Inspection on 29/05/09 for Willesden Court Care Home

This inspection was carried out on 29th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willesden Court Care Home 21/07/08

Willesden Court Care Home 04/09/07

Willesden Court Care Home 23/11/06

Willesden Court Care Home 05/12/05

Willesden Court Care Home 26/04/05

Willesden Court Care Home 28/01/05

Willesden Court Care Home 13/07/04

Willesden Court Care Home 22/04/04

Willesden Court Care Home 18/02/04

Willesden Court Care Home 02/01/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willesden Court Care Home 3 Garnet Road Willesden London NW10 9HX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 39 Information about the care home Name of care home: Address: Willesden Court Care Home 3 Garnet Road Willesden London NW10 9HX 02084597958 02084597967 willesdencourt@schealthcare.co.uk 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) : Standford Homes Limited care home 60 Number of places (if applicable): Under 65 Over 65 21 18 39 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (Maximum number of places 18) Dementia -Code DE (E) (maximum number of places 21) Physical disability -Code PD (E) (maximum number of places 39) Date of last inspection Brief description of the care home Willesden Court was first registered in January 2001. It is now owned by Southern Cross Healthcare. Willesden Court is situated in one of the many multi-cultural areas of Brent. It is a purpose built 4-storey building found on the corner of Garnet Road and Mayo Road. It is about 3 minutes walk from the main road, which is served by buses. The home has a Care Homes for Older People Page 4 of 39 Brief description of the care home parking facility at the back and there is also parking on the roads in front and on the side of the home. The home provides care for 60 residents in single and en-suite bedrooms. Accommodation is divided in 3 units, each of which has its own lounge, dining area and kitchenette. The 4th floor is for ancillary services. The ground floor has accommodation for 18 residents. The unit previously only accommodated elderly frail residents requiring personal care, but after a successful application, can now also accommmodate elderly frail residents with nursing needs. The staffing on that unit has also changed as there is now a trained nurse at all times on that floor. The first floor has 21 beds for elderly residents needing nursing care and the second floor can accommodate 21 elderly residents with dementia care needs. The home has a manager and a deputy manager to oversee the overall the running of the home. The manager is not yet registered. The home charges 400-500 pounds for residents requiring personal care depending on their needs; 500-650 pounds for residents requiring nursing and 600-650 pounds for residents requiring dementia care. There were 59 residents in the home at the time of the inspection and 1 resident was in hospital. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection started on 29th May at 10:10-20:10 and finished on 4th June at 14:00-20:00. During the course of the inspection we spoke to at least 10 members of staff, 8 residents and 2 visitors to the home. We toured some of the premises, looked at the care records of residents and at a sample of other records that the home keeps. The manager completed an Annual Quality Assurance Assessment (AQAA) that has been used where possible to inform this report. Other information made available to the commission after the inspection and before writing this report has also been used where possible in this report. Care Homes for Older People Page 6 of 39 As part of the inspection process we received satisfaction questionnaires from 10 members of staff, 12 residents, 3 relatives and 1 social and healthcare professional.The feedback has been incorporated in this report where possible. We would like to thank all the residents who engaged with us and the manager and all her staff for their kind support during the inspection. What the care home does well: What has improved since the last inspection? The manager has reviewed the service users guide and the statement of purpose to make sure that residents have up to date information about the service and for them to be able to make an informed decision about moving into the home. The standard of some care plans has improved but there was still a few that could be improved further. There was evidence that residents and their relatives were more involved in discussions about the care of residents. There has been some attempts by staff to address the cultural and spiritual aspects of the needs of residents in the care records. This is a positive step that promotes the cultural diversity of residents that live in the home. The standard of pressure area care was on the whole good and although there could have been more up to date photographs or wound mapping, the records that were kept about the ulcers were on the whole appropriate. There is closer monitoring of the meals to make sure that residents receive whatever is on the menu and that residents are informed as soon as possible if there are changes in the menu for them to make an informed choice about their meals. The standard of records that are kept for the recruitment of staff showed that the home uses a robust approach to recruitment to ensure the safety of people who use Care Homes for Older People Page 8 of 39 the service and to comply with care homes legislation. What they could do better: The home is registered to meet the needs of people whose primary care needs are frail elderly people care needs (ground and 1st floors) and dementia care needs (2nd floor). This registration provides the legal framework to ensure the safety of people who use care services and means that the home has been assessed as able to meet peoples needs that fall within these categories of registration. While the home may well meet the needs of other people whose primary care needs do not fall within the two above categories, consideration should be given to the following: whether these people will fit in with the other residents, whether staff will be able to meet peoples needs with which they are not familiar with (the needs), whether staff are trained to meet the needs of these people and the management of crises should these occur to ensure the safety of not only these people, but that of other residents, visitors and staff. During our inspection we noted that the home has admitted people whose primary care needs did not fall within the categories of registration of the home. As a result the home might not have acted in the best interests of these people (it cannot guarantee to meet their needs), of other people who live in the home and of staff who work in the home. Care plans were not always updated as and when the needs of residents changed and in some cases were not very specific about the action to take to meet the needs of residents. Residents must be weighed at least monthly to monitor their nutritional status and if this is not possible then an alternative method to monitor the nutritional status of residents must be used. Residents must be changed according to their individual incontinence plan to make sure that they do not wet their clothes. If this continues to happen then the care plan to manage the incontinence and the incontinence products to use, must be reviewed. The standard for the management of medicines has dropped. While this standard was previously rated as good, on this occasion this was rated as adequate because of the number of issues that had been identified. There are no reasons why the home should not be able to raise the standard in this area. Some items of furniture in the bedrooms of residents was not in very good condition and must be repaired or replaced. Some of the bathrooms could have been more tidy and more inviting by clearing some of the things that were stored in these rooms. We noted that the home did not have enough wheelchairs and specialised chairs for residents to sit out and for them to come to the communal areas to meet and socialise with other residents and to take part in communal activities. The home should review the numbers of wheelchairs and of specialist chairs in the home and must refer residents for seating assessments if required to make sure that the home has the necessary equipment to care for residents appropriately. The home must always provide adequate numbers of staff that are skilled and Care Homes for Older People Page 9 of 39 competent to care for residents, either by using agency staff or otherwise. The home might be putting residents and staff at risk, if the staffing levels are below the levels that have been considered safe for the relevant unit and the home. The property and valuables forms must be completed and kept up to date. These must be agreed with residents or with their relatives. This will ensure that robust records are kept about residents possessions and will help reduce the possibility of financial abuse to a minimum. 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 set out 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 10 of 39 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 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents and their representatives information about the service that it provides, for them to decide whether they would like to live in the home. The needs of residents are assessed before they are admitted to the home, but these do not seem to have been actively considered when they were offered a place in the home and whether these residents were judged suitable for the home. Evidence: A service users guide and a statement of purpose were available for inspection. These documents have been updated and were available in the rooms of residents. A recently admitted resident stated that they did not have a chance to see the home prior to coming in, but clarified that they were admitted for respite care. They added that if they wanted more information about the home, they would read the information pack that the home has provided.The manager stated that whenever possible, prospective residents or their representatives are invited to visit the home to decide whether they Care Homes for Older People Page 12 of 39 Evidence: would like to live in the home. The home has a contract that is offered to all residents or to their representatives, detailing their rights and their obligations while living in the home. However, not all newly admitted residents had a contract as the home has not had an administrator for some time. At the time of the inspection a new administrator had been appointed and the manager said that the backlog of people without a contract would be cleared as soon as possible. This is perhaps reflected in our survey of residents, when 8 said that they have received a contract and 4 said that they have not received one. The homes admission policy states that all residents should have a preadmission assessment prior to being admitted, for the home to decide if it will be able to meet the needs and aspirations of the prospective residents. We noted that 2 newly admitted residents have had appropriate preadmission assessments that was carried out by the manager. Although preadmission assessments were carried out to establish the needs of residents, we noted that the home still admitted residents with primary care needs, that it was not registered for. We noted during the course of the inspection that there were at least two residents that had been admitted to the dementia care unit with no obvious dementia care needs. There were also a number of residents that had been previously admitted on a unit that provides nursing care, when they had primarily mental health needs and with no obvious frail elderly person care needs. According to the residents survey that we conducted, the majority of residents receive the care and support that they require but 3 out of 12 residents (25 ) said that they do not always receive the care and support that they require. As the home is not registered for residents with mental health needs, residents with primarily mental health needs must not be admitted, because the home has not been assessed by the commission as suitable to meet the mental health needs of people. The mental health needs of people cannot also be dissociated from all the other care needs as these are an integral part of the person and the home must always consider all the needs of residents in a holistic manner. It also seemed that the home has not considered whether residents with mental health needs will fit in with the residents who have frail elderly people care needs or dementia care needs. Care Homes for Older People Page 13 of 39 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. Whilst the standard of care plans continue to improve, these were still lacking in some areas. As a result these might not provide a guarantee that the needs of residents would be met. Residents are not always fully supported by the home for them to meet all their healthcare needs. The management of end of life care was on the whole appropriate, although records about end of life care were not so good. A few issues were noted with the management of medicines. These must be addressed to make sure that residents are not placed at unnecessary risks. Evidence: The records detailing the care of 7 residents were inspected. The needs of residents were assessed and recorded but the degree of comprehensiveness of the care records varied from care plan to care plan. Some were completed comprehensively and others were not so comprehensive. Out of the 7 care records that were inspected, there was one set of records that had been well completed in most aspects. The care plans were Care Homes for Older People Page 14 of 39 Evidence: up to date, reviewed and there was evidence of close involvement of the relatives of the residents in drawing up and reviewing the care plans. It is therefore possible for the home to have good care plans for all the residents. Care plans were not always followed when written. One care plan said to turn a resident every two hours but the records showed that the resident was being turned every three hours. One resident had a particular infection. We asked to see the care plan to manage this infection and could not find one in the care records. There was however a care plan but it was not in the care records and had been filed. It had not been reviewed since April. One social/healthcare professional who took part in our survey said that care plans need to improve and must be regularly reviewed and updated to accurately reflect the needs of residents. The manual handling risk assessment of residents continue to lack in terms of addressing all the manoeuvres that are required to move residents. For example the manual handling risk assessment and the care plan for moving a resident did not address the transfer of the resident from bed to chair and vice versa. We were informed that the resident does not usually get out of bed. The resident might have been bed bound, but there would still be circumstances when the resident would need to be moved from the bed such as when giving them a bath, taking them to hospital for treatment or appointments, and when the air mattress needs replacing if it malfunctions. We also noted that the manual handling risk assessment and the care plan for manual handling were not always clear about the equipment to use when moving residents. We noted that the care records generally contained a range of risk assessments such as pressure ulcer risk assessment, manual handling risk assessment, malnutrition risk assessment and a falls risk assessment. In some cases there were other risk assessments such as bed rails risk assessment, when other risks were identified. However this process could have been more comprehensive to ensure the safety of residents. During the inspection we noted a number of residents using the kitchenettes that are found on each unit. The AQAA indeed states All our houses have kitchenettes and our residents have access to these kitchenettes. We encourage our residents who still retain the capacity to prepare light snacks and refreshments to go into the kitchenette and prepare something for themselves. This is usually a cup of tea and sandwiches and biscuits. It is indeed welcoming to note that the home was promoting the independence and the rights of residents. However, while this is safe for some people, this might not be safe for others. Risk assessments would have determined the risk involved and identified possible control measures to reduce the risks if these were Care Homes for Older People Page 15 of 39 Evidence: significant. Residents or in most cases their representatives were involved in the care planning process. There were signatures to show that they have agreed to the care plans and risk assessments. This again was also dependent on the extent to which relatives were willing to be involved in the care of residents as it was clear that residents or their relatives were encouraged to be involved in their care plans. Residents are registered with a local GP, but some residents have kept their previous GPs, as long as the latters were willing to keep the residents on their books. All residents who responded to our surveys stated that they were satisfied with the medical care that they receive in the home. There were records that various healthcare professionals had visited residents according to their healthcare needs. There was 1 resident in the home with pressure ulcers. We noted that there was a care plan in place that was on the whole kept under review and progress notes were completed when the ulcer was redressed. The equipment to use for pressure relief was identified in the care records and there was evidence that this was checked daily. The last photograph of the ulcers were dated February and could have been more regular to monitor the condition of the pressure ulcer. The home also benefited from the input of a tissue viability nurse that was provided by Southern Cross. While looking at the care records of residents we noted that one resident was not weighed for five months and when the latter was weighed in May, it was noted that they had lost a significant amount of weight. We did not find a care plan in place for this resident. Another resident had not been weighed for April and May. We were informed that the resident had not been cooperative but there was no evidence that staff had revisited the resident to attempt to weight them again or used another method to monitor the nutritional status of the resident such as, muscle thickness measurement or girth measurement. We observed that a resident was wet around 18:30 when they were being taken to the bathroom to be changed. We asked about the frequency for changing this resident and we were informed that residents are normally taken to the bathroom/toilet to be changed in the morning, after lunch and then after supper. The care plan for managing incontinence for that resident said that they should be changed every 3 hours. In this case the care plan was not being followed and it also seemed that residents were not changed according to their individual toileting pattern, but rather all of them were changed around the same time. The social assessment of a resident said that they cannot sit out because there are no Care Homes for Older People Page 16 of 39 Evidence: chair for her. We indeed noted another resident in bed with no evidence that the latter was getting out of bed. While we noted that one of the residents had a pressure ulcer, there appeared to be no reasons why the person could not sit out for very short period of time, in the lounge with other residents. Staff said that they did not have an appropriate chair for the resident. It therefore seems that there were limited opportunities for these residents to socialise with other residents and to take part in communal activities because they did not have appropriate seating facilities. Staff also reported that they did not have enough wheelchairs for residents. We indeed noted from the maintenance records that the home only had 7 working wheelchairs for all the residents that were accommodated in the home. Considering that the home accommodates residents with nursing needs there are a significant number of residents with high dependencies and poor mobility who require a wheelchair for mobilisation. We noted that two residents had a pain assessment chart. Staff used the pain assessment chart monthly when reviewing care plans. The aim of any pain assessment chart is to be used when a resident says that they have pain or observed to be in pain and to assess the effectiveness of the pain killer that is given when the resident has pain. The resident is normally revisited some time later when the pain killer has started to act, and is reassessed for pain. If the pain is significantly less, then the pain killer has been effective and if the pain has not been controlled then further action needs to be taken by staff. While touring the premises we noted that 2 residents who preferred to stay in their room rather than coming to the communal areas had not been given their call bell to summon help if that was required. They both said that they would use the bell if they were given these. The clothes of residents in a number of wardrobes and drawers were not arranged tidily and did not look appropriately ironed. Some items of clothing were put inside out on the hangers. The manager explained that the home has provided more staff hours for ironing. We indeed noted on the day of the inspection that items of clothing going back to the rooms from the laundry have been appropriately ironed. The manager stated that this would continue from then on, to ensure that residents clothes are appropriately ironed. Inspection of the care records showed that staff have made some attempts at addressing the end of life care of residents. Some of the care plans about this need were clear but it seems that staff lacked some confidence in addressing this subject in the care records. The care plan for a resident who has been in the home for more than Care Homes for Older People Page 17 of 39 Evidence: a year addressing end of life care, mentioned that staff should assist to meet spiritual needs and encourage family to discuss. The spiritual needs of the resident had not yet been identified and it was not clear whether staff in the home have already had a discussion with the relatives of the resident about end of life care. The care plan of at least one resident addressing this aspect of care has not been completed. The resuscitation status of residents has been identified and recorded. This was kept under review as the condition of residents deteriorates. We also noted that resuscitation equipment were available in the home to use in cases of emergency.This included suction machines that have been prepared and ready to operate. We looked at the management of medicines on the ground and the first floors. The home uses the Boots Monitored Dose System for the management of medicines in the home. We were informed that there are audits of medicines every week to ensure compliance with the medicines procedure of the home. The medicines administration record (MAR) sheets were in good order and we noted that the amount of medicines that was received in the home were appropriately recorded, but we noted that the amount of a few medicines carried over from the previous MAR sheet had not been recorded. As a result it was difficult to audit the amount of medicines that should be in place. In one case we noted that the amount of medicines that was in place did not balance with the amount that has been received and the amount that has been administered, according to the number of initials in the MAR sheet. Medicines were signed when administered and an appropriate code was used when the medicines were not administered. We noted in a few instances that the amount of medicines that has been administered was not always recorded in cases when a variable dose has been prescribed. As the date of opening for two eye drops had not been recorded on the containers, we were not sure of the expiry date of these medicines since they should not be used for more than 28 days from the day when they were opened. There were appropriate risk assessments in place that have been agreed with the multi-disciplinary team when medicines were crushed to give to residents. In one case however a resident did not have a risk assessment for crushing their medicines. Staff said that there was one, but could not find it on the day of the inspection. An up to date medicines reference book was available in the home. Care Homes for Older People Page 18 of 39 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. Although the records about the social and recreational needs of residents were not very comprehensive, there was some evidence that residents were supported to lead a fulfilling lifestyle. Residents received a variety of nutritious meals although more should be done to ensure that the choices and tastes of residents are taken into consideration. Evidence: The home has a section in the care plan about the assessment of the social and recreational needs of residents. This section is not always well completed. Residents also had a map of life in their care plans. This gave some information about the life of residents and does provide some information about the background of residents. However, this ideally should complement the life story of residents. We noted that the home did not always have full life stories of residents even for those who were accommodated on the dementia care unit. It is accepted within the area of dementia care that the life story of a resident is an inclusive part of the care plan and not an add-on, as this provides information about the background of residents and could explain particular aspects of the behaviour of residents as their level of cognition decreases with the progression of dementia. Care Homes for Older People Page 19 of 39 Evidence: The AQAA states that We have an activities organiser who is very proactive and arranges a variety of activities for the service users which they all enjoy. Our service users are encouraged to make choices concerning their day to day activities. There was a programme of activities in place that have been drawn up by the activities coordinator.This was available on all the floors. We did see staff interacting with residents on a one to one basis. There were also communal activities such as bingo. Residents listened to music during the course of the day although on one floor we noted that the modern songs that were being played did not seem quite relevant to residents on that floor. Residents either listened to music or watched the TV but did not do both together. Residents who gave feedback about activities said that they were generally pleased with the standard and quality of activities. Some members of staff stated in the questionnaires that there could be more outings for residents, to improve the quality of the service. Residents sat outside on the patio. Many stated that they enjoy being outside. A few residents are also able to go to the shops and to use the local amenities. We noticed that a resident was accompanied by a member of staff to the local shops. We were informed that outings will be organised as the summer progresses. Staff informed us that representatives from the local churches regularly visit the home. This include representatives not only from the main denominations, but also from the methodist church. Examination of the care records showed that spirituality is addressed to a certain extent in the care records of residents. The home has a menu choice form that is completed by staff in the morning to record the choices of residents for their meals during the day. The form is then sent to the kitchen for the kitchen staff to prepare the meals. We asked staff about the way they deal with the choices of residents. They said that they asked some residents who are able to make choices but decide for those who are unable to make choices, based on their likes and dislikes. We asked 3 residents on the same floor whether they were asked about their choices for meals. All 3 told us that staff bring the food for them and do not always ask them about their choices. We also did not find the menu choices sheets during lunch time on the floors for staff to serve the meals. Without this, it is not clear how staff knew of the choices of residents and it seemed that they based their decisions on what they thought the residents would like. Lunch on the first day of the inspection consisted of fried fish, chips and peas. For desert there was sponge and custard. There was fish in parsley sauce and mashed Care Homes for Older People Page 20 of 39 Evidence: potatoes as the second choice. All people who gave us feedback said that they enjoyed the fish and chips. We talked about the availability of meals that are on the menu with the manager and he said that the home always try to procure the food that is on the menu. He added that in cases when this is not possible because, of supply issues then a note is sent to each floor detailing the change in the menu so that residents are able to choose their meals according to the updated menu. The menu does contain some culturally appropriate meals for residents who live in the home and we did note some flexibility on a unit, in providing meals for some residents, to take into consideration their choices and tastes. 10 people who responded to our survey said that they always enjoy the meals and two said that they sometimes enjoy the meals. Care Homes for Older People Page 21 of 39 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. Complaints are taken seriously although at times the complaints procedure is not strictly adhered to, particularly with regards to timescales. The manager and his staff are aware of the action to take when there are allegations and suspicions of abuse to ensure the safety of people who use the service. Evidence: The complaints procedure of the home was available in the foyer of the home and is given to all residents or to their relatives in the service users guide. 9 residents who gave feedback in the questionnaires said that they knew how to make a complaint and 10 said that they knew someone with whom they could speak if they were not happy about the service. The complaints records showed that there have been 6 complaints since the last inspection. We noted that in a few instances complaints have not always been responded to or acknowledged within the appropriate timescales according to the homes own complaints procedure. In cases when the timescales to respond for complaints were not met, there was no evidence that complainants were informed of the delays. According to the AQAA there have been 2 referrals to the safeguarding adult team of the Local Authority. The home has been forthcoming in taking action where there were Care Homes for Older People Page 22 of 39 Evidence: suspicions or allegations of abuse and has followed the safeguarding adults policy of the Local Borough. Members of staff that we spoke to were clear that they would report any suspicions or allegations of abuse to the person in charge. The training matrix that has been kindly provided by the manager, shows that most people were up to date with training on abuse and protection of older people. There was however 6 members of the care staff team that have not had, and 4 that were not fully up to date with that training. Care Homes for Older People Page 23 of 39 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. The standard of accommodation that the home provides and the facilities that are available in the home are on the whole appropriate for the residents who live in the home. Evidence: When visiting the home on the first day of the inspection, we saw the handyman tidying the front area of the home. The grounds at the back of the home consist of some flower beds, lawn and patio areas. The lawn was trimmed and we could see that there has been some attempts at making the area more pleasant and welcoming by planting more flowers and keeping it free of weeds. The exterior of the building was on the whole maintained and in an appropriate state of decor. We noted that the reception area has been pleasantly decorated and the corridors have been recently decorated. The manager stated that the company decorators have recently decorated these areas. The communal areas were in a good state of decoration and appropriately furnished. There are now dedicated dining areas on each floor that are appropriately furnished and prepared when residents have their meals. The bathrooms and toilets have been decorated. We observed that the bathrooms were used to store things that ideally should not be there such as black bags of Care Homes for Older People Page 24 of 39 Evidence: clothes. At least one of the bins in the bathroom did not have a cover. All this made the bathrooms look cluttered and untidy. During the last inspection we asked for the work surfaces and for the doors to the cupboards in the kitchenettes be replaced. We noted that these have been provided where required. We found that the heating was on in many bedrooms and in at least one communal area on the first day of the inspection. It was a warm day and when we pointed this out to staff, action was taken to close the radiators to make sure that the heating was not on. However, the home should have its own internal systems to identify or pick up on issues like these and take action where required. There were 7 working wheelchairs in the home and many staff said that the home did not have enough wheelchairs to move residents. They said that they sometimes use wheelchairs that do not have appropriate footrests because there are no other wheelchairs. As a result the home should review the provision of wheelchairs in the home to ensure that residents are being moved safely (see also section under personal and healthcare). During the last inspection we noted that there were no grab rails on either sides of toilets in a number of en-suite toilets to residents bedrooms. The manager stated that all residents have been assessed and that grab rails have been provided in the ensuite toilets, where required. Residents bedrooms were generally in a good state of decoration. Some of the bedrooms have been personalised with residents personal belongings such as photos, pictures and bed linen. Some residents or their relatives have also brought some items of furniture to further personalise the bedrooms of the residents. We noted while looking touring the premises that the wardrobes or sets of drawers in at least 3 residents rooms were broken and needed to be repaired or replaced. The sluices were on the whole tidy and there was evidence that the home was taking appropriate measures to promote good infection control principles. There was no odours and the home was on the whole clean. Care Homes for Older People Page 25 of 39 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. The home does not always provide adequate numbers of staff to meet the needs of residents and to ensure their safety. The recruitment of new staff is carried out robustly to ensure the safety of people who use the service. Staff generally receive training to make sure that they are competent and skilled to care and support residents. Evidence: The nursing unit accommodates 21 residents and is staffed with 1 trained and 4 carers from 0800-14:00 and with 1 trained nurse and 3 carers from 14:00-20:00. The dementia care unit accommodates 21 residents and is staffed by 1 trained nurse and 3 carers during the day from 08:00-20:00. The unit on the ground floor accommodates 18 residents and is staffed by 1 trained nurse and 2 carers during the day from 08:0020:00. At night all the units have 1 trained nurse and 1 carer. We looked at the duty rosters for May to find out about whether the home has been maintaining staffing levels as we received feedback from staff that the home does not always replace staff who do not come on duty for example, when they are sick. We indeed noted that there have been 6 instances in May when the home has been short of staff on the dementia care unit and when the shifts have not been covered by Care Homes for Older People Page 26 of 39 Evidence: agency or bank staff. On two occasions there were only one carer and one trained on duty on the dementia care unit. We were informed that the home does not use agency staff. On the Thursday night before the inspection there was only one trained nurse on a nursing unit at night. There was no carer. The same thing occurred on the Sunday after the first day of the inspection. There was some inference from other members of staff that the trained nurse worked mostly on her own, with little help from the other members of staff, as they were also busy on their own floors. The above shows that the staffing levels that the home has provided on some occasions, were below the level that is required to ensure the provision of a good standard of care and the safety of residents. We looked at the personnel files of three members of staff. There was evidence that all checks had been carried out as required and that appropriate references has been sought. If there was an area to improve then perhaps the work history of applicants could have been completed in greater details. New members of staff were offered induction according to the companys induction procedure. An in-house induction format was available and we were informed that all care workers have to complete the companys induction that is based on the common induction standards from Skills For Care. According to the homes data we noted that the home has 63 of its care staff in the process of training for or who already have an NVQ level 2 qualification in care. The training matrix was kindly provided by the manager and we were able to note that most members of staff have had and were up to date with mandatory training. There was also evidence that members of staff have had training in other areas such as customer care, care planning, managing challenging behaviour and dementia awareness. Although, there was some dementia awareness training for care staff, we noted from the training records that only one member of staff has done the YTT (Yesterday, Today and Tomorrow) training, as recommended by the Alzheimers Society. The YTT training is a comprehensive training package for staff who work with people who have dementia. We also noted that most of the staff who have had first aid training would require this training again, as soon as possible. First aid certificates are valid for three years and staff last had the training on the 1st June 2006. Feedback from staff about whether they receive supervision was mixed. Some say that they have regular supervision and other say that they do not receive regular Care Homes for Older People Page 27 of 39 Evidence: supervision. The manager stated that he is addressing this issue and has a programme in place to make sure that supervision of all care and nursing staff takes place at least every two months. Care Homes for Older People Page 28 of 39 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. The home has a management team that have been working to improve many aspects of the service. The management style however could have been more inclusive and supportive to members of staff. There are systems in place to ensure that the personal money of residents is managed appropriately. The home has a quality management system to monitor the quality of the service that is provided. The home appropriately addresses health and safety issues to make sure that all people who use the premises are safe. Evidence: The current manager was appointed in August 2008. He is a trained nurse and has the registered managers award. He has previously worked in the NHS. There was evidence of staff meetings and we noted that he kept a visible profile on all the units. he stated that he has looked at the report from the last inspection and has been Care Homes for Older People Page 29 of 39 Evidence: working to ensure that all the requirements were met. He is supported by a deputy manager who has been recently recruited and by the management structure of Southern Cross. During our conversation with staff, at least 6 members of staff made negative comments about the management style of the manager. They stated that the manager does not listen to them and does not consider their views. They report that staff meetings tend to be one way when directives and orders are issued but their views not sought. All of them said that they try their best and that their efforts are not appreciated. The home uses the Southern Cross quality assurance procedure and systems. There are monthly audits that are carried out by the home manager and validation audits are carried out by the regional manager.The completed audits were available for inspection. We were informed that customer surveys are carried out yearly.We inspected the management of residents money by choosing the accounts of two residents and looking at the records. The financial records are kept electronically and are linked directly to the accounts of residents. We were limited to what we could look as the financial records were not fully up to date as the home has not had an administrator for some time. There have been a number of expenses that have been made on behalf of residents or when money has been received but the entries have not yet been entered on the electronic records. Some sample checks showed that there were vouchers and receipts for money that has been received for residents and for expenses that have been made for residents.The home has recently recruited an administrator and she was in the process of clearing the backlog of entries and updating the records. Southern Cross also has systems in place for auditing and monitoring of residents money and expenses and there is therefore a safety mechanism in the management of residents money. The home keeps property sheets to record the property and valuables that are brought into the home by residents. We noted that in some instances these were not completed or kept updated and in other cases when these were completed, these were not agreed with the residents or their representatives. We looked at the records for the management of health and safety and noted that all checks were carried out as required, including fire checks, water temperature checks and wheelchair checks. Fire drills are also carried out regularly. The home had a wiring certificate, a gas safety certificate, a portable appliances test certificate and a Care Homes for Older People Page 30 of 39 Evidence: certificate about the maintenance of the water system to prevent Legionella. There was an up to date fire risk assessment, fire emergency plan and a health and safety risk assessment available for inspection. Care Homes for Older People Page 31 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24 The home must have a 31/10/2008 report to summarise the findings of the annual satisfaction survey as part of the process to monitor the quality of the service that it provides. The belongings of residents 30/09/2008 must be recorded appropriately when these are brought into the home and the list must be kept updated as far as possible when residents receive new things into the home. Residents and/or their representatives must agree to the records kept. This is necessary to ensure the safety of residents property. 2 35 17 Care Homes for Older People Page 32 of 39 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 3 14 The home must only admit residents whose needs have been carefully assessed and considered in terms of whether the home will be able to meet the needs of the residents and whether they will fit with existing residents. To make sure that the preadmission assessment of the needs of residents is not just a formality but an active process when the manager and his staff carefully consider whether the home will be able to meet the needs and aspirations of the prospective resident and whether the latter will fit in with other residents who live in the home. 08/09/2009 2 4 14 The home must have a plan to rectify its current position when it has residents whose primary care needs are not 08/09/2009 Care Homes for Older People Page 33 of 39 those for which the home is registered. To ensure that the needs of these residents will be met at all times. 3 7 15 There must be up to date care plans in place that address all the needs of residents and that are followed by care staff to deliver care and support to residents. To make sure that the needs of residents would be met. 4 7 13 Risk assessments must be in 08/09/2009 place in cases when residents are being encouraged to use the kitchenettes or when being involved in any activity with a potential to cause harm. To ensure the safety of residents and of others. 5 8 12 Residents must be toileted or changed according to their individual care plan and pattern and not as part of a culture to change all residents at set times. To meet the elimination needs of residents 6 8 12 Residents must be referred for a seating assessment where required and the necessary sitting equipment must be provided when these are needed. To improve the quality of life 08/09/2009 08/09/2009 08/09/2009 Care Homes for Older People Page 34 of 39 of residents by ensuring that residents are not confined to their beds and are able to socialise where possible. 7 8 12 Residents nutritional status must be monitored monthly either by weighing them or by the use of another tool such as girth measurement. To appropriately monitor the nutritional status of residents. 8 9 13 All medicines must be administered as prescribed. Otherwise the amount of a medicine that remains will be different from the amount that should be in place. To ensure the safety of residents. 9 9 13 The amount of medicines that is administered when a variable dose is prescribed must be recorded. The date of opening of eye medicines must always be recorded. To ensure the safety of residents. 10 9 13 The amount of all medicines that are carried forward from a previous medicine cycle must be recorded to ensure an appropriate audit trail. To ensure the safety of residents. 08/09/2009 08/09/2009 08/09/2009 08/09/2009 Care Homes for Older People Page 35 of 39 11 10 13 Residents must always be offered a call bell when they are seated in their room, unless there is a risk assessment in place. To ensure that residents can summon help when this is needed. 08/09/2009 12 15 16 Residents must always be 08/09/2009 asked about their choices for their meals on a day to day basis. Evidence must be kept on the floors as required. To demonstrate that residents are being offered choices about their meals 13 16 22 All complaints must be managed according to the complaints procedure of the home particularly with regards to meeting timescales. To demonstrate that the home takes all complaints seriously. 08/09/2009 14 22 23 The home must review the provision of wheelchairs to make sure that there are enough wheelchairs in the home for staff to use to move residents. To make sure that the quality of life of residents do not suffer because of the lack of wheelchairs. 08/09/2009 Care Homes for Older People Page 36 of 39 15 23 23 The furniture that is 08/09/2009 provided in all the bedrooms of residents must be in good condition. To provide a comfortable and maintained environment for residents. 16 35 17 The property and valuables sheets of residents must be completed appropriately to record the possessions of residents when these are brought into the home. To ensure the safety of residents belongings 08/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that staff have training in using the pain assessment tool as it seemed that some would benefit from more knowledge in this area. The manager and staff should carefully monitor the ironing of residents clothes and make sure that residents do not wear clothes that have not been ironed appropriately. The home should provide training in end of life care for staff to fully understand this area of care and to increase their confidence in addressing this area of care. The home should make every effort possible to complete the life story of residents and carry out a comprehensive assessment of the social and recreational needs of residents. The bathrooms must be kept as tidy as possible to provide a pleasant environment for residents. There must be systems in place to carefully monitor the temperature in the bedrooms of residents and other parts of the home and to take action where required, such as 2 10 3 11 4 12 5 6 21 25 Care Homes for Older People Page 37 of 39 closing radiators or shutting down the central heating, to ensure a tolerable temperature in the home. 7 26 All the bins must have appropriate covers to maintain good infection control practice. Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 39 of 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!