Inspection on 23/03/10 for St Marthas Care Centre

This inspection was carried out on 23rd March 2010.

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 02/04/09

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 03/06/2010.

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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Bennett     Date: 2 3 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: St Marthas Care Centre 55-63 Victoria Road Stechford Birmingham West Midlands B33 8AL 01217897926 01217835547 stmarthas@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: 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 Southern Cross Healthcare in November 2007. Care Homes for Older People Page 4 of 33 Over 65 0 70 70 0 0 3 0 4 2 0 0 9 Brief description of the care home 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. Information about how much it costs to live there was not clear and the reader is advised to contact the home for updated information. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day, the home did not know we were going to visit. A pharmacist inspector also visited during the day to review the medicine management systems. This was the homes key inspection for the inspection year 2010 to 2011. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered including Care Homes for Older People Page 6 of 33 notifications received from the home and the Annual Quality Assurance Assessment (AQAA) . The home is required to tell us about incidents and accidents that happen there. The AQAA provides information about the home and how they think it meets the needs of the people living there. We sent ten surveys to the people living there and ten to staff. We received surveys from five people living there, three of whom were helped by their relatives to do this and five staff. We case tracked the care received by five people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, the manager and staff on duty were spoken with. Due to their care needs some people were unable to tell us what it is like to live there. To help us find this out we used the Short Observational Framework for Inspection (SOFI) tool. This involved observing four people in the lounge in Beech House for two hours and how staff and other people interacted with them. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Staff should have the information in peoples care plans so they can support them to Care Homes for Older People Page 8 of 33 meet all their needs and ensure their safety and well being. People should have clear information about the home and how much it costs to live there. All staff should be aware of what the medication they give to people is for and its side effects so they can meet peoples health needs. Menus should be varied and people should have the equipment they need to be able to eat as independently as possible. Staff should support people to eat their meals with dignity and by offering them informed choices. All incidents of safeguarding must be responded to and reported to the appropriate people to ensure that people are safeguarded from harm. Complaints records should include details of how complaints are investigated to ensure that peoples views are listened to and acted on. Equipment and furnishings should be replaced or cleaned where needed so that all people can live in a comfortable environment that meets their individual needs. A representative of the provider must visit monthly and write a report of the quality of the service to ensure that people benefit from a well run home. People must have appropriate chairs that meet their individual needs and are safe to be moved around in. Appropriate equipment must be provided to move people safely so that they and the staff supporting them are not at risk of injury. Staffing levels should be regularly monitored and reviewed to ensure they are sufficient to meet the needs of the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need to make a choice as to whether or not they want to live there. Individuals needs are assessed before they move in to ensure they can be met there. Evidence: The service users guide included the relevant and required information including how much it costs to live there. It stated that it was also available on audio cassette. The statement of purpose included the relevant and required information. However, it was not clear in the fees stated how much it would cost to live there if the person required nursing care, as both fees quoted were for residential. In addition, the documents had different information about fees. At the back of these documents there was an insert that stated the updated details of the manager and area manager so that people would have current information about this. People told us in surveys that they had the information they needed about the home Care Homes for Older People Page 11 of 33 Evidence: before they moved in. Records sampled showed that before people moved into the home an assessment was completed of their needs. This ensures that their needs can be met at the home. Records showed and the AQAA stated that the person where possible, their relatives and other professionals working with them are involved in these assessments. One record included assessments where each area was scored as to what help the person needed but the total score was not added up. This could mean that it is not clear how much support the person needs, which could result in their needs not being met. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the health and personal care needs of individuals are met, which could impact on their well being. Evidence: We looked at the records for five people living there. These included a care plan that tells staff how to support people to meet their needs. Care plans had been regularly reviewed and updated where peoples needs had changed. One person had been admitted for respite care, staff told us that the period of their stay had been extended. Their records identified their needs but there were not care plans in place as to how staff were to support them in all the areas identified. Some assessments had not been completed to assess the risk of them developing a pressure sore, nutritional risks and their general risk assessment. Their care plan for pressure area care stated that they were at risk of developing sores but it was not clear how this had been assessed. This could result in their safety and well being not being promoted or protected. Care Homes for Older People Page 13 of 33 Evidence: One persons record stated that they had been seen by the GP, as they were constipated. The GP prescribed medication to help them with this but this was not written on their care plan. This could mean that staff would not know how to support the person to reduce the risk of them being constipated. One person had been seen by the GP as their mood was low. They were prescribed anti depressants but there was not a care plan as to how staff were to support them with their depression. This could result in the persons health needs not being met and could have a detrimental effect on their well being. We found at the last inspection that the writing on some care plans was very difficult to read. This had improved but there were still some that could not be read. This could result in peoples needs not being met, as staff would not be able to read how to support people. One person who spends a lot of time in their bedroom in bed had a care plan about how to ensure their environment was safe.This stated that staff should check the person at least every two hours when they are in their bedroom. Earlier in their records it stated that staff should check the person at least every hour. This could lead to staff not knowing when to check the person and their safety and well being being compromised. Records sampled showed that people had been weighed regularly. Where people had lost weight dieticians had been involved so that action could be taken to meet peoples health needs. Where it was stated that people needed to be weighed weekly this had been done. Staff had identified when people were unwell and arrangements had been made for them to get medical advice and support. People had regular check ups with the dentist and optician as appropriate to meet their health needs. As part of our visit we did a Short Observational Framework for Inspection (SOFI) observation. This looked at how staff interacted with four people living there over a period of two hours and how this may or may not have impacted on their well being. We did this in one of the lounges in Beech House. We saw that people were offered regular drinks and were encouraged to drink them to help reduce the risk of them being dehydrated. The majority of interactions between staff and the people living there were positive. Other interactions were neutral, so were neither positive or negative. Overall care staff interacted with people when they needed them to do a task, such as moving from one place to another or having a drink. However, activity Care Homes for Older People Page 14 of 33 Evidence: staff were more able to spend time talking to people and engaging them in activities so helping their well being. We observed that one person had to wait for eleven minutes to be moved from the lounge when they told staff they needed to use the toilet. Several staff came in and out of the lounge during this time but they were involved in other tasks. This could have a detrimental effect on peoples health and well being. The pharmacist inspection lasted three hours. The reason for this specialist inspection was due to an error that the manager reported to us. The medicine management was assessed on all three units. Nine peoples medicines were looked at together with their Medicines Administration Record (MAR) charts and care plans. Three staff were spoken with. The medicine management was good on Cedar and Beech units and adequate on Ash unit. The staff see the prescriptions before they go to the pharmacy and take a copy of them so they can check the medicines received into the home for accuracy. The quantities of all medicines were recorded so that audits could take place. These showed that medication had been given as prescribed. A few mistakes were seen in Ash unit. Some medicines had been given that morning but had not been signed for. This indicated that staff were not checking the MAR charts before giving medicines and did not sign directly after wards to confirm what they had administered. We felt confident that this mistake would have been identified during the homes quality assurance system. All MAR charts were checked weekly and random audits undertaken to confirm the medicines had been given as prescribed. Due to this intensive system an error had previously identified and reported to us. Correct procedures had been followed to ensure the health and wellbeing of the people in the home was not compromised. The manager had installed an additional auditing system for all medicines dispensed in traditional boxes and bottles. Staff count the number of tablets, for example, after each medication round. This ensures that the medicines are given as prescribed at all times. Staff in Cedar unit had excellent knowledge of the medicines they gave and this was commended. Staff in Ash unit had limited knowledge. There was an agency nurse on duty in Beech unit who did not know what the medicines were for. Without such expected knowledge it would be difficult for them to fully support the clinical needs of the people living there. This was of serious concern and the manager was to address this issue. Care Homes for Older People Page 15 of 33 Evidence: The pharmacist inspector found that where people had medical conditions, they had supporting care plans written. It was possible to see when an external health care professional had visited together with the outcome of the visit. All changes in medication doses could be tracked using this system. Care plans lacked detail as to how people were to be supported with their personal care. One persons care plan stated that they needed support with shaving but did not state whether they used an electric razor or had a wet shave. Care plans did not reflect how individuals from different cultural backgrounds needed support with their skin and hair care. This should include what creams or personal care products they may need to use to ensure their comfort and well being. We noticed that some peoples finger nails were dirty so they needed more assistance with this part of their personal care. People were dressed in individual styles that reflected their age, gender, their cultural background and the activities they were doing. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that all the people living there experience a meaningful lifestyle, which could impact on their well being. Evidence: There are two activity staff employed. Activity staff were observed to interact well with the people living there and spent time talking to them about the things they like. They organise activities in the home including arts and crafts, nail care, cinema afternoons and entertainment for special occasions such as St Patricks Day and Christmas. Recently a group of people went to a theatre to see a production of Roll out the Barrel, which they said they enjoyed. The manager said that some people had also visited garden centres and that they hoped to plan other trips out. The manager said that a nail bar is to be created in Ash House so there is more privacy for people to have their nails cared for. The manager said that church services are held in the home although these are not a regular occurrence. Overall, there seemed to be more activities going on than at our last visit. People told us in the surveys that there are usually activities arranged that they can take part in. One person said that more staff are needed so they can go out more. Care Homes for Older People Page 17 of 33 Evidence: During the SOFI observation in the lounge in Beech House the TV was on showing childrens programmes. Music was also on and one person in particular seemed to be enjoying this. It was observed that people rarely watched the TV and this seemed to hinder the persons enjoyment of the music, as they were sat next to the TV. Care plans did not reflect how peoples cultural needs are to be met in relation to their lifestyle, social and religious activities. These should be included so that individuals can have a lifestyle that is meaningful to them. It was observed in Ash House that there was a good atmosphere. People were listening to music if they wanted to. Interactions between staff and the people living there were good and it was obvious that staff knew people well. One person had run out of cigarettes and asked staff if they could go to the shop to get them some more. Staff immediately responded to this and asked what brand the person wanted so offering them choice. Staff were observed to interact well with relatives and friends of the people living there who were visiting. Menus showed that people have a choice of food. Although menus did lack variety from week to week. For example, soups offered are the same each Friday and Saturday. Every Saturday people have a choice of chicken curry and rice or boiled or fried egg and chips. On Sundays people have a roast dinner but on week three and four of the four week rotating menu it states that it is roast chicken. We observed the meal at lunch time in Beech House. Tables were laid with mats and cutlery. There were three small tables with chairs around so that people did not all have to sit together. Some people who needed more support from staff were not sat at tables but in their individual chairs at the side of the dining room. People were brought to the dining room but had to wait about fifteen minutes before any food was served. People said they did not know what was for lunch, one person said, It is just put in front of us. One person who was sat in their chair at the side was given a tray with their meal on, to balance on their lap. The manager said it would be difficult for this person to sit at a chair at the table, as they find it difficult to sit upright. They appeared to be having difficulty balancing the tray on their lap and eating their dinner with their fork. So they could eat they used their hands. They had their dinner all over their fingers but staff did not help them to wipe their fingers before giving them their pudding, which they also used their fingers to eat. The manager said they would look at getting some adapted cutlery for this person to enable them to eat independently. One person had their food pureed on their plate. This was split up into separate portions, so that it was not all mixed in together. However, staff did not tell them Care Homes for Older People Page 18 of 33 Evidence: what their meal was and it was not clear to see. The person had not finished their main meal before staff put their pudding on the table next to them. The person asked staff twice if they could have their pudding, as they had eaten what they wanted of their main meal (they had eaten three quarters of it). Staff told them to finish their dinner first. On the third time of asking staff took the persons main meal away and let them eat their pudding. Another person commented that there was too much dinner on their plate, staff told them to eat as much as they could. Staff should respect peoples wishes so that they can enjoy their mealtimes. Staff sat with people they were supporting to eat so they could respect their dignity. Staff were heard referring to aprons that people wore to protect their clothing during their meal as bibs. This does not respect their dignity as an older person. Good interaction was observed between one member of staff and the person they were supporting to eat. There was little other positive verbal communication between staff and people during the meal time. Most verbal communication was task orientated and referred to people being told to eat their dinner or drink their drinks. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: People told us in the surveys that they knew how to make a complaint if they were not happy with the service provided at the home. The AQAA stated that staff explain the complaints procedure to people when they move into the home and they are given a copy of this. We looked at the complaints log. This recorded that three complaints had been made since we last visited. Records were not clear as to how the complaints had been investigated. They showed that they had been responded to but not how the outcomes had been reached so it is clear that peoples views are being listened to. The minutes of a meeting with the people living there and their relatives stated that one person had raised an informal complaint and it stated that the manager was to investigate this. This was not recorded in the complaints file and the investigation by the manager had not been recorded. This does not show that peoples concerns are always responded to appropriately. The manager had raised a safeguarding alert following medication not being given one evening in Cedar House. Action had been taken by the manager following this to reduce the risk of it happening again. The safeguarding alert has now been closed as it Care Homes for Older People Page 20 of 33 Evidence: was found that action was taken to safeguard people from harm. Since we last visited there have been another four incidents reported as safeguarding and action has been taken by the relevant professionals to ensure that people are safeguarded. Training records showed that staff have received training in how to safeguard the people living there from harm. Staff spoken to showed that they would know what to do if they witnessed people being abused by other staff and who to report it to ensure that people are safeguarded from harm. We asked staff if there have been any incidents where people who live there put other people at risk because of their behaviour. Staff told us of an incident where one person had threatened another person with their zimmer frame and had been verbally abusive to them. This had been recorded in the persons records, it stated that staff intervened and the person calmed down. However, the manager was not aware of this incident and it had not been referred to the social worker as a safeguarding issue. The manager has now put in place a managers handover sheet to ensure that issues are communicated appropriately and action can be taken to safeguard people from harm. Information was available in the home about the Mental Capacity Act and the Deprivation of Liberty Safeguards legislation. The manager said that training in this is being arranged for staff. This is important so that staff are aware of how this legislation may affect the people living there. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements generally ensure that people live in a safe, comfortable and homely environment that meets their individual needs. Evidence: Since our last visit improvements have continued to be made to the decoration and furnishings of the home to make it more comfortable for people to live in. In Beech House we saw that the carpet in one of the lounges was stained. This should be cleaned or replaced to ensure that people live in a comfortable environment. Bathrooms had been redecorated. The shower room had been refurbished and re tiled and this was now accessible to people with mobility difficulties. Since we last visited the kitchen had been re-tiled and new flooring laid. This has met the requirements made by the Environmental Health Officer. The manager said a new food mixer/blender was needed, as the current one is rusty and they are waiting for funding to be approved for this. The laundry is based in Beech House. There are two washing machines and two tumble dryers, so that people can have their laundry washed when they need it. We saw that the bedding in one persons room, who spends most of their time in bed, was very creased and looked worn. The manager said that it is not possible to iron all the Care Homes for Older People Page 22 of 33 Evidence: bedding as they need a new rotary iron. Bedrooms should be comfortable for people to spend time in, particularly when people spend most of their time in there. Some peoples bedrooms had been personalised to their individual tastes and included photos of people important to them. The home was clean and free from offensive odours making it pleasant for people to spend time in. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 can be met. Evidence: The AQAA stated that the home is now fully staffed and agency staff are rarely used. This helps provide continuity of care to the people living there. In Beech House when we visited an agency nurse was on duty. The manager said that it was difficult to recruit nurses. They said that one nurse is on maternity leave and there are vacancies on days and nights for nurses. However these are being recruited to and they are waiting for checks to be completed before nurses can start working there. Relatives and staff told us in surveys that there is a shortage of staff, one staff said there is never enough staff to meet the needs of the people living there. Staff spoken to on the day said there could be more staff, but if staff are off then agency staff are usually used to cover. The manager stated that they always cover with agency if needed to ensure that the care of the people living there is not compromised. They are willing to challenge their manager to ensure sufficient staff are employed to meet peoples needs. When we visited there were the numbers of staff on duty that the rotas said there should be. Staffing levels should continue to be reviewed to ensure that they are sufficient to meet the needs of the people living there. Care Homes for Older People Page 24 of 33 Evidence: The people living there told us that the staff are good and are there when they need help. One person said, They look after us well, everything is fine. The manager and staff said that they are doing diploma in care training at the home. This should ensure that staff have the skills and knowledge to meet the needs of the people living there. The AQAA stated that there are now two staff working in the home who have been trained to train other staff and this should increase the amount of training that is provided. Staff told us that they get plenty of training. The training matrix showed that over 60 per cent of staff have received training in the last 12 months in the areas needed. Further training is planned so that staff receive all the training they need to meet the individual needs of the people who live there. Staff said they have regular staff meetings and this helps to keep them updated with best practice. The records of three staff who work there were looked at. These showed that generally the required checks are completed before people start working there. This ensures that staff are suitable to work with vulnerable adults and includes a Criminal Records Bureau (CRB) check. One record did not include any work history on the persons application form but they had a reference from a work colleague. The manager said they would look into this to ensure that proper checks are completed for all staff. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the health, safety and well being of the people living there is promoted and protected, so ensuring their well being. Evidence: Since we last visited a new manager has been recruited. She is not yet registered with us but is applying to do so. The manager has many years experience of working with older people and is a registered general nurse. They have worked in a management role within care homes but have not previously been registered with us. Staff said that they found the manager approachable and that improvements had been made since she had been in post. The manager told us about auditing processes she had put in place to ensure that people are being supported to meet their needs. As stated earlier in this report the medication audits put in place have helped to ensure that people get their medication as prescribed. Care Homes for Older People Page 26 of 33 Evidence: A representative of the organisation had visited monthly until January this year. There has been a restructure within the organisation and since January this has not been done. The manager was unsure as to who has responsibility within the organisation for this now. It is required that a representative visits monthly and completes a visit to assess how the home is meeting the standards and regulations to benefit the people living there. Staff tested the fire alarm in the morning. Staff came into the lounge in Beech House to tell people they were doing this so to reduce their anxiety when the alarm sounded. Fire doors shut automatically in the lounge when the alarm was sounded showing that systems would work if needed to limit a fire spreading. Fire records showed that an engineer regularly services the fire equipment to ensure it is well maintained. Staff check the fire equipment regularly to make sure it is working. Regular fire drills are held so that staff and the people living there would know what to do if there was a fire. Hoist records showed that these are serviced regularly. Where issues are identified action had been taken to ensure that people are safe when being hoisted. The manager has implemented a weekly check by staff of hoists and slings to ensure these are safe to use. Since we last visited the kitchen has been refurbished and all recommendations from the Environmental Health Officer had been met to ensure this is safe to use. The AQAA stated that gas and electrical equipment is regularly tested to ensure it is safe to use. When we last visited we noticed that people who sat in chairs specially adapted for them, were being moved from one room to another in these. Several of the chairs did not have a foot rest on them that people could put their feet on. At our last visit the manager said they would ensure that foot rests were fitted to chairs to prevent injury to peoples feet. This had not been done. The manager said that the maintenance staff had looked at fitting these as the chairs were not supplied with foot rests. However, it was not possible to fit foot rests to these chairs. The manager said that they would be looking at alternative chairs for individuals. For individuals safety this is required as staff were observed pulling people in their chairs with their feet dragging on the floor, which could put them at risk of injury. Some people were not tall enough for their feet to rest on the floor so their feet were hanging down. Chairs should be adapted so they are comfortable for individuals to sit in. Staff were observed moving one persons foot rests at lunch time in Beech House from their wheelchair so their feet were hanging down during their meal, which would not be very comfortable or aid their posture. Care Homes for Older People Page 27 of 33 Evidence: We observed staff using hoists to move people. Two staff worked together to do this and we observed that they moved people safely. Some people were supported to move by staff without a hoist. Staff were observed to not use any equipment to aid with this and put their arms under peoples arms to drag them into a different position. This could cause injury to the person and to staff. One person was observed being moved in bed by one staff member without the equipment that it was stated on their care plan, to ensure their safety and that of staff. The manager said that two staff are now trained to deliver moving and handling training to staff. The manager said that these two staff are assessing the equipment that is needed to move individuals to ensure their safety. This must be done and appropriate equipment provided for the safety of the people living there and staff. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 18 13 All incidents of safeguarding must be responded to and reported appropriately. To ensure that the people living there are safeguarded from harm. 30/04/2010 2 38 13 All people must be assessed as to the equipment needed to move them safely. To ensure their safety and that of staff moving them. 31/05/2010 3 38 13 All chairs that people use and are moved around the home in must be safe and adapted to their individual needs. So that people are not at risk of being injured. 31/08/2010 Care Homes for Older People Page 30 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 3 7 People should have clear information about how much it costs to live at the home. Assessments should clealy state what support the person needs to ensure that their needs are met. Arrangements should be made to ensure that care plans are clear so that staff can read them and know how to support the people living there. Care plans should be updated as peoples needs change to ensure that staff know how to support individuals to meet their needs. Care plans should clearly state how staff are to support individuals to meet their health needs to ensure their well being. Staff should be aware of what the medicines prescribed for the people living there are for, together with the common side effects of the medicines. Care plans should clearly state how individuals are to be supported with their personal care, to ensure their well being. Care plans should state how peoples cultural needs are to be met in relation to their lifestyle, social and religious activities. This should ensure that individuals can have a lifestyle that is meaningful to them. Staff should provide the people living there with information about their choices at mealtimes and what they are eating, so as to respect their choices and dignity. Staff should respect peoples wishes about what they eat so they can enjoy their mealtimes. People should be provided with adapted cutlery and crockery so that they can eat their meals independently and their dignity is respected. Menus should be varied so that people have a varied and nutritious diet that meets their individual needs. Records should show how complaints are investigated to ensure that peoples views are listened to and acted on. Staff should have training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This will ensure they are 4 7 5 8 6 9 7 10 8 13 9 15 10 11 15 15 12 13 14 15 16 18 Care Homes for Older People Page 31 of 33 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 aware of how this legislation may affect the people living there. 15 19 Carpets should be cleaned or replaced where needed to ensure that people live in a homely and comfortable environment. The mixer should be replaced to ensure that the risks of cross infection are reduced. Peoples bedding should be clean and of good quality so that they can feel comfortable, particularly when they spend much of their time in bed. Staffing levels should be monitored and regularly reviewed to ensure they meet the needs of the people who live there. Recruitment practices should ensure that suitable staff are employed to work with the people living there to ensure they are safeguarded from harm. A representative of the provider must visit the home monthly and write a report of this visit. This will help to ensure the home is meeting the standards and regulations and the home is being run in the best interests of the people living there. Staff moving and handling practice should reflect what they have been told in their training to ensure their safety and that of the people living there. 16 17 19 25 18 27 19 29 20 33 21 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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