Care Home: Bearnett House Residential Home

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What the care home does well We have recognised the achievements made since the last key and random inspections, in which requirements and recommendations made have been, and continue to be found to have been satisfactorily addressed. We have found that Bearnett House offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys, and talking with people during the inspection include: "I would recommend the home to anyone, it is what it says it is, a well run home with good staff, mum is very settled". "I am pleased with the care staff and the doctors who come to see me, everyone is so kind and willing to help, they could do with more staff". "Whenever my family visits me the staff make them feel at home, and they take care of me very well". From our examination of care records we established that there are effective pre admission assessments, and improved care planning of individual needs, which are meaningful in formulating a satisfactory standard of personal care. When we discussed the quality of care with those people using the service and visitors, it was clear that they appreciated this personable attitude and approach to care. Comments we received from relatives and staff during the inspection include: "We have seen a vast improvement in the way it treats people with respect, although a relaxed atmosphere, very easy to get along with". "They make sure my mom eats and drinks so that she keeps well. It`s a happy home. Always made me feel welcome, staff are helpful". Our inspection has identified a clearer `person centred` approach to care away from task care, especially for people with dementia. There is a continuing positive address to the process of administering medication. We found that the standards of catering continue to offer a good service, to which those people we spoke with were complimentary. The quality and quantity of the food offered on the day was observed to be of a good standard, confirmed by those people we talked with, served in a comfortable and clean dining room. "I love the food, it is always good and tasty, always hot, and the staff are very helpful". "Very good standard of cooking and choice available. It`s always set out so nice". What has improved since the last inspection? Following on from the last key inspection we have acknowledged compliance to address those requirements, and a positive response to recommendations made. There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. With a reviewed Statement of Purpose we accepted that a greater emphasis in receiving people`s opinion has resulted in an awareness of expectation and concerns, including the improved commitment in providing meaningful activities and social interaction. There is evidence that the reviewed care planning system, established with a clearer understanding of dementia care needs, is established, maintained and accurate, reflecting the importance of socialisation and inclusion in the care process. Much work has gone into improving health and safety issues in the Home, especially on the movement and handling of people, and risk assessments. There has been a more positive progress towards an effective training programme, which has identified the importance of maintaining core issues for regular address. We have acknowledged the improvements made in improving the general environment, and upgrading facilities to assist people, especially those with a higher dependency of care or dementia needs. What the care home could do better: We have recognised the significant improvements made in meeting the requirements we, and other agencies have made in the past 12 months. There are however several issues we would wish the Registered Provider to address. The good standards of pre admission assessment would be enhanced with the confirmation of agreement for admission to be sent in writing to the person involved as soon as is appropriate. We recommend that the Provider consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. The review should include the development of the range of activities and facilities for recreation available through the provision of an activity co ordinator, having regard to the needs of people for recreation and fitness. We would advise that the Provider operates a consistent, thorough staff recruitment and appointment procedure, ensuring the protection of people who use the service. That the records of staff induction and mandatory training be kept up to date, and managed effectively. We also note that formal staff supervision and staff meetings should be implemented to ensure that all staff receive appropriate support, guidance and that communication is enhanced, to benefit people living in the home. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. We advised that the accident log, following analysis be placed in the persons care file. The procedure manual needs to be reviewed to help to staff to keep updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties, and Safeguarding regulations. A policy for covering confidentiality is recommended. Throughout the inspection of administration and record keeping we drew the attention of the management to ensure that all records are consistently authenticated with a signature, and dated appropriately. The achievements in establishing a good standard of care have been recognised, areas of detail, outlined through recommendations, will continue to play a part in the ongoing development and maintenance of an improving service. Key inspection report Care homes for older people Name: Address: Bearnett House Residential Home Stourbridge Road Bearnett Drive Penn Wolverhampton West Midlands WV4 5NF     The quality rating for this care home is:   two star good 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: Keith Jones     Date: 0 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Bearnett House Residential Home Stourbridge Road Bearnett Drive Penn Wolverhampton West Midlands WV4 5NF 01902895443 01902326853 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Peter Willis,Mrs Helen Theresa Willis,Mr Mohamed Fazal,Mr Mendi Fazal Name of registered manager (if applicable) Mrs Helen Theresa Willis Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 29 Dementia (DE) 16 Physical disability (PD) 6 Date of last inspection Care Homes for Older People Page 4 of 35 Over 65 0 29 0 16 0 6 Brief description of the care home Bearnett House stands in its own grounds it located off the busy A449 on the edge of the City of Wolverhampton. The service is registered to offer accommodation to twenty-nine older people who have a physical disability and or dementia. The building consists of two storeys; bedrooms are located on each floor. The first floor can be accessed via the stairs or shaft lift. With the exception of six bedrooms all were for single occupancy, and all had some form of en-suite facility. The full range of charges were not detailed in the services Statement of Purpose, the reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 35 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: two star good 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: We conducted this unannounced inspection with the Care Manager, Deputy Manager, senior care staff on duty, and an Expert by experience, whose input contributed to this report. An Expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service.. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 28 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and four staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. Care Homes for Older People Page 6 of 35 We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process; their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), seven survey forms returned, that we sent out to people who use the service some weeks before the inspection, and six staff responses were received. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Registered Care Manager and Deputy Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Following on from the last key inspection we have acknowledged compliance to address those requirements, and a positive response to recommendations made. There is recognition that a more person centred care approach has been generated, and a Care Homes for Older People Page 8 of 35 greater involvement by people who use the service and their relatives. With a reviewed Statement of Purpose we accepted that a greater emphasis in receiving peoples opinion has resulted in an awareness of expectation and concerns, including the improved commitment in providing meaningful activities and social interaction. There is evidence that the reviewed care planning system, established with a clearer understanding of dementia care needs, is established, maintained and accurate, reflecting the importance of socialisation and inclusion in the care process. Much work has gone into improving health and safety issues in the Home, especially on the movement and handling of people, and risk assessments. There has been a more positive progress towards an effective training programme, which has identified the importance of maintaining core issues for regular address. We have acknowledged the improvements made in improving the general environment, and upgrading facilities to assist people, especially those with a higher dependency of care or dementia needs. What they could do better: We have recognised the significant improvements made in meeting the requirements we, and other agencies have made in the past 12 months. There are however several issues we would wish the Registered Provider to address. The good standards of pre admission assessment would be enhanced with the confirmation of agreement for admission to be sent in writing to the person involved as soon as is appropriate. We recommend that the Provider consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. The review should include the development of the range of activities and facilities for recreation available through the provision of an activity co ordinator, having regard to the needs of people for recreation and fitness. We would advise that the Provider operates a consistent, thorough staff recruitment and appointment procedure, ensuring the protection of people who use the service. That the records of staff induction and mandatory training be kept up to date, and managed effectively. We also note that formal staff supervision and staff meetings should be implemented to ensure that all staff receive appropriate support, guidance and that communication is enhanced, to benefit people living in the home. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. We advised that the accident log, following analysis be placed in the persons care file. The procedure manual needs to be reviewed to help to staff to keep updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties, and Safeguarding regulations. A policy for covering confidentiality is recommended. Throughout the inspection of administration and record keeping we drew the attention of the management to ensure that all records are consistently authenticated with a signature, and dated appropriately. The achievements in establishing a good standard of care have been recognised, areas of detail, outlined through recommendations, will continue to play a part in the ongoing development and maintenance of an improving service. Care Homes for Older People Page 9 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 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 35 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. The process to ensure that the needs of people are appropriately assessed before they are offered a place, are in place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We looked at the Homes recently revised Statement of Purpose and Service User Guide, and found them to provide an informative description of the homes aims, objectives, and the way it operated. We were informed that the information was presented to all enquirers, and that information concerning fees payable are included in the Service User Guide. We found that both were able to be presented in a large print and audio version is being prepared, to assist people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Care Homes for Older People Page 12 of 35 Evidence: Through our case tracking of three peoples care records we clearly identified that the Care Manager, or her Deputy, at the point of reference, had conducted the preadmission assessment. We found that the established process identified a dependency assessment, life style and social life. There remains an inconsistency in taking ownership of responsibility with several documents not signed or dated. Nevertheless the process does form a foundation for care planning to meet needs, which included a copy of the care plan from social services (if appropriate), prior to admission. There is evidence that the assessment is produced with the involvement of people who may use the service and their family, allowing them to influence the direction of care. Those files we examined showed this to be true, with each individual having a plan of care, which included a much improved care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual are discussed and documented, although a life history or account of lifestyle would ensure that their personal needs would be met. We saw evidence during the day to confirm that a number of people who have dementia, or confusion are receiving the appropriate level of care to ensure that their needs, health and well being are being met. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving people, and their families in the admission process. I would recommend the home to anyone, it is what it says it is, a well run home with good staff, mum is very settled. Every time they come they make my family feel at home, and they takes care of me. Care Homes for Older People Page 13 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Care records we examined, and case tracking provided evidence to show that the pre admission assessment formed a basis for an improved, revised care planning process. We acknowledge that Social Services reports and assessments are taken into consideration. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, increasingly based upon a more person centred process of dependency assessment and activities of daily living. We advised that the assessment be confirmed in writing with the family and person involved, immediately. There was indication of an inconsistency with signing and dating assessments, needed to authenticate the quality of assessment. We saw that the assessment of need is considered within an individual plan of care that is reviewed monthly, to reflect their Care Homes for Older People Page 14 of 35 Evidence: changing needs and adapting care profiles. There is an informative daily progress report providing an accurate chronicle of stay and events. Established monitoring systems following a process of goals, care and evaluation of satisfactory care plans, which was shared by those people and relatives alike. Risk assessments are carried out on an individual basis and reviewed as required, these include tissue viability, mobility, continence and nutrition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The reviewed care planning process is established with a clearer understanding of dementia care needs, was found to be well maintained and accurate. We have noted the improvements made in logging of meaningful daily reports, which were seen to reflect events and incidents we followed through from source. Case tracking of three people living in the home confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. It was noted that there needs to be a closer liaison with District Nursing services attending, in recognition of their role and attention to care instructions given. Nevertheless we found, through case tracking, our discussions and inspection of records, that the Home arranges for health professionals should special health care needs be recognised. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving. The Expert by experience noted: Staff were seen to treat residents with care and respect, and relations between staff and residents appeared good. During the lunch period there were four members of staff offering assistance to the higher dependency residents to eat (in the library room) and appeared to be carrying out this task with due care and attention. I observed two members of staffing assisting A, who appeared very unsteady and nervous about walking, to get to the dining room, using a walking frame, and they were gentle and encouraging. Comments we received during the course of inspection from people using the service, visitors and professionals: Someone is always there, and when she rang her bell, someone came immediately to see what she wanted. I am pleased with the care staff and the doctors who come to see me, everyone is so Care Homes for Older People Page 15 of 35 Evidence: kind and willing to help, they could do with more staff. Whenever my family visits me the staff make them feel at home, and they take care of me very well. I have noticed that lots have changed here, the care is better, and I can say that the clients are more happier now and full of life. There was a clear appreciation of the openness and opportunity to contribute. Carers were seen to generally interact with people who use the service with understanding and friendly compassion, and people were seen to be supervised in the lounge areas. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the deputy care manager is responsible for overseeing all matters relating to medicines. She has effected a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. Our examination of the record of administration of medicines showed consistency, with no omissions observed. We advised that specimen signatures of staff authorised to administer medicines be kept up to date. Controlled drug arrangements and management are appropriate. Staff training continues to be pursued actively by the care manager, with the pharmacy suppliers helping out. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Care Homes for Older People Page 16 of 35 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. The care team promote the health, safety and welfare of people using the service, and working practices are satisfactory. There remains a need to promote social stimulation and activities to enhance daily living and quality of life. People who use the service can be assured that the home is run in their interests, based on openness and respect. People are offered a healthy, well balanced diet. Evidence: Throughout the period of inspection we found the daily routine to be flexible, offering choices and diversity for personal and social activities, religious needs and meals. Our discussions with people who use the service, and staff, identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. People also exercise choice in the time they get up and go to bed. One daughter expressed her views: Shortly after mum was admitted, I came one morning and mum was still in bed, staff had let her sleep in but had checked her occasionally to see if she was awake. She always liked to lie in, in the mornings when at home, thats normal life and I like it. Care Homes for Older People Page 17 of 35 Evidence: They make sure my mom eats and drinks so that she keeps well. Its a happy home. Always made me feel welcome, staff are helpful. We reinforced the principle that activities are a key element in the socialisation and motivational approach to care, and involvement. The home has a part time (four hours a week) activity coordinator, working with a limited budget, in an unstructured format, which showed deficiencies in the programme of events and commitment. During the course of the inspection we saw staff interact with people in a positive and polite manner, although we observed there were instances of lower levels of contact with people with dementia. We advise that attention be drawn to providing a substantial activity co-ordinator presence, to achieve a meaningful social health and care programme. The Expert by Experience reported: I was informed that there is an activities co-ordinator but that she only works for four hours a week, and did not arrive, so I was unable to witness any activities taking place at all. I was told that she provides activities such as bingo and physical exercises, but as her time is so limited, it would be hard to imaging that sufficient organised activities could be provided to residents in the time available, and no time to support one to one, individualised activity to residents. I was particularly impressed by the interaction of one member of the caring staff, who demonstrated empathy with individual residents, and knowledge of their backgrounds. Several residents informed me that previously trips out were organised by coach, but that these no longer took place. The home should make more effort to provide links for their residents with the outside community through providing more opportunity for social stimulation/entertainment inside the home and opportunity for trips out, even if only to the shops. Over lunch I talked with several people who said staff do a very good job, I like the carers, they are all very helpful. One person said that she had let slip that she enjoyed listening to classical music and that the manager had arranged for her to have a record player to listen to her music on in her room. One person told me he had been a keen gardener, and I learned that recently residents had joined in potting up some plants inside the home. It would be good if they are now able to follow up on the progress of their plants outside in the greenhouse and garden. We continue to consider that there is insufficient attention drawn to offer a therapeutic service for people with dementia, and for people who have greater dependency needs. We recommend that creative ways of providing activities such as adapted equipment Care Homes for Older People Page 18 of 35 Evidence: for those with disabilities; life story work and seeking individual interests would enhance life for people living in Bearnett House. This would be consistent with a Person Centred Care approach as stated in the Statement of Purpose. We noted the comments raised at the last relatives and residents meeting requesting that more activities would be helpful. We also recognised that people would like the opportunity to enjoy outside activities in a potentially very attractive garden and patio area, well suited for the task. Comments we received from surveys issued to people who use the service before the inspection: I would like more outings and more choice of food, More time to spend with me and other clients. More trips out to the shops, Perhaps more activities. They could do more activities and spend more time with us. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed an influence of personalisation in the inclusion of belongings, some furniture and general decor, although attention was drawn to addressing the personal needs of people with dementia, in the furnishing of bedrooms. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. We found that the standards of catering continue to offer a satisfactory service, to which those people we spoke with were complimentary. A menu, on a four weekly cycle offered a varied and suitable choice. We observed a pleasant lunch served during inspection, a choice of two main meals, and desserts. The quality and quantity of the food offered on the day was observed to be of a good standard, confirmed by those people we talked with, served in a comfortable and clean dining room. Most people were able to eat independently, but where assistance was needed it was offered in a polite and respectful manner, and at a level appropriate to individual need to encourage independence and maintain dignity. The choice of dining room, lounge or bedroom was at the discretion of people living in the home. People interviewed confirmed that that the quantity and quality food provided was good: I love the food, it is always good and tasty, always hot, and the staff are very helpful. Care Homes for Older People Page 19 of 35 Evidence: Very good standard of cooking and choice available. Its always set out so nice. The Expert by experience reported: For lunch there was a main course choice of salmon fillet, parsley sauce, mashed potato, carrots and peas, or corn beef hash, served with baked beans and tomatoes. There was mushroom soup to start with and the only dessert was lemon meringue pie, which was obviously homemade and very tasty. Residents had mostly been asked that morning which main course they preferred. I sampled the salmon and vegetables and the food was hot and well cooked. The portions were the right size, not too large or too small and it was nice to see condiments on the table, a table cloth, napkins, and glasses, not plastic cups. There were two menus in the dining room and the only disappointment was that the promised chips stated on the menu did not appear. Other than this, I thought that the meal was excellent and nicely presented. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special (cultural) needs at the time. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: From our discussions with people who used the service it was evident that issues were handled immediately, discretely and to the satisfaction of all concerned. However the complaints policy, and records of complaints dealt with were examined, which provided a barely adequate recording and evidence of handling of peoples and families concerns in a meaningful and effective manner. We advised that the Manager establish a formal process which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding. Those concerns that were recorded were seen to have been dealt with by addressing peoples, and their families concerns, in a meaningful and effective manner. Comments received from visitors, and people who live in Evergreen, in the course of inspection: I have no complaints to talk about, a little matter was discussed with the carer and dealt with properly. I know who to speak to if Im not happy, the carer always listens, and is very good at sorting things out. Care Homes for Older People Page 21 of 35 Evidence: No complaints had been received by us since our last inspection, and the overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. This process was evidenced on examination, through the surveys we sent out and case tracking. Discussion with the Care Manager confirmed that there continues to be a satisfactory protocol, and response to anyone who may report any form of abuse, to ensure effective handling of such an incident. We have received one allegation since the last inspection regarding moving and handling procedures, resulting in a direct and immediate response, presently being dealt with to our satisfaction. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed in the last 12 months have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining three staff files. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: Beaarnett House is located in a residential area south of Wolverhampton, and is accessible via public transport and is close to local amenities. The service provides care to older people, some of whom may have a physical disability or dementia care needs, and providing accommodation for twenty nine people. External access is satisfactory for visitors, with adequate parking available on the homes forecourt. We found the gardens providing a pleasant outlook, and having had effective maintenance. We acknowledge the efforts being made to improve access to the garden area, and plans to involve people with a herb garden to spend some time in. We found the general state of exterior repair and maintenance to be satisfactory. There is adequate exterior security lighting, and all external doorways are secure. Comments received from people we met through inspection were all complimentary of the quality of their place of living, indicated: We always find the home clean and tidy, my father seems to be very comfortable with his situation. Bearnett is a really nice home, we have always been impressed with the comfortable Care Homes for Older People Page 23 of 35 Evidence: living standards for mum. I came to Bearnett from another home, and I have only been here for a few months, but it is almost as good as my own home, Im very comfortable. On admission the Care Manager or her deputy assesses each individual persons needs for equipment and necessary adaptations. Internal access was equipped with ample fittings of hand and grab rails, facilitating wheelchair access throughout most areas of the home. We found sufficient hoists and a range of aids and adaptations to assist people who are dependent. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. We have indicated the need to develop the decor of corridors to reflect a growing need to assist people with dementia in pathway location signs, including corridors with themes and easily recognisable colour coordination, linked in with familiar and individualised bedroom doors. Efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of a high standard. The home provides lounge areas that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. The carer call alarm system was satisfactorily tested, with a good response from staff on duty. Our inspection of bedrooms found them well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying the personal furniture and belongings. There is a need to consider the individuality of personal space, especially in recognising the needs of people with dementia. We found the overall quality to be an improving good standard, presenting a homely and comfortable environment. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Bathrooms and toilets are located on both floors, near to bedrooms and communal areas, and fitted with appropriate aids and adaptations to meet the needs of people who use the service. We found them to be of a good quality, clean, and odour free, visible with appropriate recognisable features, although one on the first floor was cluttered with equipment. Sluice facilities have suitable arrangements to assist in control of infection, although needing to be secured when not in use. Notices regarding chemical handling in the areas that store chemicals are displayed. The housekeeping services in the Home were seen by us to be of a good standard. The people spoken to generally remarked that they find the environment always very clean and fresh. Comments from a survey we sent out: Care Homes for Older People Page 24 of 35 Evidence: They are good at promoting a caring, loving, homely atmosphere. Our mum has returned to a lovely area and very comfortable bedroom, altogether a very pleasant environment. The home achieves a good standard of cleanliness. The Expert by Experience reported: The home is pleasantly furnished in the communal areas and I noticed bookcases and wall units were stocked with items, although no evidence of these being used by the residents. The two bedrooms that I viewed differed greatly in that one was very pleasantly furnished with a homely feel and fine view, the other rather narrow and cramped with basic furnishings and not much in the way of personalised items. The gardens on each side of the building have plenty of scope for residents to walk in or to sit out, although I was not convinced that residents are encouraged to do this, despite there being one seating area provided outside the front entrance. It would be good if some of these areas were made more accessible and attractive and evidence of positive encouragement to residents to go outside when possible. Heating and ventilation were found to be satisfactory, and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. The laundry was well organised and equipped to a good standard, with COSHH regulations displayed and relevant to solutions in use. The kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices. All fridges and freezers were seen to be used in the appropriate manner, and were checked daily by the kitchen staff. A cleaning schedule was in place, evidencing the good quality of cleanliness observed. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and likes and dislikes. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. Care Homes for Older People Page 25 of 35 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. Further staff training, monitoring and supervision are required to ensure staff have the appropriate skills and knowledge to meet peoples needs. Recruitment processes are inconsistent and need review to ensure protection of the people who use the service from harm and abuse. Evidence: We confirmed that there were 28 people living in the home on the day of the inspection. Three weeks of staffing rotas showed to us an adequate balance between skills, experience and numbers to provide a good standard of care. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection the average care staff coverage was seen to be: Morning 2 Senior 3 carers Evening 1 Senior 3 carers Nights 1 Senior 2 carer Two weeks of duty rotas were examined, in which the daily care staffing rota showed Care Homes for Older People Page 26 of 35 Evidence: adequate balance between skills, qualifications and numbers to provide a foundation for a high standard of care. The Care Manager and Deputy Manager worked supernumerary to the staffing rota. We acknowledge the appointment of a Head of Care nurse who will be joining the staff in July, and also the efforts made to increase experienced staffing levels to meet increasing needs of people. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. The catering, maintenance and domestic staffing arrangements were determined and found to be appropriate for the size of the home and the needs of people. There remains a growing recognition that the arrangements for activities are inadequate, with people getting little in the way of effective supervision, and motivation to socialise and engage, especially in addressing dementia care needs. This was identified at the last inspection, and now requires an appropriate response to meet these demands. We sampled three staff files, and found them to be in need of organising. We recognise that the management have established a procedure for interview, selection and appointment of staff, but are inconsistent to provide evidence to reinforce the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. We consider that the unstructured procedure be reviewed to provide a secure and meaningful record, which will include formalisation of an interview record and follow up letter of appointment to enhance the system and reinforce the agreements made on employment of staff. We saw little written evidence that all new team members receive a thorough induction programme, or an ongoing training and development plan for all staff. We asked staff about training, all of whom were complimentary of the improved facilities and opportunities offered. There is a need for the manager to upgrade the written record of induction and training to meet standards expected, and to involve staff more in the management of training, especially in keeping abreast of mandatory subjects, such as fire, and movement and handling. The records we examined showed that 15 care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, and we recognise that a further three staff are undertaking, or planning to commence NVQ training at the time of inspection. Comments we received from people we spoke with on the day: We have always found the staff are well motivated, and great efforts are made to stimulate the residents, although that doesnt happen when they are busy caring for residents. The managers and staff are lovely people, very kind and very helpful. Care Homes for Older People Page 27 of 35 Evidence: Need more staff at mealtimes. The young carers usually listen, are very helpful and try to meet our needs. The care of our residents is excellent. We are all up to date with course work and knowledge of our role, and of the resident. Everyone there is so friendly and nice, nothing is too much trouble A little short staffed at times. The Expert by experience reported; I understand that progress is being made towards appointing key workers for individual residents, which would help to ensure improved person-centred care and individualised attention for each resident. I think that more one to one interaction with residents, particularly with those with dementia, by members of staff would be immensely beneficial. Mrs X said that the staff were caring, and that when Y wanted to take a shower, a member of staff stayed with her throughout to make sure she was safe. Someone is always there and when she rang her bell, someone came immediately to see what she wanted. A said that the staff are very friendly, and the food mixed. Records were available to demonstrate an inconsistent process of supervised practice, failing to meet the required six sessions a year. There is a need to capture the level of understanding of the staffs expectations and perceptions of the work they undertake in a more regulised manner. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: The experienced care manager has over the past year demonstrated a willingness and determination to address the issues raised at the last random inspection, reinforcing the establishment of a solid management foundation, implemented to achieve a good standard of set aims, objectives and care. We acknowledge the work done in engagement in quality reviews and audits with other health care professionals following our last inspection, meeting compliance to requirements and addressing recommendations we made. She has performed the Manager and partnership Providers role for over 23 years, having been in a senior nursing and caring professional role for many years, relinquishing her registered status, but remaining Care Homes for Older People Page 29 of 35 Evidence: active in the running of the service. We acknowledge the recent appointment of a Head of Care who will be able to offer valuable support to the Manager. We recognise a significant shift away from task centred care towards person centred care, although there remains a need to address staff attitudes towards change. There have been improvements in the provision of written evidence of care and service given, and in the organisation of care, although needing continuing observance and application, through delegation to senior staff, who need to be encouraged to take on more responsible, and wider roles in the running of the Home. We did observe an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, which has been based on mutual trust and respect. Comments from those people we met and surveyed included: When we have had a need to sort thing, the matron or her staff have always been ready to receive our views. Its a very settled and comfortable place to live in, with a good atmosphere. We are extremely happy with the staff and the home, we have found it to be very relaxed, friendly, and a homely atmosphere. The expert by experience assessor stated: There is at atmosphere of calm organisation in the home. It is clear that the manager is a strong and controlling presence in the home. Through the inspection process we found improved, and appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, and chemical safety notices were seen in areas of use and storage. An examination of administrative, monitoring, planning and care records showed to us a generally diligent attitude to effective record keeping, although there is a need for staff to apply dating and signature consistently, in ensuring that the peoples rights and best interests are safeguarded. Records inspected included recent fire prevention, hoists, and water inspections, each were examined and found to be up to date. The Manager offered evidence of procedures and safe working practices including movement and handling, missing person and medication. The procedure manual needs to be reviewed to help to staff to keep updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties, and Safeguarding regulations. A policy for covering confidentiality is recommended. We found that formal staff supervision had not as yet Care Homes for Older People Page 30 of 35 Evidence: been an established, firm practice. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. Accidents occurring to those people we case tracked were seen to be cross checked with care plans, and logged into day report. We advised that the accident log, following analysis be placed in the persons care file. We found an improved overall standard across a broad spectrum of service and care, which have improved with the review of care systems and staff training, although much remains to be achieved with a service steeped in itraditional ways and practices, especially in accommodating the needs of people with dementia. Care Homes for Older People Page 31 of 35 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 32 of 35 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 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 2 7 10 The Registered Provider will ensure that all records are authenticated with a signature and dated appropriately. The Registered Provider will ensure that confirmation of agreement for admission be sent in writing to the person involved as soon as is appropriate. That a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. Review and develop the range of activities and facilities for recreation available to people using the service through the provision of an activity co-ordinator, having regard to the needs of people to recreation and fitness. That the Care Manager establish a thorough record of handling complaints, to include Concerns, Complaints and Allegations. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. 3 12 4 12 5 16 6 24 Care Homes for Older People Page 33 of 35 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 7 29 That staff recruitment procedures are consistent and thorough, in ensuring that an interview record and letter of appointment is sent on to successful applicants. That the records of staff induction and mandatory training be kept up to date, and managed effectively. We found that formal staff supervision had not as yet been an established, firm practice. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. We advised that the accident log, following analysis be placed in the persons care file. The procedure manual needs to be reviewed to help to staff to keep updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties, and Safeguarding regulations. A policy for covering confidentiality is recommended. 8 9 30 36 10 37 11 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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