Inspection on 31/07/09 for Valley Park Nursing Home

This inspection was carried out on 31st July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Valley Park Nursing Home 11/07/07

Valley Park Nursing Home 19/07/06

Valley Park Nursing Home 06/03/06

Valley Park Nursing Home 07/11/05

Valley Park Nursing Home 07/03/05

Valley Park Nursing Home 05/10/04

Similar services:

Snydale Care Home

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Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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: Valley Park Nursing Home Park Street Wombwell Barnsley South Yorkshire S73 0HQ     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: Jayne White     Date: 3 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 32 Information about the care home Name of care home: Address: Valley Park Nursing Home Park Street Wombwell Barnsley South Yorkshire S73 0HQ 01226751745 01226341024 patl@mimosahealthcare.com None Mimosa Healthcare (No4) Limited care home 57 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Of the 57 beds, 22 are nursing care (N), 25 are personal care (PC) and 10 can be used as nursing or personal care Persons accommodated shall be aged 60 years and above, however, 3 people may be aged 55 years and above. Date of last inspection Brief description of the care home Valley Park is a care home for people with both personal care and nursing needs. The home has two levels and there is lift and stair access to both floors. It is divided up into nursing and non-nursing sections. The bedrooms are all single and some have en-suite facilities. There is a dining area and lounges on both floors. The home has extensive gardens, with some areas accessible for wheelchairs. There is parking at the front and side of the home. Care Homes for Older People Page 4 of 32 Over 65 57 0 Brief description of the care home Valley Park is close to the centre of Wombwell. Within a short walk from the home is a range of amenities including the Post Office, shops, optician, hairdressers, community centre, churches, local clubs and a bus route. The manager provided the following information about the homes fees and charges on 31 July 2009. Fees range from £356.77 to £520 per week; depending on the level of need and funding. There are additional charges for private chiropody and hairdressing. Prospective residents and their families can get information about Valley Park by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was a key inspection and the inspector visited without giving the service any notice on 31 July 2009 between 8:45 and 17:15. Ms Debbie Walton, the manager was present during the visit. The manager completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This gives the service the opportunity to tell the Care Quality Commission (CQC) how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 11 July 2007 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit, including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. We sent surveys to people living at the home, asking them about their experiences of Care Homes for Older People Page 6 of 32 living there, representatives of people living at the home, asking them about their experiences of contact with the home, health professionals, asking them about their experiences of working with the home and staff, of their experience of working at the home. Seven surveys were returned by people that lived there and three from their representatives. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as was a representative. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Formulate care plans to support that the health and personal care that people receive meets their needs. Improve medication records, so that there is a record of all medication people receive, Care Homes for Older People Page 8 of 32 the quantities of medication received into the home are recorded, medication is easier to audit and that people always receive their prescribed medication. Also, demonstrate that staff have been assessed as competent to deal with medication. When an adult safeguarding investigation has taken place and action has been identified as a result of this, to make sure people are protected in future, there must be documentary evidence to support this has taken place, for example, training certificates and supervision records. Make sure documentation is received for agency workers that are working at the home, to confirm satisfactory recruitment checks have been completed and they are safe to work with vulnerable people. There were some aspects of health and safety that needed addressing, so that the safety of people was maintained. For example, reviewing the fire risk assessment and identifying within this how often staff should receive fire training, so that they are conversant in the procedures to be followed should a fire occur, applying brakes to wheelchairs and carrying out portable appliance testing. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be confident the care home could support them. This was because there had been an assessment of their needs, which told the home about them and the health and care support they needed. Evidence: When we looked at peoples surveys it told us five people had received enough information about the home before they moved in so that they could decide if the place was right for them, one didnt and one didnt know. Six stated theyd received a contract, one hadnt. The manager told us in the AQAA a pre-admission assessment of people took place before their admission. She stated likes and dislikes were recorded, as were nursing and care needs, including equipment that was needed. She also stated culture and religious needs were identified at this time and the service received relevant assessments from commissioning bodies. Care Homes for Older People Page 11 of 32 Evidence: We looked at three peoples files to check the information we were told in the AQAA. Pre admission assessments by staff from the home had been undertaken prior to the admission taking place. They confirmed that the service was appropriate for the person and provided staff with information to formulate an individual plan of care. Information from commissioning bodies were also in place. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all peoples health and personal care needs were being met according to their care plan, but, on the whole, the support they received from staff was given in a way that maintained their dignity. Aspects of medication needed improving, so that people were supported with this in a safe way. Evidence: The manager said in the AQAA risk assessments, including falls risk assessments and care planning was completed and people were asked to engage in regular reviews. It stated care plans were reviewed monthly or as required, that pressure ulcers were recorded and body mapping took place on admission. It also stated nutritional risk assessments were carried out on everyone admitted to service and reviewed. The inspector looked at three care plans to check the information the manager had told us in the AQAA. A care plan had been formulated for some areas of need. However, where risk assessments had been carried out of presenting risks that identified a care plan needed formulating, this was not always done. This meant the person was at risk of appropriate care not being identified and provided. Examples Care Homes for Older People Page 13 of 32 Evidence: included, people at risk of pressure areas and being treated for pressure areas, where there was no specific plan, including equipment that had been identified in the admission assessment, moving and handling plans not being formulated that identified the action to be taken to reduce risks to people and nutritional care plans identifying the action to be taken to meet peoples needs, including food supplements, that had been identified in the assessment information and bed rails. There was no plan in place about how decisions were to be made about a persons capacity to make decisions and how their behaviour was to be managed, despite this being identified as a need in the assessment information. The care plans identified that health care professionals did visit people to assist in maintaining their health care needs. When we looked at peoples surveys, six stated they always received the care and support they needed, one usually. Five stated they always received the medical care they needed, two usually. One commented, looks after me and ensures I get what I need. Two representatives surveys stated the care service always met the needs of their representative, one usually. Two stated the service always gave the support and care to their representative that they expected, one usually. All stated they were always kept up to date with important issues affecting their representative. They commented, (they) look after mum very well and 99 of the time Valley Park is excellent and meets mums needs. When we spoke with staff they showed knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for, however, this did not always support information identified in the admission assessment, risk assessment and care plan information. We observed staff working to see how they valued and respected the privacy of people. There was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff spoke clearly and at a steady pace with people. On the whole, we saw that people looked clean, were well dressed and appeared to receive a good level of personal care. This indicated respect and dignity by staff when caring for them. On the whole, this was supported when we spoke to people. They said they were happy with the way staff respected their privacy and dignity. The manager in the AQAA told us medication audits were carried out regularly, with Care Homes for Older People Page 14 of 32 Evidence: the plan for the next twelve months to carry these out three monthly. She stated staff had been updated with Lloyds pharmacy accredited training. We looked at the last medication audit, which took place on 1 July 2009. It did not identify issues the inspector found when sampling the safe receipt, handling and administration of medicines for three people today. For example, the medication administration record (MAR) for one person did not include the oxygen received and given to people and in another instance a prescribed cream. Downstairs, on two occasions, hand written entries did not identify the amount of medication received or when it was received. Also, the quantities of medication on the pre-printed MAR had not been countersigned as correct. In addition, a staff member stated that medication carried forward from one month to another was not recorded. This made it impossible to carry out a drugs audit on the medication without trawling back through previous records. In one instance, someone had been without their medication for a day, because there was no stock. In another, there were discrepancies as sufficient stock could not be accounted for. Medication storage arrangements for medication held by the home identified medication was stored securely in locked trolleys within locked rooms. When we spoke to staff and looked at their training records it told us they had received medication training. Staff stated an assessment of their competency to deal with medication was undertaken, but there was no evidence available to support this. When we spoke to people about their medication, one person said they received their night time medication at about 11 oclock, which they didnt like, because they had to be woken up and sometimes couldnt get back to sleep. A survey from a representative also commented, mum says she has been woken up at 2am to be given pills. This really upsets her. Staff the inspector spoke with couldnt give a time when night time medication was given, so the manager really needs to confirm this and make adjustments where necessary. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were treated as individuals. They enjoyed their daily routines and activities provided by the service. People were able to keep in touch with family, friends and representatives. They had meals at a time and place that suited them and that on the whole met their expectations. Evidence: The manager in the AQAA told us newsletters highlight special and planned events for the home, that entertainment is provided with a programme of events including a summer fete and trips out. She stated both individual and group activities were provided and memory diaries were completed, which helped compile plans for each person. It was anticipated activities would improve by the activity co-ordinator after completing and implementing more specific needs of residents social interaction. In addition, it was planned to engage voluntary workers for social activities and individual recreational and informal support and that the activity co-ordinator enrols on an appropriate NVQ. The AQAA stated there was a church service in-house monthly or as required, residents enjoyed celebrating special events such as birthdays, easter and christmas. They also enjoyed social evenings every Tuesday and coffee mornings regularly. Care Homes for Older People Page 16 of 32 Evidence: Six of the surveys returned by people stated the service always arranged activities they could take part in, one usually. Comments included, good mixing all year round and Christmas and constant running of trips and gives us all a happy time at Christmas and good trips through the year. When we spoke to people and their representatives about their daily life they said they could get up and go to bed as they chose within reason, that they did different things during the day - watch TV, play bingo, that they get taken out now and again, which is a nice break and that theyd just been on a trip to Cleethorpes. One said, I sit here watching. Used to like reading, but gone off it. We had a wonderful singer at Easter. Another said, Im no mixer, Im a loner. I enjoy my own company - word book, paper and I enjoy that they leave me alone. Surveys returned by representatives of people told us two of them thought the service always supported people to live the life they chose, one usually. When we spoke to people and their representatives it told us their representatives were able to visit the home at any time and were made to feel welcome. Six surveys returned by people told us they always liked the meals at the home, one usually. In the section about what the service did well, one commented, get our meals etc on time and take care of our needs and help us in any way they can. When we spoke to people about the meals that were served it told us that generally people liked the meals they were served. They commented, meals not bad and meals good - dont need anything in between. We sat with people downstairs at breakfast and saw the lunchtime meal being served upstairs. The dining rooms were comfortable and provided a pleasant environment for people to dine in. A choice of meals was identified on the menu on the table, although at lunch no-one took up this alternative, despite one person just being given a plate of chips because they didnt like fish. People were served good portions. The meal time was a positive and pleasant event. The meal smelt nice and for most people looked attractive. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. However, negatives to the meal time experience was staff placing aprons on people without asking them whether they wanted one or explaining what they were doing and people sitting in the dining room with no stimulation waiting for their meal. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, people or their representatives knew how to complain, although some people said they wouldnt. Concerns were looked into and action taken to put things right. The care home need to demonstrate the action they say they have taken to safeguard people from abuse and neglect. Evidence: All surveys returned by people told us there was someone they could speak to informally if they werent happy. Four stated they knew how to make a formal complaint, 2 didnt, 1 commented to staff in blue. However, when we spoke to people, not all of them felt confident to make a complaint. One said this was because theyd be put on. The manager therefore needs to assure people their complaint would be listened to and addressed with no repercussions. The manager told us she had an open door policy for people and their representatives, but said she would work with people to improve their confidence in the complaints procedure. Two of the surveys received from representatives stated they knew how to make a complaint about the care provided by the care service if they needed to, 1 couldnt remember. Two stated the service had always responded appropriately if they or the person they represented had raised any concerns, 1 usually. One commented, no complaints. The manager told us in the AQAA the complaints procedure was displayed on the Care Homes for Older People Page 18 of 32 Evidence: notice board in the reception area and in the service user guide and welcome pack. We saw the complaints procedure in the reception area and informed the manager information about the Commission, within the complaints procedure now needs updating. The AQAA told us 4 complaints had been received in the last 12 months that had all been resolved within 28 days and none were upheld. It said these were in the complaints folder. We looked at the folder. There had been six complaints, where in all but one instance, action had been taken by the service as a result of the complaint. One was about the odour in a persons room, one about laundry, 2 about poor TV reception, one about food and one about staffing. Had appropriate action been taken after the first complaint about poor TV reception, a further complaint may not have been necessary. There had also been one adult safeguarding referral (this is the action taken to keep people safe), where the outcome had not yet been concluded. However, the service had put an action plan in place for the member of staff, but there was no evidence this had taken place, although the manager stated it had. The inspector told the manager adult safeguarding would want to see the evidence, so that they could be assured action had been taken to safeguard people in future. The CQC had not received any direct complaints or adult safeguarding referrals to deal with. The manager told us in the AQAA there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had last been reviewed in May 2006. This needs to be reviewed to make sure the information telling staff of the procedure to be followed is still in line with multi agency adult safeguarding procedures. However, the service had the multi agency adult safeguarding policy and procedure. This was available for staff to refer to so that they could take prompt and appropriate action if they were concerned that someone may be at risk of harm or abuse. The manager told us she had received adult safeguarding training and was aware of the multi agency procedures to be followed in the event of any allegation being made. The manager in the AQAA told us training in adult safeguarding was planned and is on-going. When we spoke to staff they said they had received adult safeguarding training and knew what to do to keep people safe. There was no evidence of the training on staffs files to support what they had said. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, people lived in a safe and well maintained home that was clean, tidy and hygienic. Evidence: The manager in the AQAA told us major refurbishment had taken place in the last two years that had provided people with a pleasant and comfortable environment in which to live. This included new bed spreads and curtains to match, replacing a large percentage of bedroom furniture, new carpets, all new double glazed windows and doors with restrictors fitted. She stated residents choose their colour preference when their rooms are decorated. She also stated health and safety and COSHH risk assessments were reviewed six monthly, there were no odours in the home as a result of improved cleaning schedules with a better deep cleaning programme and prompt responses to spillages on carpets. It also said there were adequate sluicing facilities available and personal protective clothing was provided for staff. In addition, audits were undertaken for infection control to control any outbreaks of any infectious diseases. It stated training for infection control was ongoing and legionnaires water testing was carried out six monthly. Everyones surveys told us they thought the home was always fresh and clean. One commented, very clean, another, could do with more air conditioning. When the inspector spoke with people they were happy with the homes environment. They said Care Homes for Older People Page 20 of 32 Evidence: it was clean and the furniture and furnishings were comfortable. They liked their rooms, that most of them had personalised with pieces of their own furniture and possessions. When we looked round the home, the environment was suitable for the needs of people that lived there. The communal lounges and dining areas were generally well decorated and were a comfortable environment for people to live. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible. The toilets had been adapted to assist people with their independence. We saw that generally peoples wheelchairs were clean, but care needed to be taken that moving and handling equipment was kept clean. We noted odours in both lounges, that the service need to act on so that people are not sat in environments where there is an unpleasant smell. There had been an outbreak of an infectious disease, but the service had managed this well. The home shared a central laundry with other Mimosa homes on the same site. When the inspector spoke with people it told us that on the whole the laundry system worked well. The inspector saw that peoples clothes looked clean. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were cared for by enough staff, who on the whole, had been safely recruited to protect people from harm. Staff appeared to be sufficiently trained, but training records needed to improve to demonstrate this. Evidence: When we looked at the surveys returned by people it told us that three people felt the staff always listened and acted on what they said, two usually. Five stated staff were always available when they needed them, two usually. Comments included, carers are always helpful and act when I ask them anything, very helpful carers, normally very nice, but sometimes a bit bossy and need more staff. When the inspector spoke to people during the visit about staff it told us that on the whole people felt staff were available when they were needed and were kind and friendly. However, one relative who was with a person we spoke with said their main concern was that no staff seemed to be about on an afternoon. She stated shed commented about this in the homes survey theyd recently completed, so hopefully theyll address it. The person also said, dont see carers much. When we spoke to staff they told us they felt there were usually enough staff available to meet peoples needs. They commented, obviously, sickness and holidays are an issue at times, but its not bad. One felt night staffing levels could improve. Care Homes for Older People Page 22 of 32 Evidence: When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The manager in the AQAA told us 40 of staff had an NVQ 2 or 3 in Care, 32 staff were trained in infection control and that training records were kept with certificates of attendance. It stated inductions were given to new staff following care common induction standards. She stated they could be better at making sure staff attended all the training provided. When the inspector spoke with staff they said they received regular training, but there was no certificated evidence of this when we looked at their training record, although there was some evidence that some training had taken place in the past. The manager in the AQAA told us residents were being invited to interview potential employees. It stated staff recruitment ensured equal opportunities and stringent following of procedures, with all staff having satisfactory pre-employment checks before they started work. We looked at two files to check this and asked to see information they received about staff working via an agency to make sure they were safe to work with vulnerable people. For the two staff members employed by the home, in the main, this was in place, but the manager must make sure she gets full employment histories for all employees. For the agency worker there was no information. This had to be faxed from another Mimosa home where the agency worker had worked. It only told the service that their pin number was up to date, enabling them to work as a nurse. There was no other documentary information for them to be sure other recruitment checks were in place such as a criminal records bureau check or references. The manager was told subsequent to the inspection she must satisfy herself of this and until they could, agency workers must not work at the service. This was because they could not be sure that satisfactory recruitment checks had taken place to make sure they were safe to work with vulnerable people. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, people had confidence in the care home because the manager had the qualifications required of the person in charge in day to day control of the delivery of care. Where the service held monies on behalf of people it was managed in a way that protected them. People and staff might not always be safe because some health and safety practices were not being carried out. Evidence: The manager in the AQAA told us there had been a change of manager and that she had been recruited on 18 March 2009. She stated she was a first level nurse and held the Registered Managers Award. She had worked 20 years as a nurse and managed elderly care for eight years. When we spoke with her she told us she had submitted an application to be registered, but this had not yet been processed by CQC. The service sent us their annual quality assurance assessment (AQAA) when we asked for it. It provided satisfactory information of the current situation within the service, what they had improved in the last 12 months and what they could do better, to Care Homes for Older People Page 24 of 32 Evidence: identify a plan for improving the quality of life for people. The manager in the AQAA told us questionnaires were completed by residents, families/representatives and visitors such as health care professionals and results published on the communal notice board. She said visits were carried out by the provider to determine the quality of care provided and three and six monthly audits were undertaken as part of the quality monitoring audit system. The AQAA had identified they could improve running the home in the best interests of residents by implementing a residents committee, meeting with residents more often and by asking residents at meetings if they would like to vary what they do on social evenings. We asked to see some of this information. We saw the visits undertaken by the provider and this identified action to be taken by the manager to meet their standards. The last relative/resident meeting was held in June and discussed activities, food and furniture. Stakeholder surveys had been received, but these needed collating and an action plan implementing. There was contradictory evidence in the AQAA about policies and procedure. In one section it stated they were reviewed yearly, but the actual dates given for some policy reviews were much older than this and needed addressing. The manager in the AQAA told us residents finances were stored safely and audited monthly with residents and families having access to records. The inspector checked the money kept by the home on behalf of two people. Records were in place and money tallied with the record. Receipts were in place, but double signatures to verify transactions were not always in place. The administrator was aware of this, because they used other administrators on site to do this and these had not always been available. However, it would be safer if the person involved in the transaction, was one of the signatories. The AQAA stated maintenance of equipment was in place for premises electrical circuits, hoists, fire detection and alarm, fire fighting equipment, emergency lighting, emergency call equipment, heating, soiled waste and gas. We checked the testing for portable applicances and the lift. The portable appliance tests had not been done, because there was no machine to test them. A director was aware, but one had not been provided. The servicing for the lift was due on 06.08.09. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. We looked at the fire risk assessment. This was dated January 2008, but the manager said it had been reviewed. There was no evidence of the review. The one dated January 2008 did not identify the frequency of Care Homes for Older People Page 25 of 32 Evidence: the fire training that was required by staff, to make sure they were conversant in the procedures to be followed should a fire take place. In the main, we observed people being moved safely, but care must be taken that brakes are always applied to wheelchairs when the move takes place, so that people are not placed at risk of injury. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a plan of care 05/10/2009 for each area of need that has been identified as a result of an assessment or risk assessments. So that appropriate care is identified, recorded and provided and can be checked. 2 9 13 People must receive all of their prescribed medication. So that their health is maintained. 05/10/2009 3 9 13 There must be a record of the quantities of all medication received into the home. So that people are protected by the homes policies and procedures for dealing with medication. 05/10/2009 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 The medication administration record must identify all medication people are prescribed. So that they receive the correct medication at the required intervals. 05/10/2009 5 18 13 Where action has been identified to prevent people from being harmed or suffering abuse, evidence to confirm the the action has been taken must be provided. When an adult safeguarding investigation has taken place and action has been identified as a result of this, there must be documentary evidence to support this has taken place, for example, training certificates and supervision records. So that people and staff are protected from further allegations of harm. 06/10/2009 6 29 19 There must be documentary evidence at the care service to confirm that agency workers who are working have had satisfactory employment checks carried out. 06/10/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that they are safe to work with vulnerable people. 7 30 19 There must be documentary evidence of any relevant qualifications and training that staff have undertaken. To verify they receive training appropriate to the work they perform. 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 06/10/2009 1 9 The manager should determine the times when night time medication is administered, so that the time is appropriate for people and they are not woken unless necessary. So that conducting an audit of peoples medication is made easier to track, medication carried forward from one month to another should be recorded. To demonstrate staff are competent to deal with peoples medication, an assessment of their competence should be carried out, recorded and available for inspection. So that there is no confusion of the action to be taken should an allegation of abuse be made, the adult safeguarding policy/procedure should be reviewed. So that the safety and welfare of people and staff are promoted and protected, the fire risk assessment should be reviewed and include the frequency of staff training, so that this can be carried out at the required intervals to make sure staff are conversant in the procedures to be followed should a fire take place. So that the safety and welfare of people and staff are promoted and protected, staff must apply brakes to wheelchairs when transferring people. Page 30 of 32 2 9 3 9 4 18 5 38 6 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 38 So that the safety and welfare of people and staff are promoted and protected, testing of portable appliances should take place. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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