Inspection on 27/04/10 for Sunrise Operations Edgbaston Ltd (Assisted Living)

This inspection was carried out on 27th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunrise Operations Edgbaston Ltd... 24/03/10

Sunrise Operations Edgbaston Ltd... 19/01/10

Sunrise Operations Edgbaston Ltd... 15/10/09

Sunrise Operations Edgbaston Ltd... 07/09/09

Sunrise Operations Edgbaston Ltd... 29/04/09

Sunrise Operations Edgbaston Ltd... 29/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Sunrise Operations Edgbaston Ltd (Assisted Living) 5 Church Road Edgbaston Birmingham B15 3SH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Lancashire     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunrise Operations Edgbaston Ltd (Assisted Living) 5 Church Road Edgbaston Birmingham B15 3SH 01214551100 01214556689 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.sunrise-care.co.uk Sunrise Operations Edgbaston Limited Name of registered manager (if applicable) Ms Joanne Anita Gordon Type of registration: Number of places registered: care home 68 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 to be accommodated is 68. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 68 Date of last inspection Brief description of the care home Sunrise Senior Living Edgbaston offers a purpose built care home for older people who require varied levels of support with day to day living (Assisted Living), nursing care and residential care. People can choose to live in the home for a short or long term stay. Care Homes for Older People Page 4 of 31 Over 65 68 0 1 9 0 1 2 0 1 0 Brief description of the care home Sunrise Assisted Living is registered to provide assisted living care with nursing for up to 68 older people. Assisted living care is provided on the ground and first floors of the premises. The home offers spacious accommodation within bedroom suites of varying sizes and layouts. Each suite provides a bedroom, living area and en suite facilities, which has a level floor access shower or a bath. Two separate spa baths are available. The home offers a welll maintained environment which is furnished to high standards. Two passenger lifts and a staircase provide access to all floors in the home. There are large lounge areas, a restaurant style dining room, bistro and a well maintained kitchen. The fees for this home are available on application and vary with the services required. Care Homes for Older People Page 5 of 31 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: zero star poor 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: We visited this home on a weekday without telling anyone that we would be arriving. The visit lasted for two days and included a visit by a pharmacist inspector. The purpose of the visit was to see how the home is meeting key National Minimum Standards and to make sure that the requirements made previously had been addressed. Before the visit we sent an Annual Quality Assurance Assessment form (AQAA) to the manager for her to complete. This asks for details about the running of the home and the plans for future development. This information arrived when we asked for it and was completed in a helpful way, with plenty of detail. During the inspection we spoke with the executive director, the manager, the senior wellness nurse, several members of the staff team, several people who live at the home and relatives. We looked round the communal areas of the building and into several bedrooms. We sampled the records of three people who live in the home. We looked at other records which the Care Homes for Older People Page 6 of 31 home is required to keep and these include records about peoples needs and preferences, safety, menus, staff rotas, medication, staff recruitment and training, complaints and minutes of meetings. We looked at the systems which the home has for monitoring its performance. We looked at the homes website. We used this information to write this report. The findings of the pharmacist inspector are included in this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We have made requirements because we found shortfalls in the way in which medication was being administered and recorded. These problems had been identified prior to this inspection and we had made the home aware of the action which should have been taken. This places people at risk. The manager and staff need to make sure that the homes policies and procedures are followed at all times so that people are kept safe. The supervision of staff needs to be improved so that all staff follow the homes policies and procedures at all times. This should make sure that people are protected from Care Homes for Older People Page 8 of 31 errors in the administration of medication. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into this home are provided with good information so that they can make an informed choice. Assessments and visits to the home ensure that people know, before they move in, that their needs can be met by the home. Evidence: The organisation has a Statement of Purpose and service user guide which contain information about what the home is like, the staff team and the services provided. The Statement of Purpose and service user guide are available in the main reception area of the home which ensures easy access for people who are considering living there. In addition, the home has web pages which provide similar information and a means of contacting the organisation for further information. There are regular open events which provide people with an introduction to the home. The manager explained that people considering whether or not the home is the right Care Homes for Older People Page 11 of 31 Evidence: place for them are able to visit. Some choose to sample a meal or a social event and many are accompanied by their relatives. We sampled three files for people who live in the home and these contain preadmission assessments. In addition to assessments by relevant professionals, the manager had been out to assess peoples needs. The manager told us that a request is made to families and or representatives to complete personal profiles of people who are moving in to the home. These provide staff with information about the persons life, achievements, relationships, hobbies and interests. The manager told us that people initially come to the home on a trial period of 30 days to give them the opportunity to decide if they would like to move in on a permanent basis. The home does not offer intermediate care but respite stays are welcomed. This is where people come to live at the home for short periods to have a break, or to give their carer a break. Care Homes for Older People Page 12 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and social care needs are set out on a plan so that they can be met by staff. People are treated with respect and their dignity is maintained. However, they are put at risk by the homes practices in relation to the administration of medication. The medicine management remains poor and fails to protect people and promote their well-being. Evidence: We sampled the care plans for three people and found that they had been drawn up using information gathered during the initial assessment as well as additional information gained from the people concerned and their relatives. The senior wellness nurse showed us the new system which is now used to audit the care files and we saw evidence that the files are reviewed on a monthly basis. She told us that the new system will mean that the key workers will be responsible for keeping the files up to date. The files which we looked at contained details of each persons history and their needs, including their preferences about how these should be met by staff. For Care Homes for Older People Page 13 of 31 Evidence: example, one contained the detail, I am able to put on top body garments without the assistance of staff, In this way, people are encouraged to maintain as much independence as possible. Peoples social needs are also recorded, so staff know the areas of peoples interests. There are also details of peoples preferred routines. For example, one file contained the detail, I like to be woken between 7 and 7.30am. I like to be brought a cup of tea when I am woken. The files which we looked at contained details of peoples health needs and the contact details for relevant health professionals. We saw details of visits to and by health workers and instructions for staff when changes in a persons care had been advised. The files contain a range of risk assessments as required for the individual. These include skin integrity, nutrition, mobility and manual handling. The risk assessments contain details of the measures which staff should take to minimise the risks. We also saw charts to monitor peoples weight and blood pressure where needed. We saw that people are treated with dignity and people told us that the staff are respectful when they address them. People have privacy in their own rooms and staff knock and wait to be asked to enter. The term of address preferred by each person is recorded in their plan and used by staff. The pharmacist inspection lasted five and a half hours. Twelve peoples medicines were looked at, together with their Medicines Administration Record (MAR) charts and other supporting information. Two medicine technicians were spoken with and the wellness co-ordinator was present throughout the inspection. All feedback was given to the manager and the executive director at the end of the inspection. Outstanding requirements regarding medicines left at the last pharmacist inspection remained breached and a further six requirements were left at this inspection. The Statutory Requirement Notice remained breached. A pharmacist inspection took place on 7th September 2010, where requirements were left due to poor practices seen in the administration and recording of medicines. A further pharmacist inspection took place on 19th January 2010, which resulted in a Statutory Requirement Notice being issued as the home failed to comply with the requirements left at the previous inspection. A third pharmacist inspection took place on 24th March 2020 to check compliance with the Statutory Requirement Notice. This was found to be breached and further enforcement action was started by the Commission. The medicine management was still poor at this inspection and the Statutory Requirement Notice remained breached and had not been complied with. In addition Care Homes for Older People Page 14 of 31 Evidence: the two outstanding requirements to be complied with by 3rd October 2009 had still not been met. The home had recently appointed a Wellness Co-ordinator. She was to be responsible for medicine management and was very keen to improve practice. She had already identified some areas of concern and taken steps to address the issues. The medicines were stored in a dedicated medicine room which was temperature controlled to ensure that they were stored at the correct temperature. A locked refrigerator was also used to store medicines requiring refrigeration and a Controlled Drug cabinet that complied with current regulations was use to store controlled drugs. A combination of Medicine Technicians and nurses now administer medicines to the people that require personal care only. Registered nurses administer medicines to the people that require nursing care. Training issues were raised during the inspection that had already been identified by the Wellness Co-ordinator. She had already booked medicine training with the local community pharmacist. The home saw all the prescriptions prior to dispensing and took a copy to check the medicines and MAR charts received into the home. Staff did not confirm peoples medicines if they were new to the home. One record was seen where four medicines were missing from the supply bought in by relatives and staff had not checked with the prescribing doctor to confirm if they were still prescribed or not. The quantity of all medicines received into the home had been recorded on the MAR chart for people who they administered medicines to. This enabled audits to be undertaken to demonstrate whether the medicines had been administered as prescribed and recorded reflected practice. Audits showed that some medicines had been signed as administered when they had not been. Some medicines were unaccounted for. A few gaps one the MAR chart were seen and it was not possible to identify exactly what had occurred. The wrong codes for non-administration had been recorded in some instances so again audits did not tally to demonstrate that the medicines had been administered as prescribed at all times. Some medicines were out of stock and staff had not recognised that the medicines Care Homes for Older People Page 15 of 31 Evidence: were running out and so obtain a new supply in time. This is of serious concern. One medicine had been administered even though it was out of date. The medicine technician failed to recognise this when asked. One person was asleep so the medicines were offered at a later time that day. The medicine technician recorded the time it had been administered in the wrong place so the MAR chart then had the incorrect administration details recorded. This resulted in two medicines being given twice a day and not the prescribed once a day for at least one dose. This is of very serious concern. One nurse had recorded one medicine on two different charts, resulting in the medicine being administered too close together which may have increased the risk of side effects. In addition the doctor had prescribed the medicine to be administered three times a day but it had been administered four times a day for one day. The audits undertaken on the nursing unit indicated that these medicines had been administered as prescribed and records reflected practice. People were encouraged to self administer their own medicine but again staff had not recorded all the medicines on the premise or assessed whether the people did take their medicines safely. This issue had been raised at the previous three inspections and had not been addressed. The home had started to audit and assess the medicine management but the last audit was dated 17th March 2010. The homes own medicine policy stated that audits on 25 of the medicines should be undertaken on a weekly basis. This had not occurred despite the March audit identifying many errors in the administration and recording of medicines. Staff had not responded appropriately to the results of the audits and increased their frequency. The new wellness co-ordinator was keen to install a quality assurance system to assess individual staff practice in the safe handling of medicines. Care Homes for Older People Page 16 of 31 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. Peoples lifestyles in the home match their preferences and suitable activities are arranged. People are encouraged to maintain significant relationships with people in the community. People receive a choice of nutritions meals which meet their needs and take account of their preferences. Evidence: We saw that people are offered a wide choice of activities, including newspaper discussion, dominoes, card games, progressive mobility, crosswords, computer games, music and gardening. The programme is displayed on notice boards within the home and the lift area. we were told that events and festivals are celebrated, such as Christmas, St. Patricks Day and Burns night. People told us that there are frequent visits from singers and other entertainers such as a recent visit from morris dancers. One person said, They are always trying to amuse us with something. We saw records which show that people are supported to undertake a range of activities of their choice. The records show that there are visits to church services for those who wish to attend and people are able to have their newspapers and magazines delivered. Some newspapers are also supplied by the organisation. Care Homes for Older People Page 17 of 31 Evidence: People can go out with their families and friends as they choose and this encourages their independence and helps them to maintain links with the community. The home has an open visiting policy and we saw several visitors. There are regular meetings of people who live in the home and people told us that their opinion is sought on an individual basis about a range of topics such as activities and security. There are also meetings which relatives attend. The files contain signed documents to show that people have been consulted about a range of issues. The home has a seasonal menu in place and people who live in the home can have their own individual copies. We also found a copy available in the lift area. The tables are well presented and staff told us that they receive training in the importance of meal times. People told us that they enjoy the meals. The food which we ate was well presented and tasty. Peoples specific needs and preferences are recorded on their files and choice is available at each meal time. We saw nutritional assessments on files and records of food intake where necessary. Peoples weights are monitored on a regular basis and staff consult with appropriate professionals and adjust peoples diets when necessary. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements for handling complaints and policies and procedures help to safeguard people. Evidence: The home has policies and procedures for handling complaints. The details of how to make a complaint are in the Statement of Purpose and service user guide to the home and are displayed around the home on notice boards. People confirmed that they would know how to make a complaint should the need arise. We received some comments during the inspection. These were specific and we passed them on to the manager who said that she would follow them up. The records show the complaints which have been made and the action taken to resolve the matters. Some issues, such as the handling of laundry, have been raised at relatives meetings and efforts have been made to put more robust systems in place to avoid further problems. The training records show that staff have been trained in the protection of vulnerable adults and we spoke with staff who know what action to take should they suspect that someone had been abused. Following alleged thefts at the home safeguarding procedures were followed and there are now improved arrangements for security. We sampled the staff records, including those for staff who had most recently been Care Homes for Older People Page 19 of 31 Evidence: employed. There are standard procedures for the recruitment and selection of staff. These are robust and the appropriate checks are carried out prior to each person commencing employment. This provides protection for the people living at the home. We saw that people living at the home have access to their personal money and there is a system to monitor and record financial transactions ensuring an accurate account is kept and enabling an audit trail to be maintained. There are policies and procedures to guide staff in the control of infection. We saw supplies of antibacterial hand gel at the entrance, in hand washing areas and being carried by staff. Staff confirmed that they have access to good supplies of gloves and aprons. Care Homes for Older People Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and safe environment which meets their needs. Evidence: Sunrise is a large and prominent building. It has a large parking area to the front of the building and access to the home is via the main reception which is on the ground floor. A person is seated in this area, known as a concierge and they ensure that people are greeted when they come into the home. This service is located on the ground and first floors of the building. The grounds include terraced patio areas and an abundance of plants and decorative ornaments. We met people who were sitting out in the sunshine and enjoying the view. Corridors are wide and suitable for both independently mobile residents and wheelchairs users. We saw people moving freely around the home. Handrails are provided and the home is well lit. Push button locks, which can be overridden in the event of an emergency are fitted on to the communal bathroom and WC doors so that the individuals privacy is respected whilst maintaining their safety. There is a bistro as well as lounges and smaller seating areas where people can choose to be quiet and read or watch the world go by as they wish. Chairs have been arranged to promote social interaction as far as possible. One area has a large television. All of the areas we looked at including the dining room are decorated and Care Homes for Older People Page 21 of 31 Evidence: furnished to a high standard. Bedroom suites can accommodate single or double occupancy and have kitchenettes. There are also walk in shower rooms and people may choose to have a spa bath. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. Lockable facilities are provided to keep items safe. All areas which we saw looked clean and there were no unpleasant odours. The environmental health officer has undertaken a visit and awarded the home five stars for cleanliness and hygiene; this is the highest rating that can be given. This means that the home has good hygiene procedures in relation to food handling and this will minimise the risk of any cross contamination. Staff told us that they have access to good supplies of gloves, aprons and antiseptic hand gel and we saw hand gel at the entrance and at handwashing points around the home. Care Homes for Older People Page 22 of 31 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. People are supported by adequate numbers of staff who are suitably trained and are generally well supported in their role. However, additional measures are needed to make sure that staff follow the homes procedures at all times so that people are kept safe. Evidence: The rotas show that there are adequate numbers of staff on duty at all times. We saw staff engaging with people and they did not appear to be rushed. Staff told us that they have time to spend talking to people as well as undertaking care tasks. The company has a standard recruitment procedure and this includes taking up references and making checks through the Criminal Records Bureau on all staff prior to starting work. We sampled four staff files and found that this procedure had been followed and there is evidence that the necessary checks have been carried out. This means that people living in the home are protected by the homes practice in this respect. The manager told us that staff undertake induction training prior to working with people on their own. They also shadow more experienced staff. We saw that staff have received mandatory training together with more specialist training, for example, food hygiene, health and safety, first aid, infection control, moving and handling, fire Care Homes for Older People Page 23 of 31 Evidence: training, medication training, knowledge of dementia and adult protection. The manager told us that all staff have access to NVQ training. We spoke with several members of the staff team and they confirmed that they have good access to training and are well supported in their roles. There are systems for making sure that staff are supervised and these include observation sessions as well as one to one discussions with the manager. Despite these arrangements, there have been shortfalls in the practice of the administration of medication. The arrangements for supervising staff in this area need to be reviewed and improved to make sure that people are kept safe. Care Homes for Older People Page 24 of 31 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. There have been some improvements in the management of this home, but people are still placed at risk by the homes practices in medication administration. The home has good arrangements for assessing risk and auditing practice, but staff need to be more proactive in providing a consistently good service. Evidence: We spoke with the executive director, the senior wellness nurse and the manager during this inspection. The manager told us that she is in the process of registering with CQC. The recent appointment of the senior wellness nurse and other manages to the other registered service in the building mean that there should now be better opportunities for the managers of this service to concentrate their efforts on achieving and maintaining high standards. This home has good systems for monitoring performance and assuring quality. These include an annual quality inspection, a Gallup Poll and monthly Regulation 26 visits. In addition there are questionnaires to gain the views of residents, relatives and staff. Care Homes for Older People Page 25 of 31 Evidence: We saw the results of these checks. The most recent Regulation 26 report highlighted several areas where improvement was needed. The manager had drawn up an action plan to ensure that suitable action would be taken. However, the manager and staff need to be more proactive in checking and ensuring that high standards are maintained, instead of relying on areas for improvement to be pointed out before action is taken. This is especially important in the area of the administration of medication, due to the possible consequences of shortfalls. The homes staff do not manage the personal finances of people who live there. However there is a facility for the safe keeping of small amounts of residents money should they choose to use this facility. We saw that there is a plan for dates for the formal supervision of staff. In sampled staff files we saw that this has started to happen and there are also annual appraisals for staff. Formal supervision ensures that staff are given the appropriate support they require and identifies any training which may be required in order to meet the needs of people living in the home, individually and collectively. This is important due to the shortfalls which have been mentioned earlier in this report. We saw that health and safety and maintenance checks have been undertaken in the home to ensure that the equipment is in safe and full working order. Also monthly health and safety meetings take place which ensures the home is well maintained and all equipment is in good working order. Regular fire checks of the system and fire doors are undertaken to ensure that they are in full working order. Fire drills are undertaken regularly and the names of staff attending are recorded to ensure that all staff attends two fire drills per year. These measures help to ensure the safety of all people who use the building. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 The medicine chart must 03/10/2009 record the quantity of medicines received and the date. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 2 9 13 All service users must be risk 03/10/2009 assessed as able to self administer their own medication and a MAR chart written to record these prescribed medicines. Regular compliance checks must be undertaken and documented and further support offered if necessary. This is to ensure that they can handle their medication safely Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All dose changes recorded on the MAR chart must be confirmed by a second member of staff. This is to ensure that the staff have clear accurate directions to follow. All medicines that are administered must be in date and have not exceed their expiry date This is to ensure that the stability of the medicines is not compromised. 14/05/2010 2 9 13 14/05/2011 3 9 13 All medication polices must 14/05/2010 be adhered to and management must take appropriate action if staff fail to follow them. This is to ensure that all staff are handling medicines safely. Care Homes for Older People Page 28 of 31 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 4 9 12 All prescribed medicines must be available for administration at all times. This is to ensure that the service users are administered medicines as prescribed. 14/05/2010 5 9 13 A system must be installed 14/05/2010 to check all the medicines received into the home. This includes service users medicines who self administer their own medicine and also all new service users to the home regardless whether they will be a permanent or temporary respite resident. All discrepancies must be addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times 6 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. 14/05/2010 Care Homes for Older People Page 29 of 31 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 This is to ensure that individual staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that staff do not administer the medicines as prescribed and records do not reflect practice. 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 36 The manager needs to make sure that all staff are adequately supervised to make sure that they follow the homes policies and procedures at all times. This should make sure that peoples welfare is protected. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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