Inspection on 08/08/08 for Valley Court

This inspection was carried out on 8th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Valley Court 09/08/07

Valley Court 14/08/06

Valley Court 15/03/06

Valley Court 07/09/05

Valley Court 07/03/05

Valley Court 26/08/04

Valley Court 19/03/04

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Valley Court Valley Road Cradley Heath West Midlands B64 7LT Lead Inspector Yvette Delaney Key Unannounced Inspection 08th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valley Court Address Valley Road Cradley Heath West Midlands B64 7LT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01384 411 477 01384 411470 Pepperhall Limited Joan Green Care Home 69 Category(ies) of Old age, not falling within any other category registration, with number (69) of places Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2007 Brief Description of the Service: Valley Court is a purpose built Care Home, opened in 1998. The home provides 69 beds for frail older people, 39 who require residential care and 30 who require nursing care. It is independently owned. The Home is located within easy reach of main routes between Halesowen, Cradley Heath and Dudley with public transport and local amenities easily accessible. It is situated next to a primary school, with a shared driveway. There is ample car parking to the front of the Home and gardens and patio areas to the rear. The Home is separated into two units, one dedicated to Residential Care, the other to Nursing Care. Shared facilities include the kitchen and laundry. Service Users accommodation is provided on two floors, all bedrooms are single, and 64 out of 69 have en-suite facilities. There are lounges and dining rooms on both units. The home currently has a range of bathing facilities, a nurse call system, passenger lifts and some disabled facilities. The Home has separate staff teams; with the Registered Manager who is a first level nurse, undertaking responsibility for the Residential beds and the Nursing beds. Fees vary between £359 and £470 and are dependant on the needs of the service user and the type of room that will be occupied. The following are not included in the fee: non NHS Chiropody (£10), hairdressing (£5.00), toiletries, telephone calls and activities such as bingo (20p a book). Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by ten people living in the home, and eight from relatives or their friends, giving their views of the service. An annual quality assurance assessment (AQAA) was completed and returned by the manager in time for the inspection. Information provided in the annual assessment by the home manager has been used to inform this report. The inspection included meeting most people living at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and the home manager. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the service does well: When people who use the service were asked what they felt that the home does well they told us: “Happy atmosphere and exceptional care of mum.” “Cares for the needs of my Nan and also shows her lots of love.” Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 6 “Deals well difficult or sometimes impossible situations.” “They are kind and sympathetic.” Assessments read provided details of resident’s health and personal care needs. Information available includes mobility, history of falls and their medical history. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care People living in the home looked well cared for. Residents are supported to be well presented and wear clothing that is suitable for the time of year. Supporting residents in this way promotes their quality of life and maintains their dignity. The home has an adult protection policy which gives staff direction on how to respond to suspicion, allegations or incidences of abuse. Staff have had training in recognising signs and symptoms of abuse. This will help to protect residents from the risk of abuse. What has improved since the last inspection? What they could do better: Residents and relatives comments on how they thought the home could improve told us: “I don’t think it can improve because the standard is very high and caring.” Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 7 “I am very happy with the care at this point. I feel that there is no need for improvement.” “Possibly more staff.” “By providing better food.” “More entertainment.” “The evening tablets are given out late at night often when people are in bed!” This inspection visit identified five areas where the home must improve. These are: Ensuring that people living in the home have an up to date, detailed care plan, which provides details of resident’s individual care needs. This will ensure that people receive person centred support that meets their needs. Ensuring that care plans provide staff with information on how to meet the care needs of people living in the home. This will ensure that people receive person centered care. Ensuring that thorough and complete risk assessments are carried out on residents so that staff know how to support people living in the home. This will minimise risks to residents from harm, which affects their health and well being whilst maintaining their independence. Ensuring that procedures are in place, which will help to reduce the risk of infection or cross contamination in the home? This will ensure the health and wellbeing of people who live in the home. Ensuring that staffing levels are reviewed so that sufficient numbers of staff are on duty at all times. Attention must be given to peak times of activity in the home. This will ensure that residents care needs can be met safely at all times. Records related to people living and working in the home must be appropriately and safely stored to ensure confidentiality is maintained at all times. A suitable lock must be fitted on the sluice door where chemicals and cleaning products are stored and the door kept locked to minimise the risk of harm to residents in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 Standard 6 does not apply to this home as people are not admitted for immediate care. Quality in this outcome area is good. People have the information they need and are given the opportunity to visit the home to help them make the decision about where to live. A comprehensive assessment of peoples care needs is carried out before admission to the home. This will support people to make an informed decision about whether to stay at the home and agree to the terms and conditions set by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were seen and read at the time of the inspection. The documents are available to people living in the home. We were given copies of both documents to take away and read. Both documents have been reviewed and updated to provide people who live in the home and potential residents with up to date details on the services provided by the home. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 10 Residents spoken with and information provided in questionnaires from relatives and residents said that they were well informed about the home before making a choice about moving in. Comments made include “Home found to be the right place.” The care files of two residents admitted to the home since our last inspection visit in August 2007 was reviewed through the case tracking process. Copies of the pre-admission assessments were available on file. The pre-admission information for these residents was examined. Assessments read provided details of the resident’s health and personal care needs. Information available includes mobility, history of falls and their medical history. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. Residents and relatives confirmed that they had received a visit from the home manager or the deputy manager to assess their care needs before being offered a place in the home. Information in the AQAA stated that all residents receive a pre-admission visit. People spoken with, both residents and relatives confirmed that they had visited the home before making the decision to use the home. A resident and their family member told us that they were aware of the procedures for the home. They had seen and read the Home’s Service User Guide and had signed contracts detailing the terms and conditions for living in the home and the cost of living in the home were included in the contract. The family said that social services had helped them to find the home by providing them with a list of homes and that social services help them to pay the fees. Care management plans from the referring agency were included in the care files. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans are not consistently completed this could result in inappropriate care being given to residents. Medicines are administered safely, which protects residents from risk of harm. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked well cared for. They were well presented and wore clothes that were suited to the time of year. While we sat in the lounges at different times of the day people told us through conversation that they were happy living in the home. Observation throughout the day showed that the health and personal care needs of residents are being met. Residents knew the nurses and carers by their first name and interaction between them was relaxed and positive. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 12 We examined the care files for three residents. The care files we asked for helped us to look at the care the home give people who have low to high care needs and therefore different levels of support from care staff. Examination of care files showed that in two of the three care plans, individual care needs had been assessed. Some care plans were written to be task related giving instructions. For example care plans for personal hygiene needs stated “prefers a Friday morning bath”. The practise also does not support person centred care. Risk assessments were available in all care plans examined. These include risks related to pressure areas, falls, moving and handling, mobility and nutrition. Moving and handling risk assessments were not all fully completed to give complete information on the abilities of people in their care. This does provide staff with all the information they need to reduce the risk of harm to residents. Staff do not have all the information they need to ensure that they provide appropriate care and suitable equipment based on the outcome of a thorough risk assessments. For example a moving and handling risk assessment examined for one of the residents followed through the case tracking process show that it covers care areas related to transferring bed to chair, chair to bed, standing, mobilising and bathing. The outcome of the assessment indicates the need for the support of two carers, a Zimmer frame and wheelchair. This information has not been used to write the persons care plan. Some information in the care plans contradicted information in the risk assessment. A care plan dated 17/07/08 states: “Can weight bear but is wheelchair bound on transferring.” “Needs one carer to sit up and turn in bed.” Information in the risk assessment dated 17/07/08 for manual handling states: “Wheelchair but can transfer with aid of Zimmer.” A risk assessment for turning in bed and supporting the resident to sitting position and moving in bed had not been completed.” A further care plan written for a person with mental health problems states “… (Resident) has a very unstable mental state, very confused and aggressive behaviour.…tends to get diverted easily and talks to none existing people.” The care plan did not include an action plan or evidence of a psychological assessment, which would give guidance to staff on how they should manage the person’s mental health care needs. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 13 Another care plan for a resident detailed the homes aim as ‘Maintain skin integrity and manage skin lesions.’ There was no further information for staff on what care they need to give to achieve this aim. The care plan stated: “… (Resident) has a small sore on her bottom (dressed).” “Has poor circulation on both limbs.” “Has a rash on lower limbs with the cream to apply.” The care plan did not provide any guidance on the type of dressing to be used or when or what cream was to be applied. The other two care plans examined for a further two residents followed through the case tracking process contained more detailed information. These care plans were written to reflect person centred care and provided staff with clear guidance on meeting their needs. For example, information in one care plan where person has problems with their hearing states “…(Resident) is very hard of hearing despite wearing a hearing aid staff need to speak loudly and clearly taking time to ensure …(Resident) understands what is being said. Good eye contact is essential…” A further plan of care says “… (Resident) mobilises with a walking stick, occasionally needing supervision and assistance to stand from x 1 carer…” Written daily reports in care files provided information on people’s day-to-day life in the home and provides details on their health and well being. Entries had been signed, dated and timed by the member of staff making the entries. Entries in each of the resident’s health records and comments by people living in the home confirmed that they are supported in getting access to health care professionals when needed. This includes access to a GP, Chiropodist, Community Psychiatric Nurse and Optician. We examined the management of medicines in the home. Medication practices show that there are good systems in place for the ordering, receipt and storage of medicines. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in locked clinical rooms. There are two clinical rooms one on the ground floor and the other on the first floor of the home. Staff record the temperature of the medicines fridge this will ensure the stability of the active ingredients in the medicines ensuring that they are suitable for use. Trained nurses are responsible for the administration of medication on the nursing care unit and care staff give out the medicines on the residential care unit. The contents of the controlled drug cabinet on the first floor of the home were audited against the controlled drug register with one of the carers. All the controlled drug balances were correct and these were reflected accurately in Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 14 both the CD register and medicine chart. The controlled drugs are stored safely. Controlled drugs are checked at each shift change over and records maintained to show the outcome of the check. These were seen to be in order and clearly documented. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 an 15 Quality in this outcome area is adequate. Open visiting arrangements encourage regular contact with relatives and friends. Residents do not benefit from varied tasty and nutritious choice of foods. Recreational activities do not meet the full needs of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has appointed a second activity coordinator to help increase and vary the activities and events occurring both in and outside the home. The employment of staff to take the lead on providing meaningful activities both in and outside the home is good practice. This should mean that care staff numbers are not decreased and residents care needs are consistently met. Residents should also receive ongoing mental and physical stimulation. Fifteen people were sitting in the main lounge on the day of the inspection residents were actively taking part in a general knowledge quiz. Residents were noted to be competitive and enjoying answering the questions. One resident was making greeting cards in the smaller lounge. These cards are sold and the proceeds added to the residents’ fund. One resident spoken with was listening to a talking book. The resident told us that the visiting library comes to the home and she is able to swap her books regularly. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 16 Residents in the home were relaxed with the activity coordinators, calling them by their first name. Residents told us that they are not always aware of evening service or events. They said that there are very few activities on offer, one person said that there are ‘No activities’, another resident said “I would like to go out more, no trips are ever arranged.” “Friend constantly complains of no activities and absolutely no outings.” The interaction between staff and family members was positive. Relatives were seen to be comfortable when communicating with staff. Information in the statement of purpose and service user guide indicates that an open visiting policy is practised in the home. This helps to support residents to maintain links with their families and friends. Relatives and friends were seen to visit during the course of day. Residents told us that visitors are made welcome. The visitor’s register demonstrated that people visit when they want to. Conversations with families confirmed that relatives are aware they are able to visit at any reasonable time. Relatives told us that they are always made welcome. As discussed briefly under the ‘Health and Personal’ care section of this report written entries in two care plans suggest that supporting residents to have a bath is task related. A nominated day for the person to have a bath is stated. A rota is in place stating the bath day of people living in the home. This is not good practice and shows institutionalised care practices. Residents should be able to have a bath or shower whenever they wish. The practise also does not support person centred care and indicate that choices are always given to people living in the home. During a tour of the home in the morning of the inspection one of the dining rooms on the residential side of the home was not well presented or clean. We had lunch with the residents in the second dining room on the ground floor by the kitchen. A poor standard of cleanliness was also noted in this dining room. The tables were laid with a table cloth, placements and cutlery. The placemats and cutlery were not washed properly. The menu available for lunch showed a choice of meals. Choices on the menu include haddock/plaice or fried egg, chips and peas, sponge cake or jelly and ice cream. Some residents said they enjoyed their meal, most residents choose fish and chips for their lunch. Salt and pepper, vinegar and tomato ketchup were available on the table for resident’s individual use. This is good practice and allows residents to choice the condiments they wish to use. At some of the tables residents were observed to be involved in conversation with other residents sitting at their table while eating their lunch. There were eleven people in the dining room eating their meal. However not all residents Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 17 were happy about the food provided in the home comments received from relatives and people living in the home told us that: “Food is terrible, complain but nothing done. Needs to be looked into.” Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. People living in the home are not confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is available and displayed in the reception area of the home. A summary of the procedure is included in the Statement of Purpose. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to, but felt that their complaints are not acted on. One person said that complaints are not acted on by management. Other comments made by residents when they were asked if staff listen to them and act on what they say include: “Some do and some don’t care often saying wait a minute.” “Don’t act on complaints.” “My friend feels there’s never any response.” “No response to complaints.” Discussions with the manager, information in the AQAA and records examined confirmed that no complaints had been received by the home since the last inspection. Since the last inspection we have received two complaints. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 19 The home has an adult protection policy to give staff direction on how to respond to suspicion, allegations or incidences of abuse. Staff have had training in recognising signs and symptoms of abuse. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures and her responsibilities for responding to allegations of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. Training records examined indicates that protection of vulnerable adults training had been received by staff. There has been one adult abuse allegation since the last inspection involving a resident and their family. The home took appropriate action referring the allegation to Social Services for investigation under the local area safeguarding procedures. The incident was related to finance and has been investigated and resolved satisfactorily by the local authority. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24 and 26 Quality in this outcome area is adequate. Practices in the home do not ensure that residents live in a safe environment to protect them from the risk of infection and maintain their health and well being at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Valley Court offers accommodation on two floors for up to 69 elderly people. The home offers a service for both men and women. The first floor accommodates residents who require nursing care and the ground floor provides a service for people who need support in meeting their personal care needs. We looked around the home with the support of the home manager. Residents were observed making use of all the communal spaces. Residents spoken with were all generally happy with the cleanliness of the home, especially with reference to their own bedrooms. Several bedrooms, including bedroom of the people involved in case tracking, were viewed. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 21 Rooms were comfortable, cosy and well decorated. Most bedrooms have en suite facilities. Residents had taken the opportunity to bring in personal items, for example small pieces of furniture, pictures and ornaments. Some fire exists were obstructed by various pieces of equipment or furniture. At one fire exit there was a Zimmer frame, chest of draws and a vacuum cleaner and a hoist was stored at another fire exit point. The manager had these items removed immediately. The home has sufficient bathrooms for use by residents. There was a notice in one of the bathrooms instructing staff about checking the water temperature before helping a resident to get into the bath. However there was no thermometer for checking the bath water temperature in the bathroom. A separate sluice room is available, a bowl for a commode was seen in the sluice the bowl was dirty and had not been cleaned properly. This does not show that good standards of hygiene to prevent cross infection are maintained in the home. The door to the sluice was not locked. Leaving the door open could present a risk to residents, who may wander into the room. The home was making the most of the storage space available in the home. However a lot of items were being stored on the floor in some storage rooms. For example quilts, cushions and incontinent pads were being stored directly on the floor. In the storage room numbered N6 ‘PEG feeds (nutritional feeds given to people through a tube into the stomach) was being stored directly on the floor. This is not good practice and can lead to contamination due to cross infection. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. Wheelchairs are stored in designated areas identified in the corridors of the home. We found at the last inspection visit that new mattresses brought for use on the beds in the home were not suitable and there were gaps between the bedrails and the beds. The large gaps caused by the bed rails increased the risk of residents becoming trapped between the bed and the bedrails. The manager started taking action to address this risk at the time of the last inspection. At this inspection visit we noted that the situation ha been resolved. Suitable mattresses and in some cases new beds complete with bedrails have been purchased to ensure that beds and equipment are safe to be used by residents. The home received a visit from Sandwell Environmental Health department in January 2008. The report gave details of a number of areas related to Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 22 cleaning, handling practices, minor repair and health and safety issues in the kitchen. Fifteen requirements and two recommendations where made. The home manager has responded to the report, her response was read this told us that all the issues had been addressed. However, there are some practices that need to be addressed so that good standards of hygiene are maintained in the home. We toured the home and found that a small dining room situated on the left of the corridor on the residential side of the home looked uninviting. The dining room was in a poor state and not very clean. Residents were having breakfast. One of the activities coordinators was giving out breakfasts. The toaster was being used on the floor, later seen to be stored on the top of fridge in the dining room. There was a mixed design of crockery, glasses and cutlery for use by residents. All items looked dirty in some cases this was due to the way they were being stored. Cups were stored turned upside down on the windowsill. Cutlery was stored in an old container, which looked dirty. Plates and bowls were stored uncovered on a small chest of drawers. Both plates and bowls looked dirty and felt greasy. The fridge was used by staff to store food; there were no dates to indicate when they had been opened. The present state of the dining room means that the risk of cross infection due to current practices is increased, which could affect the well being of people living in the home. In contrast to the above dining room a second dining room on the ground floor situated near to the kitchen looked tidier and cleaner. However further closer observation when we joined residents for lunch showed that table cloths, placemats and cutlery had not been cleaned properly. The tour of the home was carried out with the home manager. Notice boards seen said that they were intended for displaying information for residents and relatives. The notice boards displayed information for staff. The information on the boards was not easily accessible to residents or their relatives as the area below the notice boards was used to store wheelchairs. The kitchen was seen to be well-equipped, organised and clean and tidy on the day of the inspection. One of the areas requiring action in the environmental health report was the storage of food directly on the floor within the dry stores. The store room storing dried food stores was organised and food products were not being stored directly onto the floor. Plated food was covered and opened food containers were sealed and date marked. Records examined related to daily, weekly and monthly cleaning in the kitchen and fridge and freezer temperatures, these had been appropriately dated and completed. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number of staff on duty is not sufficient to meet the needs of people living in the home at all times of the day. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that the usual staffing levels for the home are: Shift/Time Nursing Unit 1 Nurse 6/7 Carers 1 Nurse 4/5 Carers 1 Nurse 2 Carers Residential Unit 1 Senior Carer 5 Carers 1 Senior Carer 4 Carers 1 Senior Carer 3 Carers Early 8.00 am - 2.00 pm Late 2.00 pm – 8.00 pm Night 8.00 pm – 8.00 pm Laundry, domestic and catering staff are employed in the home. The manager is supernumerary. Duty rotas examined show that some staff are working Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 24 between nine and ten days without a break, especially staff working night duty. The manager told us that she monitors the hours worked by staff and has made unannounced visits to the home at night to monitor and supervise the work carried out. We sat in the small lounge after lunch and observed that two staff were taking residents to the toilet. Observation showed that this was not enough staff to take residents to the toilet in a timely manner. Some residents were getting inpatient at having to wait. The other carers that were working on the nursing unit were involved in turning residents that were confined to their bed. The personnel files of six staff members were examined and they contained evidence that the Protection of Vulnerable Adult (PoVA) register and Criminal Record Bureau (CRB) checks had been made. Staff files showed, however that appropriate references were not always obtained to support information about the suitability of staff recruited into the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training in Health and Safety, Infection Control, Fire Training/drill (includes a training session for night staff), Moving and Handling, Abuse Awareness and Food Safety. The manager maintains a monitoring system, which identifies staff who require updates in their training, so that training can be arranged. Information provided in the AQAA show that 60 of the care staff have achieved a National Vocational Qualification (NVQ) Level 2 in Care. A further 17 care staff are working towards the qualification. Other training received by staff working in the home include deafness awareness, dementia awareness, infection control, administration of medicines and promoting excellence in the care of older people. This training should support staff in providing more effective and appropriate care to the residents. Since the last inspection concerns were received earlier this year from other professionals and staff indicating that there was a level of discontent amongst staff working in the home. These were discussed with us and highlighted issues related to insufficient staff, staff being asked to work long shifts, preventing staff to leave the home during their breaks. As concerns raised were anonymous and a fear of reprisals was expressed by staff we asked staff working in the home to complete questionnaires. Completing the questionnaires would give staff the opportunity to have their say on how the Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 25 home is run. The information would help to show us what the home does well and what they could do better. Responses were received from eleven staff the responses on the whole were positive. The majority of staff said that their induction covered everything they needed to know to do their job and that they always received up to date information about the needs of people they care for. All staff said that they received training relevant to their role and that they are kept up to date with new ways of working. Most staff responded usually to the question ‘Are there enough staff to meet the individual needs of all the people who use the service?’ There was one response of ‘never’ and one response of ‘always’. In response to the question ‘Do you feel you have the right support, experience and knowledge to meet the different needs of people who use the services?’ Staff gave one response of sometimes, one no response and equal responses of usually and always. There was a lack of information to support the concerns shared with us. Staff spoken with during the inspection were positive about their work in the home and there were no expressions of concern. Maintaining good relationships between staff working in the home will help to ensure that care given is in the best interests of residents. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. The home is managed by an experienced, competent person. Practices carried out in the home do not always ensure that the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and deputy manager were present at the time of the inspection. Both are knowledgeable about people in the home this includes residents and their families and staff. The manager has the necessary experience to run the home, is a registered nurse and has completed the registered manager’s award (NVQ level 4). The Manager is keen to make improvements and had taken actions to address some of the requirements made following the last Key Inspection. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 27 Resident’s and relatives commented in conversation about the management of the home to say that: “The manager is always approachable”. The home’s Quality Assurance file contained evidence that audits are carried out on the services provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are available. The records of the four residents followed through the case tracking process where asked for. Two of the residents had not deposited any money and therefore there was not a need for records to be maintained. An audit of the other two resident’s personal monies was found to be correct. The home informs us of any incident or event that affects the well being of people living in the home. Relatives were able to confirm that they were informed of important issues affecting their family member. Examination of other health and safety and maintenance checks carried out in the home to ensure equipment in use is safe and in full working order. Some of the checks carried out include maintenance and servicing of fire safety systems and equipment was carried out in October 2007 and emergency lighting was tested this year July 2008. Electrical equipment used in the home had been tested to ensure us it was safe to use and appropriately wired. Water temperatures checks had been recorded monthly and this assists in the prevention of people accidentally scolding themselves. There is a large number of resident files stored in one of the store rooms. These files are not being stored safely to maintain confidentiality in line with the requirements of the Data Protection Act. The store room is not locked and non-secure files containing personal information puts people living in the home at risk. It was observed in the home that poor standards are maintained in the storage and cleanliness of cutlery, utensils and plates provided for residents use. These issues have been discussed earlier in the report. These practices do not ensure that infection control procedures are maintained to prevent cross infection and therefore protect residents from the risk of harm. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement All people using the service must have an up to date, detailed care plan, which provides details of residents individual care needs. This will ensure that they receive person centred support that meets their needs. 2 OP7 15(1) Care plans must provide staff with information on how to meet the care needs of people living in the home. This will ensure that people receive person centered care. 3 OP8 13 30/09/08 Nursing staff must ensure that thorough and complete risk assessments are in place so that staff know how to support people living in the home. This will minimise risks to residents from harm, which affects their health and well being whilst maintaining their independence. 30/09/08 Timescale for action 30/09/08 Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 30 4 OP26 OP38 13 Procedures must be in place to 14/08/08 reduce the risk of infection or cross contamination in the home. This must include: Improving the storage of cutlery, utensils and crockery used for residents. That all cutlery, utensils and crockery used for residents are clean and safe for their use. Dining rooms provide a clean environment for people to eat in. This should include ensuring table cloths and mats are clean. Items, which include PEG feeds, should not be stored directly on the floor. This practice encourages the risk of cross infection. Commodes and bedpans left in the sluice room are appropriately cleaned and not left dirty. This will ensure the health and wellbeing of people who live in the home. Staffing levels should be 30/08/08 reviewed to ensure that sufficient numbers are on duty at all times. Attention must be given to peak times of activity in the home, which includes: Mealtimes Any interaction with residents that requires two members of staff such as using safe moving and handling techniques. This will ensure that residents care needs can be met safely at all times. 5 OP27 18(1) Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 31 6 OP38 13 A suitable lock must be fitted on the sluice door where chemicals and cleaning products are stored and the door kept locked to minimise the risk of harm to residents in the home. 14/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should contain information on the six of rooms available for use by people wishing to move into the home. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. Work should continue on developing resident care plans in the home so that they reflect a person centred approach to meeting individual care needs. Residents should be offered a bath or shower to meet their individual personal care needs. This will ensure that residents have their hygiene needs met. Residents should be consulted about a programme of activities that takes into account their individual and group needs. This will ensure that appropriate mental and physical stimulation, which meets their individual needs. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. This will ensure activities offered meet their individual needs. Notice boards in the home provided for the benefit of residents should be easily accessible, organised and contain information that is relevant to them. This will support effective communication with people living in the home. The practise of designated bath days should be reviewed. This practise encourages institutionalised care and does not show that people are offered care based on personal choice and daily living. 2 3 4 OP7 OP8 OP12 5 OP12 6 OP12 7 OP14 Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 32 8 OP15 9 OP16 10 OP27 11 12 OP37 OP38 An investigation should take place into why residents and relatives feel that the food provided to residents is ‘Terrible.’ Residents must receive wholesome food, which is varied and properly prepared. This will promote their health and well being. An investigation should take place into why residents and relatives do not feel confident that their complaints will be listened to and acted on. This will ensure residents feel protected and that the home is run in their best interests. Evidence of the ongoing monitoring of staff working excess hours that they have agreed to should be available for inspection in the home. Working excessive hours could lead to staff being tired and not completing their duties to the best of their abilities. Records related to people living and working in the home must be appropriately and safely stored to ensure confidentiality is maintained at all times. A thermometer should be available in the bathroom to check the temperature of the water before a resident is supported to get into the bath. Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Valley Court DS0000004829.V369433.R01.S.doc Version 5.2 Page 34 - 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. 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