Care Home: Beauvale Care Home

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What the care home does well We found the staff to be excellent at providing person centred care they are respectful towards people who live at the service and uphold their rights, choices and protect their personal dignity. The staff work hard to provide a range of activities both in the home and the community. People are given choices in all areas of daily life and these are respected by the staff at the home. Relatives and friends are welcomed into the home, and are encouraged to ask questions, give feedback and make themselves at home. The food is of good quality, with lots of choice and plenty to eat. Complaints are properly recorded, investigated and responded to and action plans are drawn up to prevent the same thing happening again. People can be assured that their concerns will be heard and responded to. Staff have received training on safeguarding, they know they must report any abuse of people living at the service and say they would do this. The manager understands her responsibilities to protect vulnerable people and takes appropriate action to do this. People who work at the service get lots of training to teach them how to do their jobs effectively and the staff are kind, caring and observant. They are recruited in a safe way and the acting manager checks that they are suitable to work with vulnerable people. The staff and relatives tell us the home is very well run and managed. Health and Safety testing and servicing is done at the correct intervals to make sure equipment is safe and working properly and that people are protected from harm and injury. What has improved since the last inspection? The environment has improved a lot, it is warmer, lighting, curtains and flooring have been replaced. Several areas have been redecorated and essential repairs have been done. The home is now much more comfortable, safe and homely. There is enough equipment to move and handle people who live at the service safely now. There are enough staff on duty to meet the needs of the people living there and people have lots of attention from the staff who meet their needs well. The staff are now being properly supervised and have had lots of training. What the care home could do better: The manager needs to make sure that all of the care plans are of good quality, written in a person centred way, with the involvement of the person concerned and that they reflect not only people`s needs but their likes, dislikes and preferences. This will help staff understand and support people better. When people have health care needs with symptoms that need monitoring such as their weight or their blood sugar levels the manager should make sure the staff do this and write it down. This will give staff a clearer overall picture of the person`s health. The arrangements for managing people`s medication needs to be improved so that people can be sure they will receive their tablets on time and as their Doctor prescribed to keep them well and healthy. The staff could have a better understanding of when and how to assess people`s capacity to make decisions and these could be written down in a way which complies with the Law Key inspection report Care homes for older people Name: Address: Beauvale Care Home Moor Lane Bingham Nottingham NG13 8AS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 1 2 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Beauvale Care Home Moor Lane Bingham Nottingham NG13 8AS 01949831263 01949831355 beauvale@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes Limited care home 35 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Southern Cross Care Homes No 2 Limited may provide the following categories of service only: Care Home with Nursing (N). The maximum number of places is 35. To service users of the following gender whose primary care needs on admission to the Beauvale Care Home are within the following categories:- Old age, not falling with any other category (OP) 35, Dementia over the age of 65 years (DE(E)) 35, Physical Disability over the age of 55 years (PD) maximum of places 3. Within the three physicial disability places, one named individual can be accommodated who under the age of 55 years. Ref. 20070203, Registration Report, S40350 C53. Date of last inspection 0 4 1 1 2 0 0 8 0 3 3 Over 65 35 0 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Beauvale is a purpose built care home situation close to the centre of the busy market town of Bingham with its range of shops, restaurants, public houses and places of worship. There are good public transport links from the centre and the service has its own car park at the front of the building. The service is registered to accept up to 35 older people or people with Dementia. Up to three places may be offered for people who are over 55 and who have physical disabilities. The service provides nursing care. Accommodation is provided over two floors with a vertical lift which offers access to people with mobility difficulties. There are 33 single bedrooms and there is one double bedroom which has an en suite facility. There are two lounges and a dining room at the home. The last inspection report is available in the reception area as is the service user guide, the statement of purpose and other information people may find helpful. The current fees range from £367 to £655, this fee does not include hairdressing and chiropody services. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. Care Homes for Older People Page 6 of 33 We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out surveys to people living at the home and to staff to get their views on the service being provided. We received 1 professional survey, 9 surveys from people who live at the home, 4 from relatives and 4 from staff. Their comments are in the main body of our report, but generally speaking people feel the home provides good quality staff and good quality care. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at Beauvale. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining room, during the lunchtime period. All of the people who live at the home are White, British at the moment, the staff team come from a wide variety of backgrounds and experiences. We spoke with three members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The manager needs to make sure that all of the care plans are of good quality, written in a person centred way, with the involvement of the person concerned and that they reflect not only peoples needs but their likes, dislikes and preferences. This will help staff understand and support people better. When people have health care needs with symptoms that need monitoring such as Care Homes for Older People Page 8 of 33 their weight or their blood sugar levels the manager should make sure the staff do this and write it down. This will give staff a clearer overall picture of the persons health. The arrangements for managing peoples medication needs to be improved so that people can be sure they will receive their tablets on time and as their Doctor prescribed to keep them well and healthy. The staff could have a better understanding of when and how to assess peoples capacity to make decisions and these could be written down in a way which complies with the Law 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 33 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 33 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. People who want to live at the service have their needs fully assessed before admission and can be assured that these will be met. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that people who live at the service receive a comprehensive needs assessment prior to admission by the manager or the Deputy Manager. People who want to live at the service are encouraged to participate as fully as possible in this assessment process, but if this is not possible, relatives, carers, hospital staff or other agencies will be consulted. When we looked at the file of the last person to be admitted to the service we found evidence that they have been assessed by a social worker. This assessment had been passed to the manager before admission so she could check that the person could be properly cared for at the service. Although the care plan has been started, this was not fully complete but the person had been admitted only two days before and the Care Homes for Older People Page 11 of 33 Evidence: manager tells us she aims to get care plans completed within 72 hours. Our observations of people with Dementia who live at the service and our general findings show that the people who live at the home are within the category of registration and the staff seem to be well able to meet their needs. We did, however speak to the manager about asking for a review of the registration certificate as there are categories on there which may no longer be appropriate. She will talk to the responsible individual about this. We spoke with the staff who understand the process for admission and say they are given information about the needs of new people who are admitted to the home. One told us, we get a (social workers) assessment and if people are self funding we will assess them where they are. We do turn some people down, especially if their Dementia means they need nursing care as I dont think we can manage people with very challenging behaviour well and we have to balance the needs of people who already live here. Intermediate care is not provided at the service and this standard is not applicable. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good quality, personalised care but the medication administration system is not robust enough to ensure people receive medication on time and as prescribed by their Doctor. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that people who live at the service and their advocates are given the opportunity to view and add to their own care plans, which are evaluated at least monthly. Care reviews with people living at the service or their relatives are held every 6 months. The manager tells us that the staff know people who live at the service well. We looked at the care plans of three people with differing needs who live at the service. We found the quality of care plans to be variable; one was very good, well written with clear evidence that the person concerned has been asked for their views and that these have been incorporated into the care plan. Another one we looked at has some good information about peoples preferences but these have not been incorporated into the plan of care and there was no evidence in this plan that the Care Homes for Older People Page 13 of 33 Evidence: person has been consulted about their needs. We found these differences were also reflected when we interviewed the staff who write the plans. One told us, I write the nursing plans, and have redone all of these. I have tried to bring in personalisation issues, I do an interview with the service user and then I write the plan, I also try and interview relatives, but many people do not have any contact with their relatives. All of the staff follow my care planning model. Some staff have attended personalisation care planning training. However, another person told us, I get involved in writing care plans; its our bug bear at the moment as we feel we havent the time to get this started and to do it properly. I hope my plans are personalised, we do try. I dont involve people in writing them a lot and I dont record why. That said, when we observed the staff delivering care, we found that this is done really well, the staff are attentive, kind and caring and they follow the plans of care. When we looked at the results of our observation we found that the vast majority of staff interactions with people who live at the service were either good (27 out of 57) or neutral (these are usually interactions which are practical in nature) which we saw in 30 out of the 57 interactions. The number of good interactions is high and shows that the staff understand how to help people in a kind and sensitive way. The result of this is that people spent the majority of their time in a positive mood state (in 57 of time frames.) Relatives commented to us in surveys that, I am happy with the service, and a person living at the home told us (the service does) everything (well) as far as Im concerned. This shows the service is good at delivering care, and outcomes for people who live there are positive. The manager told us in her AQAA (Annual Quality Assurance Assessment) that good relationships with health care professionals are maintained, and there are link nurses for infection control, continence, tissue viability and palliative care. People who live at the service have access to all health care services, with the Doctor holding a weekly surgery at the service as well as offering emergency appointments. We looked at the health care plans for people and found these to be good in the majority of cases, but in one case a plan makes reference to the signs of hyper and hypoglycaemia without providing any information to advise staff about what these are. It is important all staff have this information as it is essential they act quickly to protect the health of people if these signs are evident. In some cases we found the evidence of monitoring health care needs could be more consistently recorded, Care Homes for Older People Page 14 of 33 Evidence: examples we saw included not recording weekly blood sugar readings as indicated in the plan of care, not recording in the plan what allocation of continence wear people have and not recording weights regularly as indicated in the plan of care. When we spoke with the staff, they said that one of the strengths of the service is that they assess and provide treatment for health care needs well. They told us about people who have specialist mattresses to prevent pressure areas developing, and about people who are receiving help from Speech and Language Therapists and Dieticians. One said, I think we are good at identifying health needs and we have good relationships with our nurses, the Doctors and the District Nurses. A District Nurse commented to us in a survey, the residents are looked after well. Doctors visits on a regular basis. There is very good liaison between the staff and the District Nurse team, good awareness of infection control. People who live at the service told us they get the medical help they need and during our observations we saw people using pressure relieving cushions and staff maintaining good hand hygiene to prevent the spread of infections. The manager told us in her AQAA (Annual Quality Assurance Assessment) that medication is administered by the nurses and senior carers who will also support anyone wishing to self medicate. She told us that all those giving medication update their knowledge through training and have an annual assessment. There has been an incident involving medication since our last visit to the service and although the concerns expressed were not substantiated, the manager has put a number of things in place to prevent errors in medication. We observed medication being given out and this is done safely. We looked at the Medication Administration Records (MAR) and found several gaps without any reason identified for these, when we checked with the manager in some cases these were for prescribed creams which are no longer in use, but this was not indicated on the MAR. We also found in one case a prescribed medication has not been given and in another we were not able to check whether it has been given as the amount of medication received into the service has not been recorded. This makes auditing impossible. Similarly we were unable to check whether inhalers have been used or not where there were gaps on the MAR. We issued an immediate requirement, as it is important for peoples health, safety and wellbeing that they receive their medication on time and as prescribed by their Doctor. The service acted on this issue immediately and they provided us with an action plan to show how they will address these serious concerns and prevent them happening again. We are satisfied that they have taken Care Homes for Older People Page 15 of 33 Evidence: the necessary action to address the immediate requirement. When we interviewed staff they talked us through the process of giving medication safely and they said they have done training on administering medication. Before we can give out drugs we have training, we shadow 10 medication rounds with the Deputy Manager and we have direct supervision when we do it. I do feel confident to give out medication. We saw evidence that medication is regularly discussed in peoples supervision and of written competence assessments. The manager told us in her AQAA (Annual Quality Assurance Assessment) that the service has dignity champions in place and she told us that they plan to encourage staff to continue to use a person centred care approach. When we looked in care plans we found that issues of privacy and dignity are referred to and our observations would suggest that people are treated very well by the staff. We observed the staff being caring, supportive and discreet with people who live at the service. As stated above many of the interactions we saw were positive, and this is because staff are very responsive to peoples needs without being patronising or over protective. The staff we interviewed told us, issues of privacy and dignity are raised during every supervision and we spend a lot of time looking at dignity challenges. I have provided in house training for staff on issues of dignity. Another staff member confirmed, I think the staff try really hard here, maintaining privacy and dignity can be hard because of the physical limitations of the building (such as where public toilets are situated) but if I saw anyone behaving inappropriately I would raise it with them. Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live flexible lifestyles in accordance with their needs and preferences and they are supported to develop friendships and maintain contact with their loved ones. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that activities and trips out have been arranged following discussion with service users. She told us that the Activities Co-ordinator involves the service users in celebrating various events throughout the religious and cultural year. Service users birthdays are celebrated by staff and other service users. We saw the activities programme displayed in the home so people know what is planned and can join in if they choose. The activities which have been organised include crafts, exercises, quizzes, dominoes, singalongs, massages, charades, cooking, taking people out on walks, playing games and playing on a Wii. When we looked at the care plans, each person has a written activities assessment which highlights their interests, hobbies and it states what they will join in with. There is also a plan review which shows what people have enjoyed and been involved in. Care Homes for Older People Page 17 of 33 Evidence: During our observation we saw an activity where people who live at the service played archery and bowling on the Wii. Not everyone wanted or was able to join in, but the people in the lounge were really enjoying the activity. The activity organiser is enthusiastic and encouraged everyone to have a go, providing discreet help when it was needed. We noticed many of peoples very positive mood states were during the activity. We also noticed through our general observations that there is a very high level of interaction between people living at the service (58 individual interactions were seen.) Throughout our observations people were engaged with other people, staff, visitors, in doing tasks or looking at objects in the vast majority of timeframes, (in 95 time frames as opposed to 9 time frames where they had no interaction.) These are very high levels of engagement and undoubtedly are a factor in the reason people were in such positive frames of mind. The staff we spoke with told us, the activities are good, we did a meal for residents recently and the staff dressed up and waited on people, and another said, we have trips planned, to the zoo, the seaside, boat trips and we go out to the market. A District Nurse commented to us in a survey that the service have improved by providing, more group activities now for people without relatives. The manager told us in her AQAA (Annual Quality Assurance Assessment) that she holds a monthly drop-in surgery to enable relatives and/or service users to talk to her in private and she said that service user meetings are held. During our observation we saw relatives visiting throughout the morning, afternoon and into the evening. It is clear there is no restriction on visiting. Staff told us, Relatives are welcome to come at any time, the manager and I do most of the liaison with them to keep them up to date. Relatives made positive comments to us in their surveys saying they are kept informed and, the care is always very good. The manager told us in her AQAA (Annual Quality Assurance Assessment) that they plan to improve their services by providing further training on the Mental Capacity Act and Deprivation of Liberty Safeguards to make sure people are given the right to make their own decisions. When we looked at the care plans we found there has been an assessment of each persons capacity but often not in relation to a particular decision. This is not necessary as the Mental Capacity Act starts with a presumption of capacity, it needs to Care Homes for Older People Page 18 of 33 Evidence: be used mainly where there may be a doubt about capacity and choice is being made where a decision is needed. Similarly we noticed in some parts of the care plan there are key decisions such as end of life care, resuscitation issues and management of finances where there are issues of capacity and the decisions made are crucial and impact on fundamental rights. We have spoken with the manager about this issue to clarify things, but it is clear that they have tried to incorporate the new Act into their work with people. During our observations we saw the staff offering many choices to people from where they want to sit, where they want to eat, what they want to eat or drink to whether they want to join in with activities and whether they want to go to their rooms. Choices are offered consistently and by all staff, and we saw staff accepting peoples decisions and upholding peoples right to choose. The staff we spoke with told us, if someone tells us they dont want to do something we respect that unless it will make them unwell, for example one person did not want to come to the dining room today and decided to eat in the lounge. The manager told us in her AQAA (Annual Quality Assurance Assessment) that they aim to make mealtimes an enjoyable experience where people can sit and chat in an unhurried atmosphere. She told us the staff are able to assist anyone who has difficulty eating and drinking. She also said that drinks, fruit and a snack table are available between meals. We looked at the menus and could see there is a greater variety of foods that when we last visited. There is a choice for every meal and there is always a hot option for tea. We saw staff actively asking people for their food preferences and providing for these and offering further alternatives if people did not want either choice. We saw people being provided with a wide variety of drinks (including alcohol if they wish) and the food looked tasty and was well presented. People seemed to really enjoy their meals. We observed staff helping people to eat, and this was done so discreetly that we failed to observe it for some time. People are assisted at a gentle pace and the whole meal time has a relaxed atmosphere, people are not hurried from one course to the other and they sit and chat with each other and with staff. Staff told us, The food is generally ok, though I think there could be more variety at tea, especially for those who have soft diets and who have specific dietary preferences, they end up having a lot of potato bakes. Care Homes for Older People Page 19 of 33 Evidence: Relatives commented that the food is always very good. Care Homes for Older People Page 20 of 33 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 who live at the service have access to a robust complaints procedure and can be assured that their concerns will be acted upon. They are safeguarded at the service by trained and knowledgeable staff. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that there is a comments book in the reception area and she encourages relatives and people who live at the service to enter comments. She told us that complaints are recorded and responded to within 28 days and they are dealt with promptly and sympathetically. Complaints are audited monthly and efforts are made to improve the service in these areas. We looked at the record of complaints and found that there have been two since the last inspection visit, both were upheld. However, we found these have been properly recorded and investigated and the service have identified action points to improve and prevent the complaint reoccurring. We saw a copy of the service user guide (which contains the complaints procedure) in every bedroom and this is also displayed in the reception area. Two people who use the service told us they do not know how to complain and the manager needs to consider other ways of making people aware of their right to raise concerns. The staff we spoke with told us, we dont get many complaints, we get niggles, Care Homes for Older People Page 21 of 33 Evidence: mainly about laundry but even that has improved now we have a new laundry assistant, we also offer people compensation for lost or damaged items. I record niggles in peoples files and we always provide a formal response to any formal complaint. Care staff told us they know they have to report all concerns to the manager. The manager told us in her AQAA (Annual Quality Assurance Assessment) that all staff receive ongoing training in safeguarding, the Protection Of Vulnerable Adults and whistleblowing. We saw evidence of this on the training matrix, with 97 of staff having completed safeguarding training, the staff we spoke with also confirmed that they have undertaken this. The staff we spoke with know their obligations to report and record all allegations and to contact Adult Social Care and Health immediately. One person told us, I have never witnessed anyone behaving badly but a carer did come to me with concerns and I reported these to the manager who dealt with it immediately. I think the staff here would report any concerns, we get training on whistleblowing. We looked at the safeguarding policy and this has been updated to be in line with the local safeguarding procedures and it uses the correct terminology. There has been one issue investigated under safeguarding concerning the administration of medication. When we looked at the records we found they are thorough and clear action points are identified to further improve the service. Care Homes for Older People Page 22 of 33 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. People live in a warm, well maintained and comfortable home which meets their needs. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that a separate office has been created, to enable visitors and relatives to meet in privacy. The environment is clean and comfortable and they have employed a maintenance man to carry out small repairs and do regular checks. She told us that numerous improvements have been made since our last visit including; redecorating the main reception area, providing new flooring in the dining room, new lighting in the communal areas, providing decorative radiator covers for all the communal areas. New furniture has been purchased for both lounges and the dining room, new curtains have been purchased for both lounges and the dining room, and several bedrooms have been recarpeted and refurnished. We did a partial tour of the accommodation (including a sample of bedrooms) to check the home is warm, pleasant and appropriate for peoples needs. We found significant improvements in the environment which is comfortable and homely. Repairs have been undertaken and the environment is more welcoming and cosy. Staff we spoke with told us, we are really getting there with the accommodation, the Care Homes for Older People Page 23 of 33 Evidence: staff are proud of the home now and keep it clean, we are much better at repairs. We had an infection control audit just before Christmas and we did really well. Another staff member agreed, I feel the enviroinment is getting better, repairs are being done and we have the moving and handling equipment we need. Care Homes for Older People Page 24 of 33 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. People are supported by caring, well trained staff who are properly recruited and supervised, and in sufficient numbers to meet their needs. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that that there is a good skill mix and a low turnover of staff and low levels of agency use. We looked at the staff rotas and found that there is a nurse on every shift with 5 carers on a morning shift (one of whom is a senior carer) and 4 or 5 on in an afternoon. The nights are staffed by two carers and a nurse. These staffing levels have increased since our last visit. The Deputy Manager said there are plans to increase further. Our observations show that the increase in staffing numbers have had a very positive impact on the experience of people who live at the service. We saw high levels of interaction between staff and the people living at the service and many of these were good quality interactions. People are now properly supervised in the lounges and people with Dementia receive plenty of attention from staff. Staff morale appears higher. The staff we spoke with told us, I feel things have improved since you last visited, Care Homes for Older People Page 25 of 33 Evidence: morale is better because there are fewer staff shortages, we could still do with more as sometimes we havent get the time to do our care planning properly. I would like people to have more one to one time with residents too. People who live at the service told us that they either always or usually receive help from staff when they need it, one person said only sometimes and commented, (they could) help us get to bed earlier than we usually do, possibly need more staff available at night. Relatives praised the staff, the staff do a grand job but they are understaffed and underpaid. They have given my (relatives) a new lease of life. Another commented, (the) service is ok, staff are helpful and keep me informed about changes. The manager told us in her AQAA (Annual Quality Assurance Assessment) that the service has already met its target of 50 of staff trained to National Vocational Qualification (NVQ) level 2. One of the staff we spoke with confirmed they have completed their NVQ level 3. The manager told us in her AQAA (Annual Quality Assurance Assessment) that there is a thorough recruitment process in place at the service. We looked at three staff files and found clear evidence that all of the necessary pre recruitment checks have been completed as required. We also saw evidence of ongoing supervision and appraisal. Staff we spoke with confirmed that all pre employment checks are carried out. The manager told us in her AQAA (Annual Quality Assurance Assessment) that further staff have achieved their NVQ level 2 and 3, and 2 more in house trainers have been recruited. She states that overall they have achieved the Company target of 85 of staff having up to date training in the mandatory areas. She also states that staff are trained in equality, diversity and rights through induction, customer care, Dementia awareness and abuse awareness training. This training is updated annually. We looked at the training matrix and saw that most staff are up to date with mandatory training and most have had training on the specific needs of people who live at the service with plans for more to undertake this. The staff we spoke with told us, We do as much training as we can for staff, we have two in house trainers now and all statutory training courses have been done. If we identify any specialist training I will try and organise for this to be provided. Another person told us, I feel I get all the training I need. End of life training is being organised. Care Homes for Older People Page 26 of 33 Evidence: Other staff told us in surveys, I feel all the staff work together well as a team and we are a close knit group. The staff have been at Beauvale for a long time. I feel this gives the service stability and familiar family type faces as they know us all well. I feel the training is good and we are encouraged to fulfill our potential as carers. Care Homes for Older People Page 27 of 33 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 live in a well run home which operates in their best interests. Evidence: The manager told us in her AQAA (Annual Quality Assurance Assessment) that the Company run an ongoing Managers Development programme. A budget is in place and she has control of this with input from the Operations Manager. Our review of records, observations and interviews with staff show that the management of the service has improved significantly since our last visit. A new deputy manager has been appointed and is able to have a presence on the floor with staff and service users and this is helping morale. Her presence also lends support to the manager and the service is running much better as a result. It is important however that the medication issues be addressed and that they are not repeated. (See OP9.) Staff we spoke with told us, the home runs fine now, the Deputy Manager deals with Care Homes for Older People Page 28 of 33 Evidence: the staff a lot and she is very hands on. Another told us, I think the home runs well. The manager told us in her AQAA (Annual Quality Assurance Assessment) that there are regular meetings with the Operations Manager, monthly audits and Regulation 26 visits. We looked at the most recent audit, which includes a full assessment of all of the National Minimum Standards. Although these were thorough there were not many comments from service users, relatives or staff and it is essential that these views are sought as part of the ongoing quality assurance of the home. Staff told us, service users views are sought every 3 to 6 months, the only emerging theme from the last one was the laundry issues and these are now largely resolved. We hold relative/residents meetings six monthly. The manager told us in her AQAA (Annual Quality Assurance Assessment) that peoples monies are well managed and they are encouraged to take control of their own finances whenever possible. We looked at the arrangements for managing peoples finances and found the service is not the appointee for any of the people living there and does not receive personal allowances directly. They receive deposits of money from families. Some people like to have some cash in their pockets and a receipt is issued for this, others have any expenditure paid for by cheque and receipts are issued. People mwho live at the service (or their families) get statements of deposits and expenditure and the account does attract a small amount of interest which depends on the balance held. Only small balances are held for each person. The staff we spoke with told us they do not have any involvement with service users money. The manager told us in her AQAA (Annual Quality Assurance Assessment) that the change of maintenance personnel has meant that more responsibility has been delegated to him, particularly health and safety issues and record keeping. We looked at these records and found them to be well recorded, clear and all Health and Safety testing is up to date and being completed on time. Staff we spoke with told us their health and safety is well protected. Care Homes for Older People Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The signs of hyper and hypo glycaemia must be available for staff. To enable staff to act promptly to protect the health and wellbeing of people when they see these signs. 22/02/2010 2 9 13 The arrangements for 22/02/2010 medication must be safe and secure ensure that people receive their medication as prescribed by their Doctor. To ensure that people receive their medication as prescribed by their Doctor. 3 14 12 Peoples capacity must be assessed under the Mental Capacity Act where a decision is needed which impacts on their rights. To make sure they are enabled to make choices wherever possible in 22/02/2010 Care Homes for Older People Page 31 of 33 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 accordance with their legal rights. 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 People should be consulted about their plans of care and their views and personal preferences should be incorporated into their care plan unless there are valid, recorded reasons not to do this. People should know how staff intend to help them and be happy with this. Care plans should indicate the individual allocation of continence wear so staff are aware of and can provide for this need appropriately, making referrals for reassessment as needed. There should be clear evidence that staff are monitoring the weight and blood sugar readings of people who live at the service where this is required by their plan of care. To show that peoples health is being monitored and they are receiving treatment when they need it. Monthly audits should be able to demonstrate that the views of people living at the home, relatives and staff have been sought where possible. To ensure the home runs in the best interests of people living there. 2 8 3 8 4 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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