Inspection on 23/06/10 for Southcrest Nursing Home

This inspection was carried out on 23rd June 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southcrest Nursing Home 14/07/09

Southcrest Nursing Home 16/02/09

Southcrest Nursing Home 23/05/08

Southcrest Nursing Home 22/02/07

Southcrest Nursing Home 14/09/05

Southcrest Nursing Home 18/04/05

Southcrest Nursing Home 03/11/04

Southcrest Nursing Home 02/06/04

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG     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: Andrew Spearing-Brown     Date: 2 5 0 6 2 0 1 0 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527550720 01527550738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Kalpana Ananthram,Dr Sabarathnam Ananthram Name of registered manager (if applicable) Ms Sunila Samuel Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Physical disability (PD) 40 Date of last inspection Brief description of the care home Southcrest Nursing home is a forty-bedded care home providing general nursing care for older people. Accommodation is provided over three floors in both single and Care Homes for Older People Page 4 of 33 Over 65 40 0 0 40 1 4 0 7 2 0 0 9 Brief description of the care home shared occupancy bedrooms. Some bedrooms have ensuite toilets and wash band basin. The home has a passenger lift so that people using the service can access all parts of the home. There is a variety of aids and equipment available to help people to move about more independently and ramped access to the rear of the building. There are a number of toilets and bathrooms available placed close to peoples bedrooms and the lounges on each floor. There is a small car park available for visitors and staff . The home is near to the town of Redditch and local shops are within walking distance. The home is on a bus route and also in walking distance of Redditch railway station. Copies of the most recent inspection reports are availble in the home for people to read if they wish. For up to date information regarding fees the reader should contact the service directly. Care Homes for Older People Page 5 of 33 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: This inspection was unannounced. Therefore nobody within the home knew we would be coming. This inspection was carried out by one inspector over a period of two days. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA). This document was completed and returned to us. The AQAA is a self - assessment and is an opportunity for the service to focus on how well outcomes are being met for people. It also gives us some numerical information about the service. We have included some of the registered managers comments within this report. Shortly before this inspection the manager, who was registered with the Commission, following our last inspection left her employment at Southcrest. The registered provider has recently appointed a new manager. Throughout this report we have referred to the new manager as manager designate Care Homes for Older People Page 6 of 33 We spent time looking at some records within the home as well as spending time with the newly appointed manager designate. We also spoke to one of the providers of the service, some members of staff, visitors and some people living at the service. Care Homes for Older People Page 7 of 33 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 33 order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. The service provides written information so that people are able to reach a decision as to whether they wish to move into the home. The service is aware of the need to obtain as much information about people as possible prior to their admission so that people can be confident that needs will be able to be met. Evidence: Prior to our inspection we were sent a copy of the homes Statement of Purpose and Service Users Guide. The guide sets out what people can expect from the service. Having such information available to people may assist in their decision making process as to whether Southcrest is going to be able to meet identified care needs. During our visit a relative confirmed that she had seen information about the home prior to her relatives admission. In addition we saw a copy of the guide in some peoples bedrooms. It was confirmed during our visit that the information is available in large print if needed. Care Homes for Older People Page 11 of 33 Evidence: As the registered manager has recently left the service this document will need to be reviewed and amended to ensure that it reflects the current managerial arrangements within the home. The newly appointed manager designate was aware of the importance of having sufficient information regarding people prior to their admission into the care home. During our inspection an emergency admission took place. The manager designate was however aware of the persons care needs in order that she could devise a plan of care. We were informed that recent admissions into Southcrest have been urgent placements therefore we did not view any pre-assessment documents. We have however found that these have taken place in the past. Within the AQAA the former manager wrote We offer a free afternoon/morning visit so as to come along to the home and obtain an opinion prior to admission. In addition the AQAA stated that pre admission assessments are carried out so as to be sure the home can meet the current needs of the potential resident. Care Homes for Older People Page 12 of 33 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. Although people are generally happy with the care they receive they can not however be confident that their health and personal care needs will be fully met. Some practices within the home potentially place people at risk of harm. The management of medication also potentially places people at the risk of harm. The newly appointed manager designate is aware of these shortfalls and undertook to make the necessary improvements to safeguard people from the risk of harm. Evidence: While we were at the service the majority of relatives we spoke to stated that they are happy with the care provided. Within the AQAA the former manager told us that A rigorous and detailed care plan is in place for all residents which is easy to read and understand. Care plans are documents designed to give staff guidance in order that they are able to carry out the required care in a consistent way meeting identified needs. During our visit we looked over the care plans of some people living within the home. Care Homes for Older People Page 13 of 33 Evidence: The care plans are written on a computer. A paper copy of these plans was available on each persons individual file. The manager designate was aware that improvement is needed to make them more person centred. The Alzheimers Society explains how person centred care works by stating that Instead of treating the person as a collection of symptoms and behaviours to be controlled, person centred care considers the whole person, taking into account each individuals unique qualities, abilities, interests, preferences and needs. We saw that care plans are detailed including, for example, whether people have a preference regarding the gender of the care assistant providing their care. We found that care plans are regularly reviewed. However, despite the detail within them and the regular reviewing of care plans we found that some of the information was incorrect or out of date or not actually happening. During this inspection we looked primarily at the nutritional needs and wound care of some people. Prior to our inspection we received some surveys back from people regarding their experience of the care home. Under the section What could they do better one person wrote spend longer helping my mother feed, as she is given drinks that she at times cannot pick up herself, and they are left to go cold. We saw that jugs of drink were provided in peoples bedrooms. Many of these were however out of the reach of people. Therefore in the event of them having the ability to get a drink for themselves this choice was not available to them. The vast majority of people did however need assistance. The care plan for one resident stated needs a lot of encouragement with food and fluid throughout the day. Offer snacks throughout the day. We saw no snacks offered during our time within the home. We viewed the jug of fluid within this room during a period of time and did not see any reduction in the overall amount within it. We brought this observation to the manager designate, who spoke to staff to ensure a drink was given. We had similar concerns regarding the fluid intake of some other people who were seen in their bedrooms. We saw the main midday meal for this person on a bedside table. This meal was still in place when we returned later. On returning again the meal was gone. We asked whether the resident concerned had eaten the meal and we were shown a written record showing that it was eaten at 12.50 pm. However, we saw the meal at 1.15 pm. We were later told that the time recorded was when the meal was taken to the bedroom. Therefore, assuming the meal was eaten it was left in the persons bedroom for at least 25 minutes before it was given. Care Homes for Older People Page 14 of 33 Evidence: We saw meals left in other bedrooms and within the dining rooms. As some people had an identified care need regarding their nutritional needs it was of concern that people are served with cold food. The care plan stated that the person was prescribed a food supplement. We were told that this supplement was no longer supplied by the GP on prescription. The records showed that the individual concerned was losing weight. At one point the record stated that the person was underweight and to check in 2 weeks. The record did not evidence that this re check took place. Some people at Southcrest require dressings to wounds such as pressure ulcers. Records are held separately to say when the wound is dressed and when it will require to be re dressed. On looking at these they suggested that people were not getting their dressing changed in line with the plan of care. We looked at the records of one person and found no recent photographs of the wound and no body map to be in place. The records showed one person to have a sore big toe. The dressing records were incomplete. Daily records stated that the toe was oozing. We could not find any wound map or photograph of the toe. The manager designate looked at the toe and found it to be red and infected. The care plan stated that the foot should be supported by a pillow. There was no pillow in place. The records regarding one person showed that dressings are changed at 1.00 or 4.00am. The manager designate confirmed that it is common practice within the home to do some dressings during the early hours of the morning as this is when nursing staff have the time to carry out these tasks. Therefore the resident concerned is having a painful task carried out upon them at an unsociable hour. Furthermore staff are always observing the wound under artificial lighting conditions. The home has available to it pressure reliving equipment such as air flow mattresses. These pieces of equipment are a means to reduce pressure damage and aid recovery where wounds are present. The care plans of some people indicated that they need to have creams applied. The creams named in the care plan were not always the same as those within the individuals bedroom. One person had moved bedroom the day before we visited. The care plan stated that cream was to be applied. As we found the cream within the previous bedroom it was likely that this cream was not applied that morning. This was confirmed by the incomplete record sheet and a member of staff. Care Homes for Older People Page 15 of 33 Evidence: The manager designate accepted that we found some concerns about nutrition and wound care which potentially place people at risk of poor outcomes. She commented that she had already identified these shortfalls and would be taking action to ensure improvement takes place to improve the care provided within the home. Within the last inspection report we wrote We saw that one person had bed rails on their bed with no bumpers. Our report explained that Bumpers are padded covers which help to reduce the risk of injury when bed rails are used, and are required whenever bed rails are used. Following the last inspection we required that the home should assess the risks and take steps to manage them. Shortly after our arrival we saw a bed with the bumper not attached correctly to the bed rails. We found this was not an isolated incident as on viewing further bedrooms we found every one to be incorrect to some degree. One person had her legs close to unguarded rails placing her at risk of entrapment or injury. We saw a room where bumpers were not fitted on one side of the bed while the rail was not fully in place on the other side. Risk assessments regarding bed rails were in place. These indicated that in all but one case the bumpers should be in place. The risk assessments did however fail to cover a range of areas. We were later shown a blank risk assessment which highlighted potential hazards such as ensuring that the rails are compatible for the bed used and looking at gaps such as the one between the lower rail and the mattress. Although the manager designate brought these serious findings to the attention of staff we issued an immediate requirement to ensure that bed rails are used safely. Following our immediate requirement and subsequent letter the manager designate wrote back to us telling us about the actions she had taken to reduce the risk of injury to people as a result of the incorrect use of equipment. We viewed the administration, storage and management of medication. Within the last report we stated that the nurse on duty told us that the morning medication round can take up to three hours to complete. This inspection happened over two days. On both of these occasions the nurse carrying out the medication round was from an agency. Both nurses took a similar amount of time to complete the morning medication. On the day of our second visit the nurse completed her round at 1.10 pm. The last person to receive medication was prescribed painkillers. Another dose of this drug was due at 1.00 pm by which time the morning dose had not been given. On the morning of our first visit the nurse reported at 12.30 pm that she could not find Care Homes for Older People Page 16 of 33 Evidence: somebodys morning medication. These drugs where however found in the trolley. As a result the person concerned had not received medication until after mid day. Medication was suitably stored in medication trolleys and cupboards to ensure safe keeping. We did however find some soluble painkillers left in a bedroom, some liquid painkiller left on top of a trolley and some painkillers (believed to belong to a member of staff) in an unlocked cleaning materials cupboard. We viewed some of the current MAR(Medication Administration Record) sheets regarding medication within the trolleys on all three floors. We found the majority of MAR sheets to be complete to show that staff had signed for medication given. We were able to check the number of signatures in relation to the number of tablets prescribed in relation to some antibiotics and found that these balanced. We did however note some gaps on the MAR sheets where staff had failed to sign the sheet or enter a code to explain why medication was omitted. On auditing some of these drugs it became evident that medication was at times not given as prescribed. The manager designate was not able to give us a reason for why people had not received their prescribed medication. The agency nurse on duty had signed for some medication which we could not find in the trolley. We were told that the signature was an error as the resident was no longer on that drug following a visit from the doctor. The person was prescribed a new drug which was signed as given and we were assured that this drug was administered. However, we were unable to balance the number of tablets remaining against the amount signed as given over a period of 1 day. In relation to a medicine that we could not find we were told that somebody elses was used in its place. The MAR sheet of one resident showed that the home had run out of painkillers six days earlier. The manager designate was unable to tell us why this medication had run out. We viewed medication held on the lower ground level including medication within the controlled drugs cupboard. The items within the cupboard matched with the entries within the controlled drugs register. We saw a bottle of medicine which stated discard 90 days after opening. As no date of opening was recorded it was not possible to state when the medicine would be out of date. A record is maintained of the room temperature in the room on the lower floor. Medication needs to be maintained at 25 degrees Centigrade or below. Temperature Care Homes for Older People Page 17 of 33 Evidence: readings of the areas where the trolleys are stored are not done. Due to a number of concerns regarding the management of medication we issued an immediate requirement at the time of our visit. Following our immediate requirement and subsequent letter the manager designate wrote back to us telling us about the actions she had taken to improve the management and recording of medication within the home. People within the lounge appeared to be well attired taking into account gender and weather conditions. Staff were seen and heard to be kind and respectful towards residents. The manager designate told us of her interest in end of life care. Care plans did not include information regarding people end of life wishes. Care Homes for Older People Page 18 of 33 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. People residing within the home have access to some leisure activities in order to meet individual needs and wishes. Improvement is needed to ensure that people can be confident of receiving the assistance they require in eating and drinking and that these are provided timely. Evidence: Within the AQAA we were told that activities are in place and that the service has a specific employee allocated to provide activities on a regular daily basis. We saw the activities organiser upon arriving at the home engaging a small number of people in activities outside on the patio. During our time within the home we were informed that the organiser was leaving the home. The manager designate plans to make other arrangements to ensure a dedicated person is in post. Parts of the home were, at the time of our visit, decorated due to England taking part in the World cup. Some people were watching a football match involving England within their bedroom. The match was on within one of the lounges. The manager designate checked with people that they wished to watch this programme. People elected to watch an alternative. Care Homes for Older People Page 19 of 33 Evidence: There was some information on display about forthcoming activities such as a monthly church service and daily events such as knitting and a coffee morning. We saw staff engaging in some one to one activities such as word searches. We did not see anybody living at the home helping with tasks within the home such as dusting, folding laundry and preparing vegetables. These tasks can help people feel they are part of the life of the home. There is open visiting within the home, which means that people can see their visitors as they choose and maintain relationships that are important to them. We saw visitors coming and going throughout the day. The majority of visitors we saw were complementary about the service provided and the staff working within the home. We were informed within the AQAA that birthdays and special occasions are celebrated with a buffet tea and a homemade cake. On the second day of our visit the menu was on display near to the entrance of the home. We were informed that it was removed on the day of our first visit because the menu needed to be changed. We saw no other information displayed to inform people of the food available to them. We saw some people having a full cooked breakfast or egg sandwich. People told us that they were enjoying their meal. One person told us that the soup is nice although the home serves too much mashed potato. As reported elsewhere in the report meals were seen left in peoples bedrooms. We saw the sweets left in dining rooms while the main meal was served. Due to the length of time these dishes were left, uncovered around the home they were likely to be cold when people ate them. We saw one care assistant feeding a resident in her bedroom. This was been carried out in a task orientated way with the carer standing over the person concerned. This is not person centred and does not encourage people, who may otherwise not eat sufficiently, to have their meal. On our second visit to the home we saw staff using heated trolleys in order that food was kept hot. Care Homes for Older People Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to people regarding complaints however as some records were not available people can not be fully confident in the procedure. Some staff have not received training in safeguarding procedures to ensure they are aware of their responsibilities. Evidence: The homes complaints procedure was on display close to the signing in book. A complaints procedure is included within the joint Statement of Purpose and Service Users Guide. Although our address is included within the procedure it does not make it clear that complaints can be referred to us at any stage. Some relatives told us that they believed the service would listen to any concerns they may have regarding the care provided. We have received no complaints since our previous key inspection in relation to the service provided at Southcrest. Within the AQAA we were told that the service had received two complaints during the 12 months leading up to completing the document. We asked to see the records regarding these. We saw a letter in relation to a safeguarding incident involving bed rails from sometime ago however we did not see any other records regarding the complaints mentioned within the AQAA. We are aware of two current safeguarding matters. The service is aware of these and is assisting with the local authority to resolve them. The training matrix showed that Care Homes for Older People Page 21 of 33 Evidence: some staff received training in safeguarding earlier this year as part of a days training covering a range of subjects. Other staff received training some time ago. The matrix indicated that other staff have not received any training at all in relation to safeguarding people. Care Homes for Older People Page 22 of 33 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 home is comfortable and homely. Improvement is needed in some areas to ensure that risks are identified and the risk of harm to people using the service is reduced. Evidence: Southcrest is situated on a main road close to Redditch town centre. The accommodation is over three floors. The home has a mixture of single and double bedrooms some of which have en suite facilities. The main entrance to the home is near to the car park at the rear of the home which is reached via a slopping driveway. There is a communal lounge on each of the three floors. In addition the ground floor has another room known as the quiet lounge. We previously commented on the fact that this area was used for the storage of wheelchairs, walking frames and a hoist. Although these items remain stored in this lounge they are now behind a curtain to make the area more pleasant. Sit on scales were also in this area during our visit. We were told that the lounge is currently used by the hairdresser however, plans are in hand to provide better hairdressing facilities in the future. Within our last two inspection reports we have commented on the fact that there is not enough dining space for everyone to sit at a table if they wish to do so. During this inspection, and as previously mentioned we saw that the vast majority of people Care Homes for Older People Page 23 of 33 Evidence: either have meals within their own bedroom or within the lounge using small individual tables. The vast majority of people living at Southcrest are frail and many reside within their own bedrooms. There does however remain an absence of aids to assist people with a dementia type illness in their orientation around the home. The home was generally clean and tidy, one relative told us that the home does not smell. We saw some wheelchairs in the dining room which we not clean. The decor throughout the home is generally satisfactory, some areas are damaged due to the use of equipment such as wheelchairs. The floor boards on the first floor near to the lounge are squeaky. Cleaning materials were however seen left unattended and the main store cupboard was left unlocked. Unsecured chemicals can present a potential hazard to people. Throughout the home we saw an ample supply of personal protective equipment such as disposable gloves and aprons. People residing at Southcrest are able to personalize their bedrooms with ornaments, photographs, articles of furniture and television. Wardrobes are not secured to the wall to prevent them accidentally toppling over on to people. Restrictors were fitted to windows however on arrival at the home we noticed that some windows were fully open on the first floor. Due to the potential risk we brought this to the immediate attention of the manager designate. We found that two windows in the lounge were off their restrictors. Although nobody was within this area the practice of removing restrictors can be potentially hazardous due to the risk of people accidentally or deliberately falling to the ground. This inspection was carried out during a warm spell in the weather, the home was partially hot especially as the central heating came on. We noticed the bed linen in one bedroom was particularly creased. We brought this to the attention of the manager designate who raised the matter with a member of staff. We were told that bedlinen is not ironed. Within the laundry we noticed that some flannels and towels were frayed around the edges. On arriving at the home some residents were sat outside on a patio area. The area is pleasant and fenced off to ensure people are safe. Care Homes for Older People Page 24 of 33 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. Staff are kind and caring although people at times have to wait for their needs to be met. Training is provided for people although gaps in the records exist showing areas where staff may not have received the training they require to carry out their duties. Recruitment procedures are generally in place to ensure that only suitable staff are employed. Evidence: People were positive about the staff working at the home. One person stated that she is well looked after. We did however receive comments from a number of people about having to wait for sometime if needing assistance. We were told by one person that the emergency call bell is switched off if people need assistance, this comment matched a similar allegation currently under investigation. Somebody with limited vision did not have their call bell lead at hand and it was likely that they would have difficulty finding it in the event of needing to call for assistance. During our inspection seven care staff were on duty during the morning and six in the afternoon. During the morning two carers were working on both the ground and top floor with three on the middle floor. In addition to care staff were other people such as cleaning staff, a laundry assistant, catering staff, an activities organiser and an administrator. The manager designate was in the home throughout our visit and we met a newly appointed clinical lead during our second day. Both the manager Care Homes for Older People Page 25 of 33 Evidence: designate and the clinical lead are qualified nurses. The nurse in charge of the shift during both of our visits was from an agency. At the time of our visit the service was in the process of trying to appoint qualified nurses, thus the current frequent use of agency staff. Two carers and a qualified nurse are on duty throughout the night. We noted that both the carers were male during the night prior to our second visit. Photographs of most members of staff are on display as well as recognition of the employee of the month. We looked at the homes training matrix. This showed that the majority of staff have received training in moving and handling. The assistant manager, who works nights, is a trained trainer in relation to this area. Similarly many of the staff have received training in health and safety, food hygiene, fire and infection control. We noted that on some occasions staff had covered up to 4 subject areas in the course of one days training. The number of staff who have received training in practice related matters such as dementia care, tissue viability, nutrition and dignity in care is considerably lower. According to the matrix nobody has received training in medication, as the nurse on duty was from an agency we were unable to check this information with the homes own nursing staff. During the inspection we were informed that 8 out of twenty one carers have achieved an NVQ(National Vocational Qualification) in care. This level of trained staff is lower than the National Minimum Standard which was introduced in 2002. We viewed the files of two recently appointed members of staff. The files showed that the home undertakes checks upon people at the time of appointment. One file we saw written references and evidence that the service had obtained an ISA (Independent Safeguarding Authority) first check. The other file was missing a reference. We were assured by people in the home that it had arrived prior to the person commencing duty in the care home. Care Homes for Older People Page 26 of 33 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 newly appointed manager designate is aware that improvements are needed within the home to ensure that people are fully safeguarded and receive the care they require. Currently people can not be confident that they needs will be meet and their health and welfare will be promoted. Evidence: Within our report following our inspection in February 2009 we mentioned that the then registered manager had left and that a new acting manager was in place. When we returned to the service during July 2009 the acting manager had not applied to the Commission for registration. Since our previous inspection an application for registered manager was approved. However, this person has recently left. The provider has therefore appointed a new manager. We were told that the post holder is currently working on a trial basis. However, an application for registration with the Commission should be made as soon as possible. The home continues to have a general manager, who is a registered nurse working Care Homes for Older People Page 27 of 33 Evidence: night shifts. We were informed that she is responsible for some areas of management such as fire training and moving and handling training. On the second day of our inspection we met a newly appointed clinical lead nurse. The manager designate, who was appointed 6 weeks prior to our visit, told us she was already aware of some of the shortfalls we identified during our inspection especially in relation to nutrition, wound care and medication. The manager designate took an interest in the inspection process and assisted us as much as possible when trying to locate some information or seek reasons why certain things had happened. She took immediate action in relation to some areas of concern we identified such as the unsafe use of bed rails and bumpers, windows restrictors and medication. We have previously reported upon the service sending out customer satisfaction surveys to people living in the home and their relatives. During this inspection we were told that some were distributed earlier this year and we saw a file containing those returned. During this inspection we did not view accident records. The manager designate told us that none of the residents are having a high number of falls. We saw records within the home showing that many areas of health and safety are generally well managed. For example the fire alarm is tested weekly and in sequential order. Facilities are available for people to have small amounts of cash held in safekeeping on their behalf. The records are well managed upon a computer by the homes administrator. We saw that receipts are maintained regarding expenditure such as for hairdressing, chiropody, taxis and toiletries. The collective amount of cash held balanced. Prior to this visit we received a copy of a letter to the service from Hereford and Worcester Fire Service. They had given a timescale for some work to be completed. We were told that an extension to the time frame had been given. While we were at the service work was underway to improve the fire alarm system. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 12 (1) You must ensure that the 16/07/2009 use of bed rails is governed by a full written risk assessment. This is so that people are not at risk of harm or injury. 2 9 13 (2) You must ensure that an 14/08/2009 accurate record is kept of all medication which is to given on an as required basis. This is so that people receive their medication as prescribed. 3 27 12 (1) You must ensure that the 14/08/2009 numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of people living at the home, taking into account the size, layout and purpose of the home, at all times. This is so that people can be confident that their needs will be met in a timely manner. Care Homes for Older People Page 29 of 33 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 1 8 12 Regulation 12 (1). A system must be in place to ensure that bed rails and their bumpers are used correctly and safely. This is to ensure that people using the service are safeguarding against risk of injury. 25/06/2010 2 9 13 Regulation 13 (2). The service must ensure that people receive medication as prescribed and directed by the prescriber and accurate records must be maintained. 25/06/2010 This is so people can be confident that medication is managed safely and peoples health care needs are met. 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 12 Regulation 12 (1) Systems to ensure that peoples wound care is appropriately and timely managed must be reviewed. 06/08/2010 Care Homes for Older People Page 30 of 33 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 that peoples health care needs are managed. 2 8 12 Regulation 12 (1) Systems to ensure that peoples nutritional care needs are met must be reviewed. This is to ensure that people received the food and fluid they require to ensure their health and well being are maintained 3 19 13 Regulation 13 (4). Safe systems must be in place to ensure that hazardous items such as cleaning materials are stored appropriately. This is to safeguard people from the risk of harm. 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 06/08/2010 30/07/2010 1 15 Regulation 12 (1) Systems must to be reviewed to ensure that peoples dietary needs are fully met 2 28 A review of training provision should be undertaken to Page 31 of 33 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 improve the number of staff with an NVQ (National Vocational Qualification) as well as ensuring that other training needs are addressed. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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