Inspection on 31/07/09 for The Green Nursing Home

This inspection was carried out on 31st July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Green Nursing Home 01/06/10

The Green Nursing Home 09/03/10

The Green Nursing Home 07/12/09

The Green Nursing Home 08/08/08

The Green Nursing Home 09/08/07

The Green Nursing Home 07/11/06

The Green Nursing Home 02/06/06

The Green Nursing Home 15/12/05

The Green Nursing Home 16/06/05

The Green Nursing Home 15/11/04

The Green Nursing Home 23/06/04

The Green Nursing Home 19/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lisa Evitts     Date: 3 1 0 7 2 0 0 9 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN 01214513002 01214863360 flintvaleltd@btconnect.com Flintvaleltd@btconnect.com Flintvale Limited care home 59 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category of service only: Care Home with Nursing (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) 59 Dementia (DE) 59 Date of last inspection Brief description of the care home The Green is a purpose built facility, which offers nursing care for up to 59 older adults, who may also have dementia care needs. There is off road parking to the front of the property, which is sufficient for the home, and is situated close to bus links to the centre of Birmingham. There are a range of local shops and community facilities nearby. The home has a mixture of shared and single bedrooms, some of which have en-suite Care Homes for Older People Page 4 of 31 59 0 Over 65 0 59 Brief description of the care home facilities, spread over the ground and first floors of the building. There are communal bathing, shower and toilet facilities on both floors to meet the needs of the people who live there. The building has basic adaptations for people with limited mobility, including two passenger lifts. Communal lounges are situated on the ground floor and the lounge doors open onto an enclosed garden with a water feature, which has wheelchair access. Laundry and kitchen services are located on the ground floor, as are the dining rooms. Fee rates for the home vary depending if the person is privately funded or funded by Social Care and Health. Charges vary, on the assessed banding and type of room chosen and a top up fee is payable. Current fee rates are available on request from the home. Hairdressing, chiropody, opticians and dentists visit the home, and are available for additional fees. Previous inspection reports and articles of interest are available inside the reception area of the home, for anyone who wishes to read them. 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: 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 focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last inspection of this service was completed on the 8th August 2008. This visit to the home was undertaken by two inspectors over one day. The home did not know that we were visiting that day. There were 54 people living at the home and one person was in hospital. Information was gathered from speaking to people who live at the home and observing them. We spoke to five people who live at the home, four visitors and five staff. Two people were case tracked and we looked partly at three other files. Case tracking involves discovering individual experiences of living at the home by meeting or Care Homes for Older People Page 6 of 31 observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. Prior to the inspection we sent out random surveys in order to gain peoples views about the service. We sent fifteen surveys to people who live in the home and their relatives and five to staff. Seven people who live at the home or their relatives and one member of staff returned surveys. Comments are included in this report. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about the staff and people who live at the home. Before the visit we reviewed any notifications received about the home. These are reports about things that have happened in the home that they must tell us about. We made an immediate requirement on the day of our visit regarding the management of a healthcare condition. We visited the home on the 4th August 2009 and found that the home had taken action to address the concerns and had complied with the requirement. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The home has met previous requirements which suggests that the owners and manager are keen to ensure that people live in a home that complies with the regulations. Care Homes for Older People Page 8 of 31 Staff were observed to respect people who live at the home and maintain their privacy and dignity. An activities team has been introduced. There are now four activity people to help people maintain a stimulating and interesting lifestyle. One relative said She likes to walk around and go in the garden and staff support her to do this. A grumbles book has been introduced so that any low level concerns can be monitored and addressed. A number of improvements have been made to the environment including new carpets and redecoration, new windows and a new heating system. This will enhance the environment for people to live in. The numbers of domestic staff have been increased to reflect the size of the building and keep the home clean. Staffing levels have been increased to ensure that the needs of the people living at the home are met. Staff have received training and 90 of staff have a National Vocational Qualification (NVQ) level 2 in care. This should mean that staff have the knowledge and skills to meet peoples needs individually and collectively. 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 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. Arrangements are in place to ensure that people have the information they need and that they can be confident their needs will be met if they decide to live at the home. Evidence: The certificate of registration was clearly displayed in the reception area and a copy of the previous inspection report is available so that people have access to this information if they want to read it. The home has a service users guide and statement of purpose which gives people information about the home so that they can make an informed decision about whether they would like to live there. This document includes pictures to help people understand the information and each person is given a copy when they are assessed or visit the home. The documents can be made available in alternative languages, in Brail and audio cassette upon request so that all people can access the information. Care Homes for Older People Page 11 of 31 Evidence: Before anyone comes to live at the home, comprehensive pre admission assessments are undertaken so that the person and the home know that their individual needs can be met before they move in. People are able to visit the home to see what it would be like to live there before they move in. On the day of our visit some relatives had come to the home to look around without any notice. Staff showed the people around and answered any questions. This will enable people to make informed decisions about the home. People told us: We looked at two other homes before choosing The Green Its a very good home Its a first class service We were unable to speak to the most recent person who had moved into the home on the day of our visit, however another recent admission told us she was happy at the home and could do what she wanted. The home does not offer intermediate care facilities, therefore this standard was not assessed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people living at the home can be confident they will receive the care they need in a way they prefer, however lack of information and training for some health care conditions may mean that some people dont. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. We looked at two peoples care files in detail and partly reviewed three others. Most of the care plans provided good details for staff to follow to meet peoples needs, and plans contained personal preferences so that people should receive care in a way that they preferred. One persons file was detailed in relation to wound dressings and there was evidence that the staff had followed advice from the tissue viability nurse (specialist nurse for sore skin).Care plans reflected changes in dressings so that staff would know how to Care Homes for Older People Page 13 of 31 Evidence: change the dressings correctly. We looked at one persons plan for the management of epilepsy and found that the information for staff was poor and did not provide them with guidance about what to do if the person should have a seizure. There was no protocol in place to tell staff how and when to administer medication or when to call for an ambulance. Staff had not received any training in epilepsy so that they had the knowledge and skills to meet these needs. We left an immediate requirement for the home to look at the management of epilepsy and to review the care plans and risk assessments to ensure that staff had enough information. We visited the home again the following week to ensure that the home had addressed the concerns. We found that the home had reviewed the plans and risk assessments and that a protocol had been written for the use of the medication. We were assured by the home that staff would receive training. There were good details about the type of moving and handling equipment that people needed to use so that the person and staff were safe. There was evidence that people are seen by external health care professionals such as the General Practitioner, dentist, optician and people are assisted to attend hospital appointments. This ensures that people receive specialist advice and that their care needs are met. People were well presented and were supported by staff to choose clothing that reflected individual choices. Staff were observed to treat people with respect and maintain their dignity and were able to tell us about individual peoples needs. People told us: I am pleased with the care People are well looked after Im really pleased with the care mum has had We looked at the management of medication. A new fridge was on order as the temperatures had been too high to store the medication safely. The room temperature was also too high and the heating had been turned off. A new thermometer had been ordered so that this could be monitored. The Controlled Drugs were appropriately stored and records were accurate. There were some medications that had been handwritten onto the chart but had not been signed or checked as being correct. One Care Homes for Older People Page 14 of 31 Evidence: medication had the time changed but there was no evidence that this had been agreed with the GP. There was an ointment in use on the trolley but this had no name on and no date when it was opened so we did not know who it belonged to. Masks which are used to help people take inhalers were not clean and were stored together, which may result in a potential risk of infection. It was concerning that each trolley had a bottle, in which staff were placing refused medications. These bottles contained a variety of tablets and this is not safe practice as the tablets should be disposed of safely and recorded at the time of refusal. The home must review the management of medication so that records are accurate and provide an audit trail so that we can be confident people receive their medication as prescribed. Care Homes for Older People Page 15 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. People have a choice of activities so that they experience a meaningful lifestyle. There is a choice of meals to meet peoples dietary needs or personal preferences. Evidence: The home has recently developed an activity team of four people who will focus on organising a range of home based and community activities to meet peoples individual needs.The home has a weekly activity plan which consists of newspaper discussions, memory lane, arts and crafts, board and table games. The home has visiting entertainers and a barbecue took place recently. A fancy dress and a pub quiz were planned for the coming month. A cheese and wine evening had been held at the home and relatives were invited so that people could discuss activities. We observed good interactions with the staff team and saw one member of staff encouraging light movement with people by encouraging them to catch and throw a light ball. Other people were sat listening to story tapes or reading books and newspapers. Two people were taken out for lunch at a local pub and told us on their return that they had really enjoyed it. People are supported to go out to local shops and some people have attended a jumble sale at the local church. Staff are in the process of organising membership at the local library for some people and people have Care Homes for Older People Page 16 of 31 Evidence: been registered to use the ring and ride. This will encourage people to maintain links with the local community. Church services are held so that people can continue to follow their chosen religion and the hairdresser visits each week so that people can have their hair styled in a way they prefer. People told us: She likes to walk around and go in the garden and staff support her to do this Im going out today for a pub lunch I dont want to do activities I do some games or I like to sit and watch people The home has an open visiting policy, which means that people can see their visitors as they chose and maintain relationships that are important to them. One relative said I am always made very welcome when visiting. The home has a four week rolling menu. Hot meals are served at lunchtime and in the evening there is a choice of lighter hot meal or sandwiches. Alternatives are available such as soups, jacket potatoes and salads if people prefer not to have the main options. Cakes, biscuits and cheese straws are available as snacks throughout the day. Dining tables were nicely presented and the menu was displayed. Staff were observed to assist people who needed help and encourage them to eat their meals. We sampled the lunch of fish and chips, grilled tomatoes and peas and this was well presented and appetising. The home can cater for meals to meet dietary requirements. We saw portions on pureed meals were individually served so that people could experience the taste and texture of the foods. There was no one living at the home who required a special diet for cultural needs at the time of our visit. People told us: The food is quite good The food is very good, you can have a choice They dont always ask us what we want to eat but if I dont like it I can have something else. Care Homes for Older People Page 17 of 31 Evidence: We looked at the minutes of a meeting held with the people who live at the home in June and some people had mentioned that they were not being asked daily what they would like for meals or being told what was on the menu. This was discussed with the manager on the day of our visit as people need to know what choices of food they can have, so that they receive food they like. 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. People can be confident that their views are listened to and acted on. Arrangements should ensure people are safeguarded from harm. Evidence: There is a comprehensive complaints procedure which is on display in reception and in each persons room, making it accessible to people if they want to make a complaint. The procedure is also included in the service users guide. We have not received any complaints about the home since our last visit and the home have not received any formal complaints. Since our last visit the home have introduced a grumbles diary and this is used to record any low level concerns that people may have. There were two grumbles recorded and the actions taken to resolve them were documented. The home has a compliments book, which contained letters and cards, indicating peoples satisfaction with the service provided. One person told us I have no complaints. In the surveys returned to us by people who live at the home, five people told us that they knew who to speak to if they were unhappy. The manager has an open door policy so that people can speak to her when they visit. She holds a surgery on the last Tuesday of every month where people can book time Care Homes for Older People Page 19 of 31 Evidence: to speak with her if they prefer. The home has a copy of the local Multi Agency Guidelines and an adult protection policy and this should ensure that staff have guidelines to follow in the event of any allegations of abuse. There has been one adult protection case since our last visit, where a person who lives at the home sustained an injury. This is currently being investigated and the outcome is not yet known. Staff had received training in safeguarding so that they have up to date knowledge about what they should do to keep people safe. Staff spoken to were able to give satisfactory responses to questions about how to keep people safe. The manager and two trained nurses had received training in the Mental Capacity Act and Deprivation of Liberty Safeguarding. This act governs decision making on behalf of adults and applies when people lose mental capacity at some point in their lives or when they have had an incapacitating condition since birth. This training was to be rolled out to other staff so that they have the knowledge about the procedure to follow when peoples freedom may be restricted. The home had made a Deprivation Of Liberty Safeguarding for one person who lived at the home, however following assessment the assessors felt that no restraint was occurring. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely, clean and comfortable environment in which to live that meets their individual needs. Evidence: We looked around some parts of the home relevant to the people we case tracked. Corridors are wide and spacious and allow people freedom to move around the home with any equipment they may need. During our visit we found the home was clean and odour free. In surveys returned to us three people said it was always like this and four people said it was usually like this. The AQAA told us that the home had increased the number of domestic staff to reflect the size of the building. There was a friendly and relaxed atmosphere throughout the home. Since our last visit there have been some improvements to the environment such as a new heating and hot water system. Thermostatic valves have been fitted to all radiators so that people can control the temperature of their own rooms. Corridors and the entrance hall have been repainted. A new carpet had been fitted to the entrance and new blinds were being installed on the day of our visit. Throughout the home some windows had been replaced and all rooms had had new lampshades to enhance the environment for people to live in. The home has a number of plans to enhance the current communal areas. These plans Care Homes for Older People Page 21 of 31 Evidence: include themed areas such as a library room and a pub room. The hairdressing room is to be renamed Heads and Tails and staff plan to offer foot spas and treatments once they have had training. The dining room is planned to be called Green Cuisine and rooms will have signage to identify them, a sensory room is also planned. These plans show that the home is forward thinking about how they can further improve the environment and progress will be reviewed at our next visit. We looked at peoples bedrooms and found that they were personalised with items that reflected their individual preferences and choices. Shared rooms had curtains so that privacy could be maintained. One person told us that the home needed more bedside tables. We looked at some rooms and found that some of the tables were in poor condition, some rooms did not have tables. This should be reviewed so that people who want one have access to a table that is fit for purpose. Some of the bedrooms were in need of redecoration and we were advised that bedrooms are next to be painted on a rolling programme. This will ensure that people live in a homely environment. One person said My room is kept nice and clean and another told us I make my own bed, I still try and do things for myself. There is an attractive garden area, with a gazebo and water feature and seating areas. People were seen to use the garden on the day of our visit. A area has been identified so that people at the home who want to can become involved in growing plants and vegetables.There is a ramp so that people can access the garden if they use a wheelchair.One person told us that the home could improve by making the ramp access at the front of the home wider,as the main entrance was difficult if using a wheelchair. This was discussed with the manager on the day of the visit. There is work planned to the car park and this will be reviewed when the work is undertaken. We saw that the garden shed had been left open and this may mean that people could access things which could harm them. Staff locked this when we asked them to so that people were safe.This had been a concern at the previous visit to the home and staff should ensure that they lock this before they leave it unattended. 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 good 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 staff who receive training to ensure they have the knowledge to meet peoples needs. Systems for recruitment should ensure that people are protected from harm. Evidence: There are three trained staff and nine care staff on duty in the morning, three trained and seven care staff in the afternoon/evening and two trained and four care staff during the night. An external manager had discussed concerns that staff raised about people going to bed late due to suppers being given. A review of when falls were occurring in the home indicated that this was more likely to happen in the evening. An extra member of staff is now on duty from 4pm until 11pm. This means that the home reviews the number of staff to ensure that it meets the needs of the people who live there. The home maintains a core group of staff so that people know who will help them to meet their needs. There was currently two vacancies for registered nurses, these shifts were covered by agency and the home used the same two agency staff for consistency. In addition to the nursing and care staff the home also have laundry, domestic, kitchen, maintenance and administrative staff to meet all the needs of the people who live at the home. People told us: Care Homes for Older People Page 23 of 31 Evidence: Staff are always very welcoming Staff are very nice, they dont force us to do anything we dont want to Staff are OK just ask them and they will sort things out for you Staff have supported my dad as well, theres a lot of humanity here 90 of staff have completed a National Vocational Qualification (NVQ) Level 2 in care.This is above the national minimum standards and should ensure that the staff have the knowledge and skills to care for people individually and collectively. Staff were observed to interact well with people who live at the home and there was a pleasant atmosphere in the home. We looked at three staff files and information required to ensure that people were safe was available, although documentation around references could be improved. Examples of this are different references being received to those that were requested but no evidence of why other references were sought. One persons references raised some issues but there was no evidence of how this was followed up. One person did not appear to have a reference from their most recent employer, however the referee had moved jobs and was now at a different address. The manager was able to explain what action had been taken to all of the above but there was no written evidence to support this.There were no staff identity photographs on files and we found that information was not easy to find as the files were not well organised. The manager told us that this was something that the administrative person planned to do. Staff had received training in fire safety, safeguarding and moving and handling. There is an ongoing programme for staff to complete a certificate in Dementia Awareness. Staff spoken to confirmed that they received training and commented We are up to date with training and get the support to do our job, They are strict with training. New staff receive an induction into the home and the rotas confirmed that one person was supernumery for five days so that they could work with someone and get to know peoples needs and how to meet them. We looked at one persons induction and this had not been fully completed and did not ensure that they had been given all of the information they would need to know. Staff should be provided with training in the management of epilepsy so that they have the knowledge and skills to meet peoples needs. The manager told us after our visit that they were in the process of arranging this. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views about the home are sought so that it is run in their best interests. Evidence: The Registered Manager is a Registered Nurse and has experience in caring for older people. The manager has completed training in the Mental Capacity Act and Deprivation Of Liberty Safeguarding. She has also completed study days on wound and catheter care and the flu pandemic with the local Primary Care Trust. This shows she is keen to keep her knowledge and skills up to date in order to lead the staff team. People told us: The manager is very approachable We get support to do our job Care Homes for Older People Page 25 of 31 Evidence: Things have really improved with a good manager Resident and relative meetings are held and the minutes from these were available. These meetings enable people to voice any concerns or raise ideas about how the home could improve. The minutes showed that people were involved in decisions about the home. For example people said they would like to be involved in the menus and there was evidence that menus had been changed as a result of this request. A Friends of The Green meeting was held in May and people said that they found the information in reception confusing. This was being addressed with the redecoration and organisation of the area. An external person for the company visits the home to complete a review of the quality of the service the home provides and writes a report. We looked at these reports which were very detailed and showed that where concerns were highlighted, action was taken to address this. Examples of this are the new shift that has been introduced to ensure there are enough staff to meet peoples needs and the introduction of cordless telephones so that staff can answer calls more promptly. The visits are undertaken at various times of the day and night so that different people are seen and the quality of service at all times is monitored. Following the report, the manager writes a response and devises a plan about how to address any areas of concern. In addition to this the manager completes a number of audits and sends out satisfaction surveys to monitor the quality of the service. Prior to the visit the Registered Manager returned the AQAA to us in the required timescale and this was detailed with information about the home and areas it needed to improve. The home is able to hold small amounts of money for people who live there. Records were seen and balances of money were correct which means that money can be held safely by the home. Records of servicing, tests and maintenance in respect of health and safety for utilities, equipment and appliances are well maintained and should ensure that they are safe to use. Accident and incidents are well recorded and a monthly audit ensures that any trends are identified and acted upon. For example an audit identified that more falls were occurring in the evening and the extra staff on shift was introduced. Care Homes for Older People Page 26 of 31 Evidence: Fire alarms and emergency lights are checked weekly to ensure they are in working order. There was no evidence of staff participating in fire drills on the day of our visit and the manager was asked to send us this information following our visit. Fire drills will ensure that staff know what to do to keep people safe in the event of a fire. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 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 1 7 12 Arrangements must be in 02/08/2009 place for the management of epilepsy. To ensure people are safe. 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 Systems must be in place for the management of medication. To ensure that people receive this as prescribed and records are accurate. 04/09/2009 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 2 3 4 5 15 19 24 29 30 Systems should be in place so that people know what choices of food they can have. People should feel confident that they can access the home safely. People should have bedside tables that are available and fit for purpose. Written evidence should be available to support the recruitment process so that people are safe from harm. Staff should receive training in health care conditions so Page 29 of 31 Care Homes for Older People 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 that they have the knowledge and skills to meet peoples needs. 6 38 Fire safety information should be available within the home. 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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