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Care Home: Bearwood Nursing Home

  • 86 Bearwood Road Smethwick West Midlands B66 4HN
  • Tel: 01215588509
  • Fax: 01215555182

Bearwood Nursing Home provides nursing care for up to 74 elderly people. The home is a two-storey building with the second floor accessed by a passenger shaft lift. Bedrooms are on both floors with a mixture of double and single bedrooms some of which have ensuite facilities. There is a large lounge and dining room on the ground 92009 floor and two lounges/ dining rooms on the first floor. There is a car park at the front of the home and patio/gardens to the rear. The home is close to local shops and amenities and is on a local bus route. The fees at the home range from between £475 and £575 per week and are dependent on the needs of the person and the room that they occupy. Hairdressing, toiletries, newspapers, Non National Health Service chiropody and physiotherapy are not included in the fee but are available at the home for an additional charge. Top up fees apply to Social Service funded dementia nursing placements. For up to date fee information the public are advised to contact the home.

  • Latitude: 52.487998962402
    Longitude: -1.9680000543594
  • Manager: Chiedza Edith Ndoro
  • Price p/w: £525
  • UK
  • Total Capacity: 74
  • Type: Care home with nursing
  • Provider: Bearwood Nursing Home Ltd
  • Ownership: Private
  • Care Home ID: 2632
Residents Needs:
Dementia, Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Bearwood Nursing Home.

Key inspection report Care homes for older people Name: Address: Bearwood Nursing Home 86 Bearwood Road Smethwick West Midlands B66 4HN     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: Deborah Shelton     Date: 1 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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 37 Information about the care home Name of care home: Address: Bearwood Nursing Home 86 Bearwood Road Smethwick West Midlands B66 4HN 01215588509 01215555182 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bearwood Nursing Home Ltd Name of registered manager (if applicable) Chiedza Edith Ndoro Type of registration: Number of places registered: care home 74 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: 74 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 74, Old age, not falling within any other category (OP) 74 Date of last inspection Brief description of the care home Bearwood Nursing Home provides nursing care for up to 74 elderly people. The home is a two-storey building with the second floor accessed by a passenger shaft lift. Bedrooms are on both floors with a mixture of double and single bedrooms some of which have ensuite facilities. There is a large lounge and dining room on the ground Care Homes for Older People Page 4 of 37 Over 65 0 74 74 0 2 9 0 9 2 0 0 9 Brief description of the care home floor and two lounges/ dining rooms on the first floor. There is a car park at the front of the home and patio/gardens to the rear. The home is close to local shops and amenities and is on a local bus route. The fees at the home range from between £475 and £575 per week and are dependent on the needs of the person and the room that they occupy. Hairdressing, toiletries, newspapers, Non National Health Service chiropody and physiotherapy are not included in the fee but are available at the home for an additional charge. Top up fees apply to Social Service funded dementia nursing placements. For up to date fee information the public are advised to contact the home. Care Homes for Older People Page 5 of 37 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: This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Monday 12 April and Monday 19 April 2010. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An annual Quality Assurance Assessment (AQAA) was completed by the manager, information recorded was accurate but brief. This document gives information on how the Home thinks it is performing, changes made Care Homes for Older People Page 6 of 37 during the last twelve months, how it can improve and statistical information about staffing and residents. During the key inspection we used a range of methods to gather evidence about how well the service meets the needs of those people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Eight surveys were returned to us before this inspection and any comments made are included in the main body of this inspection report. Face to face discussions were also held with people who use the service, staff and the owners. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Two people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Comprehensive bed rails risk assessment and management plans have been introduced since the last inspection. The risk assessment and management plan guidance provided by the health and safety executive has been used. Bed rails are checked regularly to ensure correct fitting and to demonstrate they are still in good working order. Risk assessments have identified those people who would not be suitable to use bed rails and alternative safety methods have been put in place. Training in the fitting and use of bed rails has also been provided to some staff. Improvements have been made to the information held in care files, some of the standardised, pre populated documentation has been removed. Care plans seen were comprehensive, had been reviewed and were up to date. Information obtained from the pre-admission assessment and social workers care plan had been transferred into the Homes care plan. Risk assessments were in place for all areas of risk identified and these had been reviewed and were up to date. Mouth care trays were available for those people being nursed in bed, records were available to demonstrate mouth care undertaken. Some staff have attended training regarding catheter care and records seen in care plans regarding catheter care were up to date. Care Homes for Older People Page 8 of 37 Medication management systems have been reviewed and action taken to ensure that people receive the medication they are prescribed at appropriate times, medication is stored appropriately and records are up to date. Improvements have been made to the way that concerns and complaints are recorded. Records indicated action taken to investigate, address issues raised and details of any third parties involved in the complaint process. Appropriate action is also now taken to report any safeguarding issues to the appropriate authorities completing documentation as necessary. The management team have attended training regarding the local safeguarding procedures and staff are undertaking training regarding safeguarding, the mental capacity act and deprivation of liberty safeguarding. This helps to ensure that people living at the Home have their rights protected and promoted at all times. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 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. Pre-admission assessment processes help to ensure that the Home have the information needed to be able to meet peoples needs. People have the opportunity to visit the Home before they move in to access the facilities available. Evidence: The care file of a person who had recently moved into Bearwood was seen and a discussion was held with the owner to find out the processes for admission. We were told that once a request has been made for a place at Bearwood the manager contacts social services and requests information (where available) such as a care plan and details regarding medication. People are invited to have a look around the Home and are given information such as the Service Users Guide and Statement of Purpose. This helps people make an informed choice as to whether they think Bearwood is the right Home for them. An assessment of peoples needs (pre-admission assessment) is then completed. Care Homes for Older People Page 11 of 37 Evidence: The pre-admission assessment takes place at the persons current address or at the Home if they prefer. Assessment information is used to find out about an individuals needs and abilities and helps the Home decide whether they have the facilities, equipment and staff available and would be able to care for the person. We were told that where possible, people are invited to come to the Home and stay for half a day. They are introduced to staff and other people who live at the Home. This helps them decide whether they think that Bearwood is the right place for them. It also helps staff find out further information about peoples needs, mobility, likes and dislikes. When both parties have agreed that Bearwood would be able to meet their needs and they wish to move in, a letter is sent confirming the placement. The care file of a person who had recently moved into the Home demonstrated that pre-admission assessments are undertaken and that notes are made of peoples needs and abilities. Records showed that a range of areas such as reasons for admission, social history, pressure care, mobilising, personal hygiene, previous hospital/nursing home admissions, present medication are assessed amongst other things. It was noted that sufficient information was recorded to enable staff to meet this persons needs. There was also copy of a social services care plan on file. This shows that social workers had been involved in the admission process. The social worker care plans gave staff information about the needs of the individual. There was a letter on file from the manager confirming that following the preadmission assessment the person could move into the Home. A signed contract of residency was also available on file. There was no information regarding fees to be charged, however it recorded that fees would be paid by Sandwell Local Authority. During the inspection we saw people being shown around the Home by the owner. These people were given copies of information to sit and read such as a brochure, inspection report, Service Users Guide and Statement of Purpose. The owner made herself available to answer any questions. People are told where they can get a copy of the last inspection report of the Home. Care Homes for Older People Page 12 of 37 Evidence: Eight people responded to our survey regarding Bearwood Nursing Home. Seven people said that they received enough information to help them decide if this home was the right place for them before they moved in, one person responded that they did not know. Six people said that they have been given written information about the Homes terms and conditions, one person said that they hadnt and another person did not know. From records seen, responses to surveys and discussions with the owner it would appear that Bearwood has robust pre-admission processes which ensure that they can meet the needs of people who come to live with them. This service does not provide intermediate care so we did not assess this standard Care Homes for Older People Page 13 of 37 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. Peoples personal care and health needs are being met so ensuring their well being. Medication systems are well managed and records were up to date. Evidence: We were told that everyone who lives at this Home has a care file. We looked at two care files and other information such as medication records, information about meals and activities amongst other things. This process is called case tracking. Each of the two care files seen contained an assessment undertaken before admission to the Home. This shows that the Home have found out about the person to ensure that they would be able to meet their needs. Information obtained during the preadmission assessment had been used to form initial plans of care. These are developed when the person moves in and updated with further information within the first few weeks of admission. Care plans record information about peoples health and personal care needs, they Care Homes for Older People Page 14 of 37 Evidence: record what the person is able to do independently and what support is required from staff in order to met their needs. Risk assessments are also completed. These identify the risk to the person and record the action that staff should take to reduce the risk. Risk assessments seen included falls, constipation, nutrition and the risk of developing a pressure area. It was a requirement of the last inspection that bed rails risk assessments be undertaken. A detailed risk assessment and risk management plan is now in place. Information seen at this visit was up to date and included information in the management plan detailing the action to take to ensure the persons safety in bed, i.e. 2 hourly checks, monthly checks of bed rails to ensure correct fitting. All risk assessments recorded a management plan to try and reduce the risk of injury to the person, this included the number of staff required to provide assistance and details of any equipment to be used. Risk assessments had been reviewed monthly and were up to date. Assessments regarding moving and handling and daily living were available in care files. These recorded what the person is able to do for themselves and what assistance is needed. Details of equipment and staff needed to be able to perform a task were recorded. Detailed information was available and these assessments had been reviewed and were up to date. Care plans were informative and had been developed regarding, for example, eating and drinking, mobilising, personal cleansing and dressing, continence, medication. Information included personal preferences, likes and dislikes, staff and equipment needed to provide assistance, needs and abilities. All had been reviewed on a monthly basis. Sufficient information was recorded to enable staff to provide care to the person. We were told that a lot of work had been undertaken on care plans since the last inspection to ensure that they are more person centred, detailed and up to date. Information in care plans and risk assessments was linked, some of the prepopulated, standardised documentation previously used has been removed which enables written information to be individualised. A care plan acknowledgement details all care plans available and the person living a the Home or their representative can sign to say that they have seen the care plan and are happy with its contents. Documentary evidence was available to demonstrate that care plans are audited. Issues identified are recorded along with confirmation of issues addressed and Care Homes for Older People Page 15 of 37 Evidence: outstanding. Records show that people have access to external professionals such as GP, speech and language therapist, adult social work team as needed. This helps to ensure that health care needs are being met. Named nurse and key worker details are recorded. Key workers write a report regarding the persons general wellbeing following discussions with them. Information about how the person is spending their time and their general health and wellbeing is recorded per shift. Night staff are recording what action they have taken to meet care needs, for example, hourly checks undertaken and 2 hourly position change. Details of GP visits are recorded including details of any action that the GP suggests, for example, hand swollen GP suggested elevate hand, staff are recording in daily entries that the hand is being elevated. This demonstrates that staff are following instructions given by external professionals to ensure that health issues are being addressed. Whilst looking around the Home we saw one person being nursed in bed due to ill health. This person was not wearing any trousers or pyjama bottoms but was covered with a sheet. We were told that this may be at the persons request and would be recorded in the care plan. However, documentary or other evidence to demonstrate this was not made available during the visit. There was no slide sheet in this persons bedroom to enable staff to move this person in bed. The Home should ensure that sufficient slide sheets are made available for each person who requires one. We were told that slide sheets have been purchased since the last inspection and are available in the rooms of people who need them on a regular basis. It was a recommendation at the last inspection that mouth care practice needs to be reviewed to ensure equipment is available and mouth care can be demonstrated. It was noted at this inspection that mouth care trays were available in the bedrooms of those people being nursed in bed. Documentary evidence was available to demonstrate their use. It was also a requirement that catheter care practice be reviewed to ensure that the Home meets best practice. We were told and records confirmed that some staff have undertaken catheter care training in December 2009. Records were available in care plans regarding the action that staff should take to care for people who use catheters. People spoken to on the day of inspection were happy with the care that they receive. Care Homes for Older People Page 16 of 37 Evidence: Six of the people who responded to our survey said that they always receive the care and support they need and two said that they usually do. Five people said that the Home always makes sure they get the medical care they need and three said that they usually do. The medication and records of the two people being case tracked were reviewed. Discussions were held with the Deputy regarding medication practices at the Home. It was noted that twelve GP practices visit the Home. People are able to retain the services of their GP if they wish. Medication is stored in lockable fridges, cabinets and trolleys. Security of medication was suitable. Controlled medication was checked and found to be correct, records were in good order and up to date. Homely remedies taken are recorded in a book, there is a list of homely remedies for each person detailing which remedies they are able to take, these have been signed by their GP. Records for one person showed that a tablet had been given but had not been signed for. It was also noted that staff were not consistently recording the number of paracetamol given. If the GP had recorded, for example, one or two tablets up to four times a day staff were occasionally signing but not recording how many tablets had been given. It was therefore difficult to audit to ensure that the balance of tablets remaining was correct. All other medications and records checked were correct. Staff are monitoring and recording the temperature of the medication fridge and of the room in which medication is stored. This helps to ensure that medication is being stored within the correct temperature range. Key custody practices were discussed and found to be safe. Bearwood provides care for a culturally diverse population and during discussions it was noted that religious needs are met by visiting clergy i.e. catholic, church of england. We were told that some people have prayer tapes which staff ensure are played to them at the correct time each day. It was also noted that one family visits and sings hymns to the person in their bedroom. Cultural diets are provided and people are able to have the choice of having personal care provided by either male or female staff. Care Homes for Older People Page 17 of 37 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 so people are able to maintain important relationships. Not everyone at the Home has the opportunity to take part in an activity that promotes and enhances their social aspect of life. The choice of meals offered meets individual preferences and dietary needs. Evidence: The atmosphere at Bearwood was relaxed and friendly, staff appeared to have a good relationship with those under their care and chatted to people whilst undertaking their duties. The activities that take place were discussed with the owner. We asked if the activity co-ordinator had received specific training regarding providing activities for people with dementia and were told that she had not. We also asked if people in the dementia care lounges were involved in routine daily tasks or other meaningful activities if they wished, such as laying the table, dusting etc but were told that this does not happen. People on the first floor were observed sitting in their seats which were located around the outside of the room, staff tried hard to encourage people to be involved in the game of ring toss but some were not interested. People did not appear to be watching the television which was showing childrens programmes. Care Homes for Older People Page 18 of 37 Evidence: At the last inspection of the Home it was noted that the hours allocated for activities should be reviewed to broaden the range of activity provision. We were told that this has been done and that arts and crafts and dominoes are also undertaken regularly as well as activities recorded. However, documentation seen did not clearly demonstrate that additional activity hours are provided. An activity folder is available to record activities undertaken by people at the Home. Records show that activities take place but they did not demonstrate that they are offered or undertaken consistently. Standardised record sheets were available for each person, these show the activities planned for the week. The same activities are planned each week, Monday - catch the ball/exercise or sing along, Tuesday, armchair exercise or hula hoop, Wednesday, hand massage or art, Thursday Social event, Friday, musical instruments with sing along, Saturday residents choice, Sunday Free Time. Some of the activity records seen had not been completed for over a week. Notes were made for people who stay in their room detailing what activities they have undertaken, some had not been completed. We were told that the activity person tells people what activities are available and asks what they would like to undertake. Any changes to the activity plan are recorded on the sheet, for example reminiscence was recorded on some occasions. Families are invited to join in social events if they wish. The home employs an activity co-ordinator on a full time basis but this person also works at the other Homes (four Homes in total) owned by the company and does not spend all of her time at Bearwood. Care staff would also be responsible for undertaking activities with people when the activity co-ordinator is not available. We asked people in our survey Does the home arrange activities that you can take part in if you want? three people said always, four said usually and one person said only sometimes. We spoke to people about activities available and were told by one visitor I feel that X might by unhappy because all X does all day is sit in the same chair in the lounge from early morning until X goes to bed. I feel that X is really bored. One person spoken to indicated that he would like to go outside more in his wheelchair. Another person said I go out a lot, it is better than just staying in here, just look at everyone, the people are nice but you cant talk to them, the staff are all friendly. Care Homes for Older People Page 19 of 37 Evidence: People are able to go out into the local community, churches or places of worship if they wish assisted by their families or friends. We were told that the Head of the Temple from Handswoth came in to the Home to meet people recently which some people really enjoyed. The owner said that people go out in wheelchairs to a local park with staff. There is a sheltered Home behind Bearwood and people can book to have a meal and meet up with other people if they wish. The Home operates an open visiting policy and people can come at any time, preferably not at meal times as this distracts people whilst they are eating. We were told that people can eat in their bedroom with their family if they wish or visitors can wait in the lounge whilst the meal is being eaten. Visitors are offered refreshments and those visitors we spoke to said that staff were friendly and kept them updated regarding their loved ones health and wellbeing. There is access to a telephone for people to keep in contact with their friends and loved ones. If the Home are notified in advance that their family are going to phone they are taken to the phone to wait for the call. A discussion was held regarding the meals at the Home. We were told and records show that the main cooked meal is provided in the evening and a snack type lunch is provided. People have a choice of all meals including breakfast. A cooked breakfast is available every day upon request. Toast and a choice of cereal is available daily. The lunch menu seen showed a choice of two meals ie. Ham sandwiches or corned beef hash, fish finger and chips or meat paste sandwiches, etc. There is also a choice of three main meals each day, English with an alternative and an Asian curry or Caribbean choice. Staff go and ask people what they would like for the following days meals and keep a record of choices made. We were told that as soon as requests for changes/alternatives to the meals provided are made these are acted upon. Records seen showed that people were happy with the food provided. People are offered an alternative to the menu if they do not want what is available on the day. One person is a strict vegetarian and does not eat fish, eggs, milk etc and this is catered for. Care files seen contained a menu preference questionnaire asking information about favourite meal, snack food, dislikes, dietary requirements, religious beliefs affecting diet, preferences regarding drinks, sugar, milk, squash, beer or wine with meal, Care Homes for Older People Page 20 of 37 Evidence: preferred drink before bed. Residents meetings were held in Jan, Feb and March 2010 and the minutes of these meetings were seen. People are asked questions about meals, activities, staff, do they like living in the Home etc. No issues were raised about meals. We spoke to people during the inspection and were told The food is good, I like to go outside, the food is OK sometimes, sometimes not. One person confirmed that he was eating Caribbean food occasionally. It was recommended at the last inspection that English meals on the menu need to be reviewed as unusual combinations of foods were being served. The owner said that they had contacted a local Home and had discussed menus and changes had been made to their menu as a consequence. Menus seen showed that traditional English meals are provided on a daily basis. Three of the eight people who responded to our survey said that always like the meals at the Home and five people said that they usually like them. Care Homes for Older People Page 21 of 37 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 can be assured that their concerns are being listened to and acted upon. The Home has appropriate policies and procedures to help safeguard people. Evidence: A complaints register is available to log complaints and concerns. We looked at the complaint register and saw that the Home had recorded three complaints as received since the last inspection in September 2009. At our last inspection we noted that the complaint log should be reviewed to ensure that information is easy to retrieve and available for auditing. The complaints log was freely available, fully completed with easy to understand information recorded at this inspection. Information recorded in the complaint register included the date the complaint was received, name of resident/complainant, relationship, nature of complaint, action taken and outcome. Details of appropriate action taken was recorded by complaints received. Complaints had been reported to social services as appropriate and vulnerable adult protection forms had been completed. Two of the three complaints are now closed and the Home are waiting discussions with a social worker regarding one complaint before it can also be closed. Documentary evidence was available to demonstrate that the complaint log book had been audited on 20 January 2010 and it was recorded that all complaints up to that date had been actioned and closed. Care Homes for Older People Page 22 of 37 Evidence: The Homes complaint policy is available in large print in English, Urdu and in Punjabi language. This is on display on noticeboards throughout the Home and in the Service Users Guide. A discussion was held with the owner regarding how people can make complaints. It was noted that people can speak directly to care staff, nurse on duty or to the manager. Concerns can be put in writing and copies of these would be kept. We were told that the Home has not received any written complaints, complaints are usually reported to management who take appropriate action to address issues raised. One person said I have no worries or complaints but if I did I would speak to the manager who would sort them out. We have not received any complaints or adult protection issues since the last inspection in September 2009. Records show that the Manager from another Home owned by the company provides safeguarding (protection of vulnerable adults) training to staff. He has undertaken training provided by Sandwell Local Authority to enable him to be a trainer. Adult protection training was undertaken by staff in February 2010, or October 2009 and was being undertaken by some staff on the day of our inspection. Senior staff have also undertaken training regarding the Mental Capacity Act and Deprivation of Liberty. The owner of the Home told us that the training has been invaluable in helping them address any adult protection issues that have arisen. It was noted at the last inspection of the Home that the management team had not received any training in local safeguarding policies and procedures. This training was completed by senior manager and nurses in October 2009. An issue was also raised regarding the use of bed safety rails and risk assessments. Risk assessments should be in place to demonstrate that the use of bed safety rails is appropriate for the individual and would not put them at greater risk of injury from climbing over the rails and falling from a greater hight. We were told that the number of people using bed safety rails has reduced to thirty six. The management team have reviewed information provided by the health and safety executive and have introduced appropriate risk assessments. Where necessary bed safety rails have been removed and people are provided with alternative equipment to reduce the risk of injury if someone were to fall out of bed. The requirement made at the last inspection of the Home regarding bed safety rails has now been met. Staff appeared to have a good relationship with those under their care. Care Homes for Older People Page 23 of 37 Evidence: Moving and handling practices seen protect people from the risk of harm. Care Homes for Older People Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, warm environment in which people can live. The environment in the dementia care unit should be suitable to ensure that people are able to find their way around the Home easily. Evidence: Bearwood is not a purpose built Care Home but has been adapted to meet the needs of those that live there. The Home is a large two storey building located in a residential area of Smethwick and is close to shops, churches, public houses and transport links. The Home is divided into two sections, people living on the the ground floor are elderly with nursing care needs whilst those living on the first floor have dementia and may have some nursing care needs. We looked around the Home and noted that the ground floor has a lounge, separate dining room, nurses station, management offices, hairdressing room, kitchen and laundry, bedrooms, toilets, bathrooms and a sluice. The ground floor was clean and no unpleasant odours were noted. The ground floor lounge was arranged with seating in two groups which broke the room in half. People were watching the television or chatting with visitors. The atmosphere was relaxed. At the last inspection of the Home it was noted that new chairs were stacked in the corner of the ground floor lounge. These have been Care Homes for Older People Page 25 of 37 Evidence: removed and are now in use. We were told that since the last inspection some carpets have been replaced, ten bedrooms have been re-decorated and vinyl flooring has been laid in one bedroom. We looked in the laundry which is arranged so that there is a dirty to clean flow to reduce the risk of spread of infection. Washing machines are loaded in the dirty laundry room washed and unloaded from adjoining clean laundry room. There are two large washing machines and two large drying machines. All equipment was in good working order on the day of inspection. Infection control measures in place include the use of colour coded laundry trolleys to transport normal, infected and soiled laundry, use of disposable gloves and aprons, washable laundry bags for soiled laundry and washing machines which can be programmed to meet infection control standards. There was no backlog of items to be laundered and the area was clean and in good order. We looked in some bedrooms on both the ground and first floor, all were clean, no unpleasant odours were noted and they had been personalised with pictures and ornaments. The first floor has a nurses station, bedrooms, some of which have en-suite facilities, five communal toilets, bathrooms and two lounge/dining areas. A slight odour was noted in one of the lounges on the first floor. The television in one lounge on the first floor was a small portable type television, the radio was also playing loudly in the dining room which joins the lounge. The sound of the television could not be heard above the sound of the radio. One person spoken to said that the size of the television was ridiculous and you would need strong glasses to be able to see it. The owner said that the television will be replaced and a bigger television purchased. We were told that there was no signage on bathroom or bedroom doors because they keep being removed. Bedroom doors had a room number on them and the persons name written on a piece of paper. All doors in the dementia care unit were the same colour. We discussed the need to ensure that the environment is appropriate to meet the needs of those people with dementia which could include painting doors of bedrooms and bathrooms differently along with pictorial and written signs which may Care Homes for Older People Page 26 of 37 Evidence: help people to recognise where they are going. One person spoken to said that she likes to go outside and takes regular trips out into the garden. Access to the garden is via the ground floor and the Home provides a secured garden and patio area. Colour has been added to the patio area by adding plants in pots which was recommended at the last inspection. Four of the people who responded to our survey said that the Home is always fresh and clean whilst a further four people said that the Home is only usually fresh and clean. The Home had undertaken a survey during 2009 and the results of this record that people feel that there is sometimes an odour in the Home. Action taken to try and remove the odour was recorded. Care Homes for Older People Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust and protect people living in the Home from risk of harm from employment of unsuitable staff. Some staff require updates in mandatory and other training. Evidence: There were sixty one people living at Bearwood on the day of inspection. A copy of the duty rota for the week of the inspection was taken for review. The number of staff on duty was in line with the information recorded on the duty rota. Records show that shifts are broken down into 8 care staff and 2 nurses - am 6 care staff and 2 nurses - pm 5 care staff and 1 nurse - night Discussions with people living at Bearwood and duty rotas indicated that staffing levels were adequate for the needs of people living there. The Homes Annual Quality Assurance Assessment document records that forty five care and nursing staff are employed. Twenty three of these care staff have obtained a National Vocational Qualification at level two or above. Providing training helps to ensure that staff have the skills and knowledge to be able to care for those living at the Home. Care Homes for Older People Page 28 of 37 Evidence: It was a recommendation at the last inspection that trained staff familiarise themselves with the Nursing and Midwifery Councils Record Keeping document. Documentary evidence was available to demonstrate that staff have read this document and have received training regarding its contents. It was also recommended that the owner conduct exit interviews for staff who are leaving to identify reasons for the high staff turnover. We were told that verbal exit interviews take place but these are not documented, some of the reasons quoted for leaving were moving abroad, undertaking nurse training and working in a hospital. The Homes AQAA records that forteen staff have left the Homes employment within the last twelve months. This is still a high turnover of staff and would mean a staff changeover of approximately one third. Two new care staff have been employed recently their personnel files were reviewed. Staff files showed that robust recruitment practices take place. Written references were available, gaps in employment history had been explored, medical history statements obtained and interview notes were available on file. Relevant information such as job descriptions, terms and conditions of employment, criminal records and Independent Safeguarding Adults (ISA) checks were also on file. Staff have signed a document to confirm that they have read and will work to policies such as health and safety, sickness and absence, confidentiality, fire safety, disciplinary etc. Copies of these policies are available in the personnel file to demonstrate that these have been made available to the staff member. Personnel files were subdivided for ease of finding information, were in good order and up to date. Risk assessments are in place regarding any staff member who starts working at the Home before their criminal records check has been returned. We were told that all staff have criminal records checks on their personnel files. Upon employment staff would be required to undertake an in-house induction as well as the Skills for Care induction which has recently been purchased. All new staff will be undertaking the Skills for Care induction. A staff training matrix is available to demonstrate what training staff have undertaken. A wide variety of training courses are recorded both mandatory and specialist to meet the needs of people living in the Home for example Parkinsons disease, catheter care, Care Homes for Older People Page 29 of 37 Evidence: bed rails, nasogastric feeding. Records show that a few staff have not undertaken moving and handling, food and hygiene, fire, dementia or adult protection training recently and need update training. Records show that training has already been planned for the remainder of the year. Checks are made on nursing staff to ensure that they are still qualified to work in a nursing capacity, these records were up to date. Care Homes for Older People Page 30 of 37 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. The Home is run in the best interests of those who live there. Evidence: The manager was on annual leave and was therefore not available to assist with this inspection. The Home owner and a manager from another Home owned by the company, who was on the premises to conduct training, assisted as necessary. The Manager has been in post for approximately five years and is an RMN and RGN qualified nurse. She has undertaken the Registered Managers Award and has recently completed safeguarding training. We were told that she undertakes training updates as needed to ensure that she has the skills and knowledge to manage the Home. Lines of accountability and on call arrangements were discussed. It was noted that the manager is on call when she is not on duty unless she is on annual leave. In this instance a manager from another Home is on call, the owner said that staff can also contact them if needed. Lines of accountability are clear and senior staff are on duty Care Homes for Older People Page 31 of 37 Evidence: at all times, sufficient support is available to ensure that the Home is managed efficiently. Quality assurance systems and practices were discussed. Residents meetings are held on a regular basis, three have already been held during 2010 and a meeting is planned for April. Relatives questionnaires are sent out every six months. Questionnaires are also sent to staff, residents and outside agencies. Results of all surveys are put into graphical format to clearly show results. Action plans are completed as necessary and those seen recorded appropriate action taken to issues raised. The Homes Annual Quality Assurance Assessment document was completed as requested and information has been used during this inspection process. However, the form only contained brief information and sections throughout the document entitled what we could do better had not been completed and the section entitled our plans for improvement in the next 12 months was not completed on each occasion. This was also identified at the last key inspection of the Home. It is therefore difficult to identify from the information recorded in the AQAA that the Home are aware of any changes that are needed to improve the quality of the service provided. It also does not demonstrate that they have considered issues for action identified and the systems and practices that need to be adopted to address issues. A comprehensive Quality assurance audit system is in place which includes assessing each National Minimum Standard and auditing to ensure that systems are in place and information is up to date, for example Statement of Purpose and Service Users Guide - reviewed in 2009 and 2010 and action taken to update and include Care Quality Commission address included. Detailed information is recorded regarding any changes made in line with good practice updates or recommendations made during inspections such as new bed rail risk assessment put in place. Kitchen staff re-trained by speech and language therapy regarding pureed and mashed foods (2010). The financial records of the two people case tracked were reviewed. The person newly admitted did not have any money held at the Home at the time of inspection. The owner said, and records seen confirmed that a current account is used to hold peoples money at the bank. This helps to ensure that there is not a large amount of money stored at the Home. The bank makes charges and these charges are split between each of the people who have money in the current account. We were told Care Homes for Older People Page 32 of 37 Evidence: that nobody at the Home has power of attorney for any residents and are not responsible for collecting money from the bank. If funds are getting low the Home approach the persons appointee and asks for funds. The Home are only responsible for looking after the personal allowance monies for people. Receipts are available to show any expenditure for all purchases. Income and expenditure is signed by two members of staff. Records seen were up to date and correct. A selection of health and safety and maintenance records were checked. These records are kept to demonstrate that equipment is safe and in good working order. An external company undertakes routine servicing and maintenance of fire systems. In addition to this the Home undertake checks of fire alarms and emergency lighting. All fire records seen were up to date. West Midlands Fire Service also visited Bearwood in September 2009. All bed rails are checked on a monthly basis to demonstrate that they are correctly fitted. The person undertaking the checks has completed training regarding the correct use and fitting of bed rails. Records seen were up to date. Other records checked such as legionella, hot water temperatures, electrical 5 year check, lift and hoist servicing records were also up to date. Care Homes for Older People Page 33 of 37 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 34 of 37 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 7 A review of the number of slide sheets available should be undertaken to ensure that sufficient slide sheets are available to meet the needs of those living at the Home. Staff should record the number of tablets given on each occasion when giving PRN medication. The hours allocated for activities should be reviewed to enable the service to broaden the range of activity provision and opportunities for people living at the Home. The activity co-ordinator should receive training in the provision of activities for people with dementia to ensure that suitable activities to meet peoples needs are provided. Consideration should be given to improving signage in the dementia care unit to help people orientate themselves in the building. Consideration should be given to replacing the small portable type television from the first floor lounge to a larger television. This would enable those people sitting further away from the television to be able to view television programmes. 2 3 8 12 4 12 5 19 6 19 Care Homes for Older People Page 35 of 37 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 8 19 30 Action should be taken to remove the odour from the first floor lounge. Staff should undertake updates in mandatory training areas on a regular basis. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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