Inspection on 26/06/09 for Two Gates House

This inspection was carried out on 26th June 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Two Gates House 17/04/08

Two Gates House 28/01/08

Two Gates House 24/09/07

Two Gates House 01/02/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ     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: Ann Farrell     Date: 2 6 0 6 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 37 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 37 Information about the care home Name of care home: Address: Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ 01384567448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellmun Care Limited Name of registered manager (if applicable) Mrs Reshma Wellington Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The home is a large, detached; two storey building that has recently been extended. It is situated two miles from Halesowen town centre and is within walking distance of local shops. There is off road parking to the front of the building with a large garden to the rear that has recently been landscaped with patio and seating for use when the weather permits. They provide care and accomodation for elderly people who require support. The service does not provide nursing care. Accommodation comprises twenty six single bedrooms and the majority of them have en-suite facilities. There are two bathrooms on each floor; two have assissted baths and two have showers, so people have a choice of bathing facility to meet their needs. There are two lounge/dinging areas on the ground floor providing people with a choice of areas to sit. A passenger lift enables people to access all areas of the home and the home has a Care Homes for Older People Page 4 of 37 0 Over 65 17 Brief description of the care home range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, toilet seats. There is a leaflet, service user guide, statement of purpose and web site providing inforamtion for people who are considering moving into the home. Information indicated fees ranged from £372- £435 per week, but people are advised to seek up to date information about the fees and costs of any extras at the time of making enquiries. Care Homes for Older People Page 5 of 37 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs and focuses on aspects of service provision that need further development. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. Care Homes for Older People Page 6 of 37 The inspection was undertaken over one day by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection the home was full and information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, 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, training records and health and safety files were also examined. At the time of inspection six people who live in the home, two visitors and five staff were spoken with in order to gain comments. Surveys were also received from from six from people living in the home and four relatives prior to the inspection. Feedback and comments were mixed and examples can be seen throughout the report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? The information for people considering moving into the home had been improved, which were available in written format and information was also available on the internet, so people had a range of information to assist them in making a decision about moving into the home. Care plans were clearly presented and accessible to people living in the home, relatives and staff, so they had information about the support being provided to meet peoples needs. A new medication trolley had been purchased for the safe storage of medication. The home has a wireless broadband network and they are planning to make the internet available to people living in the home, so they can keep in touch with friends and relatives who live far away. An extension has been completed, which provides eleven new en suite bedrooms, an extra assisted shower/wet room, a new assisted bathroom, a new laundry room, a new Care Homes for Older People Page 8 of 37 central heating system, a new lounge and conservatory area enhancing the environment for people living in the home. The kitchen has been refitted to a commercial standard ensuring good hygiene standards. The garden has been landscaped, so people can benefit from sitting outside in the summer months. Ramped access has been provided, so access in and out of the building is more suitable for people who use wheelchairs. Since the completion of the extension the number of staff on duty during the day has increased to meet the needs of the increased number of people living in the home. One of the proprietors is now registered with us as the manager and is working to improve standards and outcomes for people living in the home. What they could do better: Staff should liaise with health and social care professionals during the assessment process in order to obtain information, so they have details about peoples past medical history. A review meeting should be held at the end of the trail period, to provide the opportunity for the person, family and significant others to discuss whether they wish to continue living in the home; if their care needs are being met or any changes are required and records should be retained of the discussion and outcome. Care plans should have more comprehensive details about the support people require, so care is individualised and peoples needs are met in a consistent manner. Daily records must clearly indicate follow up of concerns and peoples health, social and psychological welfare, so that care can be monitored. Records of health and social care professionals visits should be on a separate sheet and include the reason for the visit and outcome, so that care can be monitored and followed up effectively. Staff should be given training in respect of tissue viability (skin care) and health conditions to enhance their knowledge and understanding of peoples needs and ensure they are met effectively. A review of all bed rails should be undertaken and action taken to ensure they are of sufficient height to safeguard people when they are in bed. Staff should be provided with training in respect of risk assessments and the risk assessment format for some areas should be reviewed, so they are effective, staff have the knowledge to undertake risk assessments effectively and people are safeguarded. The manager should liaise with the GP practice about monitoring of chronic diseases, to ensure peoples well being is maintained. Care Homes for Older People Page 9 of 37 The bathing arrangements should be reviewed, so that effective systems are in place to meet peoples personal care needs. Peoples BMI should be recorded in conjunction with the nutritional assessment and weights. Where people are loosing weight or of low body weight staff should monitor diet and fluid intake and boost calorie intake. If there are no improvements a referral to health professionals should be made, so that people are receiving appropriate interventions to maintain their well being. The medication system needs to be more robust to ensure safe systems and people receive the medication prescribed for them. A suitable plan of activities should be drawn up and implemented with records to ensure people are suitably stimulated and their well being maintained. A review of the quality and choices of meals should be undertaken and action taken to improve meal provision, so that it meets peoples needs and expectations and their well being is maintained. The complaint procedure must be updated to reflect peoples right to contact Social Services and us with any concerns/complaints at any stage. Systems should be implemented to record informal concerns/complaints and the action taken to address them to demonstrate a proactive approach and continuous improvement. All staff must receive training in respect of safeguarding, the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with thier position, so people are protected and supported appropriately A review of toilet chairs should be undertaken and sufficient provided to meet peoples needs. Staff hand washing facilities should be provided in bedrooms where personal care is provided, in order to reduce the risk of cross infection. A review of staffing levels and deployment of staff should be undertaken and appropriate action taken to ensure there are adequate staff on duty at all times to meet peoples needs in a timely and person centred manner. Staff should be provided with training in respect of infection control plus health and safety, so they have the knowledge to reduce the risk of cross infection and ensure peoples safety. The quality assurance systems should be developed further with the development of audits, meetings etc, to improve the process of feedback and continuous development. Staff supervision should be undertaken regularly, so that staff receive the appropriate support and direction to ensure good outcomes for people living in the home. Systems should be in place to check emergency lighting and wheelchairs on a regular Care Homes for Older People Page 10 of 37 basis to ensure they are fit for purpose. 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 11 of 37 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 12 of 37 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. Information is available for people moving into the home to assist them in making a decision about moving into the home. The assessment process could be developed further, so staff are provided with information about peoples past medical history ensuring needs are met. Evidence: The home had a leaflet, service user guide and statement of purpose available for people who were considering moving into the home. These documents provide them with information about the services and facilities to assist them in making a decision about moving into the home. They also have a web site if people wish to use the internet to access further information. The home provides residential care for people who require long term or respite care. The manager stated they go out to assess people before they move into the home to Care Homes for Older People Page 13 of 37 Evidence: determine if the home is able to meet their needs. One file was looked at for a person who had recently moved into the home. A pre service assessment had been completed and provided details about a range of physical and mental care that would be required, so staff could determine if the persons needs could be met in the home. The manager should also consider obtaining a copy of the social workers assessment and contacting GPs to enhance the assessment process and provide information about peoples health needs/past history. People can visit the home before moving in so they can have lunch, view the facilities, meet staff and other people who live there in order to sample what it would be like to live there. On discussion with one person they stated they had visited the home to look around before they moved in. Information from surveys indicated five of the six people received enough information to help them decide about moving into the home and they had been given written information about the homes terms and conditions. The service user guide indicated there was a trial period of one month and a review would be held at the end of the trial period. However, on inspection of the file for a new person there was no record of a review meeting taking place. This provides opportunity to discuss whether the person would like to continue living there and if their care needs are being met or any changes are required. This area will need to be reviewed and developed in order to provide this opportunity. Care Homes for Older People Page 14 of 37 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. The systems for recording and meeting peoples health care needs should be more comprehensive to demonstrate needs are being met effectively. The medication systems need to be more robust to ensure safe systems in the home and people receive the medication prescribed to them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, tissue viability, (skin care) nutrition, falls and bed safety rails. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Care Homes for Older People Page 15 of 37 Evidence: The care plans were typed documents and they re-typed each month. Copies are put in peoples bedrooms, so they are accessible to staff, the person living in the home and their families, so that everyone is aware of the support provided. Generally they were of a fairly good standard, but lacked detail in some areas e.g. care of stomas; diabetes; the type of hoist and size of sling; type of cream to be used and where it should be applied etc. In one case there were two different documents for the same month. On discussion with a senior carer who was responsible for typing care plans she stated the manager and herself had completed one for the same month, but now she was going to be doing all of them. They have also implemented systems to make it clear where changes had occurred in peoples care plans, as this was not in place previously, so that the information is more readily accessible to staff who are caring for people. Risk assessments were in place for tissue viability and there was no guide for staff to indicate if the person was at risk. When the senior carer was asked about it she could not explain it to us and had to seek advice from the manager. There was evidence that district nurses had visited and pressure relieving equipment was in place e.g. mattress and cushion. However, there was no evidence of any other strategies for prevention of pressure sores such as regular pressure relief and the person was observed to be sitting in the lounge all morning. The risk assessment in respect of bed rails were general risk assessments and did not highlight the various aspects to be taken into consideration when considering bed rails for the safety of people in bed. On inspection it was found that the bed rails were not sufficiently high enough to safeguard the person, as pressure relieving equipment was used on top of the mattress. This area will need to be reviewed and action taken to ensure peoplw who use bed rails when in bed are safe. A risk assessment in respect to nutrition is used in conjunction with record of body mass index (BMI) and regular weights to assess peoples well being and determine if any interventions are required. On inspection it was noted that a risk assessment for two people had indicted a low risk, the BMI had not been completed and they were of a low body weight or had lost some weight. In another case one person was loosing weight and although staff had discussed the person with the GP there was no action taken to monitor their food intake or boost their calorie intake. Staff need to be more pro-active in this area. Staff will need training in respect of risk assessments plus areas such as tissue viability, nutrition and health conditions to provide them with the knowledge to ensure Care Homes for Older People Page 16 of 37 Evidence: peoples needs are met effectively. Staff recorded daily records for each person. However, in the sample of records seen they were all very similar and the information was not comprehensive with entries such as; -----appears fine, sat in lounge. In one case where there were some concerns about a person the daily records still indicted they were fine and sat in the lounge. The information lacked detail about peoples health, social and psychological welfare and this will need to be addressed. Records of bathing indicated people were offered weekly baths. On discussion with some people they confirmed they had weekly baths, which they were satisfied with. In one file it was noted the person had refused a bath on their bath day and records indicated they were offered a bath again a week later. Staff should be more proactive in determining the reason for declining the bath and implementing other strategies to support people with bathing. Feedback from surveys; one person told us they always received the care and support they needed; one person told us they usually received it and three people told us they sometimes received the care and support they required. Three people told us there was usually enough staff and three told us there was sometimes enough staff to support them. Comments at the time of inspection included; Staff are very kind and they do what they can. Sometimes have to wait a long time to go to the toilet. This morning staff had to keep leaving me to do other things. The girls are very good. I could not fault any of the staff, they are most obliging. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP was in agreement). It was stated people living in the home had access to Health and Social Care professionals, but records did not demonstrate this was occurring on a regular basis. There was a system to record visits from health care professionals on a separate sheet previously, but this had been changed and it was recorded in the daily records, so we could not confirm that people were having the opportunity of regular visits to ensure their well being. Records for one person were seen in respect of GP Care Homes for Older People Page 17 of 37 Evidence: interventions, but the reason for the intervention and outcome were not always clear. Also there was no evidence of monitoring of chronic diseases such as diabetes, high blood pressure, asthma, etc. to ensure peoples well being is maintained. Staff will need to follow up these areas to demonstrate peoples health needs are being met effectively. Also they will need to liaise with the GP practice about monitoring of chronic disease to ensure peoples well being. Information from surveys told us that four out of six people received the medical care they required. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in locked trolleys, but only one was secured to the wall as required for safety. On inspection of the medication it was found that the prescriptions are sent directly from the GP to the pharmacist to dispense medication. This is not appropriate as the staff must check all prescriptions before they go to the pharmacist to ensure they are correct. When medication is received in the home there must also be robust systems to check that the medication received is what was ordered, is correct and MAR sheets are available to record the administration of medication. On inspection of medication for the current month they were found to be correct for the majority of audits. However, some medication could not be audited as there was no record of the amount of medication at the beginning of the month. Also there was no MAR chart or record of administration of medication for one person for three to four days; handwritten medication details had not been signed by a member of staff, and these should be countersigned by two members of staff to ensure robust procedures. Some creams and eye drops had not been dated on opening and so it could not be demonstrated that they were used within appropriate timescales, to reduce the risk of cross infection. The system for controlled medication was more concerning. This system requires two staff to sign for each step and it was found that staff did not sign for the receipt of medication and on some occasions only one member of staff had signed for the administration of the medication. There were gaps in the controlled record book and on discussion with the senior carer she stated they had been left as staff had not recorded the administration of the medication at the time. Initially the record for one medication was not accurate and on investigating further it was found that a senior member of staff had administered it the previous day and had not recorded it in the controlled drug book. We found it had been recorded on the MAR chart to verify that it Care Homes for Older People Page 18 of 37 Evidence: had been given, but it had only been signed by one member of staff. Also the running total for another medication was not accurate, but later we found that it had been calculated incorrectly by the staff, who had checked it. The record of controlled medication returned to the pharmacist some time ago was not accurate. This was very concerning as this process should be checked by two people at all stages and it raises concerns as to whether the staff are following the correct procedures. The manager shoudl be undertaking regular audits of medicaiotn to ensure systems are robust. People seemed to be well supported by staff to choose clothing appropriate for the time of year which reflected their individual culture, gender and personal preferences. Also staff were seen to knock on peoples bedroom doors before entering. The service user guide informs people that they can have a telephone in their own bedrooms at their own cost. Also a hands free set is available in the home for private calls if they wish. There are two lounges, so people can have a choice of areas to sit and meet visitors. Bedroom doors had locks and lockable facilities were available in the bedrooms inspected, so people can have keys to them if they wish to enhance their privacy. Care Homes for Older People Page 19 of 37 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. Arrangements for visiting the home were flexible, so people are able to maintain important relationships. Arrangements in respect of activities and meals need to be reviewed and action taken to improve both areas, so people are provided with choices, they are adequately stimulated and their well being is maintained. Evidence: People who live in the home can go outside on their own or with friends and family as they choose, depending on their abilities. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. Feedback from people included; I get up and go to bed when I want now. I have made friends here. I can visit at any time. Care Homes for Older People Page 20 of 37 Evidence: We noted that an assessment in respect of social activities formed part of the admission process providing staff with valuable information about peoples interests etc. However, these were not consistently completed for the people case tracked. Records of activities indicated there had been some board games, plus bingo and singing once since the beginning of the year. On the day of inspection ladies were having their nails painted. On discussion with staff they stated that when they had asked people about activities they enjoyed in the past some had got upset, as they could no longer do them. Feedback from surveys and at the time of inspection indicated people did get bored and would appreciate more activities; Comments included; Bored is not the word for it I dont do anything during the day; watch television and watch people Have more things to keep us busy Need some activity There were opportunities for people to follow their own religion ensuring their religious needs are met and a religious service is held in the home regularly. There is a four week rotating menu with a set meal and pudding for lunch with the exception of Friday where there was a choice of fish or egg with chips and peas. Breakfast consists of cereals/porridge and toast and on the day inspection we were informed there had been no porridge for five days, so people had to have an alternative. We noted that staff served cereals and a drink to people in the lounges, but there was a lack of attention to detail as one person was given their cereal and drink, but there was no sugar in it. The member of staff walked away, so the person was unable to do anything about it. Feedback in respect of meals was very varied three surveys told us they usually liked the meals; one told us they sometimes liked the meals and two had been left blank. Comments received included; Meals are alright Food could be better Food good, but cold sometimes; get a choice of puddings. By enlarge they would have a job to do better Care Homes for Older People Page 21 of 37 Evidence: Meals going from bad to worse Stick to agreed mealtimes There are two dining rooms and tables were well presented for lunch with condiments, cutlery etc. On the day of visiting people were offered a choice of fish or egg and chips. A review of the arrangements for meals and activities should be undertaken with people living in the home, so that action can be taken to improve these areas in order to enhance peoples lifestyle and well being. Care Homes for Older People Page 22 of 37 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 systems in place to protect people. Staff training needs to be more comprehensive to ensure they have the knowledge to protect people effectively. Evidence: A complaints procedure was available and a copy is in the service user guide. The procedure states that complaints should be forwarded to the manager/proprietor who will investigate. Also it states In the event of there being no satisfactory resolution to a serious compliant the residents or relative will be advised to outline the grievance in writing to Care Quality Commission. People have a right to raise cocnerns with Socail Servcies and us at any time and the complaints procedure needs to be changed to reflect this information. We have received two complaints about the home, which were referred to the manager for investigation. One was in relation to the admission of a person to the home and one was about the administration of mid day medication. The manager has responded to us in writing with explanations about both matters. The manager informed us in the AQAA they had received three complaints; two had been responded to within 28 days and were upheld. The third one is in the process of being investigated. We have been informed that the manager has not responded to complaints/allgations as expected. Care Homes for Older People Page 23 of 37 Evidence: The AQAA also stated, We have a comprehensive complaints folder which contains all written complaints received and how these have been dealt with and these were seen at the time of inspection. The manager will also need to look at a system for recording and dealing with informal complaints/concerns, so that there is a proactive approach and continuous improvement. The manager made one safeguarding referral to Social Services, which they have investigated and dealth with, so the person is safeguarded. Approximately half the care staff had undertaken training in respect of safeguarding, so they are aware of the procedures in the event of any allegation of abuse. On discussion with a sample of staff some were aware of the procedure in the home, but others were not. The manager had received training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards, but care staff had not received the training/information about these important pieces of legislation. Systems will need to be put into place to ensure all staff receive training about safeguarding, the Mental Capacity Act and the Deprivation of Liberty Safeguards, so they are aware of their responsibilities in respect of safeguarding people and how to support them if they lack capacity to make decisions, commensurate with their position in the home. Care Homes for Older People Page 24 of 37 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 live in a homely, clean and comfortable environment. Evidence: The building is a large, detached; two storey building that has recently been extended. It is situated two miles from Halesowen town centre and is within walking distance of local shops. There is off road parking to the front of the building. To the rear is a fairly large garden that has just been landscaped with patio and seating for use when the weather permits. A partial tour of the home was undertaken and it was found to be warm, clean and maintained to a satisfactory standard. The atmosphere was calm and relaxed and there were no unpleasant odours. Feedback from surveys indicated the home was always/usually clean and fresh. There are two lounge/dining rooms, so people have a choice of areas to sit and eat their meals. The extension has only recently been completed and provides a very pleasant area to sit. The lounge/dining area has a glass roof and although the temperature was satisfactory on the day of inspection care will need to be taken to ensure the heating and ventilation is satisfactory when there are extremes in the weather, as it was stated that it was cold during the winter. The original lounge/dining area were showing signs of ware and were in need of re-decoration. The manager stated they would be the next areas to be re-decorated. Care Homes for Older People Page 25 of 37 Evidence: There are two bathrooms on each floor and they were provided with liquid soap and paper towels. Two of them have baths with hoists and two have showers, so people have a choice of bathing facility to meet their needs. A large number of bedrooms had en- suite facilities. However, some of the en-suite facilities in the original building had a shower base fitted, but no working shower. The proprietors are looking at what action to take about this. It was also noted that there were no hand washing facilities (liquid soap and paper towels) in bedrooms where staff undertook personal care for people. This needs to be addressed in order to reduce the risk of cross infection. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. People are able to bring in their own possessions in order to have familiar items around them to make their bedrooms more homely. A call bell facility was available in each bedroom, so people can call for assistance if required. Lockable facilities were available for the storage of valuables and locks were on bedrooms doors, enhancing the arrangements for privacy. One person stated, I have a nice big bedroom. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, toilet chairs. However, it was found that there were only three toilet seats and staff are currently moving them from en-suites to communal toilets in order to meet peoples needs. A review of this needs to be undertaken and sufficient purchased to meet peoples needs. The laundry equipment was adequate to allow sluice and pre-wash cycles and staff had aprons and gloves available to reduce the risk of cross infection. However, less than half the staff had received training in respect of infection control. This area will need to be addressed to ensure good infection control practices. Care Homes for Older People Page 26 of 37 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. The recruitment of new staff was satisfactory ensuring people are protected. Further staff training and a review of staffing levels/deployment should be undertaken to ensure there are adequate numbers of trained staff to meet peoples needs in a timely and person centred manner. Evidence: On the day of inspection there was a manager, senior carer and three care staff on duty. The duty rota indicated there was one senior carer and three care staff on duty each day 7am to 9pm and two care staff overnight. The duty rota indicated the manager or senior carer was on call each week, so that staff were provided with support when a senior person was not on duty. Ancillary staff such as domestic/laundry and catering staff support care staff. Comments received from people living in the home and visitors included; Staff are very kind and they do what they can. The girls are very good. I could not fault any of them; they are most obliging. The staff are extremely helpful. As identified earlier in the health and personal care section feedback indicated some people felt there needs were only met sometimes and there were sufficient staff on duty only sometimes. Comments were made about having to wait a long time to be taken to the toilet or helped with getting up in the morning. Also responses to their Care Homes for Older People Page 27 of 37 Evidence: own questionnaires indicated a need for more night staff. The manager will need to review this area to determine needs of people at various times of the day and ensure the appropriate deployment and number of staff are on duty at all times to ensure peoples needs are met in a timely and person centred manner. Recruitment records for new staff were sampled and showed that appropriate recruitment checks had been made to ensure staff were suitable to work with vulnerable adults before they commenced work in the home, so people were protected. New staff undertake induction training when commencing employment to the home, so they are familiarised with the homes policies and procedures etc. The manager stated they would undertake the Social Skills Council induction training if they did not already have National Vocational training. The manger stated the homes induction training is undertaken over four induction days and there was a three month probationary period for new staff. There is a rolling programme of staff training and records indicated that a range of training had taken place, which included fire safety, manual handling, food hygiene, health and safety, safeguarding, first aid, medication, dementia awareness and infection control. The manager stated training is arranged for later in the year in respect of first aid, manual handling, fire safety and staff were also going to be commencing a distance learning dementia course, so that they have the skills to care for people who have dementia, now that they are registered to care for this group of people. The training matrix indicated ten staff had completed National Vocational Training (NVQ) level 2 in care and three staff were currently undertaking the training. Also four staff had completed NVQ level 3 and two staff were in the process of undertaking the training. Training provides staff with the knowledge and skills to support people living in the home. However, it was noted from the information provided that only half the staff had undertaken training in respect of safeguarding and less than half had undertaken training in respect of health and safety, infection control and only one person had undertaken training in respect of risk assessments. Also there was no training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards. These areas will need to be addressed, so all staff have the knowledge and skills to support people effectively. Care Homes for Older People Page 28 of 37 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. Systems are in place to ensure the health, safety and protection of people living in the home. The quality assurance system needs further development. Evidence: The manager, who is also the joint provider, has completed the Diploma in Social work and NVQ level 3 in care. She is registered to undertake the managers award and is registered as the care manager with us. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The manager stated they do not act as appointee/agent for people in the home, but assist with personal allowances. Individual records were maintained for people where the home holds money on thier behalf and receipts were available to confirm expenditure on peoples accounts. However, receipts from the hairdresser were not dated or signed and this will need to be followed up with them. The balance of monies checked was found to be correct. This should ensure that peoples monies are held safely. Care Homes for Older People Page 29 of 37 Evidence: Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed. The document gave some information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home and it was completed to a satisfactory standard. The manager had sent out surveys to people who live in the home or family, district nurses and chiropodist in order to gain feedback for the quality assurance process. The information had not been collated, but we were shown some and the comments received. They identified that more toilet chairs and activities were required. Also there was a comment about requiring more night staff. These areas were feedback to us through surveys and the inspection and will need to be reviewed. There was no evidence of any audits to support the quality assurance system and the proprietors stated they did this informally as they spent a lot of time at the home. It was recommended that this should be reviewed, so that they could identify areas of improvement and put appropriate action plans into place to demonstrate a proactive approach and continuous development. An example of this was in relation to accidents as there was no auditing to determine if there were any trends or areas that needed changing and this was discussed at the time of inspection. A number of other areas need to be addressed as highlighted throughout the report to ensure robust systems are in place and everyone receives care that meets their needs in a consistent and person centred manner. Records indicated that two staff meetings had occurred this year, but there was no record of meetings with people living in the home and on discussion with some of them they stated meetings did not occur. The sample of records in relation to staff supervision indicated it had occurred twice in the last year. It is recommended that this be increased, so that staff receive the appropriate support and direction to carry out their role effectively. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and full working order. Checks were completed on the fire system and equipment, so that people should be safe in the event of a fire occurring. Areas where action is required is in relation to regular in house checks on the emergency lighting and wheelchairs to ensure they are in effective working order. Care Homes for Older People Page 30 of 37 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 31 of 37 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 8 13 An audit of all bed rails must 26/07/2009 be undertaken and appropriate action taken to ensure they are suitable and of sufficient height. To ensure the safety of people whilst in bed. 2 9 13 All creams and eye drops must be dated on opening and discarded within appropriate timescales. To reduce the risk of cross infection. 27/07/2009 3 9 13 All controlled medication 27/07/2009 must be checked and signed by two people upon receipt, administration and disposal. To ensure a robust system is in place and people are safeguarded. Care Homes for Older People Page 32 of 37 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 Staff must ensure the accurate administration and recording of all medication. So people receive the medication prescribed for them. 27/07/2009 5 9 13 Two staff must countersign all handwritten medication details. To ensure a robust checking system is in place and people receive the correct medication. 27/07/2009 6 9 13 The medication trolley must be secured to the wall. To ensure the safe storage of medication. 27/07/2009 7 9 13 Staff must record the 27/07/2009 amount of medication at the beginning of each month. So that auditing of medication can take place. To ensure robust medication systems are in place 8 9 13 Systems must be in pace for 26/07/2009 staff to check all prescriptions before they are sent to the pharmacist. Also there must be robust systems for checking medication entering the home to ensure it is correct. Care Homes for Older People Page 33 of 37 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 To ensure robust medication systems are in place and people receive the medication prescribed for them. 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 3 A review meeting should be held at the end of the trial period, to provide the opportunity for the person, family and significant others to discuss whether they wish to continue living at the home; if their care needs are being met or any changes are required and records should be retained of the discussion and outcome. It is recommended that staff should liaise with health and social care professionals during the assessment process in order to obtain information, so they have details about the persons past medical history. Daily records must clearly indicate follow up of concerns and peoples health, social and psychological welfare. Care plans should have more comprehensive details about the support people require, so care is individualised and peoples needs are met in a consistent manner. Peoples BMI should be recorded in conjunction with the nutritional assessment and weights. Where people are loosing weight or of low body weight staff should monitor diet and fluid intake and boost calorie intake. If there are no improvements a referral to health professionals should be made, so that people are receiving appropriate interventions to maintain their well being. The bathing arrangements should be reviewed, so that effective systems are in place to meet peoples personal care needs. 2 3 3 4 7 7 5 8 6 8 Care Homes for Older People Page 34 of 37 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 7 8 The manager should liaise with the GP practice about monitoring of chronic diseases, to ensure peoples well being is maintained. Staff should be provided with training in respect of risk assessments and the risk assessment format for some areas should be reviewed, so they are effective, staff have the knowledge to undertake risk assessments effectively and people are safeguarded. Staff should be given training in respect of tissue viability and health conditions to enhance their knowledge and understanding of peoples needs and ensure they are met effectively. Records of health and social care professionals visits should be on a separate sheet and include the reason for the visit and outcome, so care can be monitored and followed up effectively. A suitable plan of activities should be drawn up and implemented with records to ensure people are suitably stimulated and their well being maintained. A review of the quality and choices of meals should be undertaken and action taken to improve meal provision, so that it meets peoples needs and expectations and their well being is maintained. Systems should be implemented to record informal concerns/complaints and the action taken to address them to demonstrate a proactive approach and continuous improvement. The complaint procedure must be updated to reflect peoples right to contact Social Services and us at any stage of their complaint. All staff must receive training in respect of safeguarding, the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with the position, so people are protected and supported appropriately. Provide staff hand washing facilities in bedrooms where 8 8 9 8 10 8 11 12 12 15 13 16 14 16 15 18 16 26 Care Homes for Older People Page 35 of 37 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 personal care is provided, in order to reduce the risk of cross infection. 17 18 26 27 Undertake a review of toilet chairs and provide sufficient to meet peoples needs. A review of staffing levels and deployment of staff should be undertaken and appropriate action taken to ensure peoples needs are met in a timely and person centred manner. Staff should be provided with training in respect of health and safety, so they have the knowledge to ensure people living in the home are safe. Staff should be provided with training in respect of infection control, so they are fully conversant with good infection control practices. The quality assurance systems should be developed further with the development of audits, meetings etc, to improve the process of feedback and continuous development. Staff supervision should be undertaken regularly, so that staff receive the appropriate support and direction to ensure good outcomes for people living in the home. Systems should be in place to check emergency lighting and wheelchairs on a regular basis to ensure they are fit for purpose. 19 28 20 28 21 33 22 36 23 38 Care Homes for Older People Page 36 of 37 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!