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Inspection on 09/03/10 for The Green Nursing Home

Also see our care home review for The Green Nursing Home for more information

This inspection was carried out on 9th March 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are offered a choice of meals and food is well presented. The home can cater for special diets, personal preferences, dietary and cultural needs. The home has an open visiting policy which means that people can see their visitors as they choose and maintain relationships that are important to them. People told us: "The home is ok" "Its not too bad but not perfect" "There is always plenty of food to choose from" "Staff are alright, they always come back" "All the staff are kind and helpful".

What has improved since the last inspection?

Some profiling beds have been purchased. These are beds which people can alter their position in using hand held controls so they are comfortable. Staff recruitment files are more organised and information is easy to find.

What the care home could do better:

Information about the home should be updated so that people have relevant information to help them make a decision about whether they want to live at the home. Care plans must be written for current care needs so that staff know how to assist people in a way that meets their needs and preferences. Risk assessments must be completed for individual risks so that the risks are managed and minimised and so that people are cared for safely. People should be assisted to have baths or showers as they choose. One person said "I had a shower last week, the first one in a long long time". Staff should promote peoples privacy and dignity at all times. Staff should know about peoples needs, one person said "They work in groups so if you ask some of the staff they dont know whats happening with my relative". The management of medicines must be improved so that people are safe, medicines are stored correctly and so that people receive their medication as prescribed. Activities must be reviewed so that people can participate in activities they like inside and outside of the home. People told us "We need more things to do" and "I would like to go out in the garden more". Complaints records should be audited so that people can be confident that they are listened to and their concerns acted upon. Infection control practices must be reviewed to ensure that people live in a clean and safe environment. One person said "We need a better environment for everyone". Remedial work must be undertaken to ensure that the kitchen is clean and hygienic to minimise the risk of infection. A staff training matrix should be available so there is a clear audit about what training staff have had and what training they need to meet people`s needs. A quality assurance system must be in place to monitor the quality of the service provided. Records must be available in the home for inspection to evidence that health and safety checks are in place to keep people safe.

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:   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: Lisa Evitts     Date: 0 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 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. The home is situated close to bus links to the centre of Birmingham. There are a range of local shops and community Care Homes for Older People Page 4 of 32 Over 65 0 59 59 0 0 7 1 2 2 0 0 9 Brief description of the care home facilities nearby. The home has a mixture of shared and single bedrooms, some of which have en-suite 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 32 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: 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. A random visit to the home was undertaken by a pharmacist inspector in December 2009, to monitor the management of medication. The requirements made at the inspection in July 2009 had been met but a further three more specific requirements were made in relation to medicines management. This visit to the home was undertaken by two inspectors over one day. A pharmacist inspector visited the home to review the management of medication. The home did not know that we were visiting that day. There were 52 people living at the home and one person was in hospital. The manager was on holiday and the responsible person Care Homes for Older People Page 6 of 32 assisted us throughout the day. Information was gathered from speaking to people who live at the home and watching how staff cared for them. We spoke to seven people who live at the home, two visitors and five staff. It is not possible to speak to a number of people who live at the home due to their dementia health needs. Three people were case tracked and we looked at some other plans. Case tracking involves discovering individual experiences of living at the home by meeting or 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 ten surveys to people who live in the home and ten to staff. Three people who live at the home and one member of staff returned surveys. Comments are included in this report. We had asked the home to complete their Annual Quality Assurance Assessment (AQAA). This is a document in which the home tells us what they think they are doing well and where they need to improve. This was not due for return until after our visit and we will use the AQAA as information for our next visit to 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. On the day of our visit we left an immediate requirement regarding fire drills, to ensure that staff knew what to do in the event of a fire to keep people safe. The responsible person sent us evidence that this requirement had been met after the visit to the home. From this visit there is evidence of a downward decline in the homes overall performance since the last key inspection at the home. This means that the home is not run in the best interests of the people who live there. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Information about the home should be updated so that people have relevant information to help them make a decision about whether they want to live at the home. Care plans must be written for current care needs so that staff know how to assist people in a way that meets their needs and preferences. Risk assessments must be completed for individual risks so that the risks are managed and minimised and so that people are cared for safely. People should be assisted to have baths or showers as they choose. One person said I had a shower last week, the first one in a long long time. Staff should promote peoples privacy and dignity at all times. Staff should know about peoples needs, one person said They work in groups so if you ask some of the staff they dont know whats happening with my relative. The management of medicines must be improved so that people are safe, medicines are stored correctly and so that people receive their medication as prescribed. Activities must be reviewed so that people can participate in activities they like inside and outside of the home. People told us We need more things to do and I would like Care Homes for Older People Page 8 of 32 to go out in the garden more. Complaints records should be audited so that people can be confident that they are listened to and their concerns acted upon. Infection control practices must be reviewed to ensure that people live in a clean and safe environment. One person said We need a better environment for everyone. Remedial work must be undertaken to ensure that the kitchen is clean and hygienic to minimise the risk of infection. A staff training matrix should be available so there is a clear audit about what training staff have had and what training they need to meet peoples needs. A quality assurance system must be in place to monitor the quality of the service provided. Records must be available in the home for inspection to evidence that health and safety checks are in place to keep people safe. 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 32 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 32 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 have some information they need to help them make a decision about living at the home. Evidence: The certificate of registration was clearly displayed in the reception area and a copy of the last inspection report is displayed so that people can read this if they choose to. The home has a service users guide and a statement of purpose which is available as a written booklet in one size text. The information should be available in alternative formats so that people who may have visual or hearing impairments can access the information. There were no fee rates included in the information and people should be told this so that they know how much they would have to pay if they decided to live at the home. Some of the information in the documents was not correct for example, the fire procedure referred to another home in the group. This means that people do not have the right information about the home. In the three surveys returned to us people Care Homes for Older People Page 11 of 32 Evidence: told us that they had been given enough information about the home. Pre admission assessments are completed before people move in. These assessments are completed so that the homes staff and prospective person know that their individual needs can be met at the home before they decide if they want to live at the home. We looked at two peoples assessments. One of these was detailed and gave good information about the persons needs. The second one we saw was not fully completed and had been written in pencil. This does not ensure that all of the information is collated to ensure that the home can meet the persons needs. People and their relatives are able to visit the home before they move in to sample what it would be like to live there. We saw that a relative had been invited to the home to choose a room for their relative to move into. People told us: The home is ok Its not too bad but not perfect Care Homes for Older People Page 12 of 32 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. Arrangements do not ensure that peoples health care needs are met. Evidence: Each person had a written care plan file. This is an individualised care plan about what the person is able to do independently and what support is required from staff in order for the person to meet their needs. We looked at three peoples care files in detail and partially looked at one other. The home is in the process of introducing a new care plan format which should mean that plans are more person centred. In two of the four files that we looked at we found that a number of the risk assessments and care plans had not been completed. One person was showing some difficult to manage behaviour but no behaviour care plan was written. This means that staff did not have any guidance about how to meet peoples needs and minimise this behaviour. We observed this person to walk with two staff using a handling belt but there was no moving and handling risk assessment in place. This does not ensure that this is the correctly assessed equipment for this person to use. Daily records stated Care Homes for Older People Page 13 of 32 Evidence: that the person slips out of the chair but the falls risk assessment was not completed. The personal hygiene plan made no reference to how to meet the persons needs in relation to washing and bathing. One person was registered blind and there was no plan to guide staff about how to assist this person.One person had a significant number of needs such as a urine catheter, use of Zimmer frame and wheelchair use which staff had not planned for their care so that needs would be met. Daily records also indicated that one person had sore skin and that dressings had been applied. The Waterlow score (a tool used to assess peoples sore skin) was not completed. A care plan had been written for a wound which said to review after three days but this had not been done and it was not clear if the wound was still there or if it had healed. Another file had entries regarding wounds which should have been reviewed after three days but there were no records of this being done. This was of concern as the plans said the person had a skin sore, the last recording was made in February and it was not clear if this wound had healed or not. One persons daily records stated noticed swelling and abrasion to left foot, kept elevated. There were no other recordings made about this after four days and it was not clear whether this was still a concern. One person told us I had a shower last week, the first one in a long long time. The responsible person told us that this had been a complaint and they had identified that people were not receiving baths and showers as they should be. One persons file said that it was not possible to shower more than once a month but it didnt say why. Records showed this person had had one bath and one shower this year, with daily bed baths at other times. As the bathrooms were not accessible on the day of our visit, an audit should be undertaken as to peoples preferences and equipment needs to ensure that people receive baths and showers as they choose. Whilst sitting in the lounge we heard a member of staff to be discussing someones toileting needs very loudly and in front of a number of other people who live at the home. This did not promote the person privacy and dignity and was brought to the attention of the responsible person on the day of the visit. We looked at the medicines management. The medicines were stored in a dedicated medicine room. The temperature was 27C on entry to the room.This was too hot to safely stored the medicines inside to maintain their stability. It was a requirement at the last inspection to ensure that this room was kept below 25C at all times and this had not been met. Care Homes for Older People Page 14 of 32 Evidence: The medicines in current use were stored in three medicine trolleys used to transport the medicines to the people in the home.On two separate occasions the nurse left the medicine trolley unattended.Once with medicines left on top of the trolley instead of placing them inside and the second time the trolley was left in a lounge with the doors wide open. Everyone in the lounge had full access to the medicines held within increasing the risk of harm. This is of serious concern and breached the requirement left at the last inspection. All the prescriptions were seen prior to dispensing and used to check the medicines and MAR charts received for accuracy. The quantity of all medicines including any balances carried over from previous cycles were recorded enabling audits to be undertaken.These demonstrated that the majority of medicines had been administered as prescribed and records reflected practice for the medicines dispensed in a monitored dosage system (where one tablet is in a individual blister for each day). Errors though were still seen from medicines dispensed in traditional boxes and bottles. These demonstrated that medicines had been recorded as administered when they had not been or were unaccounted for. One medicine had run out and none was available to administer and no further supply had been sought. People did not always receive the right medication, for example, one tablet and not the prescribed dose of two tablets. A quality assurance system had been implemented but this had not reduced the number of errors seen during the inspection. The controlled drugs were correctly stored in compliance with current regulations and the balances were accurate. The nurses spoken to had a good knowledge of the medicines they handle and so would be better able to support the clinical needs of the people they look after. The morning medicine round finished very late and was not completed until midday. The lunchtime round was due to start at 2:30pm. This left only two and a half hours between the medicine rounds. It is advised that at least four hours should elapse between rounds to reduce the risk of potential overdose. Due to the previous requirements not being met and the concerns found at this visit, we have referred the information to the Regional Enforcement team. We will decide what further action to take to ensure that the home makes the necessary improvements in the best interests of the poeple who live at the home. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities do not meet the needs of all the people living at the home so that they experience a meaningful lifestyle. There are choices of meals to meet dietary needs and personal preferences. Evidence: At our last visit to the home there was a team of four people to assist people with activities. This has been reduced and there is now only one activity coordinator. Due to the number of people at the home and the number of people who need one to one time, this places time constraints on the coordinator and means that people may not be assisted with their activities and interests. There is a weekly activity plan which includes games, reminiscence, newspaper reading, gentle exercises, one to one time and music. We were told that there were celebrations planned for St Patricks Day and St Georges Day. During the day we saw some people playing skittles in the main lounge. In the morning in the small lounge three people were sitting in front of the TV which had a childrens programme on and this didnt promote peoples dignity. One person was knitting and one person was reading a newspaper. A hairdresser visits each week so that people can have their hair Care Homes for Older People Page 16 of 32 Evidence: styled in a way that they prefer. We were told that following an incident last year, no community activities are taking place and no one has been taken out of the home. This is a reactive blanket approach to a situation which means that individual people, who used to enjoy going to the local shops for example, are no longer assisted to do the things that they enjoy. The managers must review the number of hours for activity staff and the activities that people can participate in so that they experience a meaningful lifestyle. People told us: The activity person does her best When the weather gets better I will take my friend out for a walk We need more things to do I would like to go out into the garden more Residents are not getting enough in the way of activities or stimulation In the three surveys received two people said there were usually activities they could participate in and one person said sometimes. The home has an open visiting policy, which means that people can see their visitors as they chose and can maintain relationships that are important to them. The home has a four week rolling menu. Hot meals are served at lunchtime and in the evening there is a choice of sandwiches or a hot lighter meal. Alternatives are available if people choose not to have the main options. Snacks are available throughout the day. We observed the lunch and tables were nicely presented with condiments, cloths and drinks. Each table was served together and staff were observed to assist people to eat their meals in a discreet manner. The home is able to cater for specific dietary needs and individual preferences. People we spoke to were complimentary about the food. One person told us that their favourite food was the shepherds pie and that the cook had made a cake with lemon icing which they had really enjoyed. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some systems in place to listen to peoples concerns and safeguard them from harm. Evidence: There is a complaints procedure in each persons bedroom but this had not been updated and still had the previous managers details on. The complaints procedure in the service users guide did not say that We, the commission could be contacted at anytime but could be contacted if the complaint was not resolved. This does not ensure that people have the correct information if they want to make a complaint. Since our last visit we have received one complaint and this was looked into by social services using the safeguarding procedure. The home had received seven complaints since our last visit. We looked at the complaints records. Information was not easy to find as there was not a clear audit trail. Some complaints had outcome letters about how they had been investigated and what action the home had taken to minimise this from happening again. People were invited into the home to discuss their concerns. Some complaints did not have responses and some responses were not filed with the correct complaint. There was no auditing of the complaints undertaken to see if there were any themes or trends identified. Elements of the complaints recorded included staff attitudes, healthcare concerns, serving of food and communication. One person said I would speak to the manager if I had any concerns. Care Homes for Older People Page 18 of 32 Evidence: There have been four safeguarding investigations at the home since our last visit and these have all been closed. These referrals were made by external professionals and concerns were raised around wound care and standard of documentation. The home has an adult protection policy but this had not been updated since 2007. There were copies of multi agency guidelines so that staff have information to follow in the event of an allegation being made. There was no training matrix and therefore we could not see if staff had had training in how to keep people safe. Staff spoken to generally knew what they should do in the event of an allegation but one member of staff said that an allegation would be investigated by the home. This person told us that they had read the safeguarding policy and had had training. This was brought to the attention of the responsible person on the day of the visit, as the person did not appear to have the correct understanding of the procedure. Care Homes for Older People Page 19 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bathing facilities do not meet the needs of the people living at the home. Lapses in infection control may place people at risk of harm. Evidence: We looked around some parts of the home relevant to the people we case tracked. Corridors are wide and spacious and allow for people to move around the home with any equipment they may need. We noticed that there was an odour in the main corridor and this was brought to the attention of the responsible person at the time of our visit. We looked at the bathing and showering facilities in the home. We were very concerned that all of the bathrooms that we went in were very untidy and had equipment, boxes and black bags stored in them. One shower room which was accessible had a soiled shower chair and there was no plug for the bath. In many of the rooms the items were actually in the bath and this means that there were no accessible facilities for people to use. The responsible person told us that they had become aware following a complaint that people were not receiving baths or showers frequently. In a meeting held three weeks earlier it had been identified that three bathrooms needed to be cleared of equipment but this had not been done. The sluice machine on the ground floor was not accessible due to equipment being Care Homes for Older People Page 20 of 32 Evidence: stored in front of it. It was concerning that a number of commode pots which were stained were left on top of bins or on the floor. We saw in a number of bathrooms and bedrooms that staff had placed gloves and aprons into waste paper bins and often these had been thrown onto the floor rather than being placed into the bins. This places people at risk of infection. The bathrooms were emptied at the time of our visit, however this needs to be monitored so that the facilities can be accessed by people to enable them to bathe or shower as they choose. Peoples bedrooms were personalised with items that reflected their individual preferences and choices. People had the equipment that they were assessed as needing. We saw in one persons room that the protective bumpers on the bed rails were soiled, ripped and worn. Equipment should be reviewed to ensure that it is fit for purpose. A visitor told us the room is always clean. One person said Infection control needs to be better, the home can sometimes be a bit of a tip, we need a better environment for everyone. At the last visit to the home we were told that quotes were being obtained as the sink area was in poor condition. We found that this work had not been completed. The area around the sink has paint pealing off, chipped and broken tiles and the seals were split. This is the main kitchen are where meals are prepared and staff were unable to clean this properly. This must be addressed as it poses a potential infection risk. Care Homes for Older People Page 21 of 32 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. Staff may not always support people in a way they prefer or in a way that promotes their privacy and dignity. Arrangements for recruitment should ensure people are safe from harm. Evidence: There are two trained nurses on duty at all times. This increases to three during the day when the home has maximum numbers of people living there. There are nine care staff in the morning, seven in the afternoon and six at night. At our last visit a member of staff worked from 4pm until 11pm but this role had now been stopped. There had been some changes in the staff and there were some vacancies at the time of our visit. Shifts were being covered by agency staff. 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: There seem to be enough staff about Staff can be regimental in their approach They work in groups so if you ask some of the staff they dont know whats Care Homes for Older People Page 22 of 32 Evidence: happening with my relative Staff are alright, they always come back All the staff are kind and helpful We could not determine how many staff have completed a National Vocational Qualification (NVQ) as there was no training matrix. This was to be confirmed after our visit but this information had not been received at the time of writing this report. A visitor told us that there didnt appear to be any flexibility about toileting and this had been raised with the manager. A relatives meeting had been held and the manager had acknowledged that communication was a problem and was trying to address this. One person had been asking for staff to put cream on their skin following a shower and this was not done. The person had become upset by this and their relative also told us that she was upset that staff had not acted upon what she said. This does not ensure that staff are meeting peoples individual needs. In the surveys returned to us two people said that staff sometimes listened and acted on what they said and one person said usually. We looked at three staff files and these contained all of the information required to ensure that people were safe with one exception. This was one persons Personal Identification Number (PIN) had not been confirmed with the Nursing and Midwifery Council (NMC). This should be completed to ensure that the person is registered as fit to practise. The files were well organised and easy to follow. There was evidence that staff receive an induction into the home. We were not able to confirm what training staff had had as there was no training matrix available. We saw some records that some staff had completed supervision, medication training and risk assessment training this year. The manager had started to compile training records for individual staff but these records had only started in January 2010 and therefore did not tell us what training had previously taken place and what training is needed to ensure that staff have up to date knowledge. There were some training dates displayed on the notice board but it was not clear if any staff were attending this. Care Homes for Older People Page 23 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not run in the best interests of the people who live there. Evidence: Since our last visit, a new manager has been appointed and in post since approximately December 2009. The manager is a Registered Nurse and has experience in caring for older people and within management roles. The manager was on leave on the day of our visit. We have been told by the senior managers that an application for registration will be submitted to us. People told us: I havent met the new manager yet She seems like she will respond to things Care Homes for Older People Page 24 of 32 Evidence: A relatives meeting had been held in January and minutes of these were available. This gave relatives the opportunity to meet the new manager and discuss any concerns or ideas they had. There had not been any residents meetings held since July 2009. Staff meetings have been held however it is concerning that when concerns are identified, there does not appear to be any follow up. For example it was identified in a meeting that three of the bathrooms were full of none usable items and needed to be cleared so that people could have regular baths. Almost three weeks later when we visited most of the bathrooms had equipment in which meant that people could not use them. The responsible person told us that there had not been any surveys sent out to gain peoples views about the home. There had not been any regulation 26 visit reports completed since October 2009. These are unannounced visits by a senior person to monitor the quality of the service being provided. The responsible person was working at the home in a more active management role to support the new manager. It is therefore disappointing that the areas of concern had not been acted upon by the management in a pro active manner. We were not able to review the management of peoples money as the key was not available in the home. At our last visit peoples money was held safely and we have not had any concerns raised with us about this. We will review how peoples money is kept at our next visit to the home. We were unable to see a number of records such as servicing of hoists, gas safety, training matrix and fire risk assessments as they could not be located. These were sent to us following our visit but must be available for inspection. There was no evidence of staff participating in recent fire drills to ensure that they knew what to do in the event of a fire to keep people safe. The responsible person could not confirm when staff had had fire training. We left an immediate requirement for staff to participate in fire drills so that the homes management can be confident that staff have the knowledge about how to keep people safe. Three fire drills were completed following our visit and the responsible person sent us information about these. Following our visit we told West Midlands Fire Service of our concerns and they told us that they would visit the home. Management arrangements do not ensure that peoples views are sought. Infection control procedures were poor. People were not assisted to participate in outdoor activities. Risk assessments were not completed and peoples care needs were not always planned for. Documentation about skin sores was not followed up. There Care Homes for Older People Page 25 of 32 Evidence: appeared to be a lack of organisation and leadership in the home. This means that peoples needs may not be consistently met in a way that they prefer. Care Homes for Older People Page 26 of 32 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 All medicines must be stored 08/01/2010 in compliance with their product licences. This is to ensure their stability 2 9 13 All medicines must be stored 08/01/2010 in a locked facility at all times. This is to ensure that all medicines are safely held on the premise at all times. 3 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. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. 08/01/2010 Care Homes for Older People Page 27 of 32 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 38 23 All safe to participate in fire drills. To ensure they know how to keep people safe. 11/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must be written and provide staff with current information. So that staff know how to assist people to meet their assessed needs. 04/05/2010 2 8 12 Individual risk assessments must be completed. So that staff have guidance about how to assist people to manage risks and minimise potential of harm. 16/04/2010 3 9 12 All prescribed medicines 09/04/2010 must be available for administration This is to ensure that the service users is administered their prescribed medication as the doctor intended. Care Homes for Older People Page 28 of 32 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 13 The medicine administration 09/04/2010 record chart 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 reflect practice Staff must transport medicines throughout the home in a safe manner and all medicines must be held in a locked facility when left unattended This is to ensure that all medicines are safely held on the premise at all times. 09/04/2010 5 9 13 6 12 16 Provision of indoor and oudoor activities must be reviewed. So that people can continue to have an interesting and stuimulating lifestyle. 31/05/2010 7 26 23 Infection control procedures must be reviewed and acted upon. 16/04/2010 Care Homes for Older People Page 29 of 32 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 So that people live in a safe and clean environment. 8 26 23 Remedial work must be completed in the kitchen sink area. To ensure a safe and clean environment. 9 33 24 Systems must be in place to monitor the quality of the service provided. So that the home provides a quality service and acts upon peoples opinions. 10 37 17 Records must be available for inspection at the home. So that people can see that information and checks for health and safety are up to date. 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 30/04/2010 07/05/2010 23/04/2010 1 1 Information about the home should be current and relevant to the home. It should be available in a range of formats so that it is accessible to all people. Pre admission assessments should be fully completed so that the home can be confident it can met peoples assessed needs. A audit of peoples preferences to baths or showers and the equipment required should be undertaken, so that people Page 30 of 32 2 3 3 8 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 recieve baths or showers as they prefer. 4 5 6 9 10 12 It is advised that at least four hours elapse between medicine rounds to reduce the risk of potential overdose. Staff should promote peoples privacy and dignity at all times. The numbers of hours available for activities should be reviewed to ensure there are enough staff to support people with their leisure and social activities. Complaints records should be audited so that there is a clear audit trail and so that themes and trends are identified. Information about the complaints procedure should be updated so that people have relevant information. Managers should review staffs understanding of how to protect people from harm so that they follow the correct procdeure in the event of an allegation being made. Policies should be updated to ensure they have up to date information for staff to follow. Bathing facilities should be accessible to people at all times. An audit of equipment and linen should be completed to ensure it is fit for purpose. Nurses PIN should be checked with the Nursing and Midwifery Council to ensure they are registered and fit to practise. A training matrix should be available so that information about training undertaken and required is easy to retrieve. An application should be submitted for the registration of the manager as this will show a commitment to the home. Arrangements for access to peoples own money out of hours should be reviewed. 7 16 8 9 16 18 10 11 12 13 18 21 24 29 14 15 16 30 31 35 Care Homes for Older People Page 31 of 32 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). 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