Care Home: Amberley Court Nursing Home

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What the care home does well People who use the service have access to a range of health and social care professionals and this ensures that any health care needs are met. People can see their visitors as they choose so that they can continue to have relationships that are important to them. The home creates a friendly and welcoming atmosphere where people can personalise their rooms to reflect preferences and tastes. Staff know about people`s individual needs, one person said "His needs are well met by staff, his care is very good". Meetings are held so that people are involved in decisions about how the home is run. Maintenance records are well maintained and equipment is serviced regularly to ensure people`s safety. People told us: "I can`t imagine living anywhere else. It`s more like home than home" "If I am not happy about something I will just go to the manager or nurse on duty, I`m happy to do that". "The care staff are really nice" "I get companionship, its average for my needs" "It was my birthday last week and cook made me a lovely cake with icing" "Sometimes I go to the residents meetings" "Personal care is very good" "I`m happy with the care" What has improved since the last inspection? There are a range of activities and outings offered so that people lead an interesting and stimulating lifestyle. People are offered a choice of meals that meet their individual needs and preferences. People said: "I can have what I want really, I had egg and chips the last few days that`s what I wanted and that`s what I got" "Food is always OK"Some areas of the home have been redecorated to enhance the environment in which people live. One person told us "It`s a lovely bedroom, they asked me how I thought he would like his room and it looks great". The use of agency staff has reduced so that people know who will be supporting them to meet their needs. One person told us "The level of care really dropped, too many agency staff working who didn`t know what they were doing but things have really improved now". What the care home could do better: Information should be updated so that people have current information about the home to help them make a decision about whether they want to live there. Pre admission assessments should contain sufficient information to ensure that all peoples needs and preferences can be met at the home before they move in. Old documentation should be archived so that people have current information about people`s risks and needs. Care plans and risk assessments need to be up to date and reflect current care needs so that staff know how to support people in a way that they need and prefer safely. People must be told about the outcome of any complaint and the actions taken so that they can be confident they are being listened to. There must be a clear audit trail for people`s personal money to ensure that it is kept on their behalf safely. Staff training records should be clear so that the organisation can be confident staff have received the relevant training. The home must obtain references from peoples last employers to ensure that people are supported by staff who are suitable to work with vulnerable adults. A stable management team should be sought so that the people who live there have some consistency. Key inspection report Care homes for adults (18-65 years) Name: Address: Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA     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: Lisa Evitts     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 Adults (18-65 years) Page 2 of 31 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA 01214404450 01214464670 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.bupa.com BUPA Care Homes (BNH) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 63 The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 63 Date of last inspection Brief description of the care home Amberley Court is a large purpose built nursing home, situated within the Moseley/Edgbaston area of Birmingham. The home provides nursing care for younger adults who have a physical disability. The home has restricted further admissions of older people with a gradual conversion to focussing upon care for younger adults. The first floor consists of two areas, one for high dependency care and the remainder Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 63 2 9 0 4 2 0 0 9 Brief description of the care home for rehabilitation. There are a variety of communal areas and dining rooms which people can choose to use. There is also a hairdressing salon and computer room. The home has a number of aids and adaptations to assist people living there, such as hoists for lifting and transferring, a passenger lift to the upper floors and automatic opening doors in the home to allow easy passage for people who use wheelchairs. The home has a designated smoking room. There is a large off road car park and a number of bus routes are within a short walking distance. All communal rooms, bedrooms and bathing facilities are located on the ground and first floors. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. Laundry facilities, staff rooms and offices are located on the third floor. The home has a pleasant accessible garden. In the reception area of the home there are articles that give people information about the home. Our last report is on display so that people can read this if they choose to. Current fee rates for the home range from eight hundred pounds per week however the rate depends on individual care needs. Care Homes for Adults (18-65 years) Page 5 of 31 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our 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, minimum standards of practice and focuses on aspects of service provisions that need further development. We, the commission visited the home over one long day and were assisted throughout by the management team. There were forty nine people living there and the home did not know that we would be visiting that day. Information was gathered from speaking to ten people who live at the home and by watching the care given by staff. We spoke to one relative and five staff. Four people were case tracked and one other file was partly reviewed. Case tracking involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing Care Homes for Adults (18-65 years) Page 6 of 31 areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Complaints records, staff files and health and safety records were reviewed. Before we visited the home we sent ten random surveys to staff and ten to people who live at the home in order to gain their views. We received eight surveys from people who live there and eight from staff. Their comments are included throughout the report. Prior to the inspection a previous manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This tells us how the home think they are performing and gives us information about the home, staff and people who live there, improvements and plans for further improvements which was taken into consideration. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. During our visit the home experienced a power cut. We observed staff to deal with this very efficiently to ensure that people were safe. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? There are a range of activities and outings offered so that people lead an interesting and stimulating lifestyle. People are offered a choice of meals that meet their individual needs and preferences. People said: I can have what I want really, I had egg and chips the last few days thats what I wanted and thats what I got Food is always OK Care Homes for Adults (18-65 years) Page 8 of 31 Some areas of the home have been redecorated to enhance the environment in which people live. One person told us Its a lovely bedroom, they asked me how I thought he would like his room and it looks great. The use of agency staff has reduced so that people know who will be supporting them to meet their needs. One person told us The level of care really dropped, too many agency staff working who didnt know what they were doing but things have really improved now. What they could do better: 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 Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People have some information they need to make an informed decision about if they want to live at the home. Evidence: The home has a statement of purpose and service user guide which is displayed in the reception area of the home. The service users guide is available in each bedroom so that people can access the document if they want to. These documents had last been updated in February 2008 and therefore some of the information was out of date. The manager confirmed that the service users guide was only available in a standard format. Consideration should be given for the information to be available in alternative formats so that all people can access this. The certificate of registration was clearly displayed and reflected the service offered by the home. The previous inspection report was displayed so that people can read this if they choose to. Before anyone comes to live at the home, pre admission assessments are undertaken. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We looked at the assessments for two people who had recently moved into the home. We could not determine if the assessments had been undertaken in the hospital or the persons previous home. One assessment had not identified that the person required a Halal diet and this was identified after admission. Assessments should contain enough information so that people know the home can meet their needs before they move in. The AQAA told us that people who are unsure about moving into the home are given the option of a trial visit. This means that they can sample what it is like to live there before they make a decison about living there permanently. We met with the two people who had recently moved into the home, but due to the complexity of their needs it was not possible to explore the admission process with them. People told us: Ive lived here for ten years and feel the home is very good on the whole I cant imagine living anywhere else. Its more like home than home. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 are supported to make decisions about their lives. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. We looked at four peoples care files in detail and partly looked at one other. We found that there was a lot of information about people in their files, including any risks. Sometimes it was not clear which parts of the information were the most recent and some information had not been reviewed. This could lead to confusion about peoples current needs. One person who had been identified as being at risk from falls did not have the risk assessment updated following a fall. In another file we found that some risk assessments had not been reviewed. Further on in the file we found that they had been re written in a new format. Old documentation should be archived so that people have current information to support people to meet their needs. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: One person who was unable to verbally communicate their needs had a very detailed plan for staff to follow. It gave them information about how to observe facial expressions and gestures so that they understood the person. There were some good details included in this plan about how staff could support this person to make their own decisions, for example showing the person their clothes or the menu so that they could point to what they wanted. People are given choices about the activities that they like to participate in and we saw that individual risk assessments are written for activities outside of the home. This means that people can be supported to do the things they enjoy whilst minimising any risks involved. People can manage their own money if they are able to and are offered the choice of attending meetings so that they can discuss any concerns about the home. One person said Sometimes I go to the residents meetings. A relative told us that they had been asked how their relative would like their room to be decorated. Some people had been involved in interviewing the new manager the day before our visit. This means that people are involved in decisions about the home. People have the option of having their own key to their room. One person we case tracked had a key to their room and staff sought their permission to enter the room from the person before we looked in there. This promotes peoples choices, privacy and dignity. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 are offered a variety of activities and choice of meals so that they experience a meaningful lifestyle. Evidence: The home has three activity coordinators, two full time and one part time. They work flexible hours including evenings and weekends as needed. There is a weekly activity rota which is displayed around the home and is also taken to people in their rooms so that they know what activities are taking place. This includes movement to music, puzzles, gardening, watching DVDs, arts and crafts and baking. A reflexologist and aroma therapist visit the home and people can join in this activity for an additional cost. One of the staff brings their dog to work and some people enjoy spending time with her. Talking books and newspapers are available so that all people can access articles of interest. There is an activity room which contains books, arts and crafts materials, puzzles and DVDs which people can access. The home also has a snooker Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: table if people want to join in this activity. Theme nights are arranged and a Hollywood theme night was planned. A church service is held every other Sunday and prayers are said on Mondays and Wednesdays for people who wish to continue with their religious beliefs. A hairdresser visits the home weekly so that people can have their hair styled in a way that they prefer. One person told us that they went out to a day centre three times a week and another told us that they were going to the cinema the following day with the activity staff. Other people have been out to the local park and one person is supported to go to a pub quiz each week. A community tea event had been planned for the Saturday following our visit to raise awareness of isolation and loneliness in older people and people who have disabilities. People told us: I get companionship, its average for my needs The home could do better by having our own transport so we can go out more often without having to use taxis The home has an open visiting policy which means that people can maintain relationships that are important to them. The home has a four week rolling menu in place. There is a choice of cooked breakfast or cereals and a choice of two meals at both lunchtime and tea time. We observed the meal at lunchtime. Tables were well presented and people were given support from staff to eat their meals. There was a friendly atmosphere and people were having a laugh and joke at one table, making it a sociable occasion. There were alternatives offered to the main meal. One person asked for additional boiled potatoes with their meal and these were served separately in a small side dish. People said: Food is always ok It was my birthday last week and cook made me a lovely cake with icing I can have what I want really, I had egg and chips the last few days thats what I wanted and thats what I got. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Care plans may not always provide information about how people want to be supported so that their needs are met. People may not receive their medication as prescribed. Evidence: We observed staff to have good interactions with people and we saw that they explained things to them, so they knew what was happening in the home. People were dressed in clothes that were appropriate to their age, gender, culture and the weather. The home has a physiotherapist who visits twice a week, one staff member told us they show me what to do so we can continue with the exercises and one resident is now able to lift her arms up. Records showed that people were seen by external professionals such as the GP, dentist, dietitian and clinical nurse specialists. This means that people receive specialist advice. There was a lot of information in peoples files but this was not always updated and Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: did not always lead to a care plan being written. When we spoke to staff they were able to tell us about peoples individual needs. One persons weight records were very difficult to read and were dated 2009 so it was not clear if their weight had been monitored recently. A second file showed no records of a persons weight for the last two months and therefore staff are unable to monitor this. Some of the monthly assessments for sore skin had not been completed and therefore staff could not monitor any changes. One persons personal hygiene plan gave good information about how to maintain independence and an example of this was give her the cloth to wash her own face. One person who was Caribbean did not have any information about their cultural needs. This should be recorded so that individual needs can met in a way people prefer. One persons file had identified that the person appeared to be depressed but there was no care plan written regarding this and no further evidence that any action had been taken. One person was assessed as not requiring the use of bed rails to prevent them falling out of bed, however we saw one rail was in use and the care plan stated that a rail was in use on the right side of the bed. People are supported to discuss and make decisions about their end of life care, so that their wishes can be met. Some people had some detailed plans about their choices at the end of their life. One person had been seen by a nurse from a hospice, there were some good details in the file about pain control, however no care plan had been written for staff to follow. People told us: Personal care is very good I have a shower every Wednesday and Sunday and Im happy with that Im happy with the care His needs are well met by staff, his care is very good We looked at the management of medication. Fridge and room temperatures were recorded and were within a range that meant medication was stored at the correct temperature. Trolleys were clean and tidy and medication was easy to find. Controlled medication was safely stored and accurately recorded. We looked at three different trolleys in the home. Two of these were audited and were correct, records were Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: accurately completed and this means that people received their medication as prescribed. The third trolley found some errors in the boxed medications and it was not possible to audit some of the tablets. Variable doses were not always recorded. One persons handwritten charts were only signed by one person. One Medication Administration Record (MAR) said to give a medication on alternated days; however there were signatures on four consecutive days. This may mean that people have not received their medication as prescribed. We were unable to complete the audit in this trolley due to the power cut in the home and these findings were discussed with management at the end of the day so that they could review this. Some people had protocols in place which gave details about when staff should administer medication for seizures. These had not been reviewed since 2007. In addition to this one persons care plan had different information to the protocol, about how much medication to give. This could mean that people may not receive the correct dose and this should be reviewed. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 may not be confident that their concerns are listened to and acted upon. Evidence: The complaints procedure is displayed in the reception area of the home and this included our contact details. The procedure is also included in the service users guide and statement of purpose; however this needed to be updated so that people had current information. The guides were only available in a standard format and may not be accessible to all the people living at the home. The AQAA told us that the home had received eleven complaints in the last twelve months and nine of these had been upheld by the home. Since our last visit to the home we have received five complaints which were referred back to the provider to investigate using their own procedure. The complaints were around build up of laundry, lack of gloves, cleanliness of the home, people having to wait for the toilet and healthcare concerns. We looked at the complaints records. The nature of the complaints were recorded but for three of the complaints we were unable to see what action had been taken and the outcome. Senior staff were able to verbally tell us what had been done when the complaints were received, however outcome letters had not been written to the people who had complained. This means that people cannot be confident that their concerns are listened to and acted upon. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: One person told us: If I am not happy about something I will just go to the manager or nurse on duty, Im happy to do that. The home has local multi agency guidelines to follow in the event of an allegation being made so that people are protected from harm. These were easily available to staff however two staff spoken to said that they had not seen the procedure recently. One member of staff said that allegations would be reported to Human Resources and was not clear about external agencies who should be involved. This does not ensure that people would be protected from harm. There have been six safeguarding referrals at the home and these have all beeen closed. We looked at the records for peoples money held by the home. Each person has their own account and statements are available. Receipts were kept for debits such as chiropody and hairdressing. However when money was taken out of the accounts for items such as toiletries and cigarettes there were no receipts as proof that this was what the money had been spent on. We were told that when people take money out they put any loose change in pots in their room. This is of concern as we had been notified by the home previously that some people had had money go missing from their rooms and the police had been involved. During our visit one person told us that they had had some money go missing from their room. This was discussed with the management at the end of the day so that it could be looked into. Staff told us that sometimes this person misplaced their money. Systems must be in place to ensure that peoples money is safe. Care Homes for Adults (18-65 years) Page 21 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 are provided with a comfortable environment in which to live that meets their individual needs. Evidence: The home has various communal areas so that people can choose where they want to spend their time. The garden area is on one level so that people in wheelchairs can access this. There is a computer room which has a range of assisted technology so that people are able to use the equipment. There is a smoking room, an activity room and a hairdressing salon, so that people can participate in activities of their choice. There are a variety of assisted bathing facilities in the home to meet the needs of the people who live there. One of the shower curtains was stained which and some of the waste bins did not have lids on. We brought this to the attention of the managers on the day of the visit so that they could ensure that people live in a clean environment where risks of infection are minimised. Corridors are wide and spacious and enable people to move around the home using any equipment they may require. The home has hoists to help people move their position. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: We saw that some rooms had recently been decorated and the corridors on the ground floor were in the process of being repainted to enhance the environment for people to live in. All of the bedrooms are single and have a toilet and wash hand basin. We looked at the bedrooms of the people we case tracked and found these to be personalised and reflected individual choices and preferences. One persons room had had characters painted on the wall. A relative told us Its a lovely bedroom, they asked me how I thought he would like his room and it looks great. This means that people are involved in making decisions about their own rooms. The home was clean and fresh on the day of our visit. In the surveys returned to us, five people said that the home was always clean and fresh and three people said usually. There was a pleasant, friendly and relaxed atmosphere at the home. Care Homes for Adults (18-65 years) Page 23 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff receive some training so that they have the knowledge and skills to support people to meet their needs in a way they prefer. The recruitment procedure may not fully protect people from harm. Evidence: On the ground floor there are two nurses and six care staff on duty throughout the morning, two nurses and four care staff throughout the afternoon/evening and one nurse and two care staff during the night. On the first floor there are two nurses and eight care staff on duty throughout the morning, two nurse and seven carers throughout the afternoon/evening and one nurse and three carers at night. These staffing levels appeared to meet the needs of the people living at the home on the day of our visit. In addition to nursing and care staff the home has domestic, catering, maintenance and administrative staff to help meet all the needs of the people living at the home. People told us: On the night time there should be more staff The care staff are really nice Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The level of care really dropped, too many agency staff working who didnt know what they were doing but things have really improved now The care is very good. The AQAA told us that 29 staff had left employment at the home in the last 12 months. There were currently no vacancies at the home following a recruitment drive. This should mean a more stable staff team so that people will know who will be assisting them to meet their needs. The atmosphere in the home had improved since our last visit and staff were seen to interact well with the people who live at the home. 33 of staff have a National Vocational Qualification (NVQ) in care. Further staff had been nominated to undertake this training. It is recommended that a minimum of 50 of staff have this qualification to ensure they have the knowledge and skills to meet the needs of the people living at the home. We looked at three staff files and these contained the information required to ensure that suitable people were employed to work at the home. The exception was that the home had not sought a reference from one persons most recent employer. We saw evidence that new staff to the home received an induction so that they had the knowledge they needed to know about the home. On the day of our visit the maintenance person was discussing the fire procedures with some new employees. Some staff meetings had been held. In a staff survey received a person commented It has meetings fortnightly with residents, relatives and staff so any issues can be heard and dealt with or actioned. This means that people are given an opportunity to voice their opinions about the home. It was difficult to assess the training that staff had undertaken as the matrix was hard to follow. It was not clear who had completed training and when updates were due. We discussed this with senior managers at the end of the day. We were told that this had been identified in other homes in the organisation and that a new system for recording training was to be introduced. We will review this at our next visit to the home. Some staff had had training in topics such as fire, moving and handling, safeguarding, infection control and nutrition. One member of staff said my training is up to date, we have regular updates and another said Ive done fire, manual handling, first aid and safeguarding training. These topics are all relevant to the needs of the people living at the home. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 has not benefited from a stable management team to ensure that the home is run in the best interests of the people who live there. Evidence: Since our last visit to the home there had been further changes in the management of the home. The manager had left in October 2009 and the area manager managed the home temporarily until a new manager was appointed at the end of November. This manager left in March 2010. On the day of our visit another manager was at the home. This person was only in her second day at the home and told us that she was an interim manager but was interested in becoming a permanent manager at the home. The interim manager is a registered nurse and has a diploma in neuro sciences. She has previous experience of managing care homes and has moved from another home within BUPA so is aware of their policies and procedures. The manager is supported by two clinical managers; however one of these managers was leaving the home that weekend and the home were in the process of appointing someone to this role. Whilst Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: the organisation has strived to maintain a stable management at the home these constant changes may affect the people who live in the home. One person told us how the management of the home went up and down with different managers. Another person said the new manager seems nice but we will have to see how things go. The organisation has a number of audits which are completed each month. A senior person from the organisation visits the home each month and writes a report about the quality of the service offered. Prior to the inspection the previous manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This told us how well the home think they are doing and told us how they want to improve in the future. The current manager had not seen this document so was not aware of what information had been submitted to us. A sample of records in relation to health and safety and maintenance checks were looked at and we found that checks had been undertaken to ensure that the equipment was safe and in full working order. Staff attend fire drills and training to ensure that they know how to keep people safe in the event of a fire. During our visit the home experienced a power cut. We observed staff to deal with this very efficiently. Staff immediately went to people in their rooms and checked that their equipment was still working. One person who required oxygen was changed to cylinders and more of these were ordered. Staff gave meals to people to ensure that people received their food before it was cold. This visit has highlighted some areas for improvement such as updating information about the home, updating risk assessments and care plans, recording the outcomes of complaints, staff training and records and the stability in the management of the home. The interim manager was keen to address all of the areas. Care Homes for Adults (18-65 years) Page 27 of 31 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 Adults (18-65 years) Page 28 of 31 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 19 12 Care plans must be written for specific concerns. So that staff know how to support people. 18/06/2010 2 20 13 The management of medication, including protocols must be reviewed. So that people receive their medication as prescribed. 04/06/2010 3 22 22 Complaints must be responded to. So that people can be confident that they are listened to and their concerns are acted upon. 04/06/2010 4 23 13 Arrangements must be in place to ensure that peoples money is accounted for. So that money is held safely in the home. 28/05/2010 5 34 19 References must include one 28/05/2010 from a recent employer. Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people are safe from harm. 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 Information about the home should be current and in a range of formats so that all people can access up to date information. Pre admission assessments should contain enough detail so that people know all their needs can be met before they move in. Risk assessments should be updated and old documentation should be archived so that staff have current information about peoples needs. Weight monitoring and skin assessments should be completed so that staff can monitor any changes and take appropriate action. Staff should fully understand the procedures to follow in the event of an allegation so that people are safe. Waste bins should have lids on so that the risks of infection are minimised. At least 50 of staff should have a National Vocational Qualification in care so that they know how to meet peoples needs. Training records should give a clear audit of training undertaken and training needed. So that staff receive the training they need to know how to meet peoples needs. A permanent registered manager should be sought so that people benefit from a stable management team. 2 2 3 9 4 19 5 6 7 23 30 32 8 35 9 37 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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