Inspection on 13/07/09 for The Hurstway

This inspection was carried out on 13th 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hurstway 19/07/07

The Hurstway 20/09/06

The Hurstway 16/02/06

The Hurstway 17/10/05

The Hurstway 10/02/05

The Hurstway 02/06/04

The Hurstway 04/02/04

The Hurstway 21/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: The Hurstway 142 The Hurstway Erdington Birmingham West Midlands B23 5XN     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: 1 3 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 30 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 30 Information about the care home Name of care home: Address: The Hurstway 142 The Hurstway Erdington Birmingham West Midlands B23 5XN 01213500191 01213864225 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.heartofenglandcare.org.uk Heart Of England Care care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: Age: Dementia (DE) age 60 years and above. Physical disability (PD) age 60 years and above. 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 (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 59 Physical disability (PD) 59 Date of last inspection Brief description of the care home The Hurstway is a purpose built home located in a residential area of Birmingham, owned by The Heart of England Care charity. The home is registered to provide nursing care for up to 59 older adults and can accommodate people who may have dementia or a physical disability. At the front of the building is a car park for visitors, which includes disabled parking spaces. At the rear is a conservatory with an enclosed Care Homes for Older People Page 4 of 30 Over 65 0 0 59 59 Brief description of the care home garden, which provides a safe area for people to frequent during clement weather, and this is accessible via a ramp, which is suitable for wheelchair users. The accommodation is laid out over 2 floors, in 4 separate units, known as Primrose, Bluebell, Lavender and Jasmine. Each unit has a lounge/dining room for people to use. Bedrooms are for single occupancy with shared bathroom and toilet facilities. The home has three bedrooms, which have en suite facilities consisting of toilet, sink and shower. Downstairs there is a reception area with chairs and settees, which people can use and this includes a cinema area. There is a range of aids and adaptations designed to assist people with limited mobility, including a passenger lift between floors, a call system, grab rails and assisted bathing and toilet facilities. There are a variety of notice boards throughout the home, which provide information about the home which may be of interest to people. Copies of previous inspection reports are available on each unit and in reception. The current scale of charges for the home range from £536 per week for people who self fund. People who have care paid for by the local authority have separate contract prices and a top up fee of £21 is charged. En suite rooms have an additional charge of £54 per week. Additional charges include hairdressing, toiletries and newspapers. Care Homes for Older People Page 5 of 30 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 previous inspection took place on the 19th July 2007. An Annual Service Review (ASR) was undertaken on the 15th July 2008 and this showed the service continued to provide good outcomes for the people living there. The 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 56 people living at the home and one person was receiving care in the hospital. Information was gathered from speaking to people who live at the home and observing Care Homes for Older People Page 6 of 30 people. It was not possible to speak to a number of people due to communication difficulties. We spoke to two people who live at the home, one visitor and two staff. Two people were case tracked and we looked partly at two other files. 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 15 surveys to people who live in the home and their relatives, five to staff and two to healthcare professionals. Eleven people who live at the home, five relatives and four 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. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Information in care plans must be an accurate reflection of peoples current needs so that staff know how to assist people to meet their individual needs. Care Homes for Older People Page 8 of 30 Choices of food should be monitored so that people have foods that they like. People told us: The home could improve by having a different variety of foods and The cooking is not bad, but it could be improved The home must inform us and Social Care and Health of any incidents that may affect the safety and well being of people who live at the home. This is to make sure that people are safe. Staff must receive supervision so that their training needs and performance are monitored to ensure they have the skills and knowledge to meet peoples needs. 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 30 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 30 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 people have the information they need and that they can be confident that their needs will be met on admission. Evidence: The service user guide is widely available in the home as it is displayed in reception, on each unit and in each persons bedroom. The document contains information about the home so that people are able to make a decision about whether they would like to live there. Our contact details needed updating so that people know how to contact us if they need to. The document is available on audio cassette and in large print to enable people with visual impairments to access the information. The certificate of registration and liability insurance are on display in the reception area so that people can view these if they want to. Copies of our last inspection report and annual service review are available in reception and on each unit so that people can read these if they choose to. Care Homes for Older People Page 11 of 30 Evidence: Comprehensive pre admission assessments are undertaken prior to people coming to live at the home. This means that the home and the person being assessed, know that their individual needs can be met if they decide to move into the home. The AQAA told us that people can view the home without prior notice and that they can have trial visits to the home. This would enable people to sample what it would be like to live at the home and help them make an informed decision. People told us: Since moving in she has improved in her well being tremendously The home is an excellent home, mom is very happy The home does not offer intermediate care facilities, therefore this was not assessed. Care Homes for Older People Page 12 of 30 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. Staff do not always have enough or current information so that they can meet peoples personal and healthcare needs. 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 two others. Some of the care plans provided good details for staff to follow to meet peoples needs, and some plans contained personal preferences so that people should receive care in a way that they preferred. This was not consistent across all of the plans and some plans did not contain enough information for staff to know how to meet peoples needs. 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 Care Homes for Older People Page 13 of 30 Evidence: sore skin). Care plans reflected changes in dressings so that staff would know how to change the dressings correctly. Another file had a care plan that said someone had a sore on their spine and that there was a wound care plan in another folder. Daily reports stated that a dressing was in place but then the following day stated that there was no dressing and no wound. We were not clear if this person had a wound. The manager reviewed this at the time of our visit and confirmed that the person did not have any sore skin. This means that the documentation was not an accurate reflection of the persons needs. A member of staff told us that one person had an infection but there were no care plans in place for this and therefore not all staff may not know about the infection. This could result in other people acquiring the infection. A person who lives at the home had displayed some difficult to manage behaviour, which had resulted in other people being at risk from harm. There were some good details for staff to follow, but the plans didnt tell staff what to do when the behaviour occurred. The manager told us that noise was a trigger factor for the behaviour but this was not in the plan. The behaviour was more frequent at night and it was clear from records that staff had to be vigilant at this time but there was no management plan in place. This person had been seen by the psychiatric team and the home had asked for further advice from the Community Psychiatric Nurse. A meeting was to be held on the day of our visit and the manager was to follow this up. Moving and handling assessments were detailed and provided staff with details of the equipment to be used including sling sizes for hoists. People had nutritional risk assessments and people were weighed either weekly or monthly. One persons weight had dropped by 5.5kgs in one month and staff had not taken any action on this. We discussed this with the manager to see if the person had lost weight or if it was an error in the recording, however staff should have reviewed this again. Care plans were not always up to date so that staff had current information to follow. An example of this was one person who had had a social worker review had identified that they needed more showers, eye care, mouth care and facial shave. The care plans had not been updated twelve days later and this means that staff did not have current information to follow so that they could meet peoples needs in a way that they preferred. People had been supported to wear clothing and jewelry that met their needs and people were well presented. A visitor told us Mom is always clean and tidy. One Care Homes for Older People Page 14 of 30 Evidence: person who lives at the home had a wheezy chest and she told us that she had seen the GP about this. The management of medication was reviewed and was found to be robust. Medication Administration Records (MAR) were accurate and there were clear audit trails in place. This should mean that people receive their medication as prescribed. During the day we saw that two members of staff were wearing gloves while transferring people and this does not promote their dignity. This was brought to the attention of the manager at the time of the visit. Care Homes for Older People Page 15 of 30 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. People are offered a choice of meals, but these may not always meet individual dietary, cultural needs or preferences. Evidence: The home has three dedicated activity coordinators. There is a weekly activity programme which includes music, sing a longs, baking , games, arts and crafts, coffee mornings, cinema and flower arranging. In addition there is a twelve month plan where each month there is a specific theme such as Valentines Day or Easter. Other themes planned include a Hawaiian beach party and a Caribbean pirate week. During the morning we saw people involved in a karaoke and some people had music instruments such as tambourines, which they were enjoying with the music. In the afternoon there was a game of bingo and we observed the activity coordinator asking people if they wanted to join in this. Activities are organised on different units and people have the choice of attending the different units other than the one they live in. We saw photographs of people cooking and making pizza and making Indian head dresses. External entertainers visit the home and include a variety of talents to include singers, Care Homes for Older People Page 16 of 30 Evidence: musicians and comedians. The hairdresser visits once a fortnight to style peoples hair in a way that they like. A vicar attends the home and a priest gives Holy Communion each week for those people who wish to take this. This means that people can continue to follow their religious beliefs when they move into the home. The home has an open visiting policy and this enables people to maintain relationships that are important to them. There is a four week rolling menu and alternatives can be offered. In the surveys returned to us, seven people said that sometimes they liked the meals, two people said usually and one said always. These surveys were returned to us at the end of May. A regulation 26 report, a report which a senior manager writes once a month about the quality of the service, had highlighted at this time that there were concerns around the quality of the food and the home were working to improve this. It is recommended that is monitored to ensure that people receive food that they like. People told us: Sometimes we get a choice of food and sometimes not The food is adequate The home could improve by having a different variety of foods The cooking is not bad, but it could be improved Dining tables were nicely presented and were set with place mats. We sampled the lunch and observed staff. People were offered sauces with their meals and a choice of drinks and puddings. We saw that a member of the domestic team was helping someone to eat their meal and then we saw them with rubbish bags. We brought this to the attention of the manager as if this person was working on domestic duties it would not be appropriate to help with feeding due to risk of infection. A visitor told us that their relative had difficulty with meals due to poor sight and needed to use a spoon. We saw this person at lunchtime with a fork which was difficult for them to manage. Staff did provide her with a spoon after a short while but no plate guard was used to prevent food being pushed off the plate. We discussed this with the manager who said that this would be reviewed. The care plan was vague and stated offer assistance as required. This does not ensure that staff know how to assist people with the appropriate cutlery. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their views are listened to and acted on. Arrangements do not ensure people are safeguarded from harm. Evidence: The complaints procedure is displayed in the home and is included in the service user guide. The service user guide is available in each room so that people have access to the procedure if they need to make a complaint. Surveys returned to us by people living at the home told us that people knew who they could speak to if they were unhappy. People told us: I would tell the person in charge or one of the nurses if I was unhappy Staff are always on hand to deal with any concerns I am completely satisfied We have not received any complaints about the home. We looked at the homes records which showed that they had received five complaints since we completed the annual service review. The complaints were recorded clearly and included details of how they were investigated and what actions had been taken to resolve them. Care Homes for Older People Page 18 of 30 Evidence: The home had reviewed their adult protection policy and this included details of who to contact if an allegation was made. The policy said that incidents should immediately be investigated and this should be clarified as initially only details should be recorded. We discussed this with the manager at the time of the visit. The manager has raised two safeguarding alerts, for concerns when people had been admitted into the home. The cases were now closed. One person had been displaying some difficult to manage behaviour since April 2009 which potentially placed other people at risk from harm. There were records of incidents that had happened including a person who lived at the home being slapped by another person living at the home and pouring water over them on another occaision. Staff were also being hit by this person. Whilst there was no evidence that a safeguarding referral had been made, a care review was undertaken ten days after the initial incident and a psychiatric review had been undertaken for the behaviour. The home must ensure that any incidents which affect the safety and well being of people living in the home are reported to the relevant people so that people are safeguarded from harm. Following the inspection the manager sent us some subsequent information for the management of this behaviour to reduce the risk of harm to other people. One person living at the home had a Deprivation Of Liberty Safeguarding in place. This means that a decision had been made about the persons care for their best interests. This decision had been made prior to them moving into the home and the home had the appropriate records to support this. Staff training records showed that people had received training in the protection of vulnerable adults (POVA) and one staff member told us that she was due to have this training. Care staff have not had any training on the Mental Capacity Act or the Deprivation of Liberty Safeguards. This is recommended so that staff know the implications of this legislation for the people who live at the home. Care Homes for Older People Page 19 of 30 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: The home has ramped access so that people who use wheelchairs can enter the home safely. We looked around some parts of the home relevant to the people we case tracked. Each unit has its own dining area and lounge but people can move between the units if they choose to and we observed some people doing this throughout the day. The reception area includes the cinema and has settees for people to use. The home was clean and odour free. In the surveys returned to us by people living at the home, nine of the eleven people said this was always how the home was. Bedrooms are for single occupancy and rooms seen were personalised and decorated differently to reflect peoples individual choices.The home has three bedrooms which have en suite facilities, which include a toilet,sink and shower.One person had a ripped chair in their room and the locker needed replacing and this was brought to the managers attention.The manager advised that these would be replaced to ensure that the person has a homely and safe environment. Since our last visit the home has developed a sensory area on Primrose unit which Care Homes for Older People Page 20 of 30 Evidence: includes fibre optic lights and projectors.There are a number of touch and feel boards throughout the home which will help to stimulate people who may not be able to communicate their needs verbally. A number of new profiling beds have been purchased so that staff can alter peoples positions more easily. The garden area is accessible for people who have mobility difficulties and is well maintained.The home has plans for a sensory walkway and the plans were on display in the reception so that people could see them.The home are being helped to complete this by a local university and hopes it will be completed by the middle of August this year.There was a foxes den in the garden, and one person told us she had gone to sit in the conservatory so she could watch the foxes come out. Care Homes for Older People Page 21 of 30 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: The Annual Quality Assurance Assessment (AQAA) told us that the home had had an increase in the number of staff vacancies over the last 12 months and this had resulted in the need to use agency staff. The manager told us that the use of agency staff had been reduced following successful recruitment of permanent staff. Where agency staff were used they tried to use the same staff so that there was some continuity of care for the people living in the home. Since our last visit the staffing levels have increased during the morning to meet the varying needs of the people who live at the home. During the morning there are four trained nurses and twelve care staff on duty, two nurses and eight carers in the afternoon and two nurses and six care staff throughout the night. In addition to the nursing and care staff the home have domestic, laundry, administrative, kitchen and maintenance staff to ensure that all of the needs of the people living in the home are met. People told us: Care Homes for Older People Page 22 of 30 Evidence: The staff are alright Staff are anxious to make the patients as happy and comfortable as possible Staff are always helpful 80 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. We looked at three staff files and these contained all the required information to ensure that people were safe from harm. Induction records were seen and this ensures that new staff are given a basic induction into the home. The organisation has a dedicated trainer and the manager meets with her each month to review the training needs in the home. We looked at the training records for the staff files we reviewed and staff had received training in fire, moving and handling, safeguarding, food hygiene, dementia, health and safety and control of substances hazardous to Health (COSHH). This should ensure that staff have current knowledge about how to meet peoples needs. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of people as people are not always protected from harm. Evidence: The Registered Manager is a Registered Nurse and has worked at the home for a number of years. She has completed the Registered Managers Award and completes training courses to ensure that she has up to date knowledge in order to lead the staff team and ensure that peoples needs are met. People told us: The managers are approachable and I speak to them often The home runs very well The manager delivers good care The home had reported some safeguarding concerns. However there had been some Care Homes for Older People Page 24 of 30 Evidence: incidents at the home which should have been reported as safeguarding to ensure that people are safe. This showed some inconsistencies with practice. We discussed this with the manager who said that in hindsight it should have been referred and said she would arrange for a review meeting to be held. Staff meetings are held and minutes were seen. These meetings ensure that staff are kept up to date with and changes and give them the opportunity to raise any ideas or concerns. The last resident and relative meeting was held in November 2008. The manager told us that relatives had said the meeting was too big and that they would prefer the meetings to be held on each unit separately. The manger acknowledged that this is an area to be developed as this will give people the opportunity to share any ideas or concerns and have some input into how the home is run. There is a quality assurance system at the home. This is matched to the National Minimum Standards and different standards are audited throughout the year. Satisfaction questionnaires are sent out to people and the results are formulated into a report, which includes actions to be taken to improve the service. This report was displayed on each unit. The managers undertake night spot checks to monitor the service offered during the night and also complete audits such as care plans, medication and infection control. External managers visit the home each month and write a report about the quality of the service. These reports were reviewed and highlighted areas for improvement and how this could be achieved. 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. Some staff had received formal supervision which is an opportunity to discuss training requirements, or any concerns with performance. We looked at supervision records for the staff files we looked at. One staff had started work in September and one had started in October, but neither staff member had had supervision until February. Another person who had started work in April had no supervision recorded. In the five staff surveys returned to us three staff said they had regular support, one said often and one said sometimes. This suggests that supervision is not being received at least six times a year by all staff. This now needs to be addressed as it has been identified at the last two visits to the home. Care Homes for Older People Page 25 of 30 Evidence: Robust health and safety and maintenance checks had been undertaken in the home to ensure that equipment was in safe and full working order. We saw that the floor in the lift was torn and could be a potential trip hazard. The manager confirmed that this had happened on the day of our visit when new beds were delivered to the first floor, and would be be repaired. We recommended that the tears were taped until it could be fully repaired to reduce the risk of anyone tripping over. There was on going fire training for staff and weekly checks were made on equipment to ensure that it was working. Some fire extinguishers had recently been replaced and this should ensure that people are safe in the event of a fire. Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must provide accurate information. So that staff know how to meet peoples needs. 11/09/2009 2 18 13 The relevant authorities 17/08/2009 must be informed of incidents that may affect the safety and well being of people. So that people are protected from harm. 3 36 18 Staff must receive supervision. So that they are given the opportunity to discuss training needs and performance. 30/09/2009 Care Homes for Older People Page 28 of 30 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 10 10 15 18 18 Peoples weight should be re checked when there is a significant change so that action can be taken if needed. Practises should be reviewed when people are transfered so that their dignity is maintained. The menus and options should be monitored so that people receive foods that meet their individual needs. Policies should be clear so that staff know what to do to protect people from harm. Staff should receive training in new legislation so that they know how to safeguard people and act in their best interests. People should be involved in meetings about the home so that they are given the opportunity to discuss ideas and concerns. Potential trip hazards should be made safe so that people are safe from harm. 6 32 7 38 Care Homes for Older People Page 29 of 30 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. 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. 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