Inspection on 12/10/09 for Selly Wood House Nursing Home

This inspection was carried out on 12th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Selly Wood House Nursing Home 17/12/09

Selly Wood House Nursing Home 22/10/08

Selly Wood House Nursing Home 29/10/07

Selly Wood House Nursing Home 16/11/06

Selly Wood House Nursing Home 28/11/05

Selly Wood House Nursing Home 29/06/05

Selly Wood House Nursing Home 14/12/04

Selly Wood House Nursing Home 15/07/04

Selly Wood House Nursing Home 10/02/04

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Maple Lodge

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Inspirations

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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 Wood House Nursing Home 161 Selly Wood Road Bournville Birmingham West Midlands B30 1TJ     The quality rating for this care home is:   one star adequate 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: Sarah Bennett     Date: 1 2 1 0 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 32 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 32 Information about the care home Name of care home: Address: Selly Wood House Nursing Home 161 Selly Wood Road Bournville Birmingham West Midlands B30 1TJ 01214723721 01214140731 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bournville Village Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 44 beds of which 24 are for nursing care and 20 for residential care. The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 44 Old age, not falling within any other category (OP) 44 Date of last inspection Brief description of the care home Selly Wood House provides nursing and residential care for up to 44 persons of 65 years of age or more. The home is owned by Bournville Village Trust and is situated on the Trust land within the suburb of Selly Oak, South Birmingham. Care Homes for Older People Page 4 of 32 2 2 1 0 2 0 0 8 44 0 Over 65 0 44 Brief description of the care home The building is set in a pleasant quiet residential area and has sufficient off road parking to accommodate eight vehicles. The main communal rooms are situated on the ground floor. Bedrooms are located on all three floors with both upper floors providing small lounges for residents use. Care can be provided for persons with limited mobility and wheelchair users. There is a shaft lift for access to each floor, assisted bathing facilities located on all floors, mobile hoists and a call bell system. All bedrooms are single occupancy, seven of which include en-suite facilities. Toilets are situated directly adjacent to each bedroom. The home has a garden that may be accessed from the front of the premises or the ground floor lounge. There is a small parade of shops nearby and bus and rail services are within fairly close proximity. Information about the services and facilities was available on entering the home to enable anyone visiting to make an informed decision about moving in. Separate information was available about the fees on request and fees are reviewed annually. The scale of charges at the home ranged from £472 - £640.68 per week, which includes the nursing element that is paid by the Primary Care Trust. The fee information included in this report applied at the time of inspection and the reader may wish to obtain up to date information from the care service. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over two days with two inspectors on the first day and one on the second. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. 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, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 32 (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by four people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, 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. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there who were able to communicate their views, the manager and staff on duty, professionals and relatives visiting were spoken with. As some people were not able to communicate their views, time was spent observing care practices and interactions from staff. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be regularly reviewed and clearly state individuals needs so that Care Homes for Older People Page 8 of 32 staff know how to support each person. Staff should support people appropriately to ensure they are not at risk of developing sore skin, which could impact on their well being. Medication must be given as prescribed to ensure that peoples health needs are met. Food should be provided that people like so they can enjoy their mealtimes and get the nutrition they need. Staffing levels should be regularly reviewed to ensure they are meeting the needs of the people living there. All equipment must be regularly tested to ensure it is safe to use. All people must be assessed as to the help they need with moving around so that staff know this and ensure that they or the people living there do not get injured. 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. Care Homes for Older People Page 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need about the home and their needs are assessed so they know they can be met there. Evidence: The service user guide had been updated this year so it included the current information about the home. This ensures that people have the information they need so they can make a choice as to whether or not they want to live there. It included pictures and was available in large print so making it more accessible. The statement of purpose had been updated recently so it included the current information about the home. It was in large print making it easier to read and was displayed in the reception area. It included the fees charged to live there to help people to make a choice as to whether or not they want to live there. There were no vacancies and the manager said that there is a waiting list for people Care Homes for Older People Page 11 of 32 Evidence: who want to come and live at the home. The records of two of the people that had recently moved into the home were looked at. These included a detailed assessment of the persons needs before they moved in. The manager had signed the assessment to state that the persons needs could be met at the home. The home does not provide intermediate care. Therefore, standard 6 that relates to this was not assessed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that individuals needs are met, which could impact on their health and well being. Evidence: The records of four of the people who live there were looked at. These included an individual care plan that stated how staff are to support the person to meet their needs. Some work had been done on updating some care plans so that they were more person centred. Staff are continuing to update all care plans in this format with the people living there. Some care plans included personal information about the person as a Memory Book. This told staff about the person and what they had achieved so far in their life, their work and family so helping them to understand more about the person as an individual. Some people had not wanted to complete this and this wish was respected. Some care plans had been reviewed every month for several months and then not at all for a few months. There was no indication that this had stopped because the persons needs had changed meaning the care plan did not need reviewing so often. Care Homes for Older People Page 13 of 32 Evidence: They should be reviewed regularly to ensure that staff know how to support people to meet their current needs. Care plans varied in the amount of detail that was provided about the person and the support they needed. The manager said that as all care plans are being updated into a person centred format this should improve this. One persons care plan had conflicting information about them wearing hearing aids so it was not clear what support they needed with this. This could result in the person being unable to communicate their needs and wants. One persons records stated that to relieve their skin of pressure to prevent sores staff needed to move them often and the frequency of this was stated. However, records sampled did not show that staff were doing this as often as they should. This could result in the persons skin becoming sore, which could impact on their health and well being. Records sampled showed that where appropriate referrals are made to other professionals to ensure their health needs are met. Professionals told us that staff follow their advice to improve the well being of the people living there. Records sampled showed that people had regular health check ups to ensure their health needs can be met. People told us they were happy living at the home and the staff are alright. Professionals told us that the staff are knowledgeable about how to support the people living there and know people inside out. Professionals told us and records showed that staff monitor peoples weight regularly. However, they do not know what each persons Body Mass Index (BMI) is so that they do not know what each person should weigh. This could impact on their health but professionals told us that the manager is addressing this and staff are finding out peoples BMI. Records sampled showed and the AQAA stated that additional funding is provided to enable one person to have 1: 1 staff support at certain times of the day to ensure their safety and well being. Staff told us, records showed and it was observed that this additional staff support is not always provided. On the first day we visited, the support was not provided as the regular agency staff who does this was off sick. Arrangements had not been made to cover this. Staff told us and records showed that this person is at great risk to their health and safety if they do not get the support they need. Nurses told us that on a late shift there is only nurse on duty so it is difficult to do the medication round. We observed that the bleep the nurse was carrying was constantly Care Homes for Older People Page 14 of 32 Evidence: going off and nurses said that medication rounds get interrupted. Professionals have told us when they have visited that the nurses bleep constantly interrupts what they are doing. The medication round takes a long time to complete with one nurse. Nurses told us and records sampled showed that this does not always leave sufficient time between people getting doses of medication, which could impact on their health. Senior care staff are being trained to give medication to the people living there that do not require nursing care. This should help to alleviate some of these problems. When looking at medication administration records (MAR) we found that some errors had been made. For one person who was prescribed a painkiller it was not clear whether staff were giving one or two tablets. We found that for two people who were prescribed a tablet that prevents blood clots that the MAR did not cross reference with the amount of tablets in the home, indicating that medication had not been given as prescribed. An immediate requirement was made on the first day of the inspection to ensure that people receive their medication as prescribed. When we visited on the second day we found that these peoples tablets had been given as prescribed. However, we found for other people that their MAR did not always cross reference with the amount of medication kept for them in the home. This appeared to be recording errors, not that medication had not been given. The deputy manager showed that regular audits were being done to rectify this and where discrepancies had been found these were being investigated. The home is working with a GP and pharmacist from the Primary Care Trust (PCT) as a project to reduce hospital admissions. This should help to improve the medication practice at the home. The home is also working with the pharmacy and the PCT to increase audits and improve medication practice in the home. We will check compliance with medication practice by a pharmacist inspector visiting the home unannounced. We found that some people were prescribed controlled drugs. These had been given, stored and recorded appropriately to ensure that people were getting these as prescribed. The medication fridge on the ground floor was not working so all medication that needed to be stored in a fridge was stored on the top floor. This meant that nurses had to go to the top floor when they needed medication from the fridge for a person living on the ground floor, so increasing the time it took to do the medication round. We observed staff taking time to talk to people and talking to them in a respectful way. Staff were observed supporting people so as to maintain their privacy. For example, one person needed to be sat up in their wheelchair to be more comfortable. Staff needed to use a hoist to do this. Staff supported the person in their wheelchair Care Homes for Older People Page 15 of 32 Evidence: to the bathroom so this was not done in the lounge in front of all the people that were there. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there experience a meaningful lifestyle that is appropriate to their cultural background, needs and wants. People do not always enjoy the food that they have and this could impact on their well being. Evidence: Care plans included details about the support people needed to meet their social and leisure needs. These stated what the person enjoys doing and how staff can help them to do these things. Records showed that activities are planned and entertainers and therapists visit the home to lead activities that benefit the people living there. An activities co ordinator is employed who organises these and ensures that people are engaged in activities they enjoy. Staff were observed spending time with individuals, talking to them, reading the newspaper or watching TV . On the first day some people were involved in a craft group, which they said they enjoyed. The activity co ordinator said that a car is provided to enable people to get out into the local community with staff support. They said that recently some people had enjoyed a drive out into rural areas to see the changing colours of the leaves, which they enjoyed. Care Homes for Older People Page 17 of 32 Evidence: Dogs from a Pet Therapy service visit the home regularly and staff said that the people living there enjoy this. That week a donkey was going to visit the home. On the second day of our visit staff said that this had been successful and enjoyed by the people living there. Some people prefer to spend time in their bedrooms and may participate in planned activities if they want to. Their wishes are respected and staff ensure that they can do the things they want to in their bedrooms. Some people have regular visitors and they spend time with people in their bedrooms if they want to. Visitors said that they were made to feel welcome and this was observed. Some people go out to visit their relatives and if needed staff support them to do this. Regular residents and relatives meetings are held. People said and it was observed that minutes of these meetings are kept and they have an opportunity to contribute to the agenda if they want to. A service of Holy Communion is held at the home once a month. Records sampled showed that people are asked if they have any religious needs before they move in so that staff know how to help them to meet these. Records showed that where people expressed a preference to attend church or other places of worship they were supported to do so. At the last inspection we found that the food provided did not meet the tastes and needs of all the people living there. The AQAA stated that a new cook was appointed in September and it was hoped that this would improve the food served at the home. Some people living there and their relatives said that it was disappointing that this had not improved. Staff said that the food served was not of good quality, texture and lacked imagination. For example, they said that the foods for the main meal would be all the same colour such as cauliflower, mash and fish so it did not look appetising. People said that the fish or meat is often tough and difficult to eat. Menus showed that a range of foods is offered at breakfast including a cooked breakfast. People said they can have a cooked breakfast if they want it and this is often very good. Staff said, people told us and it was observed that some people have their breakfast in their bedroom if they want to. There are two sittings at lunch time so that people who need more support to eat their meals can be given this. Menus sampled showed that there are two choices of the main meal and these reflected the cultural background of the people living there. People said that the puddings are often disappointing and not what they would Care Homes for Older People Page 18 of 32 Evidence: choose. For example, the menu may say sponge pudding and custard but they get cake and custard, which is often watery or sweetened with saccharin not sugar. People said that the gravy is often watery. People said that supper can be too early at 5pm but that snacks are available and they have a milky drink later in the evening so they do not feel hungry during the night. People and staff said that the soup served at supper is often from a packet and too lumpy so does not taste good. Staff were observed at lunch time to support people discreetly to eat their meals and there was a calm and relaxed atmosphere in the dining room. People were offered a choice of drinks with their meal. People had made their choices before lunch about what they wanted but if they changed their mind staff made sure that they had what they wanted. Care Homes for Older People Page 19 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from abuse. Evidence: The complaints procedure was displayed in the home so that people had the information they needed if they wanted to make a complaint. A suggestions box was available in the home for the people living there and their visitors to make comments about the home. People and their relatives said that they knew how to make a complaint and that their complaints were listened to and resolved satisfactorily. The manager stated in the AQAA that all complaints are acknowledged, followed up and the complainant is responded to. Complaint records sampled showed this and that complaints are used to improve the service provided. Records showed that since January this year the home had received sixteen complaints, all of which had been responded to appropriately and improvements made as a result. We have received one complaint about the home since our last visit. This was investigated by the manager and was not upheld. Training records showed that half of the staff had recent training in how to safeguard the people living there from abuse. Staff and the manager said that updated training for all staff was booked and that they would have this soon. Staff spoken to demonstrated an understanding of how they would safeguard the people living there Care Homes for Older People Page 20 of 32 Evidence: and showed that they would take appropriate action if needed. Staff have had training in the Mental Capacity Act and the Deprivation of Liberty Safeguards that accompany this Act. This ensures that staff are aware of this legislation and how it may affect the people living there. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable, clean and safe environment that meets their individual needs. Evidence: The home is decorated to a good standard and well maintained. The senior manager said that the Executive Team of the organisation have agreed in principle that the building will be refurbished and any repairs needed will be done. If the Trustees agree to this, this work will start in early 2010. This will further improve the home and make it more comfortable and homely for people to live in. The corridors are wide with fitted hand rails so that it is easier for people to move around the home. Assisted bathing and shower facilities are provided so that all the people living there can get in and out of these. Call bells are provided in each room. In bedrooms seen these were positioned near to people so they can call for staff help when needed. Peoples bedrooms seen were personalised and people had several of their own possessions. People said they can bring some of their own furniture into the home if they want to. Some rooms have an en suite shower room, one room has a toilet and washbasin and other rooms are single with communal facilities. One person said,The surroundings are lovely here and I have a nice view from my bedroom. Care Homes for Older People Page 22 of 32 Evidence: The home was clean and free from offensive odours making it pleasant for people to live in. The laundry is sited so that soiled laundry does not have to be taken through areas where food is prepared, stored or eaten so reducing the risk of cross infection. Staff records showed that they receive training in infection control so they know how to minimise these risks. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development are variable, which could impact on the health and well being of the people living there. Evidence: In the morning shift there are eight care staff and two nurses and in the afternoon shift there are six care staff and one nurse. An activity co ordinator is employed during the day. Staff are employed to do the cooking and cleaning so that care staff do not have to do these tasks. Since we last visited an extra member of care staff works at night so there are five care staff and one nurse. As stated earlier in this report nurses on the afternoon shift can sometimes find it difficult to ensure that medication is given as prescribed. Professionals have told us when they have visited that the nurses are very busy and they are concerned about this. Staff told us that there are not always enough staff as peoples needs have changed and they need more support but additional staffing is not provided. Staffing levels should be reviewed to ensure that the needs of the people living there are met at all times. The manager said that three staff had recently been recruited to fill the staff vacancies. They were awaiting checks to be completed before they could start. The AQAA stated that over three quarters of the care staff have achieved National Vocational Qualification (NVQ) level 2 or above in care. This exceeds the standard and should ensure that staff have the skills to meet the needs of the people living there. Care Homes for Older People Page 24 of 32 Evidence: Some staff have achieved NVQ level 3 and these staff are taking on a senior role working with the people who need only residential not nursing care. The records of three staff were looked at. These generally included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This ensures that suitable people are employed to work with the people living there. One record did not include a reference from the last employer. This should be sought to ensure that the people living there are safeguarded and suitable people are employed. The nurses record included a copy of their pin number with the Nursing and Midwifery Council (NMC). It did not include confirmation of this from the NMC website. The manager said they do ask for this but had not printed it off. It is recommended that this is done so it is clear that all nurses remain to be registered with the NMC so safeguarding the people living there. Training records sampled showed that staff receive the training they need. Records showed that where updates are needed these are identified and staff are booked on the training they need. Staff said that they have a lot of training and have what they need to meet the needs of the people living there. Bank staff are included in training so they know how to meet peoples needs. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always ensure that the health, safety and welfare of the people living there is promoted and protected, which could impact on their well being. Evidence: Since we last visited a new manager has been appointed. They have been in post since March this year and said that they were applying to be registered with us. This shows their commitment to the home. Staff spoken to said that the manager is approachable and positive changes have been made since she has been there. A deputy manager has also been employed who works some shifts so acting as a role model for the staff. The manager is beginning a course in dementia in the new year to further her knowledge. The deputy manager is undertaking a Masters Degree in Person Centred Care and hopes that this will improve the care planning at the home. A representative of the provider visits the home every month as required and completes a report of their visit. These detailed what needed to be done to improve Care Homes for Older People Page 26 of 32 Evidence: the home to benefit the people living there. Resident and relatives meeting minutes showed that peoples views are listened to and improvements made as a result of this. Staff records sampled showed and staff said that some staff have had more regular supervision recently. Some staff had not always had regular supervision with their manager but this had been for a number of reasons and staff are aware that this should be regular. This will help to ensure that staff are supported in their role to improve the support given to the people living there. Some records sampled were disorganised and it was not clear how staff were to support individuals to meet their needs. This could result in peoples needs not being met appropriately. This was also raised in the report of the providers visit in August this year so it is disappointing that action had not been taken to address this. One person who had recently moved into the home had not been assessed as to the support they needed with moving around. However, we observed that this person needed support from two staff using a hoist to move. This could result in staff not knowing how to move the person appropriately, which could put staff and the person at risk of injury. Staff check water temperatures in each bathroom when people have a bath to ensure they are not at risk of being scalded. Records showed that these were within the recommended safe limits to ensure people are not at risk. However, people have a sink in their bedroom but staff have not recorded the temperature of these as they were told to stop doing so by a previous manager. The records of these had apparently been shredded by the previous manager so it is not clear when these were last tested. All water temperatures must be regularly tested to ensure that people are not at risk of being scalded. Records showed that the lift, hoists and bath hoists are regularly serviced by an engineer to ensure they are well maintained and safe to use. Fire records showed that the alarm is not always tested weekly to ensure it is working and would alert people if there is a fire. Records showed that there had recently been fire drills and staff had fire safety training. This ensures that staff and the people living there would know what to do if there was a fire. Care Homes for Older People Page 27 of 32 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 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Additional staff must be provided where needed and where funding is provided. To ensure the safety and well being of the people living there. 16/11/2009 2 8 12 People must be supported appropriately to ensure that they are not at risk of developing a pressure sore. To ensure their health and well being. 30/11/2009 3 9 13 Staff must record accurately when they give people their medication. To ensure they receive their medication as prescribed. 23/11/2009 4 38 13 The fire alarm must be tested weekly. To ensure it is working and would alert people if there is a fire. 16/11/2009 Care Homes for Older People Page 29 of 32 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 5 38 13 Assessments must be made of the support people need with moving. To ensure their safety and that of the staff supporting them. 30/11/2009 6 38 13 All water temperatures must 16/11/2009 be regularly tested. To ensure that people are not at risk of being scalded. 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 2 3 7 7 9 Care plans should clearly state individuals needs to ensure that staff know how to support each person. Care plans should be reviewed regularly to ensure that staff know how to support people to meet their current needs. Staffing should be reviewed to ensure that people get their medication as prescribed so ensuring their health needs are met. Fridges to store medication in, should be provided and working on each floor to ensure that staff can concentrate on giving people the medication they need to ensure their health and well being. People should be provided with food that they enjoy so they get the nutrition they need to ensure their health and well being. Staffing levels should be reviewed to ensure that the needs of the people living there are met at all times to ensure their health and well being. Evidence from the NMC website regarding nurses registration should be available so it is clear that all nurses Page 30 of 32 4 9 5 15 6 28 7 29 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 remain to be registered with the NMC so safeguarding the people living there. 8 29 A reference from staffs last employer should be sought to ensure that the people living there are safeguarded and suitable people are employed. Staff should have regular supervision sessions to ensure they are supported in their role to improve the support given to the people living there. Records should be better organised so it is clear what support the people living there need to ensure their well being. 9 35 10 37 Care Homes for Older People Page 31 of 32 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. 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