Inspection on 21/04/10 for Willows Nursing Home Limited

This inspection was carried out on 21st April 2010.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willows Nursing Home Limited 28/06/10

Willows Nursing Home Limited 16/06/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Willows Nursing Home Limited 10 Weld Road Southport Merseyside PR8 2AZ     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: Claire Lee     Date: 2 2 0 4 2 0 1 0 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Willows Nursing Home Limited 10 Weld Road Southport Merseyside PR8 2AZ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Willows Nursing Home Limited Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing- Code N to people 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 The maximum number of people who can be accommodated is: 30 Date of last inspection Brief description of the care home The Willows is an older detached property that has been converted into a care home providing nursing care for thirty older persons. It is situated close to the sea front at Birkdale and is also within walking distance of Birkdale village. The home provides accommodation over three floors with lift access to all three. One bedroom situated on a mezzanine level floor has stair access and is used for residents with no mobility problems. There are twenty four single bedrooms and three double bedrooms. The communal day space consists of one large sitting room and a conservatory extension Care Homes for Older People Page 4 of 34 Over 65 30 0 1 6 0 6 2 0 0 9 Brief description of the care home attached. There is disabled access to the rear of the building and the garden can be accessed. There is a call bell system in the home. This service is operated by Mr & Mrs Jackson and the manager is Ms Benita Calderbank. The fee rate for accommodation is from £515.00 to £616.00 a week. Care Homes for Older People Page 5 of 34 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: A site visit took place as part of the inspection and this was carried out for a duration of approximately thirteen hours over three days. Information for this inspection was gathered in a number of different ways. This included looking at service and staff records and looking at different areas of the building. All of the key standards were inspected, other standards we felt were relevant and previous requirements and recommendations from the last key inspection 16th June 2009. The site visit for this inspection was conducted with the manager. Case tracking was used as part of the site visit. This involves looking at the support a resident gets from the manager and staff including their care plans, medication, money and accommodation. Three residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service. Care Homes for Older People Page 6 of 34 Have your Say Survey forms were distributed to residents, relatives and staff as another means of gaining their views. A number of comments from interviews and surveys have been included in the report. The term resident is used in this report as this is what people accommodated liked to be called. This is therefore, used as a mark of respect to them. An AQAA (annual quality assurance assessment) was completed for this inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? The recording of residents care details has improved. The care files seen contained information that enables the staff to provide care and support to the residents according to individual need and in a way in which the residents preferred. Each person had a plan of care and supporting documents, such as risk assessments. These help to identify extra support needed to keep a resident safe and to help minimise the risk of injury to them. Following the last inspection staff have attended training in safe working practices, for example, infection control, moving and handling and first aid. This has also included food hygiene, which was required last year. We looked at the training programme and also certificates for courses attended to show this had taken place. Changes have been made to help improve the overall management of the service. There has also been the appointment of a new manager. We still however, have some concerns as to outstanding requirements from the last key inspection and also issues about how medicines are being administered to the residents. These are stated under What the service could do better. The owner is now undertaking formal visits to the home and producing a written report of his findings. These are called Regulation 26 visits. We looked at recent reports and these gave an overview of the home. The visits included talking with residents and staff, looking at service records and taking a look round the home. This helps to check the quality of the service people are receiving. Residents now have a better entertainment programme and they can join in with a Care Homes for Older People Page 8 of 34 number of events or social activities. This includes a newspaper with current and past historical events and information about the home. A resident said they enjoyed the music and exercise class and also the visits by the activities organiser. The manager stated that a number of bedrooms have been decorated as part of the general maintenance of the home. What they could do better: The Service User Guide and Statement of Purpose provide information about the service. The new managers qualifications and experience should be written in the documents. This helps to ensure prospective residents and their families/representatives have up to date information to help them to decide whether the home is right for them. We did not see any evidence of residents (or their relatives) being involved with the development of their individual plan of care. This should take place to help ensure they are aware of the care and support they are receiving and that it is given in a way they prefer. Residents should be weighed regularly if there is a concern regarding a resident having gained or lost weight. This helps to monitor their ongoing health. The management of medicines in the home does not protect the residents. We found issues with the way in which medicines were being administered and recorded. The requirements to improve medicine management are stated in the main report. There is also an outstanding requirement regarding the need to complete risk assessments for residents who wish to administer their own medicines. We found that this was lacking for a resident who is undertaking this practice. As part of reviewing how medicines are administered, competency assessments should be completed for the staff to help ensure they give medicines in the safest way. Staff should receive training regarding The Deprivation of Liberty Safeguards. This will help to ensure they understand how to deliver care in the least restrictive way or if necessary follow a standard process to protect them if they are at risk. These safeguards should be assessed as part of the initial assessment and subsequent assessments, as part of monitoring their health. The complaints procedure should be displayed in the home for everyone to see and the Commissions contact details should be stated so that people can contact us if they so wish. Checks of the hot water to the baths/showers must be undertaken and recorded to help ensure the temperature of hot water is safe for the residents to use. Improvements are needed to the environment to help ensure it is maintained to a good standard for the residents. There is a need to replace a number of items of bedroom furniture as existing ones are old and worn. These were identified with the manager at the time of the site visit. The carpet in the lounge must be replaced, as it is has adhesive tape applied in places to worn areas. The windows in the conservatory are affected by condensation as the glass has blown. Again these must be replaced to help ensure the general upkeep of the home. Care Homes for Older People Page 9 of 34 We found that some radiators did not have covers or guards in place. A risk assessment should be in place to help identify and minimise the risks involved. Plaster work and a tile are chipped in the laundry room and must be replaced or repaired to help ensure good standards of hygiene in this room. The manager agreed that urgent work was need to improve this. Staff receive an induction when they start employment. This is an introduction into the care home. These documents were with the staff and not available for inspection. We would recommend they are kept at the home to evidence the information they are given when they commence employment. An administrator brings money to the home for a resident. If the manager handles this money then a record should also be kept at the home to help protect the persons financial interests. There is an outstanding requirement from the last inspection in June 2009 in respect of staffing. The managers staff file was not available for inspection to evidence her recruitment. At the inspection in June 2009 there was no staff file for a new carer. Staff records must be made available for our inspection. This helps to provide assurance that the home is being managed effectively and safely to protect people. Supervision should be given regularly to all staff, to monitor their care practices. This also forms part of staff learning and development. Sufficient numbers of staff should be trained in the testing of the fire alarms to help ensure they are working effectively to protect people. Emergency lighting should also be checked in house, as part of the necessary checks to ensure it is working effectively. 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 10 of 34 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 34 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. Specific information about the home should be recorded in the Service User Guide and Statement of Purpose, so that people have up to date accurate information regarding the service provided. Evidence: The home provides a range of information to prospective residents; they are presented in a Service User Guide and the Statement of Purpose. These documents are generic in style and it would be beneficial if they provided specific information regarding the service. For example staffing numbers and staff training. There has also been a change of manager and the new managers qualifications and experience should be written in the documents. This helps to ensure prospective residents and their families/representatives have up to date accurate information to help them to decide whether the home is right for them. People are free to visit and look around The Willows prior to choosing to live there if they want to; they can also stay for a meal and have a trial visit before deciding. A relative commented on the friendly Care Homes for Older People Page 12 of 34 Evidence: welcome they received when looking round. The AQAA reported, once a decision has been made regarding placement either myself (manager) or a senior colleague will attend the service user (resident) to conduct a detailed assessment of care, social and psychological needs. We looked at two care needs assessments to ensure this had taken place. The assessments evidenced different aspects of daily living. For example, help with washing and dressing, sleep, diet, medicines, falls and how to support a resident with their mobility. The assessments seen provided sufficient information, so that the staff were aware of the care and support the residents needed. Details about social, leisure and cultural support are now recorded in a document called, All About Me, so that the staff are aware of family involvement and preferred interests and hobbies. This helps the residents to continue with their chosen lifestyle and maintain links with people outside the home. Assessments from social services were also on file to help the staff plan the necessary care. We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessment process. The manager said that intermediate care was not currently being provided at the home and therefore this standard was not assessed. Care Homes for Older People Page 13 of 34 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. Medicines are not being managed effectively and this may place residents at risk. Evidence: Residents had a care file and this included a number of care documents. The manager has made changes to the way in which care documents are written by the staff and the care files now contain more information. This helps the staff to know how to care for the residents and to provide person centred care. We looked at care plans and these were written in a style that was easy to read and follow. They contained details about the residents health and social care needs and the level of support needed from the staff to help them keep well. They included areas such as, eating and drinking, sleep, communication, washing and dressing and help and mobility. The information was up to date and reflected any change in treatment or care. We did not seen any evidence of residents (or their relatives) being involved with the development of their individual plan of care. This should take place to help ensure they are aware of the care and support they are receiving and that it is given in a way they prefer. Care Homes for Older People Page 14 of 34 Evidence: We looked at other supporting care documents. This included how risks are managed, how the staff record the care they given and the input residents receive from GPs and other health care professionals. Risk assessments had been completed where a risk had been identified in respect of a care need or task. For example, when a resident needs help with their mobility, they are at risk of falls, use of bed rails or have a poor dietary intake. We saw good evidence of ongoing contact with external health professionals to support a resident who was not eating sufficient and therefore staff felt that the person was at risk. We did however, note that there was no record of the resident being weighed since February 2010. This should have been recorded more regularly to help ensure staff monitor the residents weight gain or loss. We were advised that the home does not have its own scales and these have to be rented from the chemist at different times. (To resolve this problem, scales were ordered by the manager at the time of the inspection). We looked at how the staff support residents who have vulnerable skin and need regular positional changes to help ensure their comfort. We saw evidence of special dressings being applied and care plans seen gave good detail in respect of ongoing monitoring to help improve their condition. We looked at daily care records completed by the staff and these showed the care and support given to the resident. The changing needs of the residents are discussed with the staff at the handover at each shift change and at other times during the day. Interviews with staff confirmed this and the staff were able to discuss the care they give the residents. Care staff now have a keyworker role. This enables them to take on extra responsibilities for a number of residents and helps to build up relationships with them. Residents interviewed were aware of who their key worker was. Care staff should be encourged to take an active part in care planning, as this role develops. This will help them to give care and support to the residents according to their individual needs. We checked how medicines are managed in the home and this included looking at medicine charts and stock balances of medicines. It was difficult to check on the stock balances, as they arrive at different times of the month and old stock was still in use. The staff were unsure as to why this was happening. When checking one medicine we found that there were medicines left over from last month, however it had been signed as being given each day. We found that two residents were being given another persons medicines, as they did not have their own supply. Sharing medicines Care Homes for Older People Page 15 of 34 Evidence: is an unafe practice. Staff were unsure about the prescription details for these medicines and why they were being handwritten on the medicine chart for last month and this month if being given regularly. We also found that medicine charts had not been signed by the staff following adminintration of a daily medicine to a resident. This is poor evidence of record keeping. Residents can look after their own medicines if they so wish. We found that that the staff had not risk assessed this practice for the use of inhalers. Effective systems must be put into place and this includes the completion of a risk assessment to help ensure a resident can administer their own medicines safely. This requirement has not been met from the previous key inspection. We looked at how external medicines are managed. We found that a cream prescribed for a resident had not routinely been signed by the staff as being given. A tick had been entered on the medicine chart at different times. It was therefore difficult to ascertain whether it was being applied. Existing medicine practices are placing the residents at risk. We spoke with the manager about the issues we had found and the need to ensure safe administration of medicine in the home. We would also recommend a thorough review of how medicines are managed. This should include observation of the staff and recording their competencies, to help ensure they administer medicines safely. The manager said that previous audits had highlighted some concerns and that she was looking to introduce blister packs, which have the medicines pre packaged by the homes chemist to help administer medicines safely. We observed the staff throughout the day and we found they interacted well with the residents. They were seen to be polite and helpful in their approach. They had time to sit with the residents for a chat either in a group or a one to one basis. A relative said, The staff are nice and very helpful. Care Homes for Older People Page 16 of 34 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. Social activities and meals were well managed and provided daily variation and interest for people living in the home. Evidence: Residents we spoke with said they liked the routine in the home and that they could choose how to spend their day. For example, whether to attend arranged activities, what time to get up or retire at night, being able to go out during the day or having meals at different times. A resident said that staff were respectful and supportive with his social arrangements, which mainly occurred outside the home. We saw a number of residents sitting in the lounge or the conservatory. Some had also chosen to stay in their private room or to sit outside in the garden, as it was a pleasant day. Staff were seen to ask residents where they would like to sit during the morning, to help ensure they sat with people they knew. Visitors were present at different times and a relative said, I come in and spend a great deal of time at the home. The staff always make me feel welcome, early morning or late at night. Visitors were able to meet their family member in the lounge, conservatory, or in their own private room. This choice was seen to be offered Care Homes for Older People Page 17 of 34 Evidence: during our visit. The AQAA reported, The Willows has an extensive entertainment programme that is enjoyed by all the service users (residents). Residents interviewed said they enjoyed the music and also reading the Daily Sparkle a newsletter regarding the home; this has current or past historical events, which are of interest to the older person. Their comments included, Good entertainment, I like the cinema and the bingo and I like the themed parties. The home now has an activities organiser and a carer is allocated to help with social arrangements during the afternoons. Social activities appear to be well managed to help ensure the residents receive stimulation and enjoyment that suits their lifestyle. As previously stated under Standard 3, the staff complete documents called All About Me to record individual interests and social contacts. We were advised that two extra staff are brought in to take residents out from the home, at least twice a week. This enables them to join in with community based events. The menu is based over four weeks and we noted that there was a good choice of hot and cold meals served at different times of the day. The main meal for the day is served at lunch time and we saw the residents being offered a choice of three hot meals. Residents interviewed said they see the cook most days, to ensure they know what is on the menu and to request an alternative if preferred. Menus were available for the residents and the menu of the day was written up on a board in the hall for people to see. The following comments were made about the meals, Very good indeed, Lovely cakes and puddings and You can have anything you want, June (cook) is really good. Special diets were being catered for and there was evidence of this in the care plans we looked at. We also saw dietary assessments, which the staff have had completed should they have a concern about a residents dietary intake. This helps to monitor their health and well being. The kitchen was found to be clean, organised and food hygiene records were up to date to help ensure good standards of hygiene in the home. We saw plenty of fresh produce and fresh fruit was placed in the residents bedrooms in the mornings. There was also a bowl of fruit available in the lounge. A resident said, It is really nice to have this provided. Care Homes for Older People Page 18 of 34 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. People using the service were protected by the complaints and safeguarding procedures, which were understood by the staff. Evidence: Residents and their families/representatives have access to a written complaints policy and procedure. Details of this were available in the Service User Guide. We did however, note that the contact details for the Commission were not correct. The manager was advised to change these to our Newcastle address, so that people have the information they need should they wish to contact us. We also recommend that a summary of the complaints procedure be displayed in the home for everyone to see. We looked at the homes complaint log and this showed complaints received, investigated and action taken by the staff if required. Residents interviewed said they were happy with arrangements in the home and would talk to the nurse in charge if they had a concern. The AQAA reported, that six complaints had been received and none upheld. The Commission have not received any complaints. With regard to protection people, the AQAA reported, the home operates a zero tolerance policy and staff are aware of the whistle blowing policy. Staff interviewed were able to describe the different types of abuse and how to report an alleged incident to the correct authorities. Staff records showed that staff attend an alerters course about abuse. The AQAA reported that there was one safeguarding referral and Care Homes for Older People Page 19 of 34 Evidence: this was dealt with appropriately by the statutory agencies. This included the Commission. We saw information about the Deprivation of Liberty Safeguards, which have been introduced under the Mental Capacity Act 2005. These are to help protect people who cannot make their own decisions about their care home or treatment, because they do not have the capacity to do so. Staff should receive training regarding these standards. This will help to ensure they understand how to deliver care in the least restrictive way or if necessary follow a standard process to protect residents if they are at risk. There have been no referrals from the home to date. Care Homes for Older People Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement must be made to the environment, so that people are assured their accommodation is comfortable and safe to live in. Evidence: Following the last key inspection there has been some painting and decoration to help improve the overall standard of accommodation. We were informed that twelve bedrooms have new furniture. A decorating plan was seen, however the manager said that there are still a number of bedrooms that require attention. We conducted a tour with the manager and saw bedroom furniture (chests of drawers, bed side cabinets, wardrobes) and bed side tables that were chipped and worn. Some bedside tables did not have a trim and were dirty. The carpet in the conservatory is patched with adhesive tape where it has worn through and it is therefore not suitable floor covering. It may also pose a trip hazard to people in this room. The windows in this room are also affected by condensation, as it appears the glass has blown. The tread on the carpet to the top floor stairs and landing is threadbare in places and will need replacing with time. We saw two internal damp patches, on the ground and first floor, which had been caused by water leaks. The bedrooms and other areas that require attention were brought to the managers attention at the time of the inspection, so Ms Calderbank is aware of them. Refurbishment and maintenance of the home must include the purchase of new bedroom furniture and bedside tables, carpet Care Homes for Older People Page 21 of 34 Evidence: and windows replaced in the conservatory and the damp patches treated. This will improve the overall accommodation for the residents. The AQAA confirmed the need for improvement over the next twelve months and it reported, all service users (residents) room to have been redecorated and any damaged furniture replaced. The manager stated that some radiators did not have covers or guards in place. We noted this in the hall and one of the radiator valves was broken. We were advised that ongoing work is being carried out to ensure the radiators are maintained at a safe temperature. This helps to help protect the residents from harm. A risk assessment should be implemented to help identify and minimise the risks to the residents. Residents bedrooms had personal items from home and a call bell to ring for assistance. Some rooms had private telephones and all residents had a television. We noted that a number of rooms had lockable drawer space, so that residents could store their personal items safely. Some bedrooms had special nursing beds to help ensure the comfort of people who need to stay in bed for long periods. Residents being nursed in bed received regular attention from the staff during the day. The laundry room is now in a poor state of repair. The walls need to be re plastered and a chipped tile replaced around the sink. It was difficult to see how the clean and dirty linen was segregated and there were no supply of hand towels available. We would recommend infection control procedure are reviewed, as people may be placed at risk by the current standard of hygiene in this room. The manager agreed that urgent work was needed to the fabric of the laundry room to rectify this problem. Communal space comprises of a lounge and conservatory. The conservatory is also used for dining space. The lounge has comfortable armchairs and was seen to be used by many of the residents during the day. The room has a large screen TV for the enjoyment and easy viewing for the residents. Residents have the use of a bath hoist, a walk in shower and also a specially adapted bath to help those who are frail and have limited mobility. We noted that there were no up to date records of checks of the hot water to the bathrooms. The maintenance records only evidenced checks up until August 2009 and the record completed by the staff was only for one bathroom and again this was not current. The temperature of the hot water to the baths/shower must be recorded, to help ensure the hot water is delivered at a safe temperature. Residents may be placed at risk if this is not undertaken regularly. We brought this to the managers attention, as we concerned about the lack of records. We also conducted our own check as the ground floor bath was being used during the inspection. Bathrooms were fitted with suitable hand Care Homes for Older People Page 22 of 34 Evidence: washing facilities for the staff to use. Emergency lighting is provided throughout the home. There were no records of monthly in house checks which we strongly recommend, as part of ensuring the lighting is working effectively. We brought this to the managers attention at the time of the inspection. The garden is landscaped and provides seating for the residents during the warmer months. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment records must be available to evidence staff recruitment practices to ensure the ongoing safety of people in the home. Evidence: The AQAA gave us details of how many staff were employed, a number of which have been working at the home for a long period of time. This helps to provide stability for the residents and their families. A registered nurse is in charge at all times with the support of the manager who works supernumerary. The compliment of staff included carers, domestic and kitchen staff, laundry assistant, maintenance person and gardener. On the day of the inspection a registered nurse was on duty with four care staff. The manager came in to help with the inspection. Residents interviewed said it was a busy home and that the staff did their best to answer calls for assistance promptly. A comment was made that sometimes they had to wait but normally an explanation was given if this occurred. Residents interviewed also stated that the staff were polite and helpful as they went about their work. A resident said, The care is good. Staff are encouraged to undertake formal learning in care and this is provided by completion of NVQ (National Vocational Qualification) in Care at Level 2 or 3. Of the sixteen staff employed, fourteen have obtained an NVQ in Care. This demonstrates a commitment to their learning. Care Homes for Older People Page 24 of 34 Evidence: The manager undertakes the recruitment of new staff and we asked to look at three files for new staff. We also asked to see the managers staff file. The files for the care staff showed they had been recruited safely and had only commenced employment following police clearance and two written references. Although three staff members said they received an induction we did not see any record of this having taken place. We were advised that the induction documents were with the staff. We would recomemend they are available at the home to evidence the information they are given in respect of their job role when they start employment. The managers staff file was not available for us to look at. We were advised that the owner does not keep this information at the home. This is discussed further under Standard 37 (Record Keeping) of this report. The staff are now accessing regular training in safe working practices. For example, moving and handling, first aid, infection control, food hygiene and safeguarding people. A staff member said, There are always courses available and the training has certainly improved. Staff files showed evidence of course dates and certificates for attendance. This helps to ensure the staff have the skills and knowledge to work safely with the residents. We saw evidence of other courses relevant to the care of the older person, such as diabetes, dementia awareness and social activities. Care Homes for Older People Page 25 of 34 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. Records must be made available for inspection to help ensure the home is being managed effectively and safely to protect people. Evidence: A new manager, Ms Benita Calderbank was appointed in February 2010. Ms Calderbank is a registered nurse, has NVQ Level 4 in Management and has held previous managerial positions in a care home. We asked to look at the managers staff file to make sure she had been recruited safely. This was not available for inspection and we advised that the owner does not keep the file on the premises. Staff files must be made available for inspection to help ensure the protection of people using the service. This requirement has not been met from the last inspection site visit. Ms Calderbank needs to submit an application to the Commission for the position of Registered Manager for the home. Staff interviewed said they like working with the new manager as she was supportive. Care Homes for Older People Page 26 of 34 Evidence: The AQAA reported that the manager meets with the residents when on duty. We confirmed this when talking with a number of residents; they said the manager was very approachable, they got to talk with her each day and that this contact was appreciated. We are concerned about the way in which medicines are administered, recorded and managed in the home. Current practices are placing people at risk. The requirements for the medicines are stated under Standard 9 (Medication) of this report. As part of reviewing medicine practices in the home, audits had been carried out. These should continue to help monitor medicine admininistration. Separate staff and residents meetings are held, so that people can voice their opinions regarding the service. We were informed that the residents meeting was well attended and residents were told about the staff key worker system that had been introduced. The owner conducts a visit to the home each month and writes up a report of his findings. These are called Regulation 26 reports. The owner tours the building, meets with residents and looks at various documents relating to the service to give him an overview what is going on. We looked at a number of recent reports during the site visit. The manager said the home does not hold any monies on behalf of the residents. An administrator for the group of homes brings money to the home for a resident and this is given to the manager to give to the resident. We would strongly recommend that if this money is handled by the manager that a record should also be kept at the home to help protect the persons financial interests. Supervision has yet to be given to all the staff to help support them in their job role. The manager is new in post and is sorting out arrangements to ensure this is given to everyone. Supervision should be given regularly to all staff, to monitor their care practices. This also forms part staff learning and development. Staff said they could go to the manager at any time and that she always had time to listen and to advise. We looked at a number of health and safety documents and policies in safe working to check they were current and in accordance with current legislation. Details of services and equipment to the home were stated in the AQAA and we conducted a spot check of a number of contracts. For example, gas, electric, hoisting equipment and fire detection. These were in date to help keep people safe. Fire alarms are normally tested weekly to ensure they are working effectively to help protect people. We noted however, that when the staff member responsible for the Care Homes for Older People Page 27 of 34 Evidence: checks was not on duty, then the alarms were not subject to a safety test. No other staff had been trained to carry this out. The manager agreed that a more robust system needs to be put into place and this entails other staff being trained, so that they can carry out these vital tests. Fire prevention training is given to all the staff to help then know how to respond in the event of a fire. Accidents that affected a residents welfare had been recorded in an accident book and also in the residents daily evaluation record. This helps to make sure everyone is aware of the incident and any treatment needed. Care Homes for Older People Page 28 of 34 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 9 13 A risk assessment must be completed for residents who wish to administer their own medicines. This will ensure residents are able to undertake this safely and are aware of the risks involved. 11/08/2009 2 37 17 Staff files must be available for inspection. This will ensure recruitment practices are safe to protect people in the home. 11/08/2009 Care Homes for Older People Page 29 of 34 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 13 Medicines must only be given to a resident who has had them prescribed. Medicine must not be shared. Sharing medicines is unsure and places residents at risk. 31/05/2010 2 7 13 Records must be kept of all medicines given to the residents. This will help to ensure they are receiving them correctly and safely. 31/05/2010 3 19 16 The carpet must be replaced 01/07/2010 in the conservatory, as there is adhesive tape over worn areas. This will help to provide suitable floor covering in this room. The use of adhesive tape may pose a trip hazard to people in this room. Care Homes for Older People Page 30 of 34 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 19 13 The two damp patches to the first floor and ground floor must be treated. Damp may be hazardous to the residents health and must be eliminated. 01/06/2010 5 19 23 The windows affected by condensation as the glass has blown must be replaced. This will help to ensure the room is suitable for the residents to sit in. 01/07/2010 6 24 16 Bedrooms identified with the 01/07/2010 manager must be provided with new bedroom furniture, to include bedside tables. This will help to provide suitable furniture for the residents to use. 7 25 13 Checks of the hot water to the baths/showers must be undertaken and recorded This will help to ensure the hot water is delivered at a safe temperature for residents use. 01/06/2010 8 26 16 The laundry room requires plastering and replacement of a chipped tile. 01/07/2010 Care Homes for Older People Page 31 of 34 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 This will help to improve the standard of infection control in this room 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 1 The Service User Guide and Statement of Purpose should contain specific informtion regarding the servie. The new managers qualifications and experience should be written in the documents. This helps to ensure prospective residents and their families/representatives have up to date information to help them to decide whether the home is right for them. We would recommend that assessments for peoples mental capacity are introduced to the pre admission and ongoing assessment process. Residents (or their relatives) should be involved with the development of the individual plan of care. This should take place to help ensure they are aware of the care and support they are receiving and that it is given in a way they prefer. Residents should be weighed regularly if there is risk of weight loss or gain. This will help to monitor their health. Medicine practices should be reviewed and competency assessments should be completed for the staff. This will help to ensure they give medicines in the safest way. Contact details for the Commission should be updated to include the Newcastle address, so that people have the information they need should they wish to contact us. A summary of the complaints procedure be displayed in the home for everyone to see. Staff should receive training regarding The Deprivation of Liberty Safeguards. This will help to ensure they 2 3 3 7 4 5 8 9 6 16 7 18 Care Homes for Older People Page 32 of 34 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 understand how to deliver care in the least restrictive way or if necessary follow a standard process to protect them if they are at risk. 8 25 We found that some radiators did not have covers or guards in place. A risk assessment should be in place to help identify and minimise the risks involved. We strongly recommend emergency lighting is checked in house each month to help ensure it is working effectively. Induction documents should be made available at the home to evidence the information staff are given in respect of their job role when they start employment. An administrator brings money to the home for a resident. If the manager handles this money then a record should also be kept at the home to help protect the persons financial interests. Supervision should be given regularly to all staff, to monitor their care practices. This forms part staff learning and development. There should be sufficient numbers of staff who are traned to check the fire alarms are working effectively to help protect people. 9 10 26 30 11 35 12 36 13 38 Care Homes for Older People Page 33 of 34 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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