Care Home: Abbey Park

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well We received some very positive comments about the service offered in the home. These included: `The residents are well looked after and fed very well.` `Staff always at hand to assist, toileting, drinks, mobility etc.` `Look after my X, keep him happy.` `The home provide really good quality care and staff generally are a kind and caring team.` The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. People had access to a variety of health care professionals to help them keep well. Arrangements were in place to ensure people received their medicines as prescribed. Staff had received training to ensure they could care for people safely. There were good relationships between the staff and the people living in the home. Comments received about staff included: `I think they do just fine.` `Staff are cheerful and pleasant and this is consistent. They are helpful and make themselves readily available.` `Staff are good.` `Staff are friendly, happy, and consistent with care.` `Very friendly and helpful. They answer the buzzer if I want anything.` People told us they were satisfied with the environment and that they were comfortable. What has improved since the last inspection? The owner of the home was ensuring the management of the home was overseen and reporting on this. Fire equipment was being regularly checked to ensure it was working effectively so that people could be kept safe. There had been some further improvements to the environment making it more comfortable for people. What the care home could do better: Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management plans must be improved so that people are kept safe on an ongoing basis. The quality of the record keeping should be improved to enable the home to demonstrate that people receive the care they need in a way they want. Food records should be improved so that it can be determined people are eating a varied and nutritious diet. Induction training for new staff should be improved to ensure they have all the necessary skills and knowledge to care for the people living in the home. The quality of the service being offered to the people living in the home needs to be regularly reviewed. Key inspection report Care homes for older people Name: Address: Abbey Park 49-51 Park Road Moseley Birmingham West Midlands B13 8AH     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: Brenda ONeill     Date: 1 5 0 3 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 32 Information about the care home Name of care home: Address: Abbey Park 49-51 Park Road Moseley Birmingham West Midlands B13 8AH 01214424376 01214491300 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr M Salim,Mr M Mughal care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC) 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 (OP) 28 Dementia - over 65 years of age (DE(E)) 6 Date of last inspection Brief description of the care home Abbey Park is a home registered for 28 older people and has both single and shared bedroom accommodation. It is situated in the Moseley area of Birmingham in a residential street within a ten-minute walk of Cannon Hill Park. Within walking distance there is access to bus services that will take you to the centre of Birmingham or to Acocks Green or, on another route to Birmingham and to Druids Heath. Care Homes for Older People Page 4 of 32 0 2 0 4 2 0 0 9 0 0 Over 65 6 28 Brief description of the care home The home is an adapted building over three floors. The third floor is accessed by a stair lift and there is a passenger lift to the second floor. The home has four lounges and one dining areas. One of the lounges is the designated smoking area. There is an assisted bathing facility on the ground floor and an assisted shower on the first floor. The home has a large accessible enclosed garden to the rear of the property. The home has a ramped access at the front of the house but this is not the main access to the building and there is ramped access at the rear of the building. A small amount of car parking is available at the side of the home. There is information available in the home for people who may wish to go and live there such as our inspection reports and a service user guide. The range of fees charged at the home was not included in the service user guide. People should contact the home to obtain these. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over two days by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. The date for the Annual Quality Assurance Assessment (AQAA) had not been reached therefore it had not been returned at the time of the inspection. This is a document that provides information about the home and how they Care Homes for Older People Page 6 of 32 think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with seven of the people living in the home, one visitor, the manager and four staff to get their views on the home. We sent ten Have your Say surveys to people who live in the home and ten to staff members. A total of twelve were returned, six from people living in the home although these had been completed by relatives and six from staff. These views have been included in the report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management plans must be improved so that people are kept safe on an ongoing basis. The quality of the record keeping should be improved to enable the home to demonstrate that people receive the care they need in a way they want. Food records should be improved so that it can be determined people are eating a varied and nutritious diet. Induction training for new staff should be improved to ensure they have all the necessary skills and knowledge to care for the people living in the home. The quality of the service being offered to the people living in the home needs to be regularly reviewed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was some information available to help people decide if the home was suitable for them. Arrangements are in place so that people can be confident that their needs will be met upon admission to the home. Evidence: The service user guide for the home was dated November 2003. Some hand written amendments had been made but these were not all current, for example, the contact details for the Commission. The document needed to be fully reviewed to ensure all the information was current and the fees charged at the home should also be included. This will ensure people have all the information they need to help them decide if the home is right for them. The information was available in large print making it accessible to people with impaired vision. The pre admission process was looked at for one person who had been admitted to the home since the last inspection. The records showed that a social worker had Care Homes for Older People Page 11 of 32 Evidence: undertaken a full assessment of the persons needs and this information had been sent to the home before admission. This gave staff at the home details of the persons needs in relation to mobility, mental health, preferred routines and activities and so on. This would help them ensure the person received their care in the way they wanted. All the records made by the home started on the day of admission. There were no records to indicate the person had been seen by the manager or staff of the home before admission or how they had decided they could meet the needs of the individual. The manager told us she had visited this person in hospital and was able to show us the date in the diary. The person was spoken with and said she did not have a look around before moving in. She did not appear to have wanted this and was just pleased to be moving from hospital. A relative of the individual confirmed they had been to look at the home on their behalf to see if they thought it was suitable. Another person that was spoken with stated she did spend some time in the home before moving in. She told us she stayed for a meal and was able to talk to people in the home to see if she liked it. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of detail in the homes recording systems means that there is a risk that people will not consistently get the care they need in a way they preferred. Medication management was good and ensured people received their medication as prescribed. Evidence: We tracked the care for three of the people living in the home. This involved observing their care, sampling their care plans, risk assessments and daily records, speaking to them and the staff where possible. All the files sampled included some care plans but these included little detail of what peoples individual needs were, what they were able to do for themselves and what they needed help with. For example, one care plan stated staff were to help with oral hygiene there was no detail of what this meant or if the person had their own teeth or dentures. Staff told us she had her own teeth and one told us she could brush her teeth if they put the toothpaste on the brush. These details needed to be in the care plan so that she consistently received the care she needed and was encouraged to retain some independence. Care Homes for Older People Page 13 of 32 Evidence: Care plans were not clear about peoples needs in relation to continence one said some incontinence another had no details at all but from the observations made and what staff told us this individual was being taken to the toilet by staff and using continence aids. This lack of detail could lead to people not having their needs met. Staff were inconsistent in what staff they told us about how one person was moved. The individual had recently moved into the home. The care plan stated can weight bear but will ask for the sliding board sometimes to transfer from the chair to wheelchair. 2 care assistants to assist with transfers. The manual handling assessment that was in place stated can weight bear using the handling belt and for transfers from bed to chair and vice versa must use handling belt and banana board. One staff member told us this person could walk with 2 staff using the handling belt, another told us they do not use the handling belt as the person could not stand and another they use the sliding board and belt as the person can stand. We did not see this person moved however these inconsistencies could put the person at risk of not being moved safely. For another person staff were very clear that they were hoisted at all times and this was seen to be carried out appropriately. This was also very clear in the individuals care plan. This ensured the person was moved safely. Two of the people we case tracked had some behaviours that were difficult to manage. One person had some guidance on their care plan about how staff were to manage this and what staff told us was consistent and generally cross referenced to what was on the care plan. Staff were consistent when telling us about the other person but there was no detail on the care plan about this. We observed that staff were doing what they had told us. This ensured ensured the individual was kept safe. Plans for managing any difficult behaviour needed to be in place so that it could be ensured that any new staff had a point of reference to get the correct guidance so that peoples needs were met safely. People had tissue viability assessments on their files. Two of those seen indicated people were at risk of developing pressure sores. There were no specific plans in place to ensure peoples skin did not become sore. There was some mention of skin care on one of the personal hygiene care plans which stated check skin for soreness and apply creams if necessary. there was no detail to indicate if any aids were being used and so on. We were told that the individuals did not have any sore skin and we saw that both were sat on pressure cushions to help avoid this. Staff spoken with were not clear about what they should be doing to ensure peoples skin was kept in good Care Homes for Older People Page 14 of 32 Evidence: condition. Some said the individuals had pressure cushions others said not, one staff member told us one person had a pressure mattress, they did not. The manager told us this person had not been assessed as needing this. Plans must in place that ensure staff have information as to how they are to avoid peoples skin becoming sore so that people are not put at unnecessary risk. Records showed that people had access to a range of health care professionals. These included G.P.s, district nurses, chiropodists, dentists and also more specialised professionals such as speech and language therapists and psychologists. Records did not always include the outcome of the visits by the professionals. This needed to be included so that staff had access to any information that may need to ensure the well being of the people living in the home. People spoken with that were able to give an opinion were satisfied that their health care needs were met. One person told us how she had requested a visit to the doctor and the manager had arranged this and taken her. Staff needed to be mindful that they followed the advice of professionals until told otherwise. One persons care plan had been updated saying they were to have a preparation added to their water when being washed and staff should not use soap. Staff did not appear to be aware of this and the amount of preparation left in the bottle indicated it was not being used. This could have a detrimental effect on the persons skin. The daily records and the appearance of the people living in the home showed that people were having their personal care needs met. People were seen to be dressed appropriately in styles that reflected their age, gender and personal choices. We received some very positive comments about the service offered in the home. These included: The residents are well looked after and fed very well. Staff always at hand to assist, toileting, drinks, mobility etc. Look after my X, keep him happy. The home provide really good quality care and staff generally are a kind and caring team. The systems in place for receiving and administering medication were well managed Care Homes for Older People Page 15 of 32 Evidence: and ensured people received their medication as prescribed. The manager told us that only staff who had received training administered medication. Staff confirmed they had received training. We audited the medication system for the people whose care was being tracked and sampled some other boxed medication. The records for the receipt and administration of the medication were adequate and showed us that people were receiving their medication as prescribed. The balances of medication held in the home tallied with what had been received and administered. Some controlled medication was being administered and the records for this had been completed appropriately. The people living in the home had their rights to privacy and dignity upheld. Staff were seen to address people by the name of their choice. They were polite and courteous when speaking to people. People were seen to be able to spend time in the privacy of their bedrooms if they wished. Bedroom doors were lockable and people were able to have keys if they wished. Double bedrooms had privacy screening in place. It was noted that some of the toilets and bathrooms did not have locks on. These needed to be fitted so that people could have privacy while in the rooms. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were some activities available for people to take part in if they wished but it could not be shown that these met the needs of all the people living in the home. People did not always receive a varied diet or the foods they liked. Evidence: On the first day of the inspection the home was quite quiet. There was a very relaxed atmosphere but there did not seem to be as much staff interaction with the people living in the home as has been seen at previous inspections. This changed on the second day and the home was much more lively and staff were interacting much more with the people living in the home. This seemed to be due to there being different staff on duty some more experienced than others. People were seen to wander freely around the home, spend time in the smoking room, in their bedrooms and in the lounges. All the people living in the home that were seen and those spoken with seemed quite content and satisfied with the service they were receiving. Some social care plans had been put in place but all those seen were very similar and said such things as encourage board games, encourage exercise to music, give Care Homes for Older People Page 17 of 32 Evidence: individuals as much help as they require to help participate. This made it very difficult to assess if individuals social care needs were being met particularly for those who were unable to say what they liked doing. There was an activity programme on display in the home. There were no records of any discussions with the people living in the home about the range of activities on offer or how these had been decided on. Staff confirmed they facilitated at least one activity every day and that they also spent one to one time with the people living in the home. Staff were seen sitting with people ensuring they received some one to one time. Activity records showed there were such things as, sing songs, board games, reading, colouring puzzles and so. Staff did tell us about new activities that were being considered such as arts and crafts to try and enhance the range available for people. One person spoken with confirmed there were activities facilitated by staff but said they are not my thing and do not interest me this person confirmed they chose to spend much of their time in their room watching television and doing puzzle books. They did say that if they wanted to go to the shops staff would take them. Visitors were seen to come and go throughout the course of the inspection and all were made welcome. One visitor spoken with confirmed he could go to the home at any time he told us staff always make him a cup of tea and he always felt welcome. One person was seen going out with relatives and one person was seen receiving a telephone call from a relative. The arrangements in place ensured people were encouraged and enabled to keep in touch with people important to them. Comments received from relative included: Visitors are treated with the utmost respect. Visitors are always made most welcome and nothing is too much trouble. It is a joy to visit. People were seen to exercise some choice and control over their lives in respect of what time they went to bed and got up, what they wore, how they spent their time and what they ate. They had been encouraged to personalise their bedrooms to their liking and personal effects were evident in most of the bedrooms seen. There was a rotating menu at the home however the food records seen showed that this was not being followed on an ongoing basis. The meals on offer on the first day of the inspection were not what were on the menu. The manager told us the reason for this was the meat had not been taken out of the freezer. Looking at the food records Care Homes for Older People Page 18 of 32 Evidence: being kept by staff it was very clear that since there had been a change of staff the meals had been very repetitious and not in line with the menus. This issue did not appear to be have recognised by any of the staff. This meant people were not receiving a varied diet and could mean their nutritional needs were not met. The comments we received about the food varied and included: Food is good. Food good I cant eat it all too much. Not much choice sausages or beefburgers, sandwiches or something on toast for tea. We had lunch with the people living in the home on the first day of the inspection. When one person was given their pudding they were heard to say not again implying they received this all the time. This was the diabetic sweet for the day. When asked about this we were told there were only 2 choices of puddings for people who were diabetic. The manager said this should not be as people could have puddings made with sweetener. The dietary care plan for one person stated they did not like gravy or sauces on their food. This information was also written on the food choices chart and the person also confirmed they did not like gravy. They were seen to be given gravy with their lunch showing people did not always get the food they liked. Some of the people living in the home chose to eat their meals in the lounges and staff were available to assist them where necessary. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements generally ensure that the views of the people living in the home are listened to and that they are safeguarded from harm. Evidence: There was a complaints procedure on display in the home and this included all the information people would need if they wanted to raise any concerns about the service offered at the home. The surveys returned to us indicated people were satisfied that staff listen to them and act on what they say and that they know how to make formal complaints. Comments received included: The manager is always there if you need to ask advice. She is very helpful and kind. They are helpful and make themselves readily available to speak to should I need to. The people living in the home were comfortable in the presence of the staff which would give them the confidence to raise any concerns. The home did not have any ways of recording how minor concerns were addressed. It was suggested this was done to show that people were listened to and their views acted on. One example of this was seen where a person had complained that some of their clothing had been damaged in the laundry. The owner of the home had replaced this item. This shows he had listened and addressed the concern. Care Homes for Older People Page 20 of 32 Evidence: The home had not received any formal complaints. Two complaints had been raised with us. The majority of the concerns were sent back to the owner and manager to investigate. Part of the concerns were referred to the environmental health officer and part included a safeguarding issue which was referred to Social Care and Health. The owner forwarded to us the outcome of the investigation and no evidence had been found to support the concerns. The environmental health officer visited the home and had no concerns. The safeguarding issue mentioned above and another incident were ongoing at the time of the inspection. The outcome of part of the investigation had showed some shortfalls in the reporting skills of staff. This was being addressed with further training. The homes safeguarding procedures had been amended since the last inspection and in most parts complied with the multi agency guidelines. There was one statement in relation to investigation that could have been misleading that needed to be removed. The procedure should also include the contact details of other agencies that staff are able to refer to. We were told the staff team had attended awareness training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. Staff were able to tell us about this training to some degree. The manager had booked safeguarding training for staff for April. Staff were able to tell us what the issues were when protecting the people living in the home and that any events or suspicions of abuse would be reported to the manager. Some staff were a little unsure of what should be done if there was an incident between two of the people living in the home that could be deemed as safeguarding. This could mean people are not fully safeguarded should this happen. The planned training should address this issue and ensure staff are fully aware of how to safeguard people. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was generally well maintained and safe and provided the people living there with a comfortable and homely environment in which to live. Evidence: A tour of the communal areas was undertaken and some bedrooms were seen. The home was generally well maintained, safe and comfortable. The people living in the home appeared very comfortable and indicated on the surveys returned to us that the home was always fresh and clean. Comments received included: Everything is spotless. Nice and clean. Lovely bedroom on his own. The home has a warm cosy feel about the place. There had been some improvements made since the last inspection including new carpets in some bedrooms, some redecoration and some new linen and towels. The manager told us that new carpet had been ordered for the stairs and landings. Care Homes for Older People Page 22 of 32 Evidence: There was ample communal space in the home which gave people a choice of where they sat. There are three lounges on the ground floor one of which is the designated smoking area. The decor and furnishings were of an acceptable standard. There is also a lounge on the first floor but this tends to be used for training and meetings but can be used by the people living in the home if they wish. This was due to be redecorated. The dining room is quite small however not all the people living in the home choose to eat in there. Some eat in the lounges others eat in their bedrooms. The dining room was in need of redecoration and some of the ceiling tiles needed to be replaced to ensure it was kept to an acceptable standard for the people living in the home. There were adequate numbers of toilet, bathing and shower facilities throughout the home. One of the bathrooms had a hoist and the shower was floor level, both of these rooms allowed for assistance from staff. Some of the bedrooms also had en-suite facilities. As stated earlier some of the toilets and bathrooms needed to have privacy locks fitted. Bedrooms in the home were a mix of singles and doubles, varied in size and some had en-suite facilities. Privacy screening was available in the double rooms. The bedrooms that were seen had been personalised to the occupants choosing. The people living in the home had access to a large well maintained garden to the rear of the home. There was some seating available in the garden for the use of the people living there in the better weather. The arrangements in place for the disposal of clinical waste had improved since the last inspection. The home was clean and generally odour free making it a pleasant environment for people to live in. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their needs will be met by the right number of well trained staff. Evidence: There had been some staff turnover at the home but there was a core group of staff who had worked there for some time. This provided the people living there with some continuity of care. The staffing levels ensured the needs of the people living in the home could be met. Some very positive comments about the staff team were received. These included: I think they do just fine. Staff are cheerful and pleasant and this is consistent. They are helpful and make themselves readily available. Staff are good. Staff are friendly, happy, and consistent with care. Very friendly and helpful. They answer the buzzer if I want anything. Care Homes for Older People Page 24 of 32 Evidence: Good relationships between the staff and the people living in the home were evident. Staff spoken with were generally very knowledgeable about the needs of the people in the home and how they liked their care given. As stated earlier there were some inconsistencies given in relation to the moving and handling of a person recently admitted to the home. Staff told us about the training they had had which included topics such as manual handling, fire training, dementia care, medication procedures and NVQs. The training matrix also showed staff were offered a good range of training. It showed that twelve of the twenty staff employed have either NVQ (National Vocational Qualification) level 2 or 3. This is above the recommended fifty percent. This should ensure people are cared for by people with all the required knowledge and skills. One new staff member told us about her induction training which lasted approximately a month and involved her shadowing a senior staff member. This person had a certificate on file that stated the induction training complied with the specifications laid down by Skills for Care to ensure new staff are suitable qualified. Another person who had been employed at the for over a month had no induction records on file. The manager stated this training was only just starting for this person. The recruitment records for four new staff were sampled. The records showed that the manager had obtained checks such as CRBs (Criminal Records Bureau checks) and two written references to ensure people were safe to work with the people living in the home. It was not always clear how the manager had determined that people were able to work in this country, if she had pursued gaps in employment, if she had asked for references from the most recent employers or questioned why people had not fully completed their application forms. She did tell us if she was not sure of peoples rights to work in this country she contacted the immigration office. She was advised to be more vigilant when employing staff in future to ensure the people living in the home are fully safeguarded. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needed to have a development plan in place so that the people living there could be assured the service would be continually improved. Evidence: The manager of the home had been in post for a considerable amount of time. She demonstrated throughout the inspection that she has a very good knowledge of the needs of the people living in the home and how they liked to be cared for. She had a very good relationship with the proprietor and stated he was very supportive and a regular visitor to the home. We received some very positive comments from relatives about the management of the home including: The management is fantastic. She is fair with staff and residents. Communication skills are excellent and an open door is always maintained. Care Homes for Older People Page 26 of 32 Evidence: Pat the manager is always there if you need to ask advice she is very helpful and kind to the residents. The manager is very good with all in the home. Staff spoken with and the comments on staff surveys were also very positive about the manager. The people living in the home were generally receiving a good level of care however the record keeping in the home did not always reflect this. For example, risk management plans and care plans needed to be improved. These have been ongoing issues in the home. These were fully discussed with the manager at the time and need to be addressed to ensure people receive a good, safe service on an ongoing basis. The home did not have a formal quality assurance system in the home. The people living in the home were occasionally issued with satisfaction surveys and there were staff meetings. The manager also undertook audits within the home, for example, medication audits and health and safety audits. However there was no way of analysing the information gathered and drawing up a yearly development plan for the home with the aim of continually improving the service. The manager discussed with us how best to move forward on this issue which has been ongoing for some time. The provider was completing his monthly reports on his unannounced visits to the home. This ensured the people living in the home could be assured the management of the home was being overseen. There had been no changes to the system in place for managing money on behalf of the people living in the home where necessary. A specific account had been set up by the proprietor for some personal allowances to be paid into where there was no other option. The proprietor then drew the money and passed it over to the manager. All these people had individual books where this was recorded. Other people living in the home also had some personal allowance managed by the home which was deposited with the manager by their relatives. The records kept were sampled and found to be appropriate. All the balances checked were correct. All income and expenditure were detailed and receipts were available for expenditure. It was recommended that receipts were numbered so that hey could be easily cross referenced to the records. The arrangements in place ensured peoples money was kept safe. The health and safety of the people living in were well managed. Staff had received training in safe working practices and there were records on site to show the equipment being used had been regularly serviced and was safe to use. The in house checks on the fire Care Homes for Older People Page 27 of 32 Evidence: system had improved and showed the fire alarm was checked as required to show it was working effectively. The manager told us that fire drills were undertaken as part of the fire training. This should be recorded separately so that it can be shown which staff have been involved to ensure they all know how to keep people safe should there be a fire. The manager continued to notify us of any accidents and incidents in the home so we could be assured they were being managed in the best interests of the people living in the home. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must detail all the needs of the people living in the home and how these are to be met. This will ensure peoples needs are met in the way they want. 31/05/2010 2 8 12 There must be robust risk management plans in place for all the identified risks of the people living in the home. This will ensure people are kept safe and well. 30/04/2010 3 18 6 Staff must be fully aware of safeguarding procedures. This will ensure the people living in the home are safeguarded and issues are reported appropriately. 30/04/2010 Care Homes for Older People Page 30 of 32 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 People should have all the information about the home so they can make a decision about whether or not they want to live there. Information should be available to show how the staff at the home have decided they can meet the needs of people admitted. The outcome of health care visits should be documented. This will ensure staff have all the information they need to ensure the well ebbing of the people living in the home. Staff need to be mindful that they follow the advice of health care professionals so that they ensure the well being of the people living in the home. To ensure peoples privacy toilets and bathrooms should all have appropriate locks fitted. The range of activities offered in the home should be discussed with the people living there to ensure they are suitable. Care plans should detail the individual social care needs of the people living in the home to ensure they receive person centred care. Records of food served in the home should include sufficient detail to show people are receiving a varied and nutritious diet on an ongoing basis. To show people are listened to and their views acted on the home should show how they address any minor concerns. All communal areas must be kept decorated to an acceptable standard for the people living there. Recruitment procedures must be very robust to ensure the people living in the home are not put at any risk. New staff should complete the appropriate induction training in a timely manner to ensure they have all the skills and knowledge they need to care for people safely. Receipts for expenditure on behalf of the people living in the home should be numbered so that they can be easily tracked. Records should show that staff can keep people safe in the event of a fire. 2 3 3 8 4 8 5 6 10 12 7 12 8 15 9 10 11 12 16 20 29 30 13 35 14 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - 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!