Inspection on 29/09/09 for Selly Park Care Centre

This inspection was carried out on 29th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Selly Park Care Centre 18/09/07

Selly Park Care Centre 04/10/06

Selly Park Care Centre 24/04/06

Selly Park Care Centre 27/10/05

Selly Park Care Centre 31/05/05

Selly Park Care Centre 13/10/04

Selly Park Care Centre 16/04/04

Selly Park Care Centre 16/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Selly Park Care Centre 95a Oakfield Road Selly Park Birmingham West Midlands B29 7HW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Rosalind Dennis     Date: 2 9 0 9 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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. 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 Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Selly Park Care Centre 95a Oakfield Road Selly Park Birmingham West Midlands B29 7HW 01214714244 01214711107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.schealthcare.co.uk Exceler Healthcare Services Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 50 Date of last inspection Brief description of the care home Selly Park Care Centre is a converted Victorian building that has been extended to offer 24 hour care for up to 50 older people with nursing needs. The home is located in a residential area in Selly Park and is within easy access to main bus services from the city centre. There is a large car park to the side of the home. The home offers mainly single rooms, eight rooms are for double occupancy and there are three en suite rooms available. There is level access to the reception area on the Care Homes for Older People Page 4 of 34 Over 65 50 0 Brief description of the care home ground floor and two lifts provide access between the ground and first floor. There are four lounges of varying size and two dining areas available. There are bathrooms and showers which have equipment to assist people who may have mobility difficulties. People can obtain information about this service from the homes Statement of Purpose and Service User Guide, which are available along with a variety of information in the reception area. The guide notes that fees range from 356.86 pounds to 388.07 pounds per week. The reader is advised to contact the home for up to date information on the fees charged. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. The last key inspection was undertaken on 18th September 2007. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day by two inspectors. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake 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, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, over the last twelve months. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We also looked at information which we had received from other agencies, including the local safeguarding adults team. The inspection was triggered following concerns raised to us about the home. Four people living in different areas of the home were case tracked in detail. This Care Homes for Older People Page 6 of 34 involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. One of the people we case tracked was able to tell us about their day to day life at the home and the support they receive from staff. The other people we case tracked were not able to give us this information so we observed the care given by staff during the day. We also met other people during the day and spent time in different arease of the home observing staff in their work. We looked around some areas of the home and observed a sample of care, staff and health and safety records. Five staff completed surveys for us and we also spoke with staff during the inspection to establish their views of working at the home and if anything needs to be improved. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 34 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move in, however a lack of skilled, competent staff means that people cannot be confident that once they are admitted all their needs will be met. Evidence: We looked at the care records for two people who have moved to Selly Park Care Centre since the last key inspection. The manager had fully assessed their needs by meeting them in hospital before they were admitted and seeking information about their illness and care needs. This should, in practice help to ensure that only people whose needs can be met at Selly Park Care Centre are admitted. However our findings from the inspection identify that staff are lacking specialist skills and abilities to care for the people who are admitted. For example, for a person admitted earlier this year their assessment noted they may have an infection in a wound, but there was nothing documented in their care file after their admission to show this had been followed up to find out whether they still had the infection. Care Homes for Older People Page 11 of 34 Evidence: We saw a copy of the Service User Guide in the reception area along with the homes statement of purpose and copies of the Service User Guide were seen in peoples bedrooms. We looked at the service user guide, which contains a lot of information about the home, so that people should know what the service provides. However shortfalls identified at this inspection show that the information in the guide is not an accurate picture of what is currently happening at the home. For example the guide includes a copy of the homes activities programme but there was little to suggest that this is followed on a day to day basis. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because staff are not effective in ensuring care is provided according to the needs of the person or when risks to the health of that person are identified. Evidence: We spent time in different parts of the home, observing how people were being looked after by the staff working at the home. We saw that people appeared clean. What became apparent during this inspection was a lack of interaction, including meaningful conversation by staff towards people who live at the home. For example, for one person, who has a visual impairment and is therefore not able to see what is going on around them, we saw that staff did not speak with them for over one hour. We saw their care plan, which says they should be asked if they want to sit in a wheelchair at the table for lunch, but we did not see any member of staff asking the person if they wanted to do this. This indicates staff are not following what is documented in care plans. This persons care records included information on the safest ways to move them, such as the amount of staff and equipment needed, their risk of falls and risk of not receiving enough nutrition. Information was present to describe the care needed Care Homes for Older People Page 13 of 34 Evidence: whilst they are in bed to reduce the risk of pressure sores developing, however there was nothing to describe the care needed whilst sitting out of bed and we saw the person was sitting out in a chair for most of the time we were at the home. We saw staff had recorded two recent occasions when this person had become unsettled and staff wrote how the person, had been put into their room to calm mood. There was nothing in their care plan to suggest that any possible reasons for the behaviour had been looked at or methods which could be used by staff to reduce the behaviour rather than isolating the person in their room. Another persons care records also showed that staff are not exploring reasons for possible behaviour, as we found they have a care plan describing non-compliance, which notes they refuse care. Regular reviews of this care plan had taken place with staff repeatedly using phrases such as non-compliancy continues but nothing is documented to suggest the person has been consulted to find out why they choose to refuse care. For another person, who we case tracked there had not been an attempt to establish why at the time of their admission to the home they required a specific aid to help in the management of their continence. The aid was removed by staff at the home, but there was nothing to show that staff considered seeking advice from specialist professionals to determine if it would be in the persons best interests to have another aid put in place. Their care records show that since the removal of the aid they have had repeated episodes of incontinence and some skin soreness. A nurse on duty at the time of inspection could not provide us with an explanation as to why another aid has not been considered. A concern which was raised recently through the local safeguarding process is regarding how peoples wounds have been assessed and managed. The care records for the people we case tracked show recent improvements with how the home is assessing wounds and the risk of deterioration in peoples skin. For example for one person, their care records provide little information on how their wound was being cared for and monitored on a daily basis, up until September 2009 when there is an improvement in recording, including a full assessment of the persons body, which shows a deterioration in the persons wound. We saw that the home had taken photographs of their wounds. The manager told us that permission had been sought for the photos to be taken, however this had not been recorded which is advisable to show that people and/or their representatives have agreed to have photographs of their body taken. Observation of peoples care records shows that the home looks at risks to peoples health, safety and well-being but this may not trigger staff to take action. One person Care Homes for Older People Page 14 of 34 Evidence: has a care plan describing what should be done if they lose weight, including informing the persons GP and a dietician. We saw that between February and July 2009 this person had lost over 20 kilogrammes, yet it was not until July 2009 that their care records show they were reviewed by their GP and additional liquid food supplements started. This shows that people are at risk of not having their health needs met. We found in two peoples care records, care plans suggesting the plans had been written about the end stage of their lives. We asked the manager and a nurse on duty to provide more information about why these care plans had been written but neither could provide us with an adequate explanation. This suggests a lack of knowledge in end of life and palliative care, when care plans can be written in advance and in consultation with the person and their representatives to inform staff how the person wants their needs to be met at the end of their life. The manager recognised a need to improve this and described how lack of access to training has been an underlying factor. Most of the people we met at Selly Park Care Centre at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation and speaking with staff. One person we spoke with described the staff as being very kind but very busy, another person described how they have to wait a long time for their call buzzer to be answered at night and spoke of their fondness for a particular carer because the carer comes to see them when they are on duty. A person who was unable to speak with us indicated through gestures they are satisfied with the care at the home. We observed people sitting in wheelchairs which had the names of other people on the back of the chair. Staff told us that unless family members requested that their relative uses their own wheelchair staff tend to use the wheelchair that is nearest. This does not promote dignity and may also be a risk to the persons health and welfare as wheelchairs are often issued to meet the individuals specific needs, such as their height and weight. We looked at the Medication Administration Records for two of the people we case tracked which showed that these were up to date and properly recorded. Medication is stored in a locked cupboard so that people are not at risk of taking medication they are not prescribed. We found medicine which is injected to control blood sugar was not being stored correctly. We also saw written records showing that staff monitor the temperature of the medication fridge but this showed that the temperature is too high and we informed the manager of this so that action could be taken. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with opportunities to enhance their social well-being according to their preferences, needs and capabilities. Evidence: Observations at this inspection shows there is very little in the way of stimulation or that specialist activities are being arranged to involve, engage and stimulate people. After spending some time in one lounge, music was put on by a carer, but people were not asked if they wanted the music to be played. We looked at a document, kept with peoples individual care records and which is where, we were informed staff record activities. In one persons care records it showed that staff had only provided an activity on 7 out of 21 days in September 2009. The activities noted were jigsaws, board games, arts and crafts, TV, reminiscence, but there was nothing to suggest the activities were based on what the person wanted to do. This persons pre-admission assessment described how they wanted representatives from a church to visit them, but their care records did not show this had been arranged or is taking place, this was also the same for another person we case tracked. Care Homes for Older People Page 16 of 34 Evidence: For a person with a visual impairment their care plan described how they like to be read to and that they have a supply of taped books. Written records had not been made by staff to demonstrate that they had enabled the person to listen to these books and when we asked staff for more information they did not know where the taped books were kept. This indicates that what is written in peoples care plans is not happening. The manager informed us that the home has ordered a new CD player to facilitate the playing of this persons taped books. We were concerned that this person was pulling at parts of their chair and we asked staff if they had sought advice from specialist organisations about different activities/therapies which might provide distraction. Staff told us one activity had been suggested but told us the person would not be capable, it is disappointing that nothing else has been considered, which suggests a lack of specialist knowledge to enhance peoples well-being. A person we spoke with who could communicate their views told us they used to spend time in the lounge but they found it boring and depressing, and they told us they now choose to stay in their bedroom. We did not meet with any relatives or visitors to the home during the inspection but two people confirmed to us that their relatives are able to visit them on a regular basis. We looked at written records which had been made after meetings held at the home. This showed that some relatives had been able to attend these meetings. Scrutiny of the records of these meetings shows that people and their relatives make suggestions to improve the day to day lives of people living at the home, but these are not followed through. Examples include people asking to go in the garden and being told to wait until the weather is better, a person asking to go the pub and which the manager told us didnt happen, discussions about organising a summer fete, which the manager told us did not take place. The manager and staff told us one person had recently gone out to the park but confirmed this is the only community activity which has taken place, apart from people who are able to go out with their relatives. We spoke with the chef on duty who demonstrated a very good knowledge of the different dietary needs and likes and dislikes of people who currently live at the home. We looked at the kitchen and the meals being prepared, which shows that the homes catering staff place great emphasis on ensuring people receive a varied and nutritious diet which takes into account any specific need, such as cultural needs or when people have chewing and swallowing difficulties. Written records of a meeting held earlier in the year described ways to ensure everyone could enjoy a pleasant dining experience, however this was not the case at inspection. We saw a staff member trying to assist a person to have some soup, the Care Homes for Older People Page 17 of 34 Evidence: staff member provided little encouragement and the person would not eat. Another staff member then took over, they spoke positively to the person and the person started to eat. Another person whose care plan described they should be asked if they want to sit at the table to eat, which they werent. We observed this person being fed his main meal and pudding in a short period of time and apart from being asked if they wanted some ice cream, there was no other conversation or encouragement from the staff member concerned. People were offered drinks during the day. One carer was clearly aware of a persons preferences and brought drinks which reflected what was written in their care plan about their preferences and what the person confirmed to us in discussion. Another carer was seen putting a drink and sandwiches in front of a person without telling them what they were or checking if they could manage without assistance before they left their room. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not protected from the risk of harm or abuse because processes such as care planning, ensuring staff have the skills and competence to meet peoples needs, staff recruitment are not effective or robust. Evidence: The complaints procedure is on display in the reception and is also available within the service user guide. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. The manager told us there have not been any complaints received by the home and this was confirmed again by the manager during a discussion at the end of the inspection. However shortly after the inspection we attended a meeting which had been organised through the local safeguarding adults process following concerns raised about a persons care. During the meeting we were given a copy of a written complaint from a relative and a copy of a written response from the manager to the person who made the complaint. The manager could not provide us with an explanation as to why we had been given different information at the time of this inspection. Staff told us they are aware of the complaints procedure and most staff are recorded on the homes training planner as receiving training in safeguarding vulnerable adults from abuse, the training of which is provided in-house by the manager. We saw from the training planner that four staff have not had any training. Two new staff have not been included on the training planner and one of these staff was not able to tell us the Care Homes for Older People Page 19 of 34 Evidence: correct procedure for referring concerns related to adult protection. There was nothing to suggest that staff have received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act oversees decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The staff we spoke with were not aware of their roles in respect of the Act. We also saw written in two peoples care records about the need to use chairs which recline to maintain their safety, this was brought to the attention of the manager and company operations manager as these records suggest that staff may be restricting peoples freedom without following appropriate procedures. We have been made aware through the local safeguarding adults process of concerns about the service and that people may not be receiving the care they need. These concerns are still being investigated. Some of these concerns have been in respect of wound care, which as mentioned earlier in the report the home has made improvements with how it is assessing wounds and the risk of deterioration in peoples skin. However, when we looked at the homes training planner it showed that some staff have not had training in caring for peoples skin to reduce the risk of pressure sores developing, others have not had recent refresher training and there was no plan to show they would receive training in the future. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an environment which is safe but which needs more attention to ensure it is homely, well-decorated and free from offensive smells. Evidence: We looked at the bedrooms for the people we case tracked, which varied in cleanliness and decor. Three bedrooms we saw had been personalised with items which are important to the person, such as photographs, pictures and small items of furniture. Two other bedrooms we saw contained very little specific to the person to make their room individual to them. The general decor in the bedrooms and communal areas we looked at, looked tired and in need of re-decoration. Carpets were stained and worn in some areas. There was a notable smell of urine in a lounge, on a chair and in a bed room. We informed the manager and company operations manager of our findings, who informed us that the home is awaiting approval within the company to commence redecoration and refurbishment. It is a requirement from this inspection that the home ensures these plans are put in place so that people are provided with improved living accommodation and to ensure that action is taken to ensure the home is free from offensive smells. The manager confirmed that people are involved in choosing the colour of their bedrooms when their rooms are re-decorated. Care Homes for Older People Page 21 of 34 Evidence: We did not look at equipment which is needed to move people safely. The manager told us that the home has three hoists and equipment to move people when they are in bed, which should ensure staff have the equipment available to them to move people safely. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not safeguarded from the risk of harm and abuse because staff do not have the skills to ensure all health and care needs are met and the homes recruitment process is not robust. Evidence: We spoke with staff at the home and gave out questionnaires for staff to complete. Five staff completed surveys for us and all commented of a need to increase the numbers of staff on different shifts, their comments included:- We need more staff on duties at all times. Night nurses need to help carers, instead of leaving them to do most of the work while they sit doing nothing more carers and experienced carers more staff on morning shift so they can have breakfast early increase the number of carers for both day staff and night staff because the workload is too much. The staff we spoke with during the inspection also told us they viewed there are not enough staff. At the time of inspection we were told that staffing levels are as follows:-in the morning there are usually 7 members of care staff and two nurses, in the afternoon there are usually 6 care staff and two nurses, although an additional member of care staff is currently working in the afternoon. At night there are 2 nurses and 3 care staff. Our observations at this inspection indicate that there are people living at the home who need a high amount of care and would benefit from social stimulation. The Care Homes for Older People Page 23 of 34 Evidence: layout of the home may also impact on how staff are able to work. We received feedback from one person who told us they have to wait a long time for their call buzzer to be answered and another person who described staff as kind but very busy. We therefore require the home to review staffing levels so that outcomes for people are improved. We examined two staff personnel files to look at how the home recruits staff. We saw that the references for both staff had been obtained from friends and not their previous employer. This demonstrates that the home had not ensured these staff had all the necessary pre-employment checks undertaken to ensure they are suitable to work with vulnerable people, which is a requirement of our regulations. We saw that both staff were provided with an induction when they started working at the home. We saw notes of a staff meeting in August 2009 where the manager had informed staff that the staff training statistics are poor and that there are huge gaps in the mandatory training. This was confirmed when we looked at the training matrix/planner during the inspection. For example the training matrix showed that 5 staff had not received moving and handling training since May 2008, 3 staff have not received this training. The matrix showed that training for staff in the safe use of bed rails last took place in February 2008, however 5 care staff had not had any training in this area. As previously noted in the report some staff have not received training or recent updates in caring for peoples skin to reduce the risk of pressure sores developing, and no training has taken place to ensure staff are aware of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. Our observations throughout the inspection indicate most staff are not skilled in their approaches with people or in meeting peoples needs. For example we observed two care staff moving people using techniques which are not considered to be good practice procedures, this was fedback to the manager at the time of inspection. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are not effective and people cannot be confident that their health, safety and welfare is promoted. Evidence: The manager, Ms Linda Norton has worked at Selly Park Care Centre for some time and is registered with us as the Registered Manager for the home. Observations made at this inspection and evidenced throughout this report show that this service is not being managed well or in the best interests of the people living at the home. Prompt action on the part of the manager and company representative is needed to ensure management systems and processes are effective and improve outcomes for people. A representative of the company monitors quality at regular intervals with monthly unannounced visits. We observed a report for a visit undertaken the day before our inspection, which suggests the home is functioning well. Yet the findings from our inspection show this is not the case. This demonstrates that the company needs to review how these visits are conducted as the process should be robust enough to Care Homes for Older People Page 25 of 34 Evidence: identify when improvements need to be made. Two representatives of the company were present at the time of our inspection and were present when we gave the feedback of our inspection findings. People and their relatives are given opportunity to put forward ideas to improve the service during meetings, however as previously noted in this report this has not been followed through. We were informed that questionnaires are regularly sent to people who live at the home and their relatives but the manager told us there has been a poor response and none of the questionnaires have been returned. The home therefore needs to look at developing how it can enable people to comment on the service and ensure that it reports and acts on any feedback given. We looked at a selection of documentation which shows that the homes maintenance person undertakes regular checks of equipment to ensure it is well maintained. We saw a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. Records also showed that the temperature of the water is regularly tested to ensure it is not too hot. Whilst looking through maintenance records we saw the maintenance person had fitted bed rails to a persons bed. The records were clear and indicated the maintenance person had identified a risk with the bed rails and the mattress on the persons bed and had alerted the manager and deputy manager to this risk. When we asked the manager how she had made staff aware of this risk, the manager told us that nothing had been done. We were concerned by this as it meant staff working with the person would not be aware of the need to ensure the persons mattress was positioned in a certain way. The operations manager was present as we discussed this and assured us that action would be taken straight away to address this and make staff aware. At this inspection we did not look at how the home is involved in the management of peoples finances. This will be looked at during another inspection. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The home must ensure people have care which is planned and provided according to their needs, preferences and is based on good practice. This is to ensure people receive the nursing care and monitoring that their conditions require. 31/12/2009 2 8 12 The home must ensure any risks to the health, safety and well-being of people living at the home are identified, recorded and managed according to the persons wishes and capabilities and on advice from health care professionals. This is to ensure that unnecessary risks to the health and safety of people are identified, managed 31/12/2009 Care Homes for Older People Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action appropriately and as far as possible eliminated. 3 9 13 Medication must be stored in 30/11/2009 accordance with manufacturers instructions. This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication. 4 12 12 People living at the home must be provided with a range of activities that are appropriate and meet their individual needs and capabilities. This is to promote well-being and ensure that the social needs of people living at the home are met. 5 16 17 Complaints made to the home must be recorded. This is to demonstrate that complaints have been dealt with appropriately, to show the action taken to improve outcomes for people and so that the service can learn from any complaints which are made. 30/11/2009 31/12/2009 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 18 12 Arrangements must be made to ensure all staff have a clear understanding of adult protection and whistleblowing procedures. This is to ensure people living at the home are protected from harm or abuse and if allegations are made staff will know the procedure to follow. 31/12/2009 7 19 12 An action plan should be produced and forwarded to the commission, detailing the intentions of the company to re-decorate and develop the home. This is to show that people will be provided improved living accommodation. 31/12/2009 8 27 12 Staffing levels in all areas of the home and for all shifts must be reviewed to take account of peoples needs, dependency and layout of the home. This is to ensure peoples needs are met safely and promptly. 30/11/2009 9 29 19 Staff recruited by the home must have all required preemployment checks undertaken. 31/12/2009 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 10 30 18 All staff must have training appropriate for the work they are to perform. This is to ensure staff are competent and have the skills and knowledge to meet the needs of people living at the home (including specialist needs). 11 33 24 The system for evaluating the quality of the services provided at the home must be improved so that it actively seeks the views of people using the service, their representatives and other stakeholders. The results should then be used to improve the homes performance based on the feedback from others. 12 38 13 When close monitoring of equipment such as bed rails is required, the registered person must ensure there is a robust system in place to ensure all staff are made aware of any risks. 17/11/2009 31/12/2009 31/12/2009 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to protect people from the risk of harm and promote their safety. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 The home is advised to obtain written consent from people and/or their representatives prior to photographing wounds. A review must be undertaken of how wheelchairs are used to transfer people. This is to ensure people use equipment which has been assessed for them and does not compromise their dignity. The home should review all the care plans which are in place indicating end of life care. This is to ensure they are appropriate for that person and are based on good practice guidance The home should introduce a system of evaluating the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. The provision of meals and drinks should be reviewed to ensure staff have the skills to encourage people to eat and to provide a dining experience which is pleasurable. Staff should be provided with training about the Mental Capacity Act and Deprivation of Liberties. This is so that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. Staff files should be audited. This is to ensure that all preemployment checks have been completed, to meet legislation and protect people living at the home. The company should consider ways to support the manager to be effective in her role in overseeing all aspects of the Page 32 of 34 2 10 3 11 4 12 5 15 6 18 7 29 8 31 Care Homes for Older People 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 service and initiating improvements so that people and staff benefit. 9 33 The Registered person should consider developing how the service is monitored during monthly unannounced visits. This is to show that outcomes for people are monitored more closely so that action can be taken to improve the service. Care Homes for Older People Page 33 of 34 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. 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. Care Homes for Older People Page 34 of 34 - 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!