Care Home: Ashbourne Residential Home

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What the care home does well There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre-admission assessments are completed, so that the home and people who are considering living in the home are confident that their individual needs can be met appropriately. The medication systems were generally of a good standard, ensuring people receive the medication prescribed for them. The arrangements for handling people`s personal finances were good ensuring their money is protected. What has improved since the last inspection? More information is readily available in the reception area, so that it is accessible to people visiting the home. There are separate staff on the residential and dementia unit and key worker roles have been implemented to improve consistency of care. Staff have received training in respect of dementia care and this is ongoing, providing them with the knowledge to care for people with dementia. Re decoration of bedrooms and communal areas is ongoing, so enhancing the environment for people who live in the home. What the care home could do better: The service user guide and information for people living in the home should be provided in alternative formats, so that it is accessible to everyone. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes in order to demonstrate people`s needs are met effectively. Also systems need to be in place to ensure all staff are aware of the contents of care plans and the action required to meet people`s needs, so peoples individual needs are met in a consistent manner. Communication systems should be reviewed and action taken to ensure staff are aware of everyones needs to ensure consistency of care. There must be a more proactive approach to any concerns or risks identified with appropriate follow up and referral to health professionals to ensure people`s well being is maintained. Training should be given to staff in respect of clinical conditions, the Mental Capacity Act and Deprivation of Liberty Safeguards, so they have the appropriate skills and knowledge to care for people. Also a review of the training arrangements should be undertaken to ensure training is effective, leads to development of skills and so benefits the people living in the home and there are improved outcomes. The manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure and so forth to ensure people`s well being is maintained. A review of the arrangements for recording and follow up of any comments/concerns/complaints should be undertaken and action taken to ensure a pro active approach and continued improvement with learning, so people are listened to and safeguarded. The arrangements for activities should be reviewed and developed further to ensure people have opportunities of stimulation and social contact. A review of the meals should be undertaken and appropriate action to ensure people receive meals that meets their needs and preferences. There must be adequate staff on duty at all times to ensure people`s needs are met in a timely and person centred manner. Action must be taken to ensure the home is odour free, so people have a pleasant environment to live. The outside area needs to be made safe and suitable for people to access and use when the weather permits. Systems for dealing with Criminal Record Bureau Checks (CRB) should be more robust and information available in the home with risk assessments in place where appropriate so people are safeguarded. Infection control procedures need to be more robust to reduce the risk of cross infection. The medication room must be maintained at 25 degrees or blow to ensure the safe storage of medication. The hand rail to the front of the home and the shortfalls in the kitchen gas equipment must be addressed with urgency to ensure peoples` safety. The management should ensure there is a suitable television reception in all areas of the home, so people can watch television if they wish. A programme for replacement of windows should be drawn up and implemented to ensure people live in a pleasant draught free environment. Key inspection report Care homes for older people Name: Address: Ashbourne Residential Home Lightwood Road Dudley West Midlands DY1 2RS     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: Ann Farrell     Date: 0 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Ashbourne Residential Home Lightwood Road Dudley West Midlands DY1 2RS 01384242200 01384231407 ashbourne@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Centres Limited care home 38 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 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: Dementia - over 65 years of age (DE(E)) 12 Old age, not falling within any other category (OP) 26 Date of last inspection Brief description of the care home Ashbourne Care Home is a large, detached, two storey purpose built home situated off the main Sedgley to Dudley Road. The home is located in a residential area. It is close to a main bus route and a number of small shops. There are large gardens to the front and rear with limited car parking. The home provides care to Twenty-six people falling within the category of Old Age and twelve people who have a diagnosis of dementia. Care Homes for Older People Page 4 of 38 Over 65 12 26 0 0 Brief description of the care home There are two units; one providing care to people who have needs due to old age and a 12 place unit called Malvern which is dedicated to providing care to people who have been diagnosed with dementia. The home comprises of two floors; all bedrooms are single occupancy and 12 have ensuite facilites consiting of a toilet and wash hand basin. There is a separate lounge/dining room on each unit and a separate smoking room for people who smoke. Assisted bathrooms and toilets are situated around the home offering people a choice of bathing facility. In addition, the home has a range of equipment to assist people with mobility problems such as hand rails, raised toilet seats, hoists and a passenger lift, so all areas can be accessed. Weekly fees for this home range from £353- £491. 07 per week. There are additional costs for hairdressing and private chiropody. People are advised to contact the manager for up to date information about fees and extra costs. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 29th November 2007 when the home was given a two star rating. An annual Service Review (ASR) was undertaken on 25th November 2008. This is a process where we collect information from various sources and if no changes are identified a report is produced based on the information received without a visit to the home. The feedback from this inspection identified areas that required some improvement. This inspection also found areas of the home that require Care Homes for Older People Page 6 of 38 development to ensure good outcomes for people living in the home and they can be found in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 5th October 2010. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager, was forwarded to the home. Surveys were also forwarded to people who live the home, relatives, staff and professionals. Ten completed surveys had been received at the time of writing this report. The inspection was undertaken over two days by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing 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. Staff files, training records and health and safety files were also examined. At the time of inspection five people who live in the home, four visitors and six staff were spoken with in order to gain comments. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide and information for people living in the home should be provided in alternative formats, so that it is accessible to everyone. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes in order to demonstrate peoples needs are met effectively. Also systems need to be in place to ensure all staff are aware of the contents of care plans and the action required to meet peoples needs, so peoples individual needs are met in a consistent manner. Communication systems should be reviewed and action taken to ensure staff are aware of everyones needs to ensure consistency of care. There must be a more proactive approach to any concerns or risks identified with appropriate follow up and referral to health professionals to ensure peoples well being is maintained. Training should be given to staff in respect of clinical conditions, the Mental Capacity Act and Deprivation of Liberty Safeguards, so they have the appropriate skills and knowledge to care for people. Also a review of the training arrangements should be Care Homes for Older People Page 8 of 38 undertaken to ensure training is effective, leads to development of skills and so benefits the people living in the home and there are improved outcomes. The manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure and so forth to ensure peoples well being is maintained. A review of the arrangements for recording and follow up of any comments/concerns/complaints should be undertaken and action taken to ensure a pro active approach and continued improvement with learning, so people are listened to and safeguarded. The arrangements for activities should be reviewed and developed further to ensure people have opportunities of stimulation and social contact. A review of the meals should be undertaken and appropriate action to ensure people receive meals that meets their needs and preferences. There must be adequate staff on duty at all times to ensure peoples needs are met in a timely and person centred manner. Action must be taken to ensure the home is odour free, so people have a pleasant environment to live. The outside area needs to be made safe and suitable for people to access and use when the weather permits. Systems for dealing with Criminal Record Bureau Checks (CRB) should be more robust and information available in the home with risk assessments in place where appropriate so people are safeguarded. Infection control procedures need to be more robust to reduce the risk of cross infection. The medication room must be maintained at 25 degrees or blow to ensure the safe storage of medication. The hand rail to the front of the home and the shortfalls in the kitchen gas equipment must be addressed with urgency to ensure peoples safety. The management should ensure there is a suitable television reception in all areas of the home, so people can watch television if they wish. A programme for replacement of windows should be drawn up and implemented to ensure people live in a pleasant draught free environment. 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. Care Homes for Older People Page 9 of 38 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for people moving into the home to assist them with making a decision about moving into the home. An assessment is completed prior to admission, so staff can determine if peoples needs can be met upon moving into the home. Evidence: The home had a service user guide, statement of purpose and our last report available in the reception area on entering the home. The section about the dementia services was in very small print. A copy of the complaints procedure was available on the wall and in the service user guide advising people of the procedure for raising any concerns. These documents provide people with information about the services and facilities to assist them in making a decision about moving into the home. The format should be reviewed and alternative formats developed to ensure it is accessible to everyone considering moving into the home. Care Homes for Older People Page 12 of 38 Evidence: The home provides residential care for people who require long term or respite care. The manager stated they go out to assess people before they move into the home to determine if staff are able to meet their needs. One file was looked at for a person who had recently moved into the home. The assessment was satisfactory and generally a letter is to them advising them the home can meet their needs . This process gives people the confidence that their needs will be met when the move into the home. People can visit the home before moving in so they can have lunch, view the facilities, meet staff and other people who live there in order to sample what it would be like to live there and the manager stated she is promoting this. On discussion with one person and their relatives they stated they did visit the home and confirmed an assessment had been undertaken before moving into the home. There is a trial period of one month following admission to the home and a review is held at the end of a month, which was evidenced in records seen. This provides further opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. Care Homes for Older People Page 13 of 38 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 systems in place for planning peoples care and meeting health care needs were not robust enough to guarantee everyones needs were being met. The medication systems were satisfactory ensuring people receive the medication that is prescribed for them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, tissue viability, nutrition and falls. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Care Homes for Older People Page 14 of 38 Evidence: Generally it was found there were copious pieces of paper making up the care plans, but they lacked detail, some plans did not cover all aspects of the intervention, statements were vague, they were very repetitive and did not provide staff with the information required to meet peoples needs. The records in respect of peoples care were being reviewed monthly, but the comments were very brief and it was not always possible to identify when changes had occurred in peoples care or treatment. The weekly reviews completed by key workers provided no information about the person as they solely referred to checking wardrobes, drawers and peoples toiletries. The information lacked detail about peoples health, social and psychological welfare. Generally the planning of care was inconsistent and therefore we could not be certain that each person had plans of care that were up to date, accurate and addressed thier needs. One person suffered with pain and was prescribed medication; there was no evidence in the records whether the medication was effective and no evidence of monitoring of the pain. On discussion with care staff it was stated that she continued to have pain and there was no evidence of any further interventions to manage it effectively. Records were maintained in respect of peoples weight and it was noted on two peoples records they had lost weight. There was no evidence of any follow up or intervention for one person. The other person had lost 11 kgs in May and records indicated the need for a referral to a dietician, but this was not followed up effectively and no action was taken by the home to provide a fortified diet. Although the deputy manager has now liaised with the nurse practitioner and Maxijul has been prescribed staff were not aware of the arrangements for this. Therefore, we could not be assured that this persons nutrition needs were being met effectively. Staff were recording food/fluid intake for people who were nutritionally compromised, but the record of food did not give details of the types of food and fluid taken to determine if they were receiving a nutritious diet. This area needs to be reviewed. Some care plans in respect of diabetes did not indicate the range of acceptable blood sugars and staff could not provide us with the record of blood monitoring, despite the fact they were aware it was taking place. On discussion with staff they generally lacked knowledge about diabetes and they had not received any training in the procedure for undertaking blood glucose monitoring. The manager stated she was in the process of trying to arrange some staff training in respect of diabetes. It is recommended the manager consider training in other clinical areas and conditions affecting people, so staff have the appropriate knowledge and skills to meet peoples needs. Care Homes for Older People Page 15 of 38 Evidence: Care plans did not indicate the type of hoist and size of sling where people needed hoisting to ensure consistent practice and the safety of people. Also it was noted in one person records that a risk assessment stated they were chair bound and the care plan stated they were mobile. this raises concerns about staffs understanding of the risk assessment process and how it relates to care plans. This area will need to be reviewed and staff training provided where necessary. On inspection of the accident book it was noted there were a number of incidents where people had sustained skin tears, grazes, bruises and there was no evidence it had been investigated further, so that action could be taken to reduce the incidence of such accidents/incidents in the future. Staff had liaised with the district nursing team, who visited regularly to renew dressings and support staff where there was a risk of pressure sores. There was evidence of pressure relieving equipment in place and risk assessments had been completed. Feedback from some of the district nurses was generally positive saying staff were friendly and helpful, referred people appropriately and carried out instructions. However, they did state staff were always very busy and sometimes it could be difficult to get a member of staff to help them. During the inspection it was noted that staff were very busy and care was performed in a task orientated manner. Feedback from people living in the home and their relatives included; I have nothing to grumble at; nobody interferes or upsets you. The staff are nice. They push you and shove you about; they dont treat you like a person. The staff are lovely; they work their socks off. It does not matter how busy they are they always have time to talk to you. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP was in agreement). People had access to other health and Social Care professionals and records demonstrated visits were undertaken by social workers, chiropodist and optician. This ensures aspects of peoples health care needs are being met. Records did not demonstrate if checks in respect of chronic diseases such as diabetes, high blood pressure, asthma, etc. were taking place. The manager will need to follow this Care Homes for Older People Page 16 of 38 Evidence: up with the GP surgery to ensure peoples well being is maintained and complications prevented. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in a locked room in locked cupboards. On inspection of the medication for the current month, audits were found to be correct indicating people received the medication prescribed for them. A minority of audits for boxed medication were not correct. The deputy manager stated they do not use homely remedies. Staff record the temperature of the fridge regularly to ensure it is within safe limits and this was satisfactory ensuring medication was stored appropriately. The medication room was very hot although the temperature recording was about 25- 26 degrees. This area must be reviewed and action taken to ensure medication stored in cupboards is stored at the correct temperature. The morning medication round was observed and it was noted that the senior member of staff was giving out medication and breakfasts to people as they arrived in the dining room at the same time. This is not good practice and could lead to mistakes. We received a complaint recently about medication that had been dispensed and not taken by people. Feedback in one of the surveys also referred to incidents of medication being found on the floor after it had been administered. This was not observed on the day of inspection, but it does raise concerns about the safety of the procedures in the home. The manager will need to review practices. Staff were observed to assist people in a sensitive manner when undertaking interventions. Some people seemed to be well supported by staff in respect of personal care and choose clothing appropriate for the time of year which reflected their individual culture, gender and personal preferences. However, there were some people who did not have appropriate tights/socks, footwear, hair not combed and poorly shaved. Feedback from one survey was, Residents could be kept cleaner. This area will need to be followed up to ensure peoples dignity and self esteem is maintained. There is a lounge/dining room on each unit with additional chairs in the reception area that people use plus a smoking room, so people have a choice of areas to sit and meet visitors. The telephone was situated on the wall in the main lounge above a chair, so people could not easily access it or make calls in private. Bedroom doors had locks and people could have the keys to them if they wished to enhance privacy. Lockable facilities were available in bedrooms to store valuables/medication if required. Care Homes for Older People Page 17 of 38 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. Arrangements for visiting the home were flexible enabling people to maintain important relationships. The arrangements in respect of meals need to be reviewed to ensure they meet peoples dietary needs and preferences. Activities still need further development to ensure peoples well being is maintained. Evidence: There was no evidence of any rigid rules or routines in the home at the time of inspection. However, comments received from surveys included; There could be a more relaxed routine, but appreciate timescales. The home could be a much more welcoming place for families and visitors The manager will need to review this area, so there is a welcoming relaxing environment for people. People who live in the home can go outside on their own or with friends and family as they choose, depending on their abilities. On discussion with people living in the home Care Homes for Older People Page 18 of 38 Evidence: they stated they could get up/go to bed when they wanted. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. An activities co-ordinator was employed on a part time basis, but had recently left. The manager stated that they were in the process of recruiting another activities coordinator on a full time basis. Activities to date had included exercises to music, a pyjama party, stars in their eyes by staff, Irish dancers plus celebration of mothers day and Easter. One mans relatives also take him out to an overt 60s club each week, which he really enjoys. It was stated that peoples birthdays are celebrated and the cook makes a cake for them. The activities co-ordinator was also producing a monthly newsletter. Feedback in surveys indicated that activities were some times available in the home that they could take part in and one person told us, More activities and entertainment was needed. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met and a religious service is held in the home each week. Feedback from people included; I get up and go to bed when I want. We can visit at any time. Not much to do during the day, I get bored sometimes. There was a four week rotating menu based on the organisations nutmeg system, which is designed to provide the correct components for a healthy diet. The menu demonstrated a variety of foods/meals with a choice at each meal time, but over 50 of the foods were processed foods and some people did not like such foods. One person was on a special diet and stated his family brought in meals for him as he could not eat some of the meals provided. This area will need to be reviewed and referral to a dietician if necessary, so the home can provide a suitable diet to meet thier needs. Drinks and snacks were available between meals and a bowl of fruit was available in the main lounge. On the day of inspection the cook was off sick and another member of staff took responsibly for preparing and cooking the main meal, which consisted of a burger with Care Homes for Older People Page 19 of 38 Evidence: potatoes and vegetables and there was no choice available. It was also noted that some people were arriving down to the dining room for breakfast, which was served up to 11am. Although it is good that people are able to get up when they want, a number of people required the help of staff to get up and therefore were rising late for breakfast and then lunch is served at 12. 30pm. One of the comments in the homes quality assurance surveys identified that there was not enough time between meals and they did not like some of the food. The timing of meals can impact on peoples appetite and nutritional status and it is recommended that this area be reviewed. Comments about the food was variable and included; The custard is like water and the gravy is like fat floating on water. The food is nice; you get a choice and plenty to eat. The food varies The dining area on the residential unit is adjacent to the kitchen and there is a small kitchen area on the dementia unit to make drinks and snacks. The dining tables at breakfast and lunchtime were well presented with table cloth, condiments, cutlery etc. Meals were nicely presented and staff provided assistance appropriately where necessary. In the main kitchen it was noted that sacks of potatoes were stored on the floor, the foot operated pedal bins were not working effectively and the dishwasher on the dementia unit was broken. These issues compromise kitchen hygiene practices and will need to be addressed. Care Homes for Older People Page 20 of 38 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. The systems in place for dealing with concerns and complaints need to be more robust to ensure people are listened to and their comments acted upon. Staff require further training to ensure people are protected from harm. Evidence: A complaints procedure and separate notice with the photograph of the manager was available in reception advising people of the procedure if they wished to raise any concerns or complaints. There is a comments book and suggestion box in the reception area, so that people can make comments or raise any concerns. The manager also had a record of formal complaints and a separate book to record verbal complaints. The complaints procedure advised people to raise concerns with the care staff initially and if they were not satisfied to contact the manager when it would be recorded. Feedback from some people indicated they did not know the complaints procedure and feedback from one of the homes quality assurance surveys indicated some issues had been raised, were not followed up properly and they had to raise them several times before they were addressed. They stated, Staff intentions are good, but follow up is lacking. On discussion with people living in the home they were generally content and did not Care Homes for Older People Page 21 of 38 Evidence: complain. However, one person stated: They dont treat you like a person and another stated I have this feeling that I dont count. We received one complaint about the home, which was referred to Social Services under the safeguarding procedures and it is currently being investigated. The homes record of formal complaints indicated they had received five complaints that had been upheld and action had been taken to address them. However, concerns had been raised in the comments book and there was no evidence that they had been addressed or the complainants informed of any outcome. The manager will need to review the procedures for recording formal and informal concerns/complaints, so that a more proactive approach is taken and continuous improvement achieved. Records indicated that 88 of staff had undertaken training in respect of safeguarding and on discussion with some staff they had a good knowledge of the procedure within the home, but lacked information about the Whistle blowing procedure. There was no evidence that staff had received training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards. Staff need to be provided with training in these areas to ensure they are aware of their responsibilities in respect of supporting people who lack capacity to make decisions especially as there are a number of people who suffer with dementia living in the home. Care Homes for Older People Page 22 of 38 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. Areas of the home are in need to improvment to ensure people live in a homely, comfortable environment that meets their needs. Procedures in respect of infection control need to be more robust to reduce the risk of cross infection. Evidence: The building is a large, detached, two storey purpose built home for older people. It is located in a residential area within easy reach of Dudley town centre. There is limited parking to the side of the building. The exterior of the home is poorly maintained and a number of windows require replacement as they are draughty. One person stated they had to buy a heater for their bedroom due to the draught. The grounds were poorly maintained as the hedges were overgrown, the ground was uneven and the wooden hand rail up to the main entrance was rotten and could pose a risk to people using it. A letter was forwarded to the manager following the inspection advising of the need for urgent action due to the risk posed. A partial tour of the home was undertaken. Internally it is divided into two units; one for 12 people who suffer with dementia and one for 24 people requiring residential care. On entering the home there were notice boards with a range of information for anyone visiting. The home was warm and cleaned to a satisfactory standard, but there was an odour in the reception and lounge/dining area, which are adjacent to each other. Feedback from surveys indicated that the standard of cleaning could be improved. One person said. Care Homes for Older People Page 23 of 38 Evidence: It could be kept fresher with more cleaning through the day and residents kept cleaner. Each unit has a lounge/dining area, which were pleasantly decorated, but call bells were not accessible to people especially if they had mobility problems. This needs to be addressed so people can summon assistance when required as on the first day of inspection one person was heard to be calling out for help on a number of occasions. The television reception in the lounge on the dementia unit was very poor. It was stated the aerial was broken. This will need to be addressed, so people have suitable facilities to watch television if they wish. There is a separate smoking room for people who wish to smoke. The manager must ensure correct procedures are in place for cleaning and maintenance of the room and is advised to contact the environmental health department. Bathrooms and toilets were strategically placed around the home with facilities for liquid soap and paper towels, but paper towels and liquid soap was not available in a number of areas. This needs to be addressed to ensure adequate infection control procedures are in the home. The manager stated they were in the process of redecorating and providing different themes in the bathrooms based on peoples requests. All bedrooms are single and twelve have en-suite facilities consisting of toilet and wash hand basin. A call bell facility was available in each bedroom so people can call for assistance if required. Lockable facilities were available in bedrooms, so people could store medication/ valuables and bedroom doors had locks to enhance privacy. Currently there is a re decoration programme of bedrooms and communal areas enhancing the environment. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their bedrooms more homely. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails raised toilet seats etc. The laundry was adequate and had processes to prevent cross infection. Laundry equipment was adequate to allow sluice and pre-wash cycles. It was noted that staff stored there personal belongings in the laundry, which is not appropriate due to the risk of cross infection. The home had towels for peoples use, but a number of them were frayed. An audit should be undertaken and all frayed/damaged items replaced. The sluice on the dementia unit which leads to another storage room with equipment was not locked. This could pose a risk to people who wander and action will need to be Care Homes for Older People Page 24 of 38 Evidence: taken to safeguard them. Care Homes for Older People Page 25 of 38 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. A review of staffing levels and training arrangements should be undertaken and appropriate action taken to ensure a well trained team in adequate numbers is available at all times to meet peoples individual needs. Evidence: On the day of inspection there was a manager, senior carer and four care staff on duty. The duty rota indicated there were four care staff on duty during the day (two on each unit) and two on each unit overnight. However, it was noted on the rota for the past month there were at least four nights when there were only three care staff on night duty. A senior carer is on duty during the day. Ancillary staff such as domestic, laundry, catering, administration, and maintenance staff support care staff. At the time of inspection there did not appear to be adequate staff on duty to meet peoples individual needs. There were 21 people to care for on the residential unit and at least nine or ten of them required two staff for assistance. During the course of the inspection staff were very busy, some people were not having breakfast until late morning, at times communal areas were not supervised, some peoples appearance was poor (as identified in health and personal care), communication was lacking; staff were not aware of peoples needs on discussion with them, district nurses stated it was difficult at times to get help from staff as they were always busy and the routine was task orientated. Care Homes for Older People Page 26 of 38 Evidence: Feedback at the time of the annual service review last year indicated that there did not seem to be enough staff on duty and one person stated sometimes afraid to ask to go to the toilet. Feedback from surveys this year also raised issues about the lack of staff and lack of supervision Comments received at the time of inspection from people living in the home and visitors included; The staff are very pleasant; they work their socks off. It does not matter how busy they are they find time to talk to you. The staff are marvelous; if I was able I would marry all of them. The staff are nice. The staff files for three newly appointed staff were inspected and the recruitment process was fairly satisfactory and POVA first checks were obtained prior to commencing work. However, the organisation contact the home with the the result of the Criminal Record Bureau check (CRB). It was noted on one file there was no evidence of any CRB, another stated for the manger to call them, but there was no record of this documented and there was no evidence of risk assessments for people where issues had been raised in CRBs. The manager will need to follow this area up and ensure suitable risk assessments are in place where appropriate to ensure people are protected. Newly appointed staff undertake induction training and there was evidence that they had undertaken the training or it was ongoing. This provides them with the knowledge initially to meet peoples needs. However, it was noted that most of the training was undertaken before they commenced work in the home and on discussion with some of them about various aspects of their training they could not remember it. This does raise questions about the effectiveness of the training provided. There is a rolling programme of in house staff training and records indicated the majority of staff had completed training in respect of fire safety, manual handling, food hygiene, health and safety, safeguarding, first aid, infection control, challenging behaviour, dementia, health and safety. It was noted the maintenance operative was a trainer for clinical areas such as pressure sores, challenging behaviour etc. All senior staff had completed training in respect of medication. The training matrix demonstrated ten members of staff out of twenty three care staff had completed Care Homes for Older People Page 27 of 38 Evidence: National Vocational Qualification (NVQ) level 2 in care. Training should provide staff with the appropriate skills and knowledge to care for people living in the home. The manager is advised that a review of the arrangements for staff training should be reviewed and action taken to ensure it is suitable for peoples learning styles, is effective and it is evaluated to ensure staff develop the skills and knowledge to meet peoples needs. Care Homes for Older People Page 28 of 38 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 management systems in the home need to be developed to provide improved outcomes for people. Evidence: The manager works on a full time basis and is registered with us. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The home does not act as appointee/agent for people in the home, but assists with personal allowances. Individual records were maintained for people where the home held money on thier behalf and receipts were given for all deposits and withdrawals. However, it was noted there was no receipt from the visiting hairdresser and the administrator stated she would address it. Balances of monies checked were found to be correct. This should ensure that peoples monies are held safely. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was Care Homes for Older People Page 29 of 38 Evidence: forwarded to the home, which gives us information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. It gave us some of the information we required, but would have benefited from more specific information. The organisation has a quality assurance process that consisted of audits and an annual satisfaction survey. The manger stated she had recently sent out the surveys and was in the process of receiving them. The surveys returned to date were from people who live in the home or their families and there had been some positive feedback, but issues were raised in respect of the timing and quality of meals and the lack of response to issues raised. The manager stated they would be developing a plan of action this year to address any areas that required development, so that improvements could be achieved for people living in the home. Staff meetings were held approximately every two to three months. Staff supervision was occurring regularly from the records seen and discussion with staff. This provides staff with the opportunity to discuss any areas of concern, training etc. Meetings with people who live in the home and their relatives occurred approximately twice a year, providing them with the opportunity to raise any issues they wish and it was noted they had raised concerns about the availability of parking. Although the care staff work hard there appeared to be inconsistencies in care as evidenced by people we spoke with. Areas of development were found, which need to be addressed to ensure everyone receives a consistent standard of care that meets their needs in a person centred manner. Areas that need to be addressed include the handling of complaints, the inconsistencies in care provided, the lack of supervision in lounges, investigation of bruises and follow up of falls, problems with communication, issues in respect of CRBs etc. and these need to be addressed to ensure peoples needs are met adn outcomes improved for people living in the home. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and in full working order. These were found to the satisfactory with the exception of the gas safety certificate for the kitchen. The estates manger was visiting at the time and we were informed he had arranged for the work to be undertaken. A letter for urgent attention has been forwarded to the manger of the home asking her to advise us of the timescales for the work to be completed. Checks were completed on the fire system regularly, but there was no evidence seen of checks on fire stops on individual doors. This needs to be addressed to ensure people are safe in the event of a fire. Care Homes for Older People Page 30 of 38 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 31 of 38 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 8 13 Where someone is identified 08/11/2009 as being at risk robust systems must be put in pace to ensure action is taken to reduce the risk and they are followed up appropriately. To ensure the well being of people living in the home 2 8 13 An investigation of 08/11/2009 accidents/incidents involving skin tears, bruising, grazes should be undertaken and action taken to reduce the numbers in the future. To reduce the risk of people living in the home and ensure thier well being. 3 9 13 The medication room must be maintained at or below 25 degrees centigrade. To ensure all medication is stored at the correct temperature. 08/11/2009 Care Homes for Older People Page 32 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 15 13 Pedal bins must be replaced; 30/10/2009 the dishwasher on the dementia unit should be repaired/replaced and food items must not be stored on the floor. To ensure appropriate hygiene practices in kitchens and reduce the risk of cross infection. 5 19 13 Replace hand rail to the front of the home. To ensure the safety of people using it. 08/11/2009 6 19 13 Action must be taken to ensure the sluice room is secured when not in use. To reduce the risk to people who wander and ensure they are safeguarded. 08/11/2009 7 26 13 Robust infection control 08/11/2009 procedures must be in place to include the provision of liquid soap and paper towels in all areas and the storage of staff belongings in an appropriate area. To provide suitable hand washing facilities and reduce the risk of cross infection. Care Homes for Older People Page 33 of 38 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 8 27 18 There must be adequate staff on duty at all times during the day and night. To ensure peoples individual needs are met effectively. 08/11/2009 9 29 19 There must be systems in 08/11/2009 place to demonstrate a CRB has been obtained and risk assessments completed where any issues are raised. To ensure people living in the home are protected. 10 38 13 Take action to ensure the gas equipment in the kitchen in fit for use. To ensure the safety of people living and working in the home. 08/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Records must clearly indicate follow up of concerns and when changes occur in treatments/care etc, so that peoples conditions can be monitored effectively. All care plans should be updated and outline in detail the action required by staff to meet peoples needs so care is individualised and peoples needs are met in a consistent and person centred manner. Systems should be in place to ensure staff are fully aware Page 34 of 38 2 7 3 8 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations of the risk assessment process and how it links into care planning to ensure they plan care effectively for people living in the home. 4 8 Staff should be given training in respect of undertaking blood glucose monitoring, so they are suitably qualified to undertake the procedure. Systems should be reviewed for monitoring and recording of food and fluid intake where people are nutritionally compromised, so that peoples intake can be monitored effectively. Systems should be implemented for monitoring of people who experience pain, so thier pain in controlled effectivley. The manager should liaise with the GP practice about monitoring of chronic diseases to ensure peoples well being is maintained. Consideration should be given to providing staff with training in respect of clinical and health related conditions to enhance their knowledge and understanding of peoples needs and ensure they are met effectively. A review of medication procedures should be undertaken and appropriate action to ensure there are no unnecessary disturbances during the medication round and the correct procedures are followed, so peoples well being is maintained. Facilities must be in place to enable people to use a phone to make and recieve phone calls in private. Action must be taken to ensure peoples dignity and self esteem is maintained through attention to their personal grooming. The range of activities needs to be developed further to ensure people are suitable occupied and their well being maintained The routine of the home should be reviewed to ensure there is a degree of flexibility for people and it is welcoming. A review of the arrangements for meals should be undertaken and action taken to ensure meals are served at Page 35 of 38 5 8 6 7 8 8 8 8 9 9 10 11 10 10 12 12 13 13 14 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations appropriate time intervals and they meet peoples dietary needs and preferences. 15 16 Review the systems for recording and responding to informal concerns/complaints/comments to demonstrate a proactive approach to them and continued improvement. Provide systems that ensure everyone living in the home is aware of the complaints procedure, so they know how to raise any concerns they may have. Ensure all staff are trained in respect of the Mental Capacity Act and the Deprivation of Liberty Safeguards commensurate with their position, so they are aware of their responsibilities in supporting people who lack capacity to make decisions. Ensure all staff are fully conversant with the whistle blowing procedures to ensure people living in the home are safeguarded. It is recommended advise be sought from the environmental health department about cleaning the smoking room, to ensure correct procedures are followed to safeguard people. Systems must be in place to enable people living in the home to access calls bells in communal areas, so they can summon assistance if required. Take action to make the outside area even and accessible, so people living in the home have a suitable outdoor space that is safe to use when the weather permits. Provide facilities in the home for a suitable television reception in all communal areas, so people can watch television if they wish. Take action to address the odour in the home, so that people live in an odour free environment. Undertake an audit of all the windows and replace those that are draughty. This will ensure people live in a pleasant, warm environment. Undertake an audit of towels and replace any frayed damaged items, so they are fit for purpose. Page 36 of 38 16 16 17 18 18 18 19 19 20 19 21 19 22 19 23 24 19 19 25 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 26 28 A review of the training arrangements must be undertaken and systems put in pace to ensure it is effective and meets staffs individual learning styles, so peoples needs are met effectively. Care Homes for Older People Page 37 of 38 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). 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