Inspection on 10/11/09 for Silverwood Nursing Home

This inspection was carried out on 10th November 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Silverwood Nursing Home Imperial Road Beeston Nottingham Notts NG9 1FN     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: Helen Macukiewicz     Date: 1 0 1 1 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 31 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 31 Information about the care home Name of care home: Address: Silverwood Nursing Home Imperial Road Beeston Nottingham Notts NG9 1FN 01159253699 01159430715 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Modelfuture Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The manager will be based within the home 5 days each week The managers hours are not included in the qualified nurse requirement Date of last inspection Brief description of the care home Silverwood is a purpose built large care home consisting of two units separated by a Kitchen and walkway. East wing mostly accommodates people with nursing needs and West wing mostly accommodates people with personal care needs. The home is split over two floors on each Wing. Both have offices, bathrooms, bedrooms and lounge/dining areas. There are gardens to all sides and a car park to the front of the home. Care Homes for Older People Page 4 of 31 Over 65 80 0 0 3 Brief description of the care home The weekly fees ranged between 373.92 GBP to 522.11 GBP per week. Extras include hairdressing, Chiropody and some toiletries. No day care or intermediate care was being provided at the time of the last Key Inspection. Copies of the latest Inspection report can be found in the homes foyer. Care Homes for Older People Page 5 of 31 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 inspection was unannounced and involved a visit by two Inspectors to the site at 9.15am. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people using the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments such as notifications from the provider, complaints or concerns. We also use information from an Annual Quality Assurance Assessment (AQAA), referred to throughout this report as the pre-inspection self-assessment, which the provider is Care Homes for Older People Page 6 of 31 required to complete prior to a visit to the service. This provides evidence for us to make informed judgments when assessing the National Minimum Standards (NMS). The primary method of inspection used during the visit to this service was case tracking. This involved selecting three people and tracking the care they receive through review of their records, discussion with them where possible, the care staff and observation of care practices. Time was spent in discussion with the Manager and staff. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. Due to the size of this home and the fact that services are provided in two wings, some of our findings are separated into East Wing (accommodating mostly people with nursing needs) and West Wing (residential provision). All of the key standards were inspected on this occasion. Care Homes for Older People Page 7 of 31 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 31 order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 the information they need to chose a home that is suited to their needs. Gaps in peoples assessment on admission leaves the potential for care needs to be overlooked. Evidence: The completed pre-inspection self-assessment stated prior to admission service users or their representatives are provided with information about the home including the SU guide and the most recent inspection report. The manager welcomes enquiries from all groups of people and is non-discriminatory. Where it is felt we are unable to meet needs, for example clients with dementia we provide an explanation regarding the reason and advice on alternative care homes which may be able to do so. We found that the information available for people about the home, contained within the Service users Guides, was accurate and kept in locations around the home where people could see them. Visitors told us they had been able to look around the home Care Homes for Older People Page 11 of 31 Evidence: and had been given information before their relative moved in. This meant that people had information about the home on which to base their choice of home upon. Relatives told us they had been happy with their choice of home. One said mum is settled here and another said its a lovely place, weve been in a few homes and this is the best home Ive been in. East Wing Generally, people had an assessment of their needs prior to moving into the home. However, one care file on the East wing lacked pre-admission details and a visitor told us that staff did not know enough about their relative on admission. We also found that not everyone on the east wing had their needs fully assessed upon admission. In one care file the draft plan/assessment on admission was not signed as being done until a week after they were admitted. West Wing Three peoples care records were examined and all had an admission assessment in place, and information from external professionals, where applicable. This information was comprehensive and included risk assessments for nutrition and pressure sores as well as a dependency assessment and a moving and handling assessment. Care Homes for Older People Page 12 of 31 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. Gaps in staffing, care planning and medication errors adversely affect peoples well being. Evidence: West Wing Three peoples care files were examined and all had a care plan in place. However, the content of the plans was not sufficient to establish that all potential risks were addressed. For example, one persons care plan covered only two areas of need despite the assessment identifying more, and none of the care plans had any details on what to do to prevent pressure sores although the assessment information stated that they were at risk of developing them. There were also no comprehensive plans to address nutritional risks although the assessment documentation established that all three peoples nutrition was a cause for concern. There was access to health professionals such as district nurse, General Practitioner (GP), optician and chiropodist and their visits were recorded in the care files. Care Homes for Older People Page 13 of 31 Evidence: East Wing There had been a delay in producing one persons care plan following their admission. Only a limited amount of peoples care needs had been identified in some care plans we saw. Staff had not adhered to professional guidelines when recording information. This means that entries were not always completed, dated or signed in full. Care files did not support that people had been fully consulted about their care. One visitor confirmed that they hadnt seen their mothers care plan, despite the fact that their mother couldnt advocate for themself. Appropriate referrals had been made to the GP for medical advice. We observed staff knocking on peoples bedroom doors before entering. One relative told us they look after them really well here and said that staff are respectful and maintained peoples dignity. Dignity was being generally promoted within the home, a dignity board was seen in the west wing foyer along with a suggestions box for dignity issues. It was observed during the inspection visit that staff and people using the service enjoyed warm relationships and privacy and dignity was upheld. People described the staff as caring and helpful and kind. One relative, in their completed pre-inspection survey wrote my mother is always smartly dressed, clean and her hair and nails are well cared for. Two relatives said there was sometimes a wait for assistance when using the call bell and this included requiring assistance to use the toilet. One visitor said they had been concerned because their friend was told on one occasion to eliminate their bowel into their pad as there were insufficient staff to take them to the toilet. (see staffing section of this report) Medication administration procedures were examined. A general check on eight medication administration record (MAR) charts showed that charts were largely completed properly with the the amount of medicine received being recorded and dated and signatures to show the medicine had been administered. The drug fridge was locked and temperature records maintained and up to date when checked. Staff told us they had received medication training about 2 months ago. However, we also found some areas of concern in relation to the management of medicines. We had been notified of two drug errors since June 2009, one involving a controlled drug. One visitor told us that on one occasion, staff had forgotten to give their relative the pain relief they required. In the west wing, there was one extra Care Homes for Older People Page 14 of 31 Evidence: tablet in the packet than indicated on the MAR chart. This meant that staff had signed to say the person had taken a medication, which they had not. In the East wing, a person who was self medicating had no safe place to keep their medication in their bedroom and no risk assessment or consent in their care plan. The medication was not listed on their MAR chart, so there was no record at the home to support the administration of this medication. One persons MAR chart recorded they were on a medication, but no time was stated, this had not been signed for since they were admitted the week before this visit. However, the correct amount of tablets were missing from the pack, suggesting they had had them but they had not been signed for. A handwritten MAR had no second signature on to verify that the information had been correctly transferred. Variable dose medications did not always record the exact amount given each time. On one MAR, there were three occasions when a code of E refused and destroyed was used. These tablets had already been removed from the blister pack, which suggested staff were potting tablets up rather than asking the person if they wanted them, before dispensing. The stock of controlled drugs was examined. These were stored securely and the amount of medicine stored corresponded with the written record. A general check on medicine stocks was carried out and found to be satisfactory with no medicines seen being past their expiry date. The medication policy covered key areas of medicine administration and storage and and also what to do if an error occurred. We alerted the project manager for this home to our concerns about care planning and medication at the time of this visit. The Company had already put measures into place to address care planning short falls. They confirmed both during, and following this Inspection, that measures had been put into place to ensure that required improvements to the management of peoples health were addressed. Care Homes for Older People Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a varied lifestyle of their choosing. Meals are varied and nutritionally balanced. Evidence: The completed pre-inspection self assessment stated We have recruited an additional activities coordinator and increased the range of activities available to SUs. We have also increased the number of trips out of the home. Both of these issues were identified within resident meetings. We try to ensure staff and service users are aware of what is happening in the home via meetings, personal invitation and a newsletter. Trips out of the home have increased and we have had very positive comments from service users and family. Resident meetings are always well attended and we try to vary the times of these to allow a wider range of people to come. One relative, in their completed pre-inspection survey wrote there is an effort to provide appropriate in-house activities and the meals are always very good. The serving of the lunch-time meal during this inspection visit also showed that the food was plentiful and nutritious. All eight people spoken with said they enjoyed their food and one relative also confirmed this. One person spoken with described the food Care Homes for Older People Page 16 of 31 Evidence: as good and another said they couldnt complain. One relative we spoke to said (x) likes the food, says its good. New menus had been started, they looked comprehensive and nutritionally balanced, they offered a choice and we heard people being offered a choice at lunch time in the east wing dining room. The cook knew about peoples individual dietary needs. One person confirmed that they could have their own routine and that they spent time in their bedroom by preference. One relative said about the routine that it was flexible when (x) is ready to go up they see that theyre safe, (x) is one of the later people to go to bed, usually about 10.30pm. Relatives spoken with confirmed that they could visit when they wished and described the service as welcoming. One person told us that said a visitor comes from their church to see them at the home. Care plans in the west wing contained a social needs assessment and brief information on peoples likes and dislikes. However, those on the east wing did not all identify peoples social needs well, and not all had a social care plan in place. However, a manager from another Southern Cross home was present at the time of this visit and she was updating the care plans on this unit, to include personal details. Dominoes were being played with people in the west wing during the afternoon of the inspection visit and an activity co-ordinator was employed to arrange a variety of social activities. One relative said about the entertainment its there for them but if they dont want to join in they dont have to, its up to them - they take them out in the Summer. A list of activities was displayed in the west wing foyer, including up and coming entertainers events and pictures of what people had done. Care Homes for Older People Page 17 of 31 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. People are protected at the home and have their rights upheld. Evidence: People had information about how to complain, this was stated in the Service Users Guides. Seven complaints had been dealt with by the home since registration in June this year. Complaints records were comprehensive, each concern was filed separately and logged. They stated actions taken by the home to resolve the issue, and outcome including any considerations for future preventative action. However, one person only had a brief note of their complaint recorded by staff receiving it. There was nothing in their care file. One relative, in their completed pre-inspection survey wrote the new manager is aware of problems in the home, and has so far responded well to situations I have reported to her. On the day, two people said said they could speak to the manager if they had complaints and that she was a nice person, she is very approachable. Two other people said they would feel comfortable approaching staff with any concerns. Two safeguarding concerns had occurred since June 2009. The staff at the home had worked with Broxtowe Social Services to resolve the issues and they had been concluded without being substantiated. Staff training records seen stated that safeguarding training had occurred in March Care Homes for Older People Page 18 of 31 Evidence: 2009. Staff interviewed confirmed that they had received this training and were aware of their responsibilities in reporting any potential abuse. Safeguarding procedures were easily located by staff. The manager stated that no-one had training yet on the Mental Capacity Act, but she had sourced some and was awaiting a date. Care Homes for Older People Page 19 of 31 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. The environment is suitable for meeting the homes stated aims. Evidence: The pre-inspection self-assessment stated We are currently looking at a refurbishment programme which would further enhance both lodges and will additionally continue to invest in the physical structure of the home both internally and externally. Our environmental standards have always been high and we have continued this through our monthly maintenance programme. New fridges have been purchased for the kitchen and we await delivery of a new dishwasher. The kitchen has been made safer by the fitting of digilocks to both doors. One relative, in their completed pre-inspection survey wrote (x) room is clean, pleasant and hoovered; the home is warm. The premises were clean, tidy and odour free at the time of the inspection visit. People spoken with stated that the home was very clean and that there was no smell. Individual rooms were personalised with furniture, ornaments and pictures. One person had been able to change their bedroom, for one with a better view. Not everyone had been offered a key to their bedroom door. One relative spoken with said they had waiting since June for bedroom to be re-decorated. They also stated that personal clothes went missing from the laundry and that their relative was dressed in Care Homes for Older People Page 20 of 31 Evidence: mismatched clothes. Peoples clothing seen during inspection visit was clean and appeared well cared for. The project manager told us that they were looking into a new system for laundering clothes to reduce the potential for items getting lost. Staff spoken with were aware of how to control the spread of infection and confirmed that there was always a plentiful supply of aprons but that there had been recent problems with the supply of pads and gloves. Laundry staff told us that all the laundry equipment was working and that there were adequate facilities for the laundering of soiled items. Care Homes for Older People Page 21 of 31 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. Perceived shortfalls in staffing means that people may not be receiving the care they need. Evidence: We looked at the staffing rotas for the east and west wings. On the east wing there was less consistent staffing and more gaps unfilled by care staff. As a result of staff leaving, there were only 2 registered nurses permanently employed to cover daytime shifts. Staffing rotas showed that they occasionally worked long days, so one could have a day off. 4 care staff were normally provided for each shift, but due to illness many shifts were only covered by 3 staff. On nights, there was a registered nurse and 2 care staff on the rota. Many shifts towards the latter part of the four week rota needed to be covered. It identified as needing 1 carer on 13.11.09 night, then 18th, 19th and 22nd Nov. After 23rd November none or only one care staff was identified to work. One care staff was identified to work 11 consecutive shifts, including long days. On the west wing, the staff rota showed that there were five care staff on the morning shift, four on the afternoon shift and three at night for thirty-five people currently accommodated. There were also four housekeeping staff for domestic and laundry duties each day and a cook and two kitchen staff each day. Relatives spoken with commented that there werent always enough staff and that this sometimes necessitated a wait for assistance. One relative spoken with commented that getting Care Homes for Older People Page 22 of 31 Evidence: the staffing right was a way the service could improve. One relative, in their completed pre-inspection survey wrote on occasion there does not seem to be sufficient staff and my mother repeatedly complains of having to wait to be accompanied to the toilet. Sometimes complains of a delay in being taken to bed at night. A visiting professional also commented about staffing levels, describing some patchiness and questioned whether there were enough staff to give optimal care. On the day of this visit, two visitors said staffing was too low, staff are stretched and there has been a big turnover. Both said that turnover of staffing had been unsettling for their relative as they didnt like change. Minutes of the last residents meeting on 5th October were on display in the east wing foyer, these recorded that people had raised concerns about having to wait longer to have buzzers answered, baths not getting done and having to wait to go to bed. One person said the girls are very good, they look after you then said they are short of staff. She said when they are short you dont get the care that you need. The person went on to say the staff are always leaving, they cant keep the staff and its nice to see the same girls, they do their best. They said that they werent getting baths or going to bed on time, but that had got better of late. Another person living in the east wing and a visitor also confirmed that staffing had got better. However, staffing rotas still showed gaps in cover for the rota. People told us that they liked the staff. One visitor told us the staff are very nice here and another said some of the staff are very good and theres always somebody about. Two people said they look after me very well, if I need help, they are there, they are very good. In a completed pre-inspection survey, a relative wrote the staff/carers are cheerful and friendly. And in a visiting professional survey they wrote excellent senior staff, good co-ordination. On the day two people said staff are pleasant, nice, they said there were enough staff and that they were always cheerful. The pre-inspection self-assessment stated Staff working in the home are receiving regular training and supervision which ensures the standards within the home are as they should be. New staff attend a 5 day induction programme at another home which covers all mandatory areas. Each area of completed training is certificated and added to our training statistics. Staff working in the home are supported and encouraged in completing their NVQ in all areas and we currently have kitchen and housekeeping staff undergoing these in hospitality and hotel services as well. Training information provided by the service showed that mandatory health and safety training took place as well as in areas related to care. Staff spoken with confirmed Care Homes for Older People Page 23 of 31 Evidence: that mandatory health and safety training had occurred in the last twelve months. Records seen on staff files also showed that training in nutrition and challenging behaviour had occurred in 2009. About 50 of staff were trained to National Vocational Qualifications level 2 or above. Staff in east wing stated they had received all the required training and that staffing shortfalls were getting better. Four staff files were examined and generally showed evidence of good recruitment processes. Most of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place, including a Criminal Record Bureau check, evidence of identity, a Protection of Vulnerable Adults (POVA) First check and two written references, with the exception of one file that had only one reference. Qualified staff also had verification of their license to practice from their governing body. We were shown an induction course for new starters, this was a 3 day course and included training on all required mandatory subjects. Care Homes for Older People Page 24 of 31 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. Management of the home is not effective in identifying shortfalls in care standards. Evidence: A new home manager had been employed since August 2009. She is a registered nurse with experience of managing care homes. She was in the process of registering with us. She had undertaken part of a registered managers award but was yet to complete this. A new unit manager had been employed to cover the west wing and Southern Cross were looking to appoint a nurse manager for the east wing. We were concerned that we had not been notified about a couple of thefts and police involvement in the home through our routine notifications process. We had also not been informed in a timely way about the appointment of a manager and two potential safeguarding issues. However, feedback supported these issues had been dealt with as required. Some internal quality monitoring was taking place. The project manager had called to Care Homes for Older People Page 25 of 31 Evidence: undertake a regulation 26 monitoring visit. The manager was having weekly open sessions for relatives to see her. Residents meetings were taking place, although questionnaires had yet to be issued. Two managers from other Southern Cross homes were also conducting a quality audit, similar to our inspection process. However, we were concerned that internal audits had not been effective in raising standards of care planning and medication administration/management. Also, in resolving staffing shortfalls. We also noted that we had a very poor return rate following the issue of our own pre-inspection surveys to the home. Staff told us they had not been issued with these surveys. We left some more for them to complete during the Inspection. The project manager was able to provide us with information both during and following this Inspection, which showed they were addressing identified shortfalls within the management of the home. Three peoples financial records were examined and showed that there were secure systems in place for safeguarding peoples money. The written record showed with the cash available to the person and there were receipts available for individual purchases. There were secure storage facilities for cash and valuables. Staff training records seen indicated that training had been undertaken in mandatory health and safety subjects such as infection control, moving and handling, food hygiene and fire safety in 2008/9. Staff spoken with confirmed that this training took place, although one member of staff stated that their first aid training was out of date and there was no identified first aider on each shift. The project manager confirmed that a fire risk assessment and health and safety audit had been undertaken, although both documents could not be located by the manager. There was some outstanding work listed on the 5 yearly electrical installation report, the maintenance person was able to confirm by visual examination that some, but not all of this work had been completed. There were records to support that equipment such as hoists and fire extinguishers had been regularly serviced. There was a system in place whereby requests for maintenance could be made. The manager and administrator said Southern Cross are very responsive to maintenance requests. Records showed that staff supervision took place approximately every two to three months. Records seen showed that this had occurred in September and October 2009. Care Homes for Older People Page 26 of 31 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 31 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 3 14 All people admitted to the home must have a thorough assessment of need upon admission. This is to ensure care needs are not overlooked. 31/01/2010 2 7 15 Records must support that people have been consulted about their plan of care. This is to ensure care is planned in a person centered way and that people have their rights upheld. 31/01/2010 3 7 15 People must have a plan of care in place that clearly details all of their care needs. This must be completed in a timely way following admission. Care plans must identify all personal details about the person. 31/01/2010 Care Homes for Older People Page 28 of 31 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 ensure no care needs are overlooked. 4 9 13 2) People must receive the medication they require. People who are selfmedicating must have the appropriate documentation and storage arrangements in place. Staff must receive further training in safe management and administration of medicines. This is to ensure people are safely cared for and receive the medication they need. 5 27 18 1a) Staff must be provided at all times, in sufficient numbers. This is to ensure people receive the care they need and are kept safe. 6 31 37 We must be notified, within 24 hours of any incident listed in this regulation. This is to ensure people are safeguarded at the home. 7 38 13 4) The fire risk assessment and general health and safety assessment must be present at the home. All 31/01/2010 31/01/2010 31/01/2010 31/01/2010 Care Homes for Older People Page 29 of 31 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 work required as a result of the 5 yearly electrical installation test must be undertaken. This is to ensure safety of the building. 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 7 Registered nurses should adhere to their code of good practice when recording in care plans, to ensure contemporaneous records of care are made. Hand written entries to the MAR sheet should be accompanied by a second signature to verify that the information has been written correctly. There should be a full record of all complains received by the home. This is to support people have their rights fully upheld. People should be offered a key for their bedroom door and personal lockable space inside, following risk assessment. This is to promote privacy, dignity and choice. Supplies of pads and gloves should be maintained, to ensure people receive the care they need and to maintain infection control. Staff must be given sufficient rest periods between shifts, this is to promote quality within the service provision. There should be a designated first aider for each shift to ensure people have access to appropriate emergency treatment. 2 9 3 16 4 19 5 26 6 7 27 38 Care Homes for Older People Page 30 of 31 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. 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