Inspection on 13/11/08 for Stennards (Kn)

This inspection was carried out on 13th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stennards (Kn) 28/02/07

Stennards (Kn) 20/02/06

Stennards (Kn) 20/10/05

Stennards (Kn) 15/03/05

Stennards (Kn) 14/07/04

Stennards (Kn) 08/03/04

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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: Stennards (Kn) 150-152 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN     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: Tina Smith     Date: 1 3 1 1 2 0 0 8 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 38 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 38 Information about the care home Name of care home: Address: Stennards (Kn) 150-152 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN 01214583311 01214590467 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Peter David Lee-Harris,Mrs Dawn Lee-Harris Name of registered manager (if applicable) Miss Philomena Mary Malanaphy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 25 Date of last inspection Brief description of the care home Stennards Kings Norton is located on Middleton Hall Road which is a residential area. The home is close to local shopping centres, amenities and public transport. Personal care and accommodation is offerred to 25 older people on two floors via a shaft lift and stair lift. There are nineteen single and three double bedrooms some of which have ensuite and their own shower facilities. There are toilets within close proximity of the Care Homes for Older People Page 4 of 38 care home 25 Over 65 25 0 Brief description of the care home communal areas and bedrooms, and there are five bath and shower rooms. Three of these allow for staff assistance. On the ground floor there are two interconnecting lounges, dining room and a conservatory, and a well maintained and enclosed rear garden. The office can be found in the dining room. Enquiries need to be made from management about the fee range, as this is not published in the homes information, although there is information about services included in the fee and a small top up if council funded. Care Homes for Older People Page 5 of 38 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: One inspector visited the home over one day. The home was not informed that we would be visiting. We examined records, talked to people, staff and visitors, including a professional. Medication administration was observed and a meal was sampled. During our visit we case tracked 3 people that management helped us to choose: the newest admission, the person with the most complex care, and a person needing manual handling. We closely examined their records, equipment and rooms and spoke with them and their staff. We sampled other records about people, staff and the running of the home and discussed our findings with the acting manager, an owner and the area manager. We would like to thank people in the home, visitors and staff for their cooperation and hospitality. Care Homes for Older People Page 6 of 38 Prior to our visit the home supplied information to us annually from their legally required Annual Quality Assurance Assessment (AQAA). Information from this and from other sources was also used when forming judgements on the quality of service provided at the home. We received surveys twice in the past two years from people, relatives and staff. There were 6 requirements from a previous inspection; we found 5 fully met and 1 was replaced. We sent immediate and urgent requirements after our visit to ensure peoples safety, which were promptly acted upon. A list of current requirements and recommendations is at the end of this report. What the care home does well: What has improved since the last inspection? Since the homes last inspection on 28.02.07, management improved recruitment checks, and staff induction. Record keeping now shows care provided, how individual social needs are met, and peoples wellbeing on a daily basis. Management do more recording so that staff have more time to spend with people in the home. The acting manager ensures that all relevant information on prospective new admissions is collated prior to residency. Links were made with a local day centre where transport is provided. Domino and card sessions in the afternoons were arranged for interested people. There is a new treatment room and activities room, and a new fire safety system. Garden furniture, new bedding, sit on weighing scales were purchased, and aerials were fitted in 3 rooms. Two toilets and bedrooms were refurbished and decorated, carpets were replaced, and chairs re-upholstered. Care Homes for Older People Page 8 of 38 The acting manager completed management training. Stennards introduced an Area Manager to support home managers and develop services. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 38 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 38 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. There is written information to help people decide if the home is suitable, but it is needs updating. Everyone has a visit, trial and assessment, but these do not ensure that preventable risks are recognised and avoided. Evidence: People told us they had enough information about the home, and their needs are well met. One person said, ... Im happy I decided to live here. There is general information about all Stennards Homes: what to expect, needs that can and cannot be met, visiting arrangements, services included in the fees and those at additional charge, and some of the homes procedures for staff are attached. The information is useful but needs up dating to reflect current management. We did not see the service user guide, which is legally required, but we note it contains contact details for advocacy services to help people make decisions. Training and qualifications Care Homes for Older People Page 11 of 38 Evidence: of staff need to be in the statement of purpose so that people can assess whether staff have the knowledge and experience to meet their needs. Management told us in the AQAA they want to improve their information. The reproduction quality and changing font of the statement of purpose we saw will pose problems for people with sight difficulties. Other formats would also make it more accessible to older people. The procedures would be easier for people to understand if summarised. The AQAA provides quotes from people about the home, and these could enhance the homes published guide. People and their representatives have opportunity to visit and try the home before moving in. A review is held with them after a 28 day trial period. The Welcoming Procedure sent after the inspection has some very good content on how staff help people to settle in, such as a named senior officer. There are written terms and conditions, and useful information about council funding and top up fees. On our visit there were 23 people living at the home and one vacancy, and most have been living in the home over 12 months. There were 8 admissions and 1 discharge during the past year. A double room has been converted into a single room, so there are 24 bedrooms in use. One family found the home through a bed agency; relatives visited, and arranged for the person to visit the next day. Another family visited two homes before choosing this one. There is a company assessment format with tools to identify peoples needs, preferences and screen for risks. People have verbal confirmation from the home that their needs can be met. The statement of purpose says that pre admission assessments are always completed by the proprietors or senior management. We are not clear on the proprietors training to do so. We found that the homes screening tools are not used consistently to recognise and avoid key risks for peoples health and safety. This is discussed in the next report section. Care Homes for Older People Page 12 of 38 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. People are treated with respect, personal care is provided in private, and independence is promoted. Care planning does not ensure that all screened risks are identified, care is reviewed and agreed with people so that health is promoted and protected. The medication system and staff competence need to ensure peoples health is protected. Evidence: Progress has been made since the last inspection to identify peoples health, personal and social care needs and preferences and we found mainly good outcomes for people. Independence is encouraged so that people maintain their abilities, and make decisions in keeping with their lifestyle, culture and religion. Some had social histories or A Day in the Life descriptions of peoples needs and preferences and interests. Each of the 3 care records seen had care plans drawn up from comprehensive assessments in the homes standardised format which has screening tools for key risks. However screening for risks are not accurate or re scored, including nutritional, falls and pressure sore risks. The care planning system is not recognising and planning Care Homes for Older People Page 13 of 38 Evidence: for risks identified at early points, or evaluating whether measures have effectively reduced risks or responded to changes affecting people. Nutritional needs are identified on care plans, although detail can improve for people with diabetes and is discussed in the Daily Life section. Falls risk is discussed below. We found that people have their nutritional needs met and gain weight in the home. There is good access to NHS and private health care, medication reviews and flu injections, and people have their sensory, oral hygiene, footcare and continence needs met. Staff identify and involve the GP if there is a concern of depression. Pressure sores, leg ulcers and blood sugar monitoring are managed by District Nurses. Peoples wounds heal, and diabetes is stable. We recommend that the home introduce night time and end of life care planning to recent best practice guidance. There is one person in the home with dementia that is being managed, but the condition has advanced. The home is not registered for dementia but their family are satisfied with the homes management of agitation, aggression, and their changing religious needs. Staff have Level 2 dementia awareness training. Staff review care plans monthly and the homes statement of purpose encourages people to take part in reviews. However care plans we saw are not signed, and one person and their family told us they have never seen them. We could not confirm that annual reviews were held in consultation with two people, their representatives or staff. We spoke to a number of people who are satisfied with their care, but also some who feel they have insufficient support. One person had views about their bathing and the role of two carers to assist with personal care as they expected. Their care plan lacked detail about transfers by the person and with assistance of two staff for personal care. However everyone we saw had good personal hygiene; their appearance and clothing is of a good standard and appropriate for the weather. So the care plan may need more detail agreed with them. Clear instructions for staff ensure care is delivered in the way people want, and prevents injuries. Another person and their family told us they experienced delay in relieving mouth pain, and another family are bringing laxatives into the home. We are not clear whether staff check this in reviews, and with the doctor and pharmacist for contra indications, but families are advised in the homes information to make staff aware of over the counter remedies brought into the home. The screening of falls risk needs development to best practice standards. The Care Homes for Older People Page 14 of 38 Evidence: screening tool omits important considerations and we found falls risk underestimated and needs not met. A history of falls from information provided by people, families and professionals is not always consistently scored and the tool is not fully understood. In each care record there are instructions about how to lift people with equipment if they fall regardless of their risk level, but no measures to prevent falling. In one room we saw a loosely fitted single bedrail that would not prevent a fall from bed for someone, and a bedrail risk assessment was not in place to prevent entrapment of limbs. The person was at high risk and had falls from bed, but their screening identified low risk. Management said that the rail is not to prevent falls, but its purpose is not on the care plan. The care plan needs instructions for staff about fitting, checking and maintaining the bedrail, as the Stennards Welcoming Procedure leads people to expect. People in shared rooms have a privacy screen, and there is access to a private pay telephone in the dining room, when not in use. People are treated with respect, preferred names are used and personal care is provided in private, but a prescribed cream was applied and left in the lounge. This posed an infection control risk to other people. Oversight of the medication system and staff competence needs to prevent unnecessary risks to people of the spread of infection or illness. We observed good practice as well as cross contamination risk when medication was handled when administered to people without gloves or washing hands in between people. This practice was changed as soon as we raised concern, however the homes current monitored dose system makes it difficult for staff to avoid touching the drugs, which needs review. We praised staff for checking the right medication is given to people and consent is sought. Arrangements for the storage, recording and disposal of medicines did not meet standards to ensure people receive stable medication to manage their health, and to protect people and the public from medication going missing. Medication fridge temperatures are not taken and the fridge needed defrosting. We found eyedrops stored at room temperature in the trolley that needed storage below 8 degrees C. We also found inhalers in the trolley that were not listed on the homes medication administration records (MAR) and are likely to be out of date from March, May and June. We queried this and found that medications are not always disposed of when they are discontinued by the doctor. Staff roles to check medication is in date are unclear. Drug audits are carried out monthly by management, and periodically by the homes pharmacist. However audits cannot check drugs that are not recorded, and supplies cannot be easily audited if discontinuations are not marked on the MAR. This means that we could not confirm that the homes system ensures people have and take prescribed medication safely, and can account for all medication on the premises. The medication register did not have a list of staff signatures and initials so that staff performance can be checked during audits, and individual records did not always have a photograph so that the right medication is given to the right person, but some Care Homes for Older People Page 15 of 38 Evidence: photos were on the Nomad box. There were drugs that need checking with a clinician and guidelines so that staff are aware of side effects and peoples allergies. Pre printed pharmacy instructions about one medication needed administration before food. We saw that this was followed at night but not during the day. Occasional use, or when required medication was being administered regularly without referral back to the doctor to check, for instance whether the person is having sufficient pain relief. Management administer medication, and they have accredited training. After discussion we are unclear how regular updates are provided. Staff medication competence and knowledge is not regularly observed and confirmed once staff are trained, and annual staff appraisals we saw do not include medication practice. Management told us that there is no one managing their own medication but we found three people who did so. One person told us they had difficulty breathing at night, managed their own inhaler but said lately it was not working quickly enough. Their care and medication records did not have a risk assessment, checks or reviews to ensure they remain competent to use inhalers as the doctor intended for their health, and store them safely to protect others. The home orders and stores other inhalers, but this is not on the MAR, as their policy requires. We raised concerns about one person with management who consulted their GP immediately. It is good practice to give people choice about managing their own medication, but management systems must ensure safety, accountability, and their duty of care to monitor peoples health and wellbeing. Care Homes for Older People Page 16 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are flexible routines and daily choices. Relationships with family and friends are maintained according to peoples wishes. There are opportunities for exercise and socialising in the home and community, appropriate to peoples interests, religion and lifestyle. Meals are nutritious and dietary needs are met. Evidence: The home have improved peoples outcomes in leading interesting and healthy lives. There are flexible routines and everyone makes daily choices and decisions in accordance with their lifestyle, culture and interests. There is a user friendly activity programme on display, and a number of people attend social clubs and day centres in the community. There are celebrations, outings and meals out. People told us they enjoy exercise and anything musical. There is also arts and crafts and a room in the home is used for activities. An entertainments officer is shared by Stennards homes, and at Middleton Hall Road we are told there are activities 3 days a week. Staff help at other times with games. We saw people reading newspapers, doing word puzzles, watching TV and using all communal areas and the garden. Peoples likes, dislikes, interests and hobbies are noted in their care records in detail, Care Homes for Older People Page 17 of 38 Evidence: such as Irish music and how people like their coffee. Since the last inspection the home has improved their records of activities people take part in. Not everyone chooses to join in. There are a few people who need one to one staff support to participate, because of sensory or memory impairment. Their care plans needs to reflect this. We confirmed with people and visitors that their religious needs, as recorded in their care plans, are met. One person used to attend services in the community but can no longer manage this so a friend from their church continues to visit. Another person has holy communion in the home. People are encouraged to maintain their abilities and their independence. Some people manage their own room keys, medication, and their own finances although improvements are discussed in other sections of the report. People have support to take risks, but also gave us a mixed picture. One person and their family were supported to make decisions about whether to have further health investigations. Another person wanted to go shopping by themselves; this is noted in their records but without an outcome. The home assists other people to use Ring and Ride. People needing support have respectful and sensitive help, and privacy. A number of people have visitors who take them out regularly. There are no visiting restrictions, but a poster on display suggests mealtimes should be avoided. We advise that some people eat better when relatives are present. Stennards Middleton Hall has a happy and welcoming environment, and we saw several visitors during the day, and people talked with friends they made in the home. People are supported to maintain their relationships, e.g. staff informed someone that they have a new grandchild. Many relatives assist people to manage their finances and shopping, and the home usually work in partnership with them. One family however hoped their mother had enough underwear and tights as the home has not asked them for these. We did not see up to date inventories in peoples care records, or care plans that ask staff to check clothing. Food likes and dislikes are noted and updated, and special diets are catered for, however catering staff said they are not always informed about peoples needs. A care plan for someone with diabetes did not ensure that staff avoid a 12 hour gap between meals, but their diabetes is stable. Some people have assistance to eat. Mealtimes are enjoyed, not rushed and people can eat where and when they want. Care staff do not prepare food unless the cook is off, and all have safe food handling training. People are asked in the morning their choice for dinner, but they forget what they are eating and what they may want at tea time so that they choose a balanced diet. We sampled menu records and found there are healthy choices for a nutritious diet. Everyone we case tracked has gained weight, but this is not excessive. Most people told us that Care Homes for Older People Page 18 of 38 Evidence: they like the food, but one person said I am sick of sandwiches and Saturday dinners, and brought in a pizza. The cook told us that the tea menu recently changed to include chilli and pizza in response to requests. Care Homes for Older People Page 19 of 38 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. People cannot have confidence that their complaints will be taken seriously and acted upon. Staff are vetted so that they are safe to work in the home, and are trained to recognise and report abuse and poor practice. Peoples financial interests need more protection. Management need to keep up to date on new laws for serious decisions and about restraint. Evidence: The homes documents and a poster on display tells people how to make a complaint inside and outside the home, but a relative told us they do not know how to make a complaint. The Welcoming Procedure has the most up to date procedure, and the timescales exceed national minimum standards. Staff said that concerns are addressed quickly so that they do not fester but this did not match everyones experience. Most people are satisfied with the homes care and staffing. Some people and relatives have confidence a concern or complaint will be acted upon appropriately, but others told us of matters that have not been addressed to their satisfaction, such as delays to reduce discomfort by purchase of a homely remedy, or obtaining personal hygiene products they prefer. Relatives and staff felt that the laundry service needs to improve, that clothing and labels go missing, and one family are doing the persons laundry because of losses in the home. Care Homes for Older People Page 20 of 38 Evidence: There are no recorded complaints in the homes log since the last inspection, so there are no records of whether these concerns are known to management and acted upon. We therefore find that the homes complaints procedure is not being used to the satisfaction of people and their relatives. The procedure needs to be accessible and responsive when a concern is expressed to any staff. People and their representatives may want help to express themselves to report a concern inside and outside of the home, sometimes anonymously. The Welcoming Pack has up to date CSCI contact details and says that local advocacy services are in the service user guide. People funded by the council can also use the council complaint process; contact details could be published to promote peoples rights. Quality audits should identify any patterns of complaint or concerns so that systems and policies can change. Staff protect peoples rights by supporting them to express daily decisions or views. Staff could explain individuals communication modes to us, and how important decisions are sought several times if someone has temporary or fluctuating incapacity. There is access to a private telephone and people open their own mail. People can refuse medication, personal care and food and this is respected but monitored, and specialist advice is usually sought at an early point where there may be concern for health or wellbeing. The home assists NHS specialists and relatives to understand people when best interest treatment decisions are needed. This is good practice. Information about how people register and vote would be useful in the homes service user guide. People are in safe hands because of the homes staff recruitment process. All staff files seen had police and government list checks, but some date back to 2002 and a good practice policy to refresh checks should be considered. The home has a number of policies to safeguard people, and staff sign to confirm they have read and understood them. The homes adult protection policy is linked to the local council protocol. Staff are trained and knowledgeable about recognising and reporting adult abuse, and there have been no adult protection concerns since the last inspection. We were told that the home does not manage personal allowances, and saw that people or relatives are billed and receipts provided if purchases are made occasionally on peoples behalf. Management confirmed there were no other records. While the person in discomfort could not get a homely remedy perhaps because of this policy, another person told us that a staff member regularly holds most of their money for hairdressing, and they didnt think they could manage their money without this help. Another person told us that staff collect money for the Irish Lottery. The Welcoming Procedure recognises that exceptional decisions may need to be made to assist people, but there is no transparent accounting system in place if staff receive funds in advance of providing services. Care Homes for Older People Page 21 of 38 Evidence: Peoples financial interests need more protection, especially if a person lacks mental capacity to make financial decisions, and occasional betting is a service provided by staff. This may or may not be in keeping with their lifestyle and best interests. Free training in new laws about mental capacity are provided through the council or online through the Department of Health. Management need to keep up to date about peoples rights, including access to statutory advocates, staff duties, new crimes about abuse, and lawful practice about serious decisions, such as accommodation and regarding types of restraint in use in the home, such as bedrails and covert medication. We did not see written consent or best interest decisions about restraint. Care Homes for Older People Page 22 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, clean, and generally well maintained and safe. People can bring their own possessions and personalise their room. Shared rooms have privacy screens. The homes risk assessments and systems need development to prevent people tripping and falling, scalds from the shower and the spread of infection. Evidence: The home is comfortable with a good standard of decor and furnishings. It is maintained, cleaned and refurbished according to schedules. The environment is secure from intruders and for people who may wander outside. There is open access to the enclosed garden which people told us they use, especially for smoking. Communal games and large screen tvs and music system in the lounges meet the needs of people with sensory impairments. Repairs are timely and a handyperson is shared between the Stennards Homes and calls twice weekly. The owners undertake a daily role in health and safety at the home. The fire risk assessment was updated in Sept 08, and the home passed the Fire Officers inspection without requirements. The council inspected food safety and their report in February 08 required the home to have a sickness policy for staff to prevent the spread of contagion. We asked to see this policy but were told that a staff member removed it and has not returned it. Care Homes for Older People Page 23 of 38 Evidence: We saw a folder for Safer Food Better Business, which shows us that the home have best practice guidance on food safety. In the kitchen, temperatures and food probing measurements are taken daily showing that the fridges and freezers are working correctly, and food is cooked to a safe temperature. We saw three items open in the fridge that did not show dates they were opened. These were immediately discarded when mentioned, so that they dont go out of date. We recommend management conduct spot checks about this. People could fall into the laundry, as the door was not locked and there is a step down into the room. The manager acted immediately and said it would be kept locked. We pointed out a trip risk on an uneven floor in an upstairs hallway. Contractor certificates and safety checks were sampled. The two lifts have been serviced. Regular hot water temperature checks are made on communal and bedroom sinks, the hot water cylinder flow and valves and are in the safe range. However no checks are made on baths and showers to ensure people are protected from scalding water. We were told that no one uses these facilities without staff assistance, but we spoke to a person who told us they did and queried this again. Care staff check water temperature with a thermometer, however there is a manual over-ride in the shower. In the management section we also discuss missing safeguards to prevent the spread of bacteria through the water supply. Peoples rooms and equipment generally suit their needs, apart from a bed rail being used as a grab rail for one person. The need was not clear on the persons care plan, and a specialist such as an occupational therapist was not consulted about appropriate equipment for this purpose. Care plans need detail about equipment fitting, checks and maintenance. The AQAA told us that one person requested to change room. The home are planning to meet this request when there is a vacancy. There are privacy screens in shared rooms so that people can maintain their dignity. Shared rooms are sometimes made into single rooms, and one person is provided with space for their equipment and staff assistance. There are sufficient toilets and bathing facilities. One persons room has ensuite facilities that are used instead to store an electric wheelchair. The ensuite doesnt have sufficient space for two staff, so communal facilities are used. Everyone has a wash hand basin in their bedroom. People personalise their rooms with photographs and can bring furniture. Personal inventories, not in evidence, need to include furniture and ornaments. We toured the building and found the home to be clean. The carpet is shampooed twice a week to manage a slight odour in only one room seen. The AQAA says there is Care Homes for Older People Page 24 of 38 Evidence: a best practice action plan about infection control, but we found clean and soiled laundry were too close to eachother to prevent cross contamination. The council collect clinical waste. We noticed that the bins are not locked so the public are protected. Care Homes for Older People Page 25 of 38 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. There are sufficient staff, who are committed, well trained and supervised. Recruitment and induction to safe working practices also ensure people are in safe hands. Evidence: There are staff on duty 24 hours a day that match peoples needs, and there are staff trained in first aid on each shift. There are stable staff who provide cover when necessary so that there is consistency and peoples needs are known. There is a keyworking system so that each person has one carer who takes a special interest in ensuring their needs are known. The workforce is female, so men do not have choice about who helps them with personal care. Surveys told us that communication systems work well so that staff are aware on a daily basis of any changes affecting people in the home. Since the last inspection management improved the recruitment and induction process so that we can confirm people are in safe hands. We sampled three staff files and found that there was no application form or references in one, but these were located and sent to us after the inspection. Management could audit staff files periodically to ensure all necessary documents are kept together on site. Each record seen had required police and vetting checks. One long standing carer has not been checked Care Homes for Older People Page 26 of 38 Evidence: since 2002. Management confirmed they have not changed post or home since then. Staff have a four day induction to safe working practices and a code of conduct expected by the home, their policies and procedures. This is followed by an induction and training programme that meets TOPSS or Skills for Care standards and is completed within six months. Staff qualifications at NVQ 2 or above exceed the standard, and there are opportunities for staff to gain further qualifications. The appropriate level of mandatory training is undertaken in accordance with staff roles. This includes: fire safety, infection control, food safety, first aid, COSHH chemicals, moving and handling, challenging behaviour, abuse, care planning and risk assessment. Medication training was discussed earlier. There is also distance learning through Solihull College in nutrition, dementia awareness, equality and diversity, and staff complete assignments. Staff are supervised the required six times a year, and topics include their practice, peoples needs and progressing their learning. Staff performance is appraised annually, and there are written records of observations of their practice and quality audits to confirm competence, apart from medication practice. People, relatives and other professionals told us that staff have the knowledge and experience to meet peoples needs, and we saw that specialist advice is followed. We saw that the home work in partnership with families and representatives to make best interest spending or care and treatment decisions. Care Homes for Older People Page 27 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is led by interim management who are qualified and experienced, maintain records and have support to ensure the smooth running of the home. Risk assessments and systems need development so that health, safety, and peoples financial interests and rights are fully protected. The quality assurance system remains under developed, but there are ways that the views of people influence the running of the home. Evidence: There are accountable interim management arrangements in place with qualified and experienced senior staff. The registered manager has been on maternity leave and is due to return on reduced hours. The deputy has been acting as manager since the last inspection, and just completed their management and NVQ 4 qualifications. The acting deputy manager will be commencing this training, and the owners visit the home daily. Stennards recently introduced a new role of area manager, and meetings are now held with their home managers for support and service development. Care Homes for Older People Page 28 of 38 Evidence: People, relatives and professionals told us on our visit and in surveys over the past two years, that the manager is approachable. The AQAA was completed on time and provided us with required information. This demonstrated that value for money is well understood. Staff said there is a warm, friendly, happy environment. Professionals told us that staff are very helpful, very good and answer the door quickly. There is a signing in book and on display are the required fire evacuation posters, the homes current registration and liaibility insurance certificates. Policies and procedures are reviewed annually, but all versions in use should be up to date and be available on the premises, such as the sickness policy required by another regulator. The complaints procedure is not being used to its full potential to help management continue to learn from peoples experiences. Records are generally kept up to date and are secured for confidentiality. Their importance for monitoring peoples wellbeing and ensuring policies and procedures are followed is recognised, and some record keeping has been taken over by management so that staff have more time to spend with people in the home. Incidents and accidents are audited periodically, but we were told that no one is falling. This did not match notifications we received from the home, which are made in accordance with our guidance. We recommend audits of care plans are undertaken to ensure that there are detailed instructions for staff to prevent risks, and about equipment, medication and safe manual handling. There are updated fire safety and evacuation plans, and fire drills are held twice yearly. A Legionella risk assessment or scheme is needed to prevent bacteria entering the water supply, and up to date council guidance needs to be checked. Systems that need improvement are discussed in various sections of this report to prevent spread of infection, scalds in a shower, bedrail restraint, trips and falls. Government safety alerts and regulator guidance is produced to protect people and their rights. Management should review how their health and safety systems promote these rights while balancing their legal responsibilities. Peoples financial interests may need a more transparent accounting system. For the past two years the AQAA says that the home are developing their quality assurance system. There are meetings with people and staff, where views about the running of the home are discussed. Surveys are undertaken yearly and management have a development plan, which would be useful to publish to show people how they have influenced service and policy development. Care Homes for Older People Page 29 of 38 Care Homes for Older People Page 30 of 38 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 31 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 13(2): All service users must 15/11/2009 be risk assessed as able to self administer their own medication. Regular compliance checks must be undertaken and documented to ensure that they can handle their medication safely. People managing their own medication must be competent and store it safely to protect others. The home has a duty of care for their wellbeing. 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 12: People at risk of falls 30/04/2009 day and night must be identified and the risk minimised with their consent and/or with least restriction assessed. The care plan must reflect any equipment used, frequency of checking fittings, and its maintenance. Re-scoring of risk and review of the care plan must evaluate whether the risk has been minimised, still exists and whether Page 32 of 38 Care Homes for Older People measures have been effective. The home needs to prevent falls safely, where possible, for peoples health and wellbeing. 2 9 18 18(1)(a): Staff involved in the medication system must be regularly assessed to be knowledgeable and competent. This is to ensure that peoples health is protected and effectively monitored. 3 9 13 13(2): The registered 30/04/2009 person must make arrangements for appropriate recording, handling, safekeeping, storage, safe administration and disposal of medicines received into the care home. This includes: all medications and homely remedies received into the home are recorded on the medication administration records (MAR) medications are stored in accordance with their product licence, are marked when opened and checked to ensure they remain in date regular checks are made of the medication fridge temperature and action taken so that the stability of medication is maintained 30/04/2009 Care Homes for Older People Page 33 of 38 Each persons MAR has a photograph, any allergies, side effects to be monitored, and contra-indications to avoid the reason for medication being discontinued and/or quantities disposed of is clearly marked on the MAR and disposal records are up to date all medication must be auditable and staff administering, managing receipts and disposal must be identifiable. Regular drug audits must take place to confirm safety of the medication system, the individual and staff competence. medication is discussed with an appropriate clinician to understand its purpose, agree any necessary staff guidelines and pre administration checks, and ensure these are followed, including occasional use and variable dose medication For peoples health, they need stable medication, administered to the right person and as the doctor intended. The homes systems must prevent medication going out of date, or going missing for public safety. 4 16 22 Reg 22(2)(3)(6)(8): The complaints procedure must 30/04/2009 Care Homes for Older People Page 34 of 38 be appropriate to the needs of service users. It should be known and used effectively when a concern is expressed verbally or in writing to any staff. A summary log of timescales, findings, outcomes and satisfaction must be maintained for regulator inspection. This is to ensure that peoples rights to raise concerns and complaints are taken seriously, in accordance with the homes procedures. 5 22 12 Reg 12(1)(a): The registered person must ensure a suitably qualified professional is consulted about an identified need for an aid to assist people to adjust their position in bed independently, such as a grab rail, and safe provision must be made, fitted and maintained. This is to ensure peoples independence and safety are promoted and protected. 6 38 24 Reg 24(5): The registered 30/05/2009 person must consult with the local council environmental health authority about their responsibilities to risk assess and ensure safe working practices and schemes to protect people from the spread of Legionella and bacteria in the homes water 30/04/2009 Care Homes for Older People Page 35 of 38 supply, cross contamination of infection and illness, manual handling and equipment safety. This is to ensure accountability for minimising avoidable risks to the health and safety of people and staff. 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 The statement of purpose must set out accurate required information as in Schedule 1, Care Homes Regulations 2001 and any amendments, including staff, management, their qualifications and training. User friendly language and alternative formats would benefit the people it is intended for. Care plans and reviews should provide evidence that they have been discussed and agreed with people. Night time care plans, and end of life care planning will help ensure that peoples views and needs are known in advance, and can be met. Care planning should identify and provide for people needing one to one staff support to participate in activities matching their interests and needs for physical and mental stimulation. Inventories of personal possessions should be kept up to date, and checked so that the need for replacement clothing is decided in partnership with families and representatives. Catering staff need to be informed about peoples dietary needs so that food provision can meet them. People with diabetes need care plans that identify how 12 hour gaps between meals are to be avoided to help their blood sugar level remain stable. Contact details for the council complaints process and local advocacy would enhance the homes complaints procedure, so that people have access to independent support in expressing themselves, inside or outside of the home. Page 36 of 38 2 8 3 12 4 14 5 15 6 16 Care Homes for Older People 7 17 The Mental Capacity Act 2005 and Mental Health Act 2007 and codes of practice must be known and used by staff so that peoples rights are met, and there is lawful practice, particularly for financial decisions, physical or chemical restraint such as bedrails and covert medication. We recommend that clinical waste bins outside the property are locked to protect the community from any infection risks. We suggest the comments of people, stakeholders and the homes own quality findings, actions and development plans should be published and displayed. Policies and procedures should be available on the premises at all times. It is recommended there is a master copy and spares for staff use. Policies and staff practices in handling service user money and making purchases on peoples behalf should be reviewed to ensure there are transparent records and peoples needs are met in a timely and safe way, and their financial interests are fully protected. We recommend audit of staff files to ensure they contain all required records. A good practice human resource policy for periodic re-checking of staff with police and government lists is advised so that people are further protected from abuse. Registered persons must evidence that they have and use a robust risk based approach and scheme to prevent legionella and bacteria in the water supply so that people are protected. Health and Safety Executive guidance is available. 8 26 9 33 10 33 11 35 12 36 13 38 Care Homes for Older People Page 37 of 38 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. 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