Inspection on 24/11/08 for Stennards (Mos)

This inspection was carried out on 24th 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stennards (Mos) 04/01/07

Stennards (Mos) 08/12/05

Stennards (Mos) 09/06/05

Stennards (Mos) 25/01/05

Stennards (Mos) 24/08/04

Stennards (Mos) 05/02/04

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Maple Lodge

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stennards (Mos) 133 Anderton Park Road Moseley Birmingham West Midlands B13 9DQ     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: 2 4 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 41 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 41 Information about the care home Name of care home: Address: Stennards (Mos) 133 Anderton Park Road Moseley Birmingham West Midlands B13 9DQ 01214494544 F/P01214494544 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Peter David Lee-Harris,Mrs Dawn Lee-Harris care home 16 Number of places (if applicable): Under 65 Over 65 0 0 16 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 16 16 0 The maximum number of service users to be accommodated is 16. The registered person may provide personal care and accommodation for service users of both sexes whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 16 Dementia (DE) 16 Mental Disorder (MD) 16 Date of last inspection Brief description of the care home Stennards Moseley is in a residential area close to the centre of Moseley and near public transport. There is car parking at the front of the home. Care and accommodation is provided for up to 16 people, and was recently registered to provide specialist care for dementia care or mental health conditions. The home does not have an office. There are ten single and three double bedrooms, eight of which have enCare Homes for Older People Page 4 of 41 Brief description of the care home suite facilities. The remaining rooms have a wash hand basin. There are three bathrooms and one shower, and toilets located near to the communal areas, such as the lounge, dining room and a conservatory. The dining room leads to the kitchen, a small room for washing up and food preparation and the laundry, sluice and storage areas. There is a well maintained enclosed garden accessible from the conservatory. There is no published fee information and people are advised to discuss this with the management. Care Homes for Older People Page 5 of 41 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 home was last inspected on 04/07/07. One inspector visited the home over one day. They were not informed that we would be visiting. We examined records, talked to people, staff and visitors, including relatives and a professional. Medication administration and a meal were observed. During our visit we saw the records of two people that management helped us to choose. We saw their equipment and rooms, spoke with them and their staff. We sampled records about other people, staff and the running of the home. We discussed our findings with the manager and an owner. We would like to thank people in the home, visitors and staff for their cooperation and hospitality. Prior to our visit the home supplied information to us annually from their legally Care Homes for Older People Page 6 of 41 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. The home sends us notifications, and we receive reports from other sources. There were 8 requirements from a previous inspection; we found 3 fully met and others were replaced or removed after additional information was provided. The home has kept us informed of their progress since the inspection. A full list of requirements and recommendations are at the end of this report. What the care home does well: What has improved since the last inspection? Stennards applied for a variation and since 25/01/08 has been registered by the Commission to provide services for older people, adults with dementia and mental disorder. Staff training has been arranged about these conditions. The manager attended a council Mental Capacity Act workshop, is undertaking equality and diversity distance learning with Solihull College and a mental health level 3 course at Bourrnville College. Assessments for people funding their own care improved. The manager ensures that all relevant information on prospective new admissions is collated prior to residency. People are now regularly weighed, and daily records now show the care provided, sling size, how social needs are met, and wellbeing. Hair and beauty sessions have been incorporated into the activity programme. The conservatory now has TV, DVD and video so that people have a comfortable and well equipped quiet area. Bedrooms and other communal areas were decorated, refurbished and new bedding was provided. The kitchen was completely refurbished, including the cooker and other appliances. The manager attended a council Safer Food Better Business course and a new food hygiene system is in place. The home achieved a 5H council award, which means that there is excellent food safety. Care Homes for Older People Page 8 of 41 Staff recruitment checks improved. Training opportunities were expanded. Half the staff completed skin and pressure area care training, and half started nutrition and health distance learning with Solihull College. Management do more recording so that staff have more time to spend with people in the home. 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 Care Homes for Older People Page 9 of 41 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 41 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 11 of 41 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. People can visit and try the home to decide if it is suitable. Everyone has an assessment and ongoing review, but this needs to improve so that trials are reviewed and appropriately screened risks are prevented and managed. Evidence: People and relatives on our visit and in surveys told us they had enough information about the home and an assessment of their needs and preferences, and said they are very informative. One person said I was here for a visit first...everyone is good to me...staff very kind...GP is good...I am happy. Their representatives were particularly pleased with the quality of care and told us: Due to the mental illness my cousin has suffered, I think the care by the staff is second to none; My friend is very happy...everyone is looked after well; ...Stennards provide a first class care home.... Care Homes for Older People Page 12 of 41 Evidence: There is general written information about Stennards Homes. The statement of purpose is partly in large print, but reproduction quality is poor, and people with sight problems may find it difficult to read. It could be more accessible if available in other formats, and the procedures attached would be easier for the public to understand in plain English and large font. It is recommended that the home consult people about the content and design of their information. Written information tells people what to expect, needs that can and cannot be met, facilities and services and important procedures - such as fire precautions, complaints, missing persons and incidents. Required information about fees is missing or where it can be obtained. We did not see a service user guide or a philosophy of care. The facilities at Anderton Park Road are clear, but staff qualifications are not specific to this home. This means that people cannot judge for themselves whether staff have the knowledge and experience to meet their specific needs. People will not have all the necessary information to make an informed decision about the homes suitability without enquiring further from management, who are very welcoming. People have opportunity to visit before moving in, and during our visit one person arrived from hospital unexpectedly for a day visit. We saw that they had personal attention from staff to get to know other people, while the staff assessed their needs and how they got on with the person they were matched to share a room with. This is good practice. Records confirmed that a person funding their own care has a contract identifying the fee and their room number, signed by their representative on the day of admission, so their rights are protected. On our visit there were 12 people living at the home, although the homes register listed 13. One person recently passed away. During the past year there were 8 admissions and 2 discharges, and one person told us they were hoping to return home in the warmer weather. This means that people can return home after regaining their health and confidence, and that others can get to know the home over a longer period, which is good practice. We were told they had a review after a four week trial, but that a decision about staying permanently has not yet been made. In two other care records there was no record of reviews with people and their representatives after trial periods. A requirement about this was not fully met from the last inspection; this was replaced with a recommendation. Trained staff use a company format with in-built tools to identify individual needs, and risks, confirm with people verbally that their needs can be met as they prefer, and maintain their independence. However we found through records and discussion that Care Homes for Older People Page 13 of 41 Evidence: these screening tools are not fully understood and regularly reviewed to manage and prevent risks such as falls. Requirements from the previous inspection were not met (see health and personal care). We discussed a specific persons assessment with a visiting doctor and the manager during our visit to ensure their condition, abilities, mental capacity are fully assessed and staff have medical advice. Care Homes for Older People Page 14 of 41 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. Respectful staff maintain peoples abilities and dignity. Risk assessment, care planning, and the medication system needs to fully promote health, and effectively monitor and manage peoples conditions and risks with health advice. Evidence: People and relatives said that their needs are met as they expected, and medical support is always or usually provided. One relative said: my dad has had many ups and downs with his health but they all remain on top of this...It is very hard with Alzheimers but they are all very thoughtful...dressing clients well...regular checks. People we spoke to are all happy in the home and with the daily decisions they make they are supported to be comfortable, to maintain their abilities, independence and mental wellbeing and this is what people valued. Staff know people well, treat each as an individual and with respect and spend time with each person daily. Dignity is maintained by discreet and sensitive care. We are told that there is choice of the gender of staff to help them, but preferences were not Care Homes for Older People Page 15 of 41 Evidence: recorded. Staff report to each other and note changes in daily records. This improved from the last inspection, but daily records rather than care plan updating has become the main way of recording new needs and new instructions to staff. This means that if staff have been away, they would need to read through back records to find new instructions, or ask other staff. This will not prevent errors and does not enable management to easily check if peoples needs are fully met by staff performance. It also does not enable people and their representatives to formally agree care plan changes, and they will not have easy access to their records. We expect to see accurate assessed needs and detailed individual care plans with instructions for staff about monitoring measures, how care and medication is to be safely provided, equipment used and maintained. Care plans should be signed to show peoples consent, or the home needs to record decisions in the persons best interests due to assessed mental incapacity and after appropriate consultation. We did not find this for two people with fluctuating mental capacity. Full use was not made of information the home collated from all sources, and clarification was not always sought where necessary. The unsigned care plans we saw have not changed since 2007. Monthly care plan reviews stated no changes and did not record the significant events we found in daily records, medical letters and health professional notes in peoples care records. Stennards Homes use an assessment booklet with screening tools about key risks. These tools are not based upon current best practice regarding nutrition, skin integrity, prevention of falls and use of equipment. Some peoples conditions are complex, and through discussion the scoring and purpose of the tools was not fully understood. They were used once on admission and not reviewed, and this was also found at a previous inspection. Written advice from health professionals was stored elsewhere and was not used to form sufficient staff guidelines about managing and monitoring for instance, unstable diabetes. Care plans are not up to date and did not match the care that staff told us they provide. One persons contagious infection, for example was not identified in their care plan review. There was no short term care plan to control its spread to others - but we checked and found that the homes practice was better than their recording (see Environment). Advice from health specialists was not always sought or followed up, for example to identify whether the infection was still present. We discussed with the manager and a visiting doctor concerns about two peoples conditions, associated risks and mental capacity. Adjustments were necessary to prevent false blood sugar readings. The home had not assessed or periodically reviewed a persons ability to self administer insulin, and there were insufficient Care Homes for Older People Page 16 of 41 Evidence: monitoring records to prevent pain and lumps. We queried unclear guidelines for staff responsible for storing and preparing insulin. Following our visit the manager confirmed that people are safe and have access to necessary health tests and specialists about diabetes, infection and falls. Risk screening needs regular review so that increased risk can be identified or prevented. We did not see mobility or falls prevention plans for two people at risk, only lifting assessments in case people fall. All had the same sling size (colour) as there is only one size in the home. Someone could be dropped from a hoist if a sling is too large. Both had falls before admission as well as in the home, not noted in care plan reviews, one resulting in a fracture and both were inaccurately assessed to be at low risk. We also saw two people mobilising with staff assistance in a way that could cause injury. And the homes records note that a person was lifted after a fall in a way that did not match their lifting plan. The hoist was not readily accessible. This suggests that hands-on manual handling and hoist training may need to be refreshed; falls prevention knowledge, professional networks and systems need development so that unnecessary risks to people are recognised and eliminated. Care plans about diabetes did not have instructions about well known associated risks - eye, skin and foot care. Two people case-tracked have not seen a chiropodist for nearly a year. One does not have an annual health check to monitor how their diet is controlling the condition. The other person was due to have an NHS diabetes team involved since June 08, but this did not take place and was not followed up. Leg ulcers developed twice, and infection in hospital, but instructions to staff have not changed. Nutritional screening was incorrectly scored and there is contradictory information for staff about their dietary needs and no nutrition plans. The home respects informed risk-taking, such as choosing food with sugar, but this was not monitored and there were no records of liaison with health about this. Immediate action was appropriately taken so that the two peoples needs are now being met. Improvements are needed to prevent errors and to evaluate the effect of a care plan. A requirement about this made at the last inspection was not met, and was replaced. We were impressed that there are few people in the home prescribed medication. The medication system is generally safe. Daily temperatures are not taken where medication is stored to ensure medication remains stable for peoples health, and the key was not always secure. Medication administration records were completed when medication was administered to people in another room, unobserved. This is not therefore an accurate record, and does not ensure that the right person has the right medication, especially as not every record has a photo. Staff who administer Care Homes for Older People Page 17 of 41 Evidence: medication had accredited training. The Primary Care Trust conduct an external audit quarterly and give the home a report about general findings. Staff knowledge and competence about medication has not been regularly confirmed by the home, and this is not included in staff appraisals seen. Care Homes for Older People Page 18 of 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead flexible lives in the home and community, keeping physically and mentally active and maintaining their interests and important relationships. There are four nutritious meals daily and snacks. Evidence: Stennards give priority to promoting peoples independence and meaningful lifestyles and have sustained good outcomes for people in most regards in this area. Each person is treated as an individual, choosing what they want to do each day. Their likes, dislikes and preferences are well known to staff and recorded. There are flexible routines and relationships are promoted within the home and with families and friends. People get up and go to bed when they want to. People said they have enough activities for physical and mental agility, and that their religious needs are met. There are community links with two churches and a day centre one day a week, and staff take people on walks. Staff enjoy providing activities and people particularly like exercise with music and a ball, and we saw good practice. Some people like to play a part in the home, such as laying tables. Staff assist someone to use an exercise machine provided by their family to improve their blood Care Homes for Older People Page 19 of 41 Evidence: circulation. There are rituals when watching old movies that people like to make this special. During our visit there was a discussion group about the days newspaper. Some people told us they do not want to go out or take part in all activities. One care plan showed that a person showing signs of depression is gently persuaded to get up each day and spend some time with others. This prevents them from becoming isolated. In reception there is a poster about the rights of residents and care plan reviews note how independent people are and tell staff how to continue promoting this. Staff provide people with information in a way they understand so that informed decisions are made, especially if a person refuses something important to their wellbeing, such as medical attention. People can refuse and are able to take risks in leading their lives. But the home also needs to exercise a duty of care and improve the nutritional system. Nutrition plans did not clearly instruct staff, for instance about how to avoid long gaps between meals for people with diabetes. We queried puddings containing sugar served to people with diabetes without asking if they preferred fruit. There were many positives too, and people liked the food. Mealtime was unhurried. Sufficient support is provided if necessary, and people were patiently fed or encouraged to eat. Nutritious food is cooked by care staff, especially one Senior carer. There are four meals a day, snacks and we saw fruit available anytime in the dining room. There are choices at each meal and no set or rotational menu. In the morning people say what they want and a handwritten menu is put on a notice board in reception before meals. Staff could remind people what they are eating as they did not recall when it was served. Care Homes for Older People Page 20 of 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can feel confident that their concerns will be listened to and acted upon. Their legal rights and best interests are in the main protected but not recorded. Evidence: People have a copy of the complaints procedure and it is displayed in reception. Timescales exceed the minimum standard in the homes policy. Managment told us there has been no complaints since the last inspection.. Relatives and people confirmed with us that they know who to raise a concern with and had no need to complain. People told us they feel safe. Legal rights continue to be protected by staff knowledge of the homes complaints and adult protection policies and procedures. There have been no complaints or safeguarding concerns in the past year. Staff deal with minor concerns when they arise. The home welcomes compliments and suggestions and acts upon these. The owners and manager talk to people daily. Staff continue to maintain refresher training and are knowledgeable about types of abuse and how to report it if a concern arises in the home or community. The homes adult protection procedure is linked to the local councils, in accordance with the local protocol. Care Homes for Older People Page 21 of 41 Evidence: The Manager is trained in The Mental Capacity Act and ensures it is used in supporting people with daily decision-making. Best interest decisions are not yet recorded, but discussions showed that these are made. Mental health services are sought if there is uncertainty about someones diagnosis. Staff will be attending Deprivation of Liberty Safeguard training soon. There is no current need for restraint and most people in the home are active and move around freely. The Primary Care Trust is always involved if there is a concern someone may fall out of bed and needs bedrails, if safe to provide. Records show that the home will only accept people for hospital discharge if they are independently mobile, and the homes statement of purpose identifies that people cannot be bedfast. This affects the homes ability to provide end of life care and we recommend further development of the service in this area, so that people can make advance decisions. Care Homes for Older People Page 22 of 41 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 and grounds are secure, comfortable, generally clean and well maintained. The homes systems need improvement so that people are protected from the spread of infection and bacteria, scalding hot water, and have the right equipment when it is needed. Evidence: The home is located in a residential area near local facilities. There is a lovely walled garden, accessible by two ramps with grab rails. The conservatory is used all year round for activities. During the inspection contractors were re-wiring the building and conducted tests of portable electrical equipment, without much disruption with the owners oversight. Contractors are used for servicing checks, such as the chair lift and heating system. People have access to safe and comfortable indoor and outdoor facilities. Fire drills are held twice a year and we were told the homes fire risk assessment has been reviewed. The Fire Officer last visited in 2006. Fire alarms, emergency lighting and room alarms are tested regularly. The visitors book is not in regular use, which is an essential fire and security precaution so that the home knows who is in the building at any time. Care Homes for Older People Page 23 of 41 Evidence: There is specialist equipment to meet peoples needs, such as raised toilet seats. A care-taker checks and maintains peoples walking frames. Upstairs there is a locked gate on the back stairs, protecting people from falling. Radiators have protective covers. Rooms are aired and smelled fresh. We were told there are window restrictors to prevent falls and intruders. Clinical waste is collected. Seating in the communal lounge could be more stimulating for conversation if chairs are arranged in small groups rather than around the walls. The TV has a large screen to assist people with sight difficulties. One person with a hearing aid is able to hear in the lounge, but a hearing loop could improve this. People told us they like their rooms and we saw they are personalised. One person said: My bedroom looks nice and tidy, and another is bringing their own curtains. Most rooms have ensuite toilets and door locks, and all have a sink and lockable drawer and call system, providing privacy and security. This allows people to lead the life they choose and meets their needs. There are three shared bedrooms but only one privacy screen; we are told that others are available through the Head Office. One shared room is currently used as a single room. A wheelchair was secured safely near reception. There is no one needing a wheelchair indoors at the home. There is sufficient storage space except for the hoist. This is kept in one persons bedroom, but we were told it is not needed for anyone in the home. This should be secured elsewhere so that the person feels that their room is their own and have more space for their own mobility aids; and so staff can access the hoist in an emergency. We discussed with the manager that the hoist was not used to lift someone after a fall as in their lifting care plan. This could have placed the person and staff at risk of injury. The manual handling system and training, including use of hoists needs review. The home only has one large-sized sling to use with the hoist. Appropriately sized slings must be available on the premises to match assessed needs. After the inspection we were notified that this was addressed. There is no medication trolley because most people are not on medication, however this could change at any time. The medication procedures talk about a trolley, but there is none in the home. We recommend there is a plan about where and how a trolley can be secured as this may become necessary at short notice. People told us the home is always fresh and clean. A relative said cleanliness is a priority in all areas. There are sufficient toilets and assisted bathing facilities throughout the home. Apart from the sluice, we found the home to be clean and there were no odours. Care Homes for Older People Page 24 of 41 Evidence: The AQAA told us that government guidance was used to check the homes infection control and that there is no action plan to improve this. We found that the home have not used best practice to make changes, although we saw that clean and soiled laundry is separated. Mops are not colour coded. The manual sluice had not been fully cleaned after use. This could contaminate staff as they leaned over it. The only handwashing facility for staff after using the sluice is in the laundry two doors away, where we found a hand towel in use and no paper towels. This poses cross contamination risk. One person in the home has a contagious infection. Staff told us that this persons clothing and bed linen are washed separately although there is no care plan about this. The sluice and laundry did not have a supply of gloves and aprons which are essential to contain infection. Although there has been no spread of contagious infection in the home we found there are insufficient infection control measures posing unnecessary risk to health and safety of people and staff. Stennards Moseley has a homely feel and the staff and owners work hard to maintain this, but infection control risks in communal facilities used by people in the home were identified at the last inspection. We found hand towels as well as paper towels in communal bath, toilet and shower rooms. There were personal toiletries, hard soap and bathing aids in the shower room that had not been returned to peoples rooms. The manager took action when this was brought to their attention. We saw chemical safety and handwashing posters in the pantry to guide staff. Most chemicals are in a locked cupboard, but we queried one that posed a risk to people with dementia in reception. A box had been stored in the hallway to enable contractors to work. Immediate action was taken to our query. The kitchen and pantry are exceptionally clean, and the council awarded the home a 5H for excellent performance in food hygiene. We sampled daily checks and facilities and confirmed the home ensures food is stored, cooked and served safely. There was no risk assessment about preventing bacteria and legionella entering the water supply. We were notified that action has been taken about this since the inspection. We sampled checks on hot water and found that these are up to date in peoples rooms but not for bathing facilities. Some action was taken during the inspection to our query. Actual temperatures are not recorded so Directors are unable to spot a problem developing. The homes records show that the safe temperature range is kept under 43 degrees C, however the shower should be 41 degrees C to prevent people being scalded. Care Homes for Older People Page 25 of 41 Care Homes for Older People Page 26 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Qualified staff meet peoples needs and additional training ensures health conditions are understood. Head Office recruitment checks need to be robust and made known to the manager, and staff appraisal needs development so that people can be appropriately protected. Evidence: According to people, staff have the right experience and skills to meet their needs and are available when they need them. Carers told us there are enough staff, and they are happy to cover sickness and leave so that people have familiar workers helping them. The manager assists with hands-on care and cover arrangements. There is a low staff turnover, and temporary staff, when necessary are consistent so that peoples needs are known. Relatives said that communication systems work well so that staff are aware of changes affecting people. Staffing levels reflect the needs of people in the home. There are two waking night staff and sufficient staff at peak periods, such as mealtimes. There was an extra staff member during our visit as the manager was supporting the inspection. The home has a domestic worker and a care-taker. Care staff do the cooking, food ordering and provide activities. A Senior Carer was on a 12 hour shift and cooked four meals during our visit, but has an adequate break the next day and said she enjoys this. There is an Care Homes for Older People Page 27 of 41 Evidence: all female workforce. After the inspection we were told that men have choice because a male owner will assist. The recruitment process includes police and government list checks undertaken by Head Office. The law also requires checks on staff before they move between Stennards homes. Staff files did not contain all legally required recruitment information on the premises and we could not confirm whether an outstanding requirement was met. After the inspection some documents were located and sent to us. The manager needs essential information from Head Office to appropriately protect people as well as to support new staff. Staff have NVQ qualifications in care that exceed minimum standards. The company and manager promote staff development, have a training plan, and there are opportunities for staff to gain additional qualifications. There is company in-house training, purchased packages, and staff sometimes attend external courses. There is free on-line training available so that staff can progress at their own pace; at present the home does not have a computer. Additional training about peoples needs includes level 2 dementia care, which staff told us has helped them to understand peoples needs better, and staff looked forward to equality and diversity training. 50 of staff are taking courses at college on nutrition/health care and skin care/pressure areas. Staff had mental health awareness training in 2008 and the manager started a level 3 course in mental health. The Manager attended a Mental Capacity Act workshop, and another is booked for staff. One worker had end of life care training, and this area for staff development was not mentioned in the AQAA. This is important for services meeting the needs of older people, and people with progressive conditions. Staff have awareness training about challenging behaviour; there is currently no one in the home needing a behaviour plan. We queried training and staff appraisal because of the lack of published information. The level of mandatory training and refreshers must match the needs of people and the home for health and safety, and rotas need to ensure an appropriate skill mix on each shift, day and night. People need to know how their needs will be met in an emergency, and to have confidence that staff will assist them safely if manual handling and equipment are necessary. We saw concerns about infection control, medication administration, first aid and manual handling on our visit. For example, two staff seated someone in a cramped space in the dining room by lifting the person and the chair, which is not safe practice to prevent injury. After the inspection Stennards confirmed that staff have hands-on manual handling training refreshed, including use of hoists and slings, and advised us that medication training is accredited. Staff have awareness of first aid training. This will not save someones life in an emergency, and we recommend that this is reviewed. Care Homes for Older People Page 28 of 41 Evidence: Staff appraisal is carried out annually and throughout the year supervisors observe staff practice, apart from medication competence. Records show that staff knowledge and practice about privacy, dignity, communication skills, infection control, food preparation and providing activities is checked. Manual handling is not currently observed, and care plans need more detail to guide staff. The staff appraisal system needs further development and audits need to sustain safe working practices. Care Homes for Older People Page 29 of 41 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. People benefit from the person centred approach of the home and manager. They control their own money or make their own arrangements. There are some improvements needed to ensure the environment and working practices promote health and safety. Evidence: There is a qualified and experienced manager, with an open and person-centred approach that benefits people living in the home. The home comes alive when she walks in the front door. People seek the managers attention, are respected and made to feel special. Staff told us they are fully supported. The manager keeps her knowledge up to date, provides leadership and accepts accountability for care planning and working practices, including those we found to need improvement. Since the inspection the manager has kept us informed on steps taken to address risks we identified during our feedback. Care Homes for Older People Page 30 of 41 Evidence: The manager is supported by the owners who visit daily, and by meetings with an Area Manager and other Stennards managers. Anderton Park Road does not have an office or access to a computer. The manager ensures smooth running of the home but has little time or access to external resources, such as guidance issued by regulators and government bodies. This means that regulators have not always been notified as per our current guidance. The home needs to work in partnership with us to safeguard people and the community. The AQAA was completed on time, and provides the required information. The manager told us that requirements from the previous inspection were met but when we checked this could not be fully confirmed. As a family business, with related and long-standing staff, there is a successful team approach that benefits people. However ways of working are not critically examined to develop the service. Proactive management steps are needed to improve systems, set and sustain standards. Progress on compliance with the law and the Commissions reports needs oversight. Management told us of their development plan in the AQAA, so are aware of some of our findings and want to improve nutrition, skin care and quality assurance. The need to develop robust quality assurance and quality monitoring has been noted in past inspections, and remains under-developed. This means that the homes self monitoring system and continual learning is not being achieved. We were told that the Area Manager will be supporting the home manager to undertake audits. But the AQAA told us the manager has not found the time to do so. The owners visit the home each day, talk to people and are actively involved in health and safety of the environment. There are no records of findings and actions. To gain the views of people who use the service, relatives and other professionals, we saw letters encouraged and compliments on display. Surveys are not used, and local advocacy services and the local council contact details are not published, so people cannot report matters anonymously. Findings and actions taken are not published so that people and other stakeholders know how responsive management are. There are staff and residents meetings, but minutes are not on display. One relative told us: Stennards provide a first class care home. They are an example of how things should be done. We found strengths in the way the home is run for peoples comfort and independence, but we also found that the home needs to exercise a duty of care with more diligence, particularly for people who have fluctuating mental capacity, complex and progressive health conditions. Registration and liability insurance certificates are displayed in reception. We sampled and discussed health and safety and contractor checks, audits and compliance with Care Homes for Older People Page 31 of 41 Evidence: other regulators. Accidents and incidents are not analysed to identify any patterns, environmental hazards or systems that could be improved to prevent recurrence. Infection control and fire precautions need robust audit. There is an effective maintenance and refurbishment schedule, but safeguards to prevent scalds from hot water, bacteria risk, cross contamination and manual handling are not sufficient. Company policies and procedures about recruitment and safe working practices are in place and reviewed annually. Some were written long ago and have not been fully updated but are safe, if they are followed. We recommend staff files are audited to ensure there is effective liaison between Head Office and the home manager regarding recruitment checks. Staff skills and training plans need review. We note after external training that best practice service developments resulted in achievement, such as the excellent food hygiene award, and recommend the development of more community networks to benefit people. Personal records were not secured or kept together, so confidentiality is not being fully maintained and errors can be made. We found one persons manual handling assessment in another persons care records. Personal records were left in an open box with unsecured cleaning materials in reception. This posed a safety risk to people with dementia in the home. They were removed, but later we saw records left in the dining room. There were medication records in two places concerning one person, and others loose in the Medication Administration Record. Guidance on health conditions and blood monitoring records were also kept separately. Record keeping was seen as a burdensome barrier in the AQAA and in discussions - by management, staff and the owner. The quality of daily records has improved since the last inspection, but other records about care planning, health and safety and environmental checks are not all of sufficient quality - the home must have early warning systems that are used to protect people and staff in the home. Management have well thought out strategies to retain a knowledgeable workforce, including good wages that staff value. Staff are highly regarded and told us they are supported in their roles and love working with people in the home. Records of bimonthly supervision show us a mixed picture. One staff record had regular supervision; another had a blank format for October so will not have met the required minimum of 6 times a year. The home does not manage peoples personal allowances and finances. People control their own money, or make their own arrangements and choose how they spend it. If staff assist with a purchase, reimbursement is immediately sought - records are at head office. Care Homes for Older People Page 32 of 41 Evidence: The AQAA showed us that the home has a clear and sophisticated understanding of how they achieve value for money. We were told that the home does not rush to fill a vacancy - that they seek to match a prospective new person who will gel with people already in the home. This is good practice. People at the home able to tell us said they are happy, feel safe, independent and well cared for. Care Homes for Older People Page 33 of 41 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 34 of 41 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 3 14 14: Up to date assessments 30/06/2009 must include all needs, abilities and conditions, mental capacity, risks of malnutrition, pressure sores, falls day and night, and from medication; necessary aids, equipment and staff skills. They must be reviewed especially when there is a change of circumstances. Peoples changing needs and risks should be identified, planned for and met. 2 7 12 12: People at risk of falls day and night should be consistently identified and the risk minimised. Screening should be regularly re-scored, including after changes or incidents. This is so that patterns can be identified and acted upon for prevention. 31/08/2009 Care Homes for Older People Page 35 of 41 3 8 15 15(1)(2): Care plans about 31/08/2009 current health, safety and welfare needs must be detailed, revised and agreed when there are changes. This should include short term illness when necessary, and all aspects of conditions, e.g. diabetes. This is to ensure all needs are planned for and staff have clear directions. 4 9 18 18(1)(a)(c): Staff involved in the medication system must be regularly assessed to be knowledgeable and competent. People need confidence that skilled staff effectively monitor and protect their health. 30/06/2009 5 9 13 13(2): People determined 24/12/2008 and regularly checked to be competent to self administer medication / injections must have an up to date and accurate MAR record, monitoring charts and clear staff guidance agreed with a health clinician. An audit trail is used to check peoples health and staff performance . 6 9 13 13(2): Medication administration records (MAR) must be accurate, and the person administering medication must complete them. 24/12/2008 Care Homes for Older People Page 36 of 41 This is to ensure that the right person has their correct medication when they need it. 7 15 12 12(1): People with dietary 24/08/2008 needs, such as diabetes, must have clear and detailed nutrition plans, and be provided with appropriate choices at the right times of day. Staff need clear instructions and food stocks to meet peoples needs, prevent and monitor prevent risks to their health. 8 19 13 13(3)(4)(5): Unnecessary 30/06/2009 risks must be assessed and minimised in accordance with council health and safety and health protection agency guidance: a. of Legionella and bacteria entering the homes water supply b. of cross -contamination in communal areas and laundry c. from scalding water in showers d. from equipment and manual handling e. from slips, trips and falls. This is to promote and protect peoples health, safety and and prevent the spread of infection. 9 29 19 19, Schedule 2: All staff must have an appropriate government barring list 31/08/2009 Care Homes for Older People Page 37 of 41 check before they commence employment. They must be supervised at all times until full CRB disclosure is received. This is to ensure that people are in safe hands. 10 33 24A 24A: Registered persons must progress and report to the Commission on improvements to comply with the law and requirements in this report. Timely and effective oversight will improve the quality of outcomes for people. 11 38 37 37: Notifications to regulators must be made in accordance with current regulator guidance. The home and Commission work in partnership to safeguard people. 24/12/2008 30/06/2009 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 and service user guide need detail about Anderton Park Road, staff/qualifications and fees so that the public can make an informed decisions. People may want to contribute views about the accessibility of content, design and reproduction quality. Care records should show when trial periods are reviewed and agreed with people and their represensentatives and up to date care plans should be signed. Storage of medication should be reviewed to ensure: Page 38 of 41 2 5 3 9 Care Homes for Older People a. Access to the keys and the medication are secure so that medication does not go missing. b. A daily temperature of the storage area is kept so that medication remains stable to have the effect the doctor intended 4 10 Care plans should reflect choices made by people about the gender of staff providing personal care. If a male worker is chosen, the care plan should show how this is to be provided if there are no male care workers in post. 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. It is recommended that the home have a format to record mental capacity assessments and best interest decisions where necessary, in accordance with the Mental Capacity Act code of practice so that peoples legal rights are maintained. The visitors book should be in regular use as it is part of the homes fire evacuation precautions for anyone on the premises. A hearing loop in communal areas could improve communication and quality of life for people with hearing aids. The hoist and appropriately sized slings need to be readily available when needed for people in the home, day and night. Storage facilities should be found outside of peoples bedrooms. A review of the level of first aid training in keeping with staff roles should be undertaken if people have need for emergency first aid to save lives, and rotas adjusted accordingly. There are on-line resources for staff learning and briefings, e.g. about end of life care, that can be used in supervision and at staff meetings, such as the Social Care Institute for Excellence website, and through the Department of Health. It is recommended that comments from quality assurance measures and findings from the homes self monitoring and audits should be published/displayed and used in the homes development plans. Staff files should be audited so that they contain all required records. A good practice policy for periodic rechecking of staff with police and government lists is advised so that people are further protected from abuse. Regular audits of incidents, accidents and complaints should be undertaken to identify any patterns, Page 39 of 41 5 15 6 18 7 19 8 20 9 22 10 27 11 30 12 33 13 36 14 38 Care Homes for Older People environmental, system or practice risks that can be minimised to prevent recurrence. Care Homes for Older People Page 40 of 41 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 41 of 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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