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Inspection on 08/01/10 for St Johns Nursing Home

Also see our care home review for St Johns Nursing Home for more information

This inspection was carried out on 8th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents receive support from a caring team of people who show respect for people`s privacy and dignity. On the surveys we sent out we received positive comments about the service provided. One resident wrote ` Excellent care`. Other comments primarily written by relatives included: `The staff are helpful and friendly` `Excellent in all departments.` `Provides overall care and attention.` `xx treated with respect and as a individual.` `xx is very happy, he is well cared for. All the staff are kind and devoted to the care of the patients.` `I am pleased with St John.` Before somebody is admitted into the home an assessment is carried out. Within The Limes people are invited to come and visit the home. These methods help to ensure that the staff have the necessary skills to be able to meet individual care needs. A complaints procedure is available and the manager and staff have an awareness of their responsibility to safeguard people from abuse or potential abuse. The home is clean and tidy.

What has improved since the last inspection?

Following our previous inspection in February 2007 we made no requirements and no recommendations. We concluded that the home was doing well and was setting objectives for continual improvement.

What the care home could do better:

Care plans need to be accurate and up to date. Improvement is needed in the recording of medication once administered. The temperature within the area where medication is stored needs to be at a level in line with manufacturers instructions. Staffing levels need to be reviewed in order that sufficient staff are on duty to meet the needs of people living there including their social and emotional needs.

Key inspection report Care homes for older people Name: Address: St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU     The quality rating for this care home is:   two star good 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 8 0 1 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 30 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 30 Information about the care home Name of care home: Address: St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU 01905794506 01905798258 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw healthcare (Homes) Ltd care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 2. The maximum number of service users to be accommodated is 43 The registered person may provide the following category of service only Care home with nursing CRH N To service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Dementia code DE 26 mental Disorder Code MD 17 This home may also accommodate people with dementia illness between the ages of 55 - 64 years. Date of last inspection Brief description of the care home St Johns nursing home is currently registered for 43 residents. The home specialises in providing 24 hour nursing care for residents with a degree of mental illness and a dementia type illness. The home is registered to care for residents from the age of 55 years onwards. St Johns is part of the Shaw healthcare (Homes) Limited. The responsible individual is Mr P J Nixey. The registered manager is Julia Roberts. St Care Homes for Older People Page 4 of 30 Over 65 26 17 0 17 Brief description of the care home Johns moved into the home during October 2002. The home was then further extended in May 2003 to provide accommodation for an additional 17 residents. More recently 3 flats designed to rehabilitate people have been developed and added to the registration therefore making the current number of 43 places. The home is situated in Droitwich close to the town centre and public transport. Car parking spaces are available at both the side and rear of the home for staff and visitors. The home is spacious. All bedrooms are single occupancy with en-suite facilities of a toilet and shower. Communal areas include lounges, dining areas and specialist bathrooms. The kitchen room contains kitchenette facilities for visitors; this room is to become an activities room in the near future. The home has enclosed gardens. Fees are available upon request. Care Homes for Older People Page 5 of 30 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: two star good 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 last inspection at St Johns was carried out during February 2007. Since the last visit to the home we have carried out Annual Service Reviews (ASR). An ASR is when we look over the information we have received upon a service without carrying out a visit. This inspection was what we call a key inspection; this is one when we look at what we believe to be the most important standards and look at outcomes for people using the service. As part of this inspection, in addition to the visits to the home, we also took into account other information we have received. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the registered manager. This is a document within which providers of care services are able to demonstrate to us where they believe they are providing a quality service and where they could improve in the Care Homes for Older People Page 6 of 30 future. The AQAA also provides us with certain data which we need to know. The AQAA was completed by the manager and returned to us. We also posted out surveys to some residents, their representatives and staff. The majority of the surveys sent to resident and returned to us were completed by the persons relatives. We have taken account of the surveys returned to us as part of this report. During this inspection we had a look at the communal area of the home and saw some bedrooms. We spent time in different areas of the home talking to people and observing what was going on. We saw some care plans and viewed other documents such as medication and staffing records. At the time of our inspection the home had two vacancies and one person was in hospital. We spoke to the registered manager, unit manager, nursing staff, carers and domestic staff. We were also able to speak to some residents and some visitors to the home. Care Homes for Older People Page 7 of 30 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 order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 9 of 30 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. Information is available to help people make a choice about whether they would like to live at St Johns nursing home. The service is aware of the need to carry out a full assessment prior to admission so that individuals and their relatives can be assured that staff will be able to meet identified needs. Evidence: We asked on our survey whether people had received enough information about the home before moving in to the home. On the majority of surveys returned to us people stated that they had received this information. People also confirmed that they had received a contract or a statement of terms and conditions. In the AQAA the registered manager wrote that the statement of purpose and the service users guide are updated and on display. During our inspection we saw information about the service. We saw a copy of the Service Users Guide. This document gives the reader some useful information about the service people can Care Homes for Older People Page 10 of 30 Evidence: expect to receive. The guide needs to be updated in some areas for example the information about complaints is no longer correct. We viewed the assessment of one person recently admitted into the home. The assessment gave brief details of care needs under a range of headings although there were some gaps. The information was however likely to be sufficient to commence an initial care plan. The manager confirmed that she also takes into account assessments from the social worker and or the hospital when undertaking her own assessment of a potential new resident. One relative confirmed that she had visited the home prior to an admission taking place. We were also told by staff working on The Limes that people visit the unit for a meal or an over night stay before their admission. The home is registered as a nursing home therefore trained nursing staff are on duty at all times. We are aware that nurses working at the home have a mixture of general nurse training and mental health training. Care Homes for Older People Page 11 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an individual care plan which is reviewed although at times some areas are not fully evaluated in order to give staff full and clear guidance about how to meet needs. The management of medication needs some improvement to ensure records are always fully maintained to ensure people receive medicines correctly and safely. Evidence: Each person residing at the home has a written care plan as well as other records such as risk assessments. The files we saw during our inspection on both units were well maintained. The care plan system in use differs between the two units, examples of both systems were seen during our visit. The care plans on both units generally covered most areas of identified needs. Within The Limes unit the care plans cross referenced each other and were linked closely to risk assessments. The care plans covered areas such as food preparation, shopping, activities and transport as well as personal care and mental health needs. Records showed that people were involved in the reviewing of their care plan. Care Homes for Older People Page 12 of 30 Evidence: On the The Pines unit care plans are reviewed on a monthly basis. We discussed the care needs of one resident with a number of members of staff and found that the written plan covered many areas described to us by staff. Risk assessments were in place covering nutrition, and falls. The information obtained from risk assessments was not always transfered on to a care plan. We saw some short term care plans covering care needs such as urine infections. One relative wrote Medical attention by the local GP,is always sought. During our visit a relative also confirmed that a GP is called when needed. The AQAA states that the home ensures residents are seen regularly by their doctor and have access to chiropodist, optician, dentist and physiotherapy to meet their needs. We saw a list of people due to see a chiropodist and a GP attended while we were visiting. We are aware that the home contacts a psychiatrist for advice and assistance. We looked at the storage, recording and management of medication on both units. The room where medication is stored on The Pines was noticeably warm when we entered. Records of the room temperature were maintained. The record stated Optimum temp will be 22 - 25 C. The house manager is to be alerted if 2 or more consecutive recordings are above 25 C or below 22 C and a record made of the action taken. The record over the previous 12 days had some gaps upon it however when a temperature was recorded on 13 out of 17 occasions it was over 25 C. A air cooling machine was in place but seemed to be ineffective. We were told of other plans the company have to rectify the situation. The date of opening was recorded upon medication stored within the fridge. We looked at the majority of the current months Medication Administration Record (MAR) sheets within The Pines. On most occasions we found them to be completed correctly however we saw a number of gaps where the nurse had failed to sign for medication or enter a code for why medication was omitted. In some cases we checked the blister packs and found that medication was not still in the system therefore likely that medication was administered but not signed for. Prior to each MAR sheet was a photograph of each individual resident to ensure people can be correctly identified. We also saw information regarding known allergies. The MAR sheets were double signed when medication was booked in by hand to ensure the details were correct. We noted that out of 23 residents at least 14 were receiving a night sedative. We Care Homes for Older People Page 13 of 30 Evidence: discussed this with the unit leader and the manager. We were told that medication is reviewed to ensure people are receiving medicines they require to meet their health care needs. We looked at controlled medication and found the records to balance with the medication held. We also viewed the medication on The Limes. We found some gaps on the MAR sheets. We tried to audit some medication which was on occasions difficult as staff had not carried forward medication held from one MAR sheet to the next. We tried to find medication prescribed to one person on an as and when basis. We could not locate this medication and later discovered that it had been returned to the chemist because it was not being used however it remained on the MAR sheet as available. The MAR sheet and care plan of one person did not match. One part of the care plan indicated that the resident concerned could take one of two different prescribed drugs however elsewhere it appeared that both could be taken at the same time. We were told that the care plan would be amended to be an accurate reflection of the medication regime. During our inspection we saw staff being kind, courteous and caring towards people. Staff were seen to be up holding peoples privacy and dignity. Care Homes for Older People Page 14 of 30 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 are able to engage in some in house activities and community participation. Meal times are busy however people generally like the food available to them. Evidence: The manager told us within the AQAA that the older peoples unit has a full time activities organiser. Unfortunately due to annual leave we were unable to talk to this person during our visit. The unit manager described to us the butterfly approach used by carers whereby staff move from one person to another. We were also told about the implementation of the clipper (Cardiff Lifestyle Improvement Profile for People in Extended Residential care)tool. This is an assessment tool to help staff understand the types of activities that could be of benefit to people with dementia. The team manager on the older peoples unit is currently studying dementia care to degree level and showed a genuine desire to improve care for older people who have a dementia illness. We were told about doll therapy, rummage boxes and a sensory garden. We were also told that the home has some chickens living in the garden and some residents are, at times encouraged to assist collecting eggs. One relative wrote Their seems a lack of activity for the residents their recreation seems to be sitting in the lounge with only a TV as their sole pastime. The television Care Homes for Older People Page 15 of 30 Evidence: within the lounge on The Pines unit was on at times during our inspection although often playing a DVD of music or showing entertainers such as Dean Martin. The manager explained to us that care staff are aware that it is not only the activities organisers role to ensure people are occupied. We saw some activity taking place with a small number of residents within the small lounge on the lower ground floor. A list of planned activities was displayed within the The Pines unit. The schedule included events such as painting and reminiscence. We saw some evidence that things have happened such as cress growing in the lounge however we saw little social interaction taking place other that staff attending to residents physical care needs. Staff told us about some parties that have taken place such as at halloween. We were told that a planned outing to a local garden centre was cancelled due to a lack of staff to assist. A sensory room is provided although we did not see it in use at anytime when we were in the home. Within The Limes a number of people were busy doing their own things. People are encouraged to take part in daily living routines such as preparing their breakfast, washing up, ironing and tidying their bedroom. Some people went out and we saw care plans saying that people go into Droitwich for a cup of coffee. We were told that bingo or quizzes take place some evenings. Information about visiting is included within the Service Users Guide. The guide states that people can see their visitors in their own room, one of the lounges or the garden room. We were told that 14 people on the older peoples unit needed assistance with feeding. We saw staff, including the nurse on duty feeding people with sensitivity and in an unhurried manner. The days menu was on display within both the units. People on The Limes told us that they enjoyed the food supplied. Wychavon District Council rated the homes food hygiene standard as very good when they visited in July 2009. Care Homes for Older People Page 16 of 30 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 using the service and their representatives have access to the homes complaints procedure and are able to express any concerns they may have. Staff receive training to help them know how to protect people from any risk of abuse or risk. Evidence: Within the AQAA the manager wrote that the company has a robust complaints policy and that it is included within the Statement of Purpose and Service Users Guide. A complaints procedure is included within the homes Service Users Guide. The procedure states that they hope people will not need to complain but gives details of a number of people who may be contacted if needed. The procedure makes reference to the former commission. It gives people details of our former address in Birmingham. It is therefore necessary to up date the procedure within the guide to ensure that not only does it give the correct name and address of the commission but also makes clear that the commission can be contacted at any stage. One resident who on our survey indicated an awareness of the complaints procedure added Never had to make one. During our inspection a relative said that she would speak to either the manager or the unit leader if she had any concerns. Care Homes for Older People Page 17 of 30 Evidence: Most people who returned a survey to us indicated that they are aware of how to make a formal complaint. The manager indicated on the AQAA that the service has received 1 complaint over the last 12 months. This matter was investigated appropriately. Following some issues regarding incidents of challenging behavior within the home safeguarding referrals were made by the home and ourselves to the local authority as a means to protect people using the service. The manager demonstrated that she has an understanding of the local procedures for safeguarding. The manager is also aware of her responsibilities under the Deprivation of Liberty Safeguards and spoke to us during this inspection about a potential referral to the local team. The AQAA states that All staff have received POVA (Protection of Vulnerable Adults) training and updates are accessed as required. The training matrix shows that the vast majority of staff received training in safeguarding during July 2009. We spoke to staff on duty during our visit who were able to tell us about the actions they would take if they were aware of or suspected abuse taking place within the home. We looked at the records for two recently appointed members of staff. These showed that the required checks were carried out before new employees commenced duties at the home. These checks included a CRB (Criminal Records Bureau) disclosure and written references. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained environment. Facilities are widely available to protect people from the risk of cross infection. Evidence: The original part of St Johns nursing home is a former Victorian cottage hospital. The home consists of 2 separate units over three floors accommodating a total of 43 residents. The Limes unit has 14 single en-suite bedrooms and 3 self contained flats for adults with enduring mental health needs. The Pines has 26 single en-suite bedrooms over 2 floors for people over aged 55 years and over with a dementia type illness. During our visit we viewed communal areas of the home as well as a number of bedrooms. Bedrooms are located on all three floors. A call bell system is fitted within the home so that people can call for help if they need it. Passenger lifts are provided to afford easy access to all areas of the home. Signage and colour coded doors on The Pines unit are in place to assist people with a dementia type illness find their way about. Within The Pines there is a large lounge which is broken down into two parts. The smaller section contains a fish tank. A central area, called the garden room is used by Care Homes for Older People Page 19 of 30 Evidence: a number of residents. On the lower floor an activity room contains kitchenette facilities. The Limes unit has a lounge dining area with kitchenette facilities. A large separate kitchen is also available. People are able to furnish their own bedrooms and bring in their own personal possessions. Wardrobes are not secured to the wall to prevent accidental toppling over if pulled, no risk assessments were seen regarding this risk to people. The gardens are landscaped and well maintained with raised beds and summer houses. The manager informed us of plans to add a conservatory so that people can view the garden. Infection control procedures are generally good although we did see some items such as a tub of cream and a razor in communal bathrooms. Hand gel dispensers are situated close to the entrance and within bedrooms. Staff were seen to be carrying hand gel on their person. Care Homes for Older People Page 20 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training to ensure that they have the skills and knowledge necessary to care for people. The registered persons need to be sure that sufficient staff are on duty at all times to meet all the identified needs of each person using the service. Evidence: During the inspection the manager confirmed the staffing levels as recorded within the AQAA which were similar to those within the service users guide. On the Pines unit the morning shift consists of 6 care staff, called support workers plus a nurse, this figure is reduced to 5 in the afternoon. On The Limes there are usually 2 support workers plus a nurse throughout the day plus somebody working 3 hours per day with people in the 3 flats. During the night a nurse is on duty within each unit with 3 support workers on The Pines and 1 on The Limes. Other people are also employed within the home such as catering, domestic and maintenance staff. An activities organiser works full times on The Pines only. A relative wrote on a questionnaire that staff are helpful and friendly. One member of staff said I love my job. Care Homes for Older People Page 21 of 30 Evidence: Staff photographs are displayed just inside The Pines as well as a board showing who is on duty. Some updating is needed with the photographs as some newer staff are not as yet on there. We asked staff on their survey whether there are enough staff to meet the individual needs of people using the service. The responses were either usually or sometimes. Staff on The Pines unit were seen to be very busy meeting the physical care needs of people which usually left little time for meeting the social needs of people. We were told that 14 people need assistance with feeding as well as many residents needing 2 carers to take them to the toilet. At one time when we were in the home staffing was reduced to 4 support workers due to circumstances with some staff. One person working at the home told us that it is only due to the dedication of staff that care needs are met. Another person when asked what the home could do better said improve staffing levels while somebody else told us that in order to improve individual care for people that staff number need increasing. We are aware that the number of qualified nurses employed has reduced as a number have recently left. As a result the remaining staff need to work additional hours to ensure that the rota is covered. Although staff were seen to be very busy throughout our visit we saw staff being kind, calm, respectful and considerate towards people using the service. Training is provided for staff. A matrix shows when people last received training. The matrix is colour coded and shows when a training up date is needed. The matrix showed that some staff require an up date in some areas in the near future. The manager was aware of the need to ensure training is up to date to ensure that people have the skills and knowledge to meet the needs of people and keep them safe. We were informed that 4 people have completed training in order that they can train staff in moving and handling in house. Another member of staff has just completed the training therefore bringing the number up to 5. Just over 50 of carers have completed their NVQ (National Vocational Qualification) level 2. Further members of staff are currently working towards this qualification. A list of staff who have attended training in dementia care was on display. Some people are no longer working at the home since the list was devised and other staff who have since completed the training need adding to it. The unit leader in The Pines unit is currently working towards a degree in dementia care. Care Homes for Older People Page 22 of 30 Evidence: We looked at records to see how the home recruits new staff. The required checks are carried out and documents were either available at the home or held at head office and were visible on the computer. In the event of anybody having a conviction the service needs to ensure a risk assessment is held to demonstrate how a decision to appoint was reached. These measures are to help protect people from the risk of neglect or abuse by making sure that only suitable people are employed. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they need from the care home because the manager is experienced and keen to provide a quality service meeting their needs. Some systems could be improved to ensure the monitoring of health and safety is fully robust. Evidence: On our survey one resident wrote The manager is lovely. A member of staff wrote I find the support from Julia Roberts is very good, effective and understanding. The registered manager who is a registered nurse, has extensive experience of working in the care sector. She has also completed the Registered Managers Award (RMA) which is a NVQ (National Vocational Qualification) level 4 in care. On the AQAA the manager wrote that she has in the past won The Caring Times Manager of the year award (2007) and the West Midlands Out Standing Contribution to Care Award (2009). The manager told us that she has attended training in employment law, Mental Care Homes for Older People Page 24 of 30 Evidence: Capacity Act, Deprivation of Liberty and dementia. On the training matrix it was evident that the manager needs to take refresher training in some areas such as moving and handling, health and safety and risk assessments. The manager is supported by a unit manager in both The Limes and The Pines as well as an administrator. The managers office is now near to the front door therefore ensuring she has a higher profile to visitors. The manager completed the AQAA (Annual Quality Assurance Assessment) when we asked for it. The information within it was detailed and useful. St Johns has a number of different internal systems for monitoring quality within the home. Audits were available covering areas such as care planing, medication and environment. The area manager visits the home in order to carry out regulation 26 checks. Copies of the reports of these visits were available within the home and also showed that audits are undertaken of the care provided and of systems of work. The results of surveys carried out by the organisation were not collated together and therefore no plan was devised to reflect any areas where people believed improvement was needed. The manager told us that she would have written to anybody who raised a concern if there had been any. We saw one comment which said Thanks should always be given to all staff you are an exceptional caring people. A certificate of employer liability insurance was on display in the home along with other documents such as Shaw healthcares mission statement. The home holds in safekeeping small amounts of money on behalf of some people using the service. This money is then available for hairdressing or purchasing items such as toiletries. We checked the records held and the balance of a small random sample of people and found them to be in order. We also saw a record of an item held in safe keeping. On the staff survey we asked whether the manager gives enough support and meets with them to discuss how they are working. The majority of staff replied always with the remaining answering usually. We were supplied with a copy of a document showing when people have received a supervision session or an appraisal during 2009. This showed some gaps but many had received regular sessions. Staff confirmed that regular staff meetings take place. We were told that the manager is seeking a new contractor regarding the maintenance of wheelchairs used within the home. During the inspection we were told that no Care Homes for Older People Page 25 of 30 Evidence: routine checks are carried out regarding window restrictors and bed rails to ensure their safety. Furthermore no risk assessments regarding freestanding wardrobes were in place. Information on hoisting equipment showed that items that lift people are serviced. This finding was confirmed within the AQAA and by the manager during our visit. Fire records showed that the alarm is tested regularly however it appeared that not all break glass points are included within the schedule. We noticed that a fire extinguisher was not in position near to the treatment room however we were told that it was no longer needed in that location. Care Homes for Older People Page 26 of 30 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 30 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 9 13 Regulation 13 (2) The service must make arrangements to ensure that medication administration records are accurately maintained that the reasons for non administration of medication are recorded by the timely entry on the medication administration record. To ensure that medication is managed safely 15/03/2010 2 9 13 Regulation 13 (2) The service must make arrangements to ensure that medication is stored at the correct temperature recommended by the manufacturer. To ensure that medication is stored safely. 31/03/2010 Care Homes for Older People Page 28 of 30 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 Care Homes for Older People Page 29 of 30 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). 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