Care Home: Beechlands

What the care home does well People wishing to move into the service are offered an opportunity to come and look around. The manager makes sure that all people have their needs (assessed) before they move into the service. Beechlands provides a variety of day trips out for those people living in the service who like to go on trips out. The appearance of the service is clean and tidy. It and decorated in a "homely" manner. People living in the home are offered the opportunity to make their bedrooms their own by bringing personal items. This makes the bedrooms look warm and welcoming. The majority of people living in the service believe that any concerns they have will be addressed. Staff were confident that they understood the ways to protect people from potential abuse and were able to clearly explain who had responsibility for dealing with serious concerns. What has improved since the last inspection? Since the last visit some areas of decoration have been undertaken including refurbishment of the laundry and the bathrooms updated. At the last visit we issued a statutory requirement notice also known as an enforcement notice. This is a legal notice that informs the manager and provider of areas that must be improved and when they must completed this improvement by. The notice was with regards to the safe management of medications, meeting health and welfare needs and care planning. At this visit we noticed that there is sufficient evidence to show us that the service has now improved these areas to a safe manner and the enforcement notice has been met. What the care home could do better: Despite the majority of the notice being meet their remains issues in care planning and instructions to staff. The instructions to staff in care plans are not always clear or accurate. Where instructions are available staff are not always following these instructions A number of other records were noticed to be unclear or not available such as accident records, staff training, staff supervision and an unclear AQAA from the manager. Our observations through out the day, talking to people and reading records showed that the service is not always run taking into account people`s personal preferences, choices and needs. Adaptations such as ramps into the garden are not in place to help maintain people`s independence. The service has no quality assurance system in place that looks at the quality of the service or plans how to make improvements. Fire safety arrangements are not sufficient to maintain the safety of people living in the service. Key inspection report Care homes for older people Name: Address: Beechlands 54 Church Road Huyton With Roby Liverpool Merseyside L36 9TP     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: Julie Garrity     Date: 1 6 0 3 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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 31 Information about the care home Name of care home: Address: Beechlands 54 Church Road Huyton With Roby Liverpool Merseyside L36 9TP 01514890598 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): beechalndsemihome@hotmail.co.uk Beechlands Care Home Ltd Name of registered manager (if applicable) Miss Madeleine Ward Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following categories of service only: Care home only - code PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is 21. Date of last inspection Brief description of the care home Beechlands care home is registered to accommodate 21 older people who experience dementia. The premises comprises of 18 single and 3 double bedrooms, 5 of which have en-suite facilities. Accommodation is provided over 2 floors the upper floor being accessible via a passenger lift. Ramp access is available at the side entry to the service. A call bell system is fitted throughout. A variety of lounges and sitting areas are available together with a dining area and secure rear gardens. The home is located 0 Over 65 21 Care Homes for Older People Page 4 of 31 Brief description of the care home close to public transport facilities to include rail travel and is within easy reach of local shops and amenities. Fees are between GBP415 and GBP450 per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home 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 visit to the home started at 09.30 and finishing at 19.00. We spoke with a total of two people who live in the home, four members of staff, the manager and the homeowner. The manager completed a document known as an Annual Quality Assurance Assessment (AQAA). This documented is completed and sent to us by the home before we visit. The AQAA tells us what the home does well and what their plans are to increase the quality of the home. We sent surveys to people living in the home and staff their responses are included in this report. When we visited the home we looked at many of the records these included care records, staff records, medications, policies and procedures, menus, duty rota, staff training and activities records. We also looked around the building and observed staffs interactions with the people living in the service. After out last visit an enforcement notice was issued regarding medications as a result a specialist pharmacy inspector was included in this visit. Feedback was given to the manager and homeowner during and in detail at the end of Care Homes for Older People Page 6 of 31 the visit. . Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Despite the majority of the notice being meet their remains issues in care planning and instructions to staff. The instructions to staff in care plans are not always clear or accurate. Where instructions are available staff are not always following these instructions A number of other records were noticed to be unclear or not available such as accident records, staff training, staff supervision and an unclear AQAA from the manager. Our observations through out the day, talking to people and reading records showed that the service is not always run taking into account peoples personal preferences, choices and needs. Adaptations such as ramps into the garden are not in place to help maintain peoples independence. The service has no quality assurance system in place that looks at the quality of the service or plans how to make improvements. Fire safety arrangements are not sufficient to maintain the safety of people living in the Care Homes for Older People Page 8 of 31 service. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has assesses people to determine what their needs are.The assessment is not in sufficient detail to help the manager decide if staff can meet the persons needs and help promote their independence. Evidence: We looked at how the service assessed (a review of peoples needs), before they moved into the home. To do this we spoke to the manager who told us that she usually assess people before they move in to see if the service can meet the persons individual needs. The AQAA submitted by the manager stated, The AQAA We carry out pre-admission assessments for all Service Users and this is carried out by myself accompanied by my Deputy. We offer an induction visit and meal if they wish, also a tour around the home. We provide them with all the relevant information they require. We also encourage them to question us and we answer as honestly as possible. Each service users is issued with terms and conditions after 4 weeks of admission. . Care Homes for Older People Page 11 of 31 Evidence: We looked at two peoples records who had recently moved into Beechlands. We noticed that records were unclear one person had a document called a pre-admission assessment another did not have this but had a different document. The records viewed gave no evidence that peoples needs had been looked at before they moved on. One pre-admission assessment was signed by member of staff working in the home. It was not possible to determine that the member of staff had received suitable training in undertaking assessments. The assessments viewed concentrated of physical needs such as mobility, eyesight, past medical history and medications as examples. Whilst it is good practice to assess peoples physical needs Beechlands is registered to support people with dementia needs. The assessment did not explore their skills, capacity and needs within this area. There was a small space available for social needs and this had brief information. Without looking at the persons capabilities and what behavioural needs that may result from dementia the service will not have enough information to help them decide if they can meet peoples needs. We spoke to people living in the home about the information they received before they moved into the home. We received surveys from people living in the service (completed by family members) all who told us that they had received sufficient information before they moved in. We looked around the service and noticed that people living there did not have a copy of the information know as the service users guide in formats that met their assessed needs. When we reviewed this information we noticed it had not been updated and several sections were unclear. The information needed an explanation for the circumstances that a person can be admitted to the service and the arrangements for emergency admissions. People spoken with had been given the opportunity to look around the service before moving in without an appointment. On the day of our visit the manager was showing people around the service and explaining what needs the service can meet. Care Homes for Older People Page 12 of 31 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. There have been improvements in meeting peoples health and welfare needs. Further improvment is needed in order to make sure that staf fhave clear instructions. Clear instructions will support staff to meet peoples needs in a manner that meets their persons preferences and choices. Evidence: During the day we observed staff talking to people in a respectful manner and actions were taken to maintain their dignity. We noticed that the hairdresser was doing peoples hair. This was in the main lounge where other people were having snacks or watching the television. The service does not have a separate hairdressing room but consideration needs to be made to maintain peoples dignity in accordance with their wishes. We received surveys from people living in the service (completed by families). Views were mixed with one person stating they always receive the correct support and another saying usually. We looked at the professional visits records. These show when a professional has visited (such as a doctor) and what actions they wish to be taken to Care Homes for Older People Page 13 of 31 Evidence: support individuals medical needs. These included some information about the reasons that a visit had been requested and what actions staff needed to take. It was not possible to determine that these actions had always been carried out as the information from professionals was not always used to update individual care plans. We noticed risk assessments for falls, risk of pressure ulcers and nutrition were not always calculated correctly and the information from these was not always reflected in the care plans. As an example one persons nutritional risk had been incorrectly calculated stating that they needed to be weighed monthly. The correct calculation would mean that they needed to be weighed weekly. Another persons had been correctly calculated and meant that the person should be weighed weekly. The records showed that in the last three months neither of the people had, had their weight monitored correctly. Although some people had lost weight this was a very small amount others people had gained weight. We looked at how information within peoples care plans supported the use of their medicines. In most cases we found that the information was not up to date, and there was no clear guidance for staff about the use of medicines prescribed when required and the application of creams. It was not possible to determine from the records, how often, when or in what circumstances staff were to use creams. As such staff were not getting the instructions that the needed to give these medications correctly. When we looked closely at seven care plans and a brief look at a further two we noted that it was not always possible to see that care plans had been updated to meet peoples needs. As an example one person had been noted to have several incidents of bruising. When we looked at the care plan the manager had identified that the person was at risk of falls and had stated to be observed at all times. There was no information about monitoring the bruising, investigating the cause or clear actions if the bruising was due to falls. It is also not possible to support one person living in the service at all times. As such the instructions to staff did not give clear guidance or support them to appropriately monitor the individual. The lack of clear instructions in care plans places people at risk of having vital care needs missed or receiving support that does not meet their needs. We spoke to staff about how the actioned care plans. Staff told us that they read care plans when the person moved in. After that they relied on verbal communications such as a daily report to keep them up to date. We did note during the visit that staff were carrying out support that was different to that described in the plan. This also places people at risk of receiving support that does not meet their needs. A legal notice regarding health and welfare and care plans was issued following the Care Homes for Older People Page 14 of 31 Evidence: last visit. The manager had undertaken significant work to improve care plans but they remained lacking in accurate instructions that would help staff decide what actions they need to take to support individuals. We looked at medicines administration. All medicines were administered by staff, including night staff, who had completed training and further training was planned in the near future. A record viewed agreed that one of the people living in the home has their medication given covertly (in food). There was little information about how decisions to administer medication covertly were made and reviewed. Staff described the process they followed when actually administering the medicines but the written guidance in the care plan was not as the staff described. It is important that decisions to use covert administration are kept under review to ensure peoples best interests are protected and staff follow clear guidance. We found that medicines stock control had improved helping to reduce the risk that doses of medication will be missed. We did see one example where someone who did not have a prescription for painkillers was given painkillers. This was clearly recorded, but the home did not have a policy for the use of home (non-prescribed or over the counter purchased) remedies. Without this policy staff may inappropriately give medication of this nature. We compared a sample of medicines stocks and records. We were generally able to account for (track) medicines handling in the home. Records seen showed that the application of prescribed creams were not completed by the person who actually applied them. This means that although the records cannot be relied upon as being accurate records of the treatment people have received. We saw that medicines were securely stored and handled. Controlled Drugs were safely locked away. We were unable to evidence that the cupboard in use met the current law for storage of controlled drugs. The manager had continued to carry out medication audits (checks) and checked staff understanding of the homes medicines policies helping to make sure medicines are safely handled. A legal notice regarding medications was issued following the last visit. We noticed that manager had made significant improvements in the safe management of medications. There remained some areas that needed improving including as needed medications, cream usage, storage of controlled drugs and instructions for covert medications. Care Homes for Older People Page 15 of 31 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. Daily life and social activities are available. The activities and meals on offer do not meet the individual needs, choices and preferences of all the people living in the home. Evidence: We looked at how people living in the service were supported to have a life style of their choosing. We noticed that the menus available did not show a choice available and this menu was not available to people living in the service. People living in the service told us, its nice enough, a lot of snacks. We watched lunchtime and noticed that all meals were presented in an identical manner. One person pushed their plate away three times staff kept encouraging them to eat it, but did not offer an alternative. The person did not eat their meal. We looked at how the service managed meals for people with a special diet or in need of additional support. When we looked at how supplements were given to people we noticed that it was not possible to determine that they had received these correctly. The menus available did not show any provision to special diets such as diabetic diet. We discussed with the kitchen and the manager how the meals were decided on. The manager stated that she had written the menu and the kitchen staff ordered the food. Care Homes for Older People Page 16 of 31 Evidence: Records as to what people liked to eat were not always available. There were brief details taken when people were admitted to the service. This was not updated or used to determine the food that is available on the menus. During the day we looked at how staff supported people to spend their time. We did not observe any activities taking place during the day and could not locate a programme of activities that were on offer. We were told of many trips out on barges, to museums and lunch out. We looked at care records available in the service there was a brief history about the person but very little information was available as to how people would like to spend their time. In other plans for several people it stated that the person did not go out and did not take part in activities. Whilst it is good practice to offer trips out that people pay for, this does not meet the assessed needs of all the people living in the service. Relatives are offered an opportunity to visit. The service supports people living in the service to maintain contact with their families. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff and relatives of people living in the service believe that their concerns will be listened too. Not all the staff have the training and skills that they need to recognise and deal with safeguarding concerns. Evidence: The home has a complaints policy and procedure. Surveys returned from people living in the service told us that people knew how to make a complaint or who to tell if they had concerns. The AQAA returned to us although completed contained no information as to how the service dealt with complaints. When we looked at the policy we noticed that it was out of date and did not include clear information about how the service would address any concerns received. A log of complaints is maintained. This showed that there have been no complaints made since the last visit. There have also have been no complaints raised directly with the commission about this service from people living in the service. A safeguarding issue dealt with by social services was documented. When we looked through the records one person had several incidents of bruising. The records did not make it clear if there was an explanation or if the bruising was unexplained. When we checked the accident records we could not find any records of an accident on two occasions. When there is an injury of no known cause the service needs to report this to social services as part of their safeguarding responsibilities. An adult protection policy and procedure is in available. The policy is out of date and Care Homes for Older People Page 18 of 31 Evidence: needs to reflect how the service will deal with any allegations of this nature. We spoke to staff about their understanding of concerns of this nature. Two staff told us they had not had any training in recognising and dealing with issues of safeguarding adults. Staff training was unclear and it was difficult to determine who had received up to date training. Without clear and up to date training that staff are competent in following people in living in the service will not be fully safeguarded. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. Beechlands is a clean and tidy environment. Some areas of the environment does not meet the individual needs or maintain their safety. Evidence: Beechlands is a two storey house situated in well presented grounds. The home is located approximately 1/2 mile from Huyton Town Centre and is well served by public transport. There is car parking space available at the front of the building. There is no smoking allowed in building and smoking area has been created at the rear of the building. During our visit we noticed that exit from the building at the rear was always from at least one step. This does not support people who are unable to use steps safely. We sent surveys to staff and people living in the service. The returned surveys were received from people living in Beechlands were completed by families. Surveys from relatives told us that they thought that the home was always clean and tidy. Staff surveys told us that decorating is needed but the company is in the middle of the process. The AQAA informed us that, We plan to continue to upgrade the home. There was no further expansion on this plans such as which areas of the service were to be upgraded, when and how. The service has a cleaning staff available and on viewing the service we noticed that it was generally clean and tidy. Some redecoration has taken place in particular fire doors have been covered fully in murals. Some Care Homes for Older People Page 20 of 31 Evidence: consideration has been made to helping people identify their personal spaces but in some cases the pictures are identical and do not help identify a separate room. People living in the service have dementia care needs. It is good practice to assist people in identifying areas such as bathrooms, lift and bedrooms in order to maintain their independence. Beechlands has a shower room and an assisted bath. We looked at the assisted bath and noticed that the bath hoist had not been charged up and therefore did not work. A member of staff told us that they had never used the bath hoist in their time working in the service and did not know how it worked. When we looked at the hoist we noticed that it was an aid to help people get up and down in the bath but not to help them get in or out. Some people would need to be able to step into the bath and others would need a further piece of equipment such as a slide board to slide from a wheelchair into the bath. We were unable to locate a slide board in the service. The assisted bathing arrangements may limit some peoples choices and not be suitable for others. When we looked at how the fire safety was maintained we noticed that a several of the bedroom fire doors failed to correctly close. We also noticed that the risk management plan for the prevention of fires has not been updated since 2008. Ineffective fire doors increase any risk to people living in the service in the event of a fire. We looked at how the prevention of the spread of infection was managed. Of the staffing records viewed for staff we could find no evidence that any staff had received training preventing the spread of infection in the last three years. Observations showed that gloves and plastic aprons were available in the service for staff to use. Staff were observed to use these appropriately during mealtimes. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are checked that they are fit to work with people before they start working in Beechlands. Staff training is not sufficient to keep them up to date to support them to meet the needs of people living in the service safely. Evidence: We spoke to people living in the service and staff all agreed that there was enough staff working in the service. Care staff also confirmed that there was enough staff. Beechlands has people attend a day care within the service. Staff told us that they always know how many people are coming and staff to meet their needs. . The service has cleaning staff additional to the care staff available. We looked at the training that staff had undertaken in the last 12 months and found that records were not clear as to what training staff had received this included fire safety, food hygiene, infection control and safeguarding training as examples. It was not possible to determine that staff have up to date training that gives them skills that they need to support the people living in the service. As part of their training staff need to have an induction we looked at the inductions for staff working in the service. We noticed that these were brief and did not always include the full training needed to be in place before the person started working in the service. Staff need inductions that provide them with the skills to meet the assessed Care Homes for Older People Page 22 of 31 Evidence: needs of people living in the home. Staff surveys done by the service two years ago stated that staff thought they needed to work better as a team. These have not been repeated to see if this the way staff still feel. Surveys sent to told us that they staff thought that they were well supported and they were attentive to residents needs. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a lack of ongoing quality monitoring that would support the service to identify its strengths and weakness and plan to improve the service. Evidence: The service had an enforcement notice in place following previous visits. This was in relation to medications and meeting health needs. This visit showed that the manager and the staff team had taken action to meet this breach in regulations and had made sure that medications were now safely managed. Staff told us both in person and in surveys sent to us that they felt they thought that they very well meet and support all the service users. They also thought that they were well supported by the manager. The manager has achieved the Registered Managers Award and has worked in the service for nearly two years. The homeowner stays in the home Monday to Friday to support the manager. During the day we noted that the manager told us that she does the majority of tasks in the service such as writing care plan and updating the care Care Homes for Older People Page 24 of 31 Evidence: plans. All the care plans viewed had been written by the manager. The plans were not always clear or correctly described actions that staff needed to support peoples needs. We spoke to the manager about her own training. Training records for the manager did not record any training after October 2008. The manager stated that she had not had up to training in mental capacity, deprivation of liberty or safeguarding that was suitable to her role as the manager. The AQAA completed by the manager and returned to us was not fully completed, it did not clearly identify what actions the manager had taken to improve service. There was also very little information on what plans the service has to increase quality in the future. We were given copies of surveys sent to relatives and people living in the service these were dated 2008 and there was no evidence that this quality assurance survey has been recently repeated. Audits in the service were not available such as recruitment, care planning, environment and accidents. We looked at the accident records for the last 6 months and noticed that daily records identified accidents such as falls there was not always an accident record done. It is part of health and legislation that all accidents must be recorded using an official accident record. Auditing areas in the service such as accidents will help identify areas of that can be improved and helps provide the opportunity for staff to take preventative action. Risk assessments for the environment such as fire safety had not been updated for two years and practice observed within the home during the visit showed that peoples safety regarding fire was being placed at risk. We also noticed that other guidance to staff such as policies and procedures were out of date. As such staff had no access to guidance such as over the counter medicines that helped them support people in the best way. A random sample of staff files were looked at in order to assess the frequency of supervision meetings. The records showed that the majority of staff have not been provided with formal supervision any in the last three months. Staff need to have regular supervision in order to identify the strengths and weaknesses and support them to develop and maintain their skills to undertake their job role. We looked at how the service managed peoples personal allowances. All incoming money and out going money was recorded. The records were not clear as to how much money each person should have available. Access to funds was limited by the availability of the manager or the owner. There was no arrangements in place to support people living in the service to access their own funds in the absence of the manager or the owner. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 The arrangements for the 31/05/2010 prevention of the spread of fire need to be reviewed and expert advice sought. In order to maintain the safety of people living in the service. 2 8 15 Where risk assessments 03/05/2010 have been completed these need to accurate, up to date and included in the care plan. Staff need to carry out the instructions in care plans as indicated from the risk assessment. Staff need to have the correct instructions and carry those out in order to meet peoples needs. 3 9 13 Clear and accurate records need to be maintained for the use of external preparations e.g. creams and medicationsgiven on an as needed basis. 19/03/2010 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to support and evidence their appropriate use, when needed. 4 9 13 Controlled drugs must be stored in a controlled drugs cupboard That is confirmed as compliant with current law. 5 18 12 All unexplained injuries need 30/04/2010 to be dealt with inaccordance with an up to date policy for safeguarding. In order to maintain the safety of people living in the home. 6 33 24 An effective quality 25/06/2010 assurance arrangement needs to be made that identifies the strengths of the service and plans how to increase quality in areas that need improvement. In order to meet the people needs of people who live in the service in accordance with their wishes and personal preferences. 7 38 37 Any incident detrimental to the health and welfare of people living in the service needs to be notified to the commission. All accidents 19/04/2010 03/05/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action need to be recorded correctly. In order to maintain the safety of people living in the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information provided to people wishing to move into the service needs to be updated and available in formats that meet their personal needs. Consideration needs to be made to making sure that preassessments are completed by somebody with the correct skills. that records of the assessment are clear and that the assessment has more emphasis on the meeting dementia, mental health and social needs as apposed to physical needs. The service needs to make sure that all people living in the home have a care plan in place that gives staff clear, accurate and upto date guidance on how to meet individuals needs. Consideration should be given to implementation of a policy for the use of home remedies to enable people to have access to treatment for minor ailments without delay. Decisions to use covert administration of medication need to be clearly documented and kept under review to ensure peoples best interests are protected. 2 3 3 7 4 9 5 12 The services needs to consult people who live in the home about their social interests and food preferences. Then provide recreation and meals that meets their needs choices and personal preferences. All staff working in the service need to have up to date training in recognising and reporting safeguarding concerns. Page 29 of 31 6 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 30 Review staff training and check that staff have received up to date training that meets the assessed needs of people living in the service. Training needs to be monitored to make sure that staff training remains up to date. Provide the manager with on-going training and supervision to increase her skills for the job role she undertakes. Provide the manager with on-going training and supervision to increase her skills for the job role she undertakes. Review and update all policies and procedures in line with best practice arrangements and changes in legislation Update the arrangements for dealing with peoples personal allowances. 8 9 10 11 31 33 33 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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