaten were either not being routinely completed or people were not eating well and this was not being addressed. We were told in the AQAA that the home had started arranging for Asian and Caribbean meals to be provided from an outside source. The providers own audit stated that the home was not compliant in providing culturally appropriate food. Recently the home had tried a provider of cultural foods this had not been successful but we were told that they were looking at other options. DS0000024882.V375036.R01.S.doc Version 5.2 Page 18 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. We have made this judgement using a range of evidence, including a visit to this service. Complaints are investigated in an appropriate and timely manner so that people using the service are confident that their views are listened to. Systems are in place to protect people from harm. EVIDENCE: We have received one concern since the last inspection and this appeared to be an isolated incident. The home had recorded three complaints, one in April 2008 about the nutrition and weight loss for a person. The home had committed to ensure good food, fluid and bowel charts were to be maintained. The second about the loss of a person living in the homes belongings and a third that wasnt upheld. The home does not keep a record of small concerns and this may help in improving the service. The homes service user guide points people in the direction of a leaflet on how to make a complaint and this leaflet was appropriate at the last key inspection. People spoken to did not make any complaints one said I don’t know who I would complain to I have never had any need to complain. Surveys are completed with people on a monthly basis about the home is operating. We undertook a thematic inspection in April 2008 to look at how a selected number of homes managed safeguarding issues. Robert Harvey House was one of the homes chosen. We found that there were no issues of concern. At that inspection and this we looked at the staffing records of staff recently employed DS0000024882.V375036.R01.S.doc Version 5.2 Page 19 and staff had the appropriate checks before they were employed. Since this thematic inspection staff records and staff spoken to confirm that training in the safeguarding of vulnerable people had been given. Staff talked to understand their responsibility to report any concerns they have about the welfare of people. DS0000024882.V375036.R01.S.doc Version 5.2 Page 20 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, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have the benefit of warm, comfortable, wellmaintained environment. Proposed plans should ensure that there is enough communal space and a move to individual bedrooms for people. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) completed May 2008 said that the home would start to have a complete refurbishment commencing within the next 12 months. This had not started at the time of the inspection. However plans were on display for people to see. This refurbishment is expected to improve the shortage of communal areas available to people living in the home. At the inspection a number of people DS0000024882.V375036.R01.S.doc Version 5.2 Page 21 were seated in an area of the first floor without a call alarm for large part of the day and this could pose risks to them. The home appeared clean and fresh on the day of the inspection and was reasonably decorated throughout. A number of profile beds were in place to enable people to change their position in bed. We found that some of the mattresses in these beds were smaller than the frame allowing pillows to move into a gap at the top of the mattress. The head of care said that this had been raised with the bed provider but this was to enable the mechanism to work. We advised that they should consult the Health and Safety Executives information about bedrails to ensure this does not pose a risk. The home had equipment to move people from place to place and to assist moving people in bed. Peoples bedrooms looked at showed that people were able to bring belongings that were important to them. There is a six bedded “ward” area for the more dependent and frail people using the service. Space is limited in this area and this may not promote the comfort and dignity of the people living there. At the time of the inspection this area was being used to accommodate females. One relative spoken to stated that their relative was only there until a single room became available. A person told us that the only problem they could think of in the home was the laundry. Peoples clothes do not get ironed well. We noted in one bedroom that the cover for the bed was very creased as if it hadnt been ironed and there had been no attention to colour when making the bed as there was a green cover, blue sheet, blue pillow case and an orange pillow case. This showed a lack of care of how people experience their environment. The home has the appropriate laundry equipment however we noted that some blankets were being left to air on the hand rails in the corridor by the laundry; this is not appropriate as is not good infection control practice. We were advised that the laundry provision was going to improve in the refurbishment of the building. DS0000024882.V375036.R01.S.doc Version 5.2 Page 22 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. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that appropriate levels of trained staff are available to assist them when needed. Staff have appropriate checks to ensure that they are safe to work with vulnerable people before they are employed. EVIDENCE: We have had no concerns raised with us about the staffing levels in the home and their appeared to be adequate staff on the day of the inspection. Staff interviewed had no concerns about the staffing levels in the home. We looked at three recently employed staff files and found that staff were not employed until appropriate checks from the Criminal Records Bureau (CRB), Protection of Vulnerable Adults (PoVA) list and references had been received. This helps to ensure that people employed at the home are safe to work with vulnerable people. We found on one staff file a self declaration that the person was legally allowed to work in the country, this is not sufficient, the home needs to ensure that they have the appropriate page on the passport photocopied and documents from immigration to confirm this. We looked at staff records and talked to staff about their training. On the day of the inspection we were unable to find evidence that all nurses have a valid DS0000024882.V375036.R01.S.doc Version 5.2 Page 23 registration with the Nursing and Midwifery Council. We received a statement from the home that this was the case but we did not receive the PIN numbers or photocopies so we could not confirm this. Staff files showed that the new staff came to the home with some training that they had already completed. Staff spoken on the day of the inspection said, I have been working at home for 8 months have done lots of training, infection control, health and safety, PoVA, fire, end of life care, manual handling and doing first aid tomorrow. I have worked here as a carer and then trained as a nurse. I have had training recently on tissue viability, pharmacy plus, basic principles of care, first aid, completed Registered Managers Award and moving and handling approximately 9 months ago. I have completed my National Vocational Qualification level 2 (in care, NVQ2) Im supposed to start level 3 but it has not been sorted out yet. I have done manual handling, first aid and a dementia course over 3 days recently. The homes Annual Quality Assurance Assessment stated that 50 per cent of staff have achieved a minimum of NVQ2, staff recently employed have improved this percentage. DS0000024882.V375036.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 People using the 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 there is some evidence of change, the home could not show that people have an individual service where their choices are promoted and their individual needs met in the way that they wish. EVIDENCE: The manager was on leave on the day of the inspection and the head of care assisted with information collection. The Manager Anthea Reid was registered with us in November 2008. She has experience in her role having over 18 years experience in care work most of it in a senior capacity. DS0000024882.V375036.R01.S.doc Version 5.2 Page 25 She has relevant and appropriate qualifications, which include the Registered Managers Award obtained in 2007 a wide range of appropriate qualification that have been undertaken in a timely manner including dementia care. The previous manager completed an AQAA this was poorly completed and did not give a good overview of the service provided or assist in developing plans for the home. We found that more staff meetings were being held recently and the records of these showed that shortfalls were being identified and staff were being told about how they could improve. The manager was in the process of undertaking a supervision session with each individual member of staff. We found that monthly meetings were held with the home, relatives and people living in the home represented. The home does survey people in key areas however there are limited number of people surveyed due to peoples health conditions and different ways of determining peoples wellbeing needed to be found. It was not clear in all cases what the outcome of consultations of people were. Money is not held on the premises for people living in the home. Hairdressing and chiropody services are charged to the individual people after they have received the service. Mostly invoices for these are sent to relatives. There is a computer database, which the administrator records the amounts the residents owe. The system appeared to be safe. The home purchases toiletries such as soap, dental cleaning tablets and talcum powder in bulk and then charges people for these when they need them. We could not see how people living in the home were enabled to have a choice of toiletries or have the benefit of going out to buy such items. The homes AQAA showed that a large number of policies and procedures had not been reviewed for some time. This will be looked at a future inspection. We looked at some health and safety records and that there were appropriate inspections and checks to ensure Gas, Electrical and fire safety. We looked at accident records and found where there had been an accident plans were made to ensure accidents did not happen again however this was not recorded on the care plan in two situations looked at in detail. DS0000024882.V375036.R01.S.doc Version 5.2 Page 26 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 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 DS0000024882.V375036.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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. 1. Standard OP7 Regulation 12(1)(a) 15(1) Requirement Where an assessment identifies a need a care plan must be put in place to meet it. Timescale for action 31/05/09 2 OP8 This is to ensure that peoples health and social care needs are met. 13(4)(a)(c Where bedrails are fitted there ) must be a risk assessment that determines that this is the best option and ensures that they are fitted, covered, monitored and maintained. 31/05/09 3 OP8 13(4)(c) 12(1)(a) This is to ensure that risks to people who have these fitted on their bed are minimised. 31/05/09 Where nutritional risk assessments determine a course of action these must be adhered or the reasons why not recorded. This is to ensure that people are assisted to stay as nutritionally well as possible. Where people are restrained in either wheelchairs or special chairs an assessment must be carried out showing that it is DS0000024882.V375036.R01.S.doc 4 OP8 13(8) 12(1)(a) 31/05/09 Version 5.2 Page 28 needed to keep the person safe. A plan must be developed to ensure that the person is not at more risk and that they are not restricted at all times. This to ensure that people are safe and their health and wellbeing maintained. Staff files should contain all evidence to determine that staff are eligible to work. People have where necessary appropriate NMC registration. These must be available for inspection. This is to ensure that people are employed appropriately. 5 OP27 19(1)(a) 31/05/09 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 OP2 Good Practice Recommendations Further consideration should be given regarding the appropriateness of charging people using the service for the provision of a staff escort for hospital appointments. This remains outstanding All information received by health and social care professionals assessments should be added to the homes assessment to ensure that all needs are met. Plans should be in place to ensure that peoples pain relief is managed and reasons for non administration of pain relief recorded. It is recommended that all occasional use medicines have supporting protocols to administer them against to ensure they are administered as the doctor intended endorsed by a clinician. Further consideration should be made to increase opportunities for people using the service to participate in DS0000024882.V375036.R01.S.doc Version 5.2 Page 29 2 3 4 OP3 OP9 OP9 5 OP12 6 7. OP14 OP24 trips outside of the Home. People should be given choices of food in a way that is meaningful to them. A review of the use of the multi-occupancy ward area should be undertaken to promote the privacy and dignity of people in this area. This remains outstanding. 8 9 OP26 OP35 Laundry services need to improved to ensure that clothing and bedding is ironed and that laundry is not aired in the corridor. People should have the opportunity to purchase toiletries that reflect their likes and have a regard to their lifestyle. DS0000024882.V375036.R01.S.doc Version 5.2 Page 30 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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