Inspection on 02/04/09 for St Marthas Care Centre

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Marthas Care Centre 27/07/10

St Marthas Care Centre 23/03/10

St Marthas Care Centre 08/01/09

St Marthas Care Centre 16/10/08

St Marthas Care Centre 15/05/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Marthas Care Centre 55-63 Victoria Road Stechford Birmingham West Midlands B33 8AL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Bennett     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: St Marthas Care Centre 55-63 Victoria Road Stechford Birmingham West Midlands B33 8AL 01217897926 01217835547 stmarthas@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross BC OpCo Ltd care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 70. 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 category Old Age, not falling within any other category: Code OP 70 Dementia: Code DE 70 Date of last inspection Brief description of the care home St Marthas provides care and accommodation for older people in three buildings, Ash House, Cedar House and Beech House. Beech House provides nursing care. The home has been established for a number of years however was acquired by 0 8 0 1 2 0 0 9 70 0 Over 65 0 70 Care Homes for Older People Page 4 of 32 Brief description of the care home Southern Cross Healthcare in November 2007. St Marthas accommodation is provided over three levels in each house. Ash House provides accommodation for 25 people. There are 2 double bedrooms and the remainder are single occupancy. Cedar House provides accommodation for 13 people. Some of the rooms on the upper level require people to be able to manage some steps. A passenger lift is available to the first floor and there is a stair lift to the second floor. Beech House provides accommodation for 26 people. The houses share a spacious, well maintained patio/garden area. St Marthas is about a fifteen minute walk from the Bordesley Green Road, where there is a main bus route into Birmingham City Centre. Stechford railway station is nearby. Limited off road parking is available. The current scale of charges are 345 to 497 pounds per week for residential care and 363 to 662 pounds per week for nursing care. These fees applied at the time of our visit and the reader is advised to contact the home for updated information. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is one star. This means the people living there experience adequate quality outcomes. This was the homes key inspection for the year 2009 to 2010. They did not know we were going to visit. The inspection lasted for two days, two inspectors visited on the first day and one on the second. The focus of our inspections is on the outcomes for people who live in the home and their views of the service provided. We look at how the home meets the Regulations, the minimum standards of practice and what they need to do to make the service better. The last key inspection was in May 2008. In June 2008 all three homes were registered as one home. Before that Beech House was registered as a separate home. Since then we have visited twice. We visited in October 2008 in response to concerns raised about Care Homes for Older People Page 6 of 32 the events leading to an admission of a person to hospital. Following this the manager completed an investigation and these concerns have now been addressed. A pharmacist inspector visited in January 2009 to look at the medication. They found that medication was managed safely and the people living there were given the medication they were prescribed. The manager completed the Annual Quality Assurance Assessment (AQAA) about the home and how they think it is running. They sent this to us before our visit. We looked at some parts of the building. We looked at records for four of the staff that work there. We looked at health and safety records. We talked to the people living there, the staff on duty and the manager. Some people were unable to communicate their views verbally so we observed what was going on during the day. We completed a Short Observational Framework for Inspection (SOFI) on the first day. This lasted for two hours, we observed four people and the interaction they had with staff and the other people living there. This helps us to see what it is like to live in the home for people who are unable to communicate this verbally to us. Four people who live there were case tracked. This means we look at their experiences of living in the care home by meeting or observing them, talking about their care with staff and looking at their records. Tracking peoples care helps us understand the experience of people who use the service. What the care home does well: What has improved since the last inspection? What they could do better: Pre admission assessments should contain more information about individual needs so that people who want to move there know that their needs can be met. Staff should have more information about individuals needs so they know how to support them. Care Homes for Older People Page 8 of 32 Medication must always be locked away so that people are safe from harm. There should be more activities that are suitable to individual needs so that people are not bored. Mealtimes should be reviewed so they suit what people want and people can have the food they enjoy eating. Staff should support people to move around the home safely so they are not at risk of being injured. Staff should have all the training they need so they know how changes in the law may affect the people that live there. Arrangements for cleaning commode pots must ensure that the risk of cross infection is reduced. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have the information they need to make an informed choice as to whether or not they want to live there. The needs of individuals are not always fully assessed before they move in, which could result in their needs not being met. Evidence: The statement of purpose and service user guide needed some updating, as there had recently been a change of senior managers within the organisation. Apart from this they included the relevant information so that people had the information they needed about the home. Each person had a copy of the service users guide in their bedroom. At the front of this it stated that it was available in other formats if required so that it was accessible to all people who may want to use the service. Before a person comes to live at the home an assessment of their needs is completed to see whether they can be met there. Four pre admission assessments were looked at. One persons pre admission assessment could not be found. The other three Care Homes for Older People Page 11 of 32 Evidence: included most of the information needed so that a decision could be made as to whether or not their needs could be met there. Two peoples assessments about how dependent they are were not fully completed, although a score had been totalled stating how dependent the person was. It was not clear how the person completing the assessment had come to this conclusion when information about the needs of the person was missing. One persons records stated in their pre admission care plan that they had difficulty hearing but the hearing part of the dependency assessment was not completed. This could result in staff thinking the person is less dependent than they are so not giving them the support they need. One person who had recently moved into the home said that they were beginning to settle in. They said they had some difficulty in finding out who to ask for certain things like how to have the hairdresser visit but had now done this. They thought from what staff said when they visited them to do the assessment that this would be easier than it had been. Since the last inspection each individual had a contract with Southern Cross. This stated what the terms and conditions of their stay were so they were aware of their rights and responsibilities while living at the home. A representative of the organisation and the individual or their relative or a person acting on their behalf had signed the contract. The home does not provide Intermediate Care. Therefore, the standard relating to this was not assessed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the health needs of individuals are met, which could affect their well being. Evidence: The records of four of the people living there were looked at. These included an individual care plan that showed staff how to support the person to meet their needs and do the things they liked to do. Some care plans were very detailed and included information about the individuals preferences so that staff could offer individual care. Others lacked detail for example one persons continence care plan stated that they needed to wear incontinence pads but it did not state what size the person wore. One persons moving and handling care plan stated that staff needed to use a hoist to move the person. It did not state what type of hoist or what size or type of sling. Lack of detail in care plans could result in people not being supported in the way they should. Some care plans had been regularly updated and reviewed involving the person and their relatives so they can have a say in how they are supported. Other care plans had Care Homes for Older People Page 13 of 32 Evidence: not been updated as the persons needs had changed. For example, one persons care plan stated that they needed thickener in their drinks to assist them with swallowing. Staff on duty and the person said they did not need this anymore. One person told us that they had an eye condition and they were wearing special lenses to help with this. They did not have a care plan for this so that staff would know how to support them. One person told us they had a medical condition. Their health records showed they had seen the GP about this, but they did not have a care plan as to how staff are to support them with this. One persons moving and handling risk assessment was blank indicating they did not need support with this. Their mobility care plan stated they needed staff to supervise when they were walking with their zimmer frame. Not updating care plans as peoples needs change could result in the persons needs not being met. Some care plans were handwritten and difficult to read. This could result in staff not knowing how to support individuals. Since our last visit the manager has regularly audited individuals care plans. Two of the four care plans we looked at had been audited and improvements had been made to them as a result of this. Two records we looked at did not show that the person had been regularly weighed. One person had not been weighed since December 2008 but before that had lost weight so it is not clear whether or not this has continued. Losing or gaining a significant amount of weight could be an indicator of an underlying health need. The manager said that some new weighing scales had been delivered and these were seen so all people should now be weighed regularly. Doctors from the local GP practice visit the home twice a week to do a round so that anyone who is unwell can get to see them on these days or sooner if there is an emergency. The manager said that people could go to another GP if they want to. The GP keeps peoples records in the home. These are stored in a metal cabinet that is padlocked so they are kept private. A pharmacist inspector visited the home in January this year and found that the systems for managing the medication that people have were good and people were getting the medication they need. Since then a pharmacist from Boots, who supply the medication to the home, had visited and said that the systems were good. At this visit we looked only at the medication in Ash House. On the first day of our visit when looking around Ash House we found that the trolley was left in one of the lounges. It was locked but there was a box of tablets on the top of it that people who they were not prescribed for could have taken. The manager went to get staff to attend to the trolley so this could not happen. Care Homes for Older People Page 14 of 32 Evidence: Before staff can give medication to the people living there they complete the accredited Safe Handling of Medication training so they have the skills and knowledge to do this. We found that the Medication Administration Records (MAR) had been signed appropriately. At the front of each persons MAR there was a photograph of the person so that unfamiliar staff would know who to give the medication to. Audits of medication showed that people had been given their medication as prescribed. Some people are prescribed PRN (as required) medication. A protocol was in place for each of these so that staff knew how, when and why to give the medication to the person so that it is not misused. Records showed that the temperatures of the fridge were monitored daily. These were within the correct range so that medication was being stored at the right temperature so it is effective. As part of our visit we did a Short Observational Framework for Inspection (SOFI) observation. This is an observation of up to five people over a period of two hours that looks at how staff interact with them and how this may or may not impact on their well being. We did this in one of the lounges in Beech House on the first day. In the two hours there was a period of 40 minutes that there were no staff in the lounge, 30 minutes of these was consecutive. We found that when staff were present in the lounge that their interaction with the people who live there was generally good. One person spent most of their time asleep. One person showed a negative state of being for more than half of the time although they had more interaction from staff than any of the other people being observed. However, they did ask to go to the toilet and staff responded to this request after a few minutes. Staff seemed confused and disorganised about who was going to take the person to the toilet and whether or not they had been. This resulted in the person having to wait over ten minutes to be taken from the time they asked. This may have contributed to their distress. On the first day of our visit we noticed that several of the women living there were not wearing tights. One person in one lounge said they preferred to wear socks, another said that they preferred to wear tights but did not have any on. We found on the second day that more women had tights on and this seemed to be their preference. Staff were generally observed to be respecting individuals privacy and dignity. They discreetly asked people if they needed to go to the toilet. One member of staff was heard describing a person as playing up and being moody. This does not show they Care Homes for Older People Page 15 of 32 Evidence: respect the persons dignity. The GP did their round in one of the lounges where they examined two peoples chests, one persons leg and one persons eye in the lounge where other people were sitting. Staff accompanying them did not question the right of the person to be examined in private. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not ensure that all the people who live there experience a meaningful lifestyle, which could impact on their well being. Evidence: The activity worker was on maternity leave. This role was now being covered by one of the housekeeping staff who did the activity worker role as extra hours. They said they were trying to organise activities such as entertainers. Recently, there had been celebrations for St Patricks Day and celebrations were being planned for St Georges Day. The activity worker had not had training in activities for people with dementia but the Operations Manager said this would be arranged. People told us that there are not many activities and they sometimes get bored. During the SOFI observation there were no activities taking place in the lounge in Beech House. During the morning on the second day in one of the lounges in Ash House we observed no activities taking place. Some people said, we are wasting our lives doing nothing. Another person said, I get bored sitting here all day. Other people said that activities such as parties and bingo are arranged. On the second day in Cedar House we observed people who wanted to, playing bingo. Visitors told us this was unusual although the people living there said they often do this. Activity records Care Homes for Older People Page 17 of 32 Evidence: sampled showed that often people do a variety of activities in Ash and Cedar Houses but there is very little activity in Beech House. Some people living in Beech House said that they go to the other houses when there are activities on there, such as parties or shows and enjoy these. People told us and records showed that there are several different church services talking place that people can take part in if they want to so helping to meet their cultural needs. Several relatives and friends visited during our visit. We observed that staff made them welcome and people were given an opportunity to meet with them in private if they wanted to. People said they could have visitors when they want to. In Beech House there are two sittings for lunch so that staff can support all the people that need assistance with their meals and there are less people in the dining room at one time making it a more pleasant experience. On the first day the second sitting did not start until after 1.40pm. One person said Its a bit late for me. Staff told us that this was later than usual. On the second day the second sitting was served at 1.25pm. Tea is served between 4.30 to 5pm. Staff said that left over sandwiches from tea or biscuits are available as well as drinks overnight that people can have when they want them. One person said, Anything I ask for I get. Some people said that they had not been offered sandwiches, only biscuits and may not have their breakfast until 8am the next day. There seems to be a long time between the evening meal and breakfast the next day but only a short gap between some people having lunch and tea. The arrangements for mealtimes should be reviewed to ensure that people have food when they want it and their well being is not affected. The food looked well presented. People said it was nice and the food was what they liked. There are two choices of each main meal and people are asked the day before what they would like. Alternative meals can be provided if people do not like either of the two choices. The chef was aware of which people needed a special diet. Some people prefer food that reflects their cultural background. The chef said that they buy ready made culturally appropriate meals or the individuals family bring in meals for them. Menus were displayed on a notice board but in small print so people may have had difficulty in reading them. Menus were not available on the tables. Some people said they did not know what was for lunch but they thought it would be nice anyway. Some people have their meals sitting in small groups at small tables in the lounges. They said they preferred this and it was more of a family atmosphere, quieter and they Care Homes for Older People Page 18 of 32 Evidence: could chat to the other people at their table. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: The people living there were aware of how to complain if they were not happy. The complaints procedure was included in the service users guide and displayed in the home so that people knew how to complain. The AQAA stated that in the last twelve months there had been six complaints made to the home. The complaints record showed that complaints made had been investigated. Where needed, action had been taken as a result of the complaint to improve the service offered. This included staff training to ensure that they support people in the right way. The AQAA stated that in the last twelve months two safeguarding referrals had been made and one safeguarding investigation had taken place because of the referral. As a result of this professionals from the Primary Care Trust (PCT) and Social Services have been reviewing the people living there to ensure that individuals needs are being met and they are safe living there. The manager had ensured that where allegations had been made about staff that the people living there were safe while there was an investigation. Care Homes for Older People Page 20 of 32 Evidence: Staff training records showed that all staff had received training in how to protect the people living there. Staff spoken to were aware of how to safeguard people from harm. They knew who they would contact if they suspected that a person living there was being abused. Staff have not yet received training in the Mental Capacity Act 2005. This Act came into force in April 2007. It requires an assessment to be done if there is any doubt that a person does not have the capacity to make decisions about their welfare. All staff should be aware of this legislation and the implications it has for the people living there. If a person does not have this capacity, Deprivation of Liberty Safeguards (DOLS) must be used. These ensure that people only have their liberty taken away to receive care or treatment if it is in their best interests or to protect them from harm. Information about this legislation was available in the home but staff have not yet had training in this. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements generally ensure that people live in a safe, comfortable and homely environment. Evidence: Since our last visit a number of improvements have been made to the decoration and furnishings in the home making it a more comfortable place to live. Some new carpets had been fitted making it more homely. Partitions had been built in some lounges so that these were smaller and more homely. Small tables had been put in some lounges so that a few people can sit together to eat their meals there making it more homely. People said that they liked this and it gave them a chance to have a chat with some of the other people living there whilst eating their meals. A decking area is being built in the back garden. Ramped access is being provided from the home to the decking so that people who use wheelchairs will be able to access it and spend time sitting in the garden. Hand rails are provided to help people get around the home more easily. In the first floor of Cedar House there are several small steps that people have to go up and down to get to their bedrooms. This makes it inaccessible to people who have Care Homes for Older People Page 22 of 32 Evidence: mobility problems. The manager said that they are proposing that this part of the home will be used for people who are more independent. At the top of the first flight of stairs a gate had been fixed to reduce the risk of people falling down the stairs, which were steep. Since our last visit the laundry system had been reorganised. Staff and the people living there said that this had improved things and less items were going missing or put in the wrong persons bedroom. Staff said that soiled laundry is washed separately in bags to reduce the risk of cross infection. Sluice cycles are provided on washing machines so that soiled laundry can be washed properly and reduce any risk of infection. New flooring had been ordered for the laundry, as there were some parts that were worn, which could put staff at risk of tripping. There are only two bedrooms that have en suite facilities. All other bedrooms have a commode so that people do not have to go far to use the toilet at night. There is not a sluice machine to wash the commode pots hygienically. Staff said that they empty and clean them in the toilets then have to take them in the lift or down the stairs to the sluice room. During our visit it was found that the sluice in Beech House was broken so staff had to take them to the sluice room in Ash House. There is not a sluice room in Cedar House. This does not ensure that the commode pots are cleaned sufficiently, which could increase the risk of cross infection. The manager said that they would ensure procedures are put in place to address this so that staff did not have to manually clean these. Separate housekeeping staff are employed so that care staff do not have to spend time cleaning but can concentrate on caring for the people living there. The home was clean and free from offensive odours making it pleasant to live in. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for staffing, their support and development ensure that the needs of the people living there are met. Evidence: Rotas showed and staff said that in Beech House there is one nurse and five care assistants on duty during the day except Monday and Friday when the GP visits, there are two nurses. Nursing staff spoken to said this was sufficient to meet the needs of the people living there. In Cedar House during the day there is one senior care and one care assistant. In Ash House during the day there are three care assistants or the unit manager and two care assistants. The manager of the home manages all three units and is not included as part of the rota. In addition to care staff, maintenance, admin, housekeeping and catering staff are employed. The manager said that there are vacancies of forty four hours for care staff during the day and eighty eight hours for care staff at night. Relatives and people living in Cedar House said there were not enough staff on duty at night. The manager said that there is one staff on duty in Cedar at night but there is also a member of staff who is based in Ash House but floats between the two homes. This should be monitored and reviewed regularly to ensure that this is sufficient and if peoples needs change they are supported safely. Care Homes for Older People Page 24 of 32 Evidence: Relatives and the people living there said that the staff are good and kind. Records sampled showed that regular staff meetings are held and staff are kept updated with what is going on in the home, within the organisation and with best practice in care. The AQAA stated that 48 per cent of care staff have National Vocational Qualification (NVQ) level 2 or 3 in Care but other staff are working towards achieving this. There should be at least 50 per cent of staff who have achieved this qualification. The AQAA stated that they plan to improve the number of staff who have achieved this qualification so they have the skills and knowledge to meet the needs of the people living there. Staff records sampled included the required information to show that checks are completed before staff are employed to work with the people living there. This included ensuring that a satisfactory Criminal Records Bureau (CRB) check is completed to ensure that staff are suitable to work with vulnerable people. Staff spoken to said and training records sampled showed that staff receive the training they need to know how to support the people living there. A record of what training staff do is kept and this shows when staff need to have updated training to ensure they know about any changes to legislation or practices. Staff spoken to and records sampled showed that when staff first start working there they have an induction. This ensures that staff know how to support individuals to meet their needs. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the health, safety and welfare of the people living there is promoted and protected, so ensuring their well being. Evidence: The manager has managed the home since May last year. She is not yet registered with us but is submitting her application for registration. The manager said that she always works extra to the rota and is never expected to work as part of the shift. This helps to ensure that the manager can concentrate on managing the home. The manager demonstrated that she knew the people living there and had a clear idea of what was needed to make improvements in the home. She has worked for Southern Cross for several years and has the experience needed to manage the home. The manager is not a Registered Nurse but the Deputy Manager is and provides clinical support to the nursing staff. The Operations Manager had left the week before. A new Operations Manager was in post and assisted with this inspection. Records sampled showed that a representative of the organisation visits the home Care Homes for Older People Page 26 of 32 Evidence: monthly to assess how the home is meeting the needs of the people living there. Comprehensive reports of these visits are made that state where improvements are needed, for example, ensuring that care plans are more centred on the person. Regular audits are carried out to assess how the home is meeting individuals needs and what it can do to improve. Staff at the home are not responsible for managing individuals money. This is usually managed by relatives or friends or if this is not possible by the local authority that were responsible for placing the person at the home. Small amounts of money are kept safely at the home so that people can buy the things they need. A personal allowance contract is made between the home and the person or the person acting on their behalf. Records showed that peoples money is looked after safely and they can spend it on the things they want to. At the end of each month a statement of their money is made available and this showed that they earn a small amount of interest on the money that they deposit at the home. Staff records sampled showed and the AQAA stated that staff have regular supervision. This ensures that staff are supported in their role so they can meet the needs of the people living there. Staff were observed hoisting people who needed it safely so the person and staff were not at risk of being hurt. Some people sit in chairs that have been made specially for them. Staff were observed moving people from one room to another in these chairs. Several of the chairs did not have a rest on them that people could put their feet on. Some staff lifted peoples feet up when moving them but others did not so the persons feet could be injured. The manager said she would ensure that all chairs were fitted with a foot rest to prevent this from happening. An Environmental Health Officer visited the home in August last year. All recommendations they made had been met with the exception of replacing the flooring in the kitchen. The manager said that quotes had been obtained for this to be done. Fire records showed that the fire equipment is regularly serviced and staff test it regularly to make sure it is working. Records sampled showed that the gas and electrical equipment is regularly serviced to ensure it is safe to use. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 There must be a care plan for each identified need of an individual. To ensure that staff know how to support them to meet their needs. 31/05/2009 2 9 13 Staff must ensure that they do not leave medication unattended. To ensure that people do not take medication they are not prescribed, which could harm them. 30/04/2009 3 26 13 Arrangements for cleaning commode pots must be sufficient. To ensure that the risk of cross infection is minimised as much as possible. 31/05/2009 Care Homes for Older People Page 29 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 People should have the information they need so they know what the home provides and know who to contact when they need something so ensuring their well being. Assessments of individuals needs should be fully completed so they can be sure that their needs can be met at the home. Care plans should be clearly written so that staff know how to support each person so ensuring their well being. Care plans should be updated as the persons needs change so that staff know how to support them to meet their needs. Individuals weight should be regularly monitored to ensure their health and well being. Staff should respect the privacy and dignity of each person living there so ensuring their well being. Activity workers should have training in activities for people who have dementia so they know how to meet individual needs. Activities should be provided that meet individuals needs so they can do the things they enjoy and have a meaningful lifestyle. Menus should be accessible to the people who live there so they can make informed choices about what they want to eat. Mealtimes should be reviewed to ensure they suit the needs of the people living there. People should have the opportunity to have food that is appropriate to their cultural background so ensuring their well being. Staff should be aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DOLS). This will ensure they are aware of how this legislation may affect the people who live there so safeguarding them from harm. Staffing levels should be monitored and regularly reviewed to ensure they meet the needs of the people who live there. All chairs that people are moved around the home in should 2 3 3 4 7 7 5 6 7 8 10 12 8 12 9 15 10 11 15 15 12 18 13 27 14 38 Care Homes for Older People Page 30 of 32 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 be safe so that people are not at risk of being injured. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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