Care Home: Beechwood

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What the care home does well The home has a cheerful atmosphere and visitors feel welcome. The positive approach to providing activities continues and people are being offered very good social opportunities that can enhance the quality of their life. People feel their rights and preferences are respected. They are given choices and asked their views. A relative said, `My mum has settled in well and the staff are good to her. There is a good atmosphere and staff always smile and are pleasant`. People like the food and the mealtimes are relaxed and sociable. The building is designed so people live in groups, which helps make it homely and personal. All the bedrooms are single. Staff have a positive attitude and work well together to meet people`s needs. What has improved since the last inspection? Helpful information about the home is available in the home. There is now a visual tour available on the company website. Many improvements have been made to the building and it looks attractive. The conservatory has been refitted and people are being encouraged to use this area to take meals with their visitors. Now half the staff hold a Care qualification. More specialist training is being provided to staff to help them do their job well. There has been a low staff turnover and the team is more balanced now there are some male care staff. What the care home could do better: Care records need to reflect people`s current needs and show that staff are following good practice to help ensure their safety and wellbeing. People need to be better protected from known hazards that can lead to them being harmed. The administration of medication needs to be improved to ensure people are offered the medication prescribed for them. More staff could be on duty in the afternoons and evenings to increase the levels of interaction and supervision available to people. All required checks need to be in place before new staff start work. Staff should become more knowledgeable about the needs of people with dementia. Key inspection report Care homes for older people Name: Address: Beechwood The Beeches Holly Green Upton-upon-Severn Worcestershire WR8 0RR     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: Jean Littler     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) 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 31 Information about the care home Name of care home: Address: Beechwood The Beeches Holly Green Upton-upon-Severn Worcestershire WR8 0RR 01684593474 01684593095 beechwood@orbit.org.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited care home 38 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, Not falling within any other category (OP) 38 Dementia (DE) 38 Physical Disability (PD) 38 Date of last inspection Brief description of the care home Beechwood is registered to provide long-term and respite care for up to 38 older people of either sex who may have a physical disability and/or dementia care needs. The home also offers a day care service to older people living in the local community. The home is located in the residential area of Ryall on the outskirts of Upton-uponCare Homes for Older People Page 4 of 31 Over 65 0 38 0 38 0 38 Brief description of the care home Severn. It was purpose-built and is a single storey building divided into four separate units. Three units ahve nine single bedrooms, one has eleven, there are no en-suite facilities. There are communal toilets and adapted bathrooms, lounges and dining areas. All the corridors have rails for ease of access. On 29.09.09 the scale of charges were quoted at £455 with additional charges for hairdressing, private chiropody, dental care, opticians, taxis, toiletries and magazines and mini bus outings. Information regarding the home is available in the Statement of Purpose and the Service Users Guide. These are available in the homes reception area and on request, as are the inspection reports. 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: At the last inspection in 2006 the service was rated as providing Excellent outcomes, so in line with current guidance it has not been inspected for three year. We have carried out Annual Service Reviews to monitor the service and a short Thematic inspection was carried out in 2007 that focused on privacy and dignity. The overall findings of that visit were that people are generally able to expect their privacy and dignity to be respected by well trained and well motivated staff. This was a key inspection that focused on the key standards. We spent eight hours in the home. As part of the process we circulated surveys to residents, their relatives, health professionals and staff. We spoke to people living in the home and some showed us their bedrooms. Care Homes for Older People Page 6 of 31 We looked around the home, saw some of the records and spoke to the manager and some of the staff. The manager, Mrs Milward, completed an Annual Quality Assurance Assessment. The AQAA is a self-assessment that enables registered people to show how well outcomes are being met for people using the service. It also gives us some numerical information about the service. 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: Care records need to reflect peoples current needs and show that staff are following good practice to help ensure their safety and wellbeing. People need to be better protected from known hazards that can lead to them being harmed. The administration of medication needs to be improved to ensure people are offered the medication prescribed for them. More staff could be on duty in the afternoons and evenings to increase the levels of interaction and supervision available to people. All required checks need to be in place before new staff start work. Care Homes for Older People Page 8 of 31 Staff should become more knowledgeable about the needs of people with dementia. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information and opportunities to visit and try the home before they make a decision on their future care. Peoples needs are assessed prior to a place being offered. Evidence: Mrs Milward has kept the information about the home up to date. Some of this could be improved if a larger font was used to make it easier to read for some older people. There is a lot of information on display at reception and around the home including a Statement of Purpose and a Service Users Guide to help inform people about the service. In the last year a visual tour has been recorded and is available on the company website. Residents reported personally and in questionnaire responses that where possible either they or their representative had visited the home to assess its suitability. Care Homes for Older People Page 11 of 31 Evidence: Senior staff confirmed that they or Mrs Milward carry out assessments of prospective residents needs. Assessment information is obtained from the local authority when placements are being funded by social services. People are then offered one months trial stay and a meeting is held before a placement is confirmed. Staff said often people are already familiar with the service because they have been coming in for day care or for respite care stays beforehand. A welcome pack is in place and given to all new people. Some health professionals and staff felt the assessment process could be improved to prevent people being admitted whose needs can then not be met. The care records were examined for a person who has not been resident for long, but a move to a nursing home is being sought. Records did show that the persons physical needs had changed significantly in a matter of weeks. No assessment tool is used, but staff use a blank care plan format and make their assessment notes straight into this. These care plans are then added to so it was not always clear what the original baseline assessment information was that informed the decision to admit the person. A well designed tool may help demonstrate that a comprehensive assessment has been carried out with all risks and needs considered. The home offers a service for people who already have dementia when they move in. There is a practice of the front door being unlocked. The reception area is not always staffed, which raises two issues; a confused person leaving unseen and being quickly at risk from the roads nearby; and uninvited people coming into the home and putting vulnerable people at risk. People do not generally leave their front doors unlocked so anyone can come in, so this practice should be reviewed. It is of course each residents right to leave the home when they wish to, however, a risk assessment should always be completed when people with dementia are being assessed. We had been made aware of one such case when a person with dementia was admitted for emergency respite care while their carer was in hospital. The person was confused and kept trying to leave, putting herself at risk. Additional one to one staffing was provided to help keep her safe until her social worker could arrange for her to move to a more appropriate setting. 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. People all have a care plan that is being reviewed each month. They cannot be fully confident that their plans give clear guidance to staff about their current care and health needs and how they should be supported to remain well and safe. Their medication is not always being well managed on their behalf. Evidence: Each person has a care plan. Four were sampled as part of assessing how the service was provided to these people. A keyworker system is in place to help provide a personalised service to people, however, it is senior staff who are responsible for reviewing and updating the care plans each month. The system in place is suitable for the purpose. Many of the care plan areas contained helpful guidance for staff. It is positive that Life Story Books are being introduced to enable staff to have an understanding of residents backgrounds and how these may influence their choices and support arrangements in the home. The activities worker is completed these. The moving and handling assessments did not contain adequate information to guide staff about the type of hoist, the sling size and type and the number of staff that need Care Homes for Older People Page 13 of 31 Evidence: to be present. The current guidance relies on staff making these decisions based on their training. We cross referenced some specific information about residents care needs to test how the system is working to inform staff and ensure people get their needs met. The findings are below. One persons plan indicated she was at risk from poor nutrition and weight loss. Her doctor had prescribed a nutritional supplement. Her plan said she was to be weighed monthly, but a senior worker said this was incorrect and because of the risks she should be weighed weekly. Seated scales are available in the house, for this purpose. Her weight record showed the last entry was three months ago. There was a two month gap between this entry and the last and a loss of 2.5 Kgs was noted. The weight loss trend had not been closely monitored. One person had choked three days prior to the inspection while eating a bacon sandwich she had chosen from the menu. An ambulance was called and she was admitted to hospital. She had no lower teeth but staff had not cut up the sandwich or stayed with her while she ate it in her bedroom. Staff said they normally only offer her a soft diet. Senior staff said an error was made with the meal ordering the previous day and on the day concerned. It has not been the homes practice to complete risk assessments for choking. This person did not have a care plan about eating. Mrs Milward said these are usually only completed if people need staff assistance with eating or drinking. We referred the matter to Worcester County Council under local Safeguarding procedures, as Mrs Milward had not done this. She had informed the companies Health and safety department and they submitted a RIDDOR report. Mrs Milward reviewed arrangements and put an action plan in place to reduce the risk of this occurring again. The County Council Safeguarding Team and Environmental Health both felt the action plan was appropriate so took no further action. The senior in charge of the shift was asked if any residents had pressure sores. She reported that she had been on a weeks leave and she was not aware that anyone did. Daily notes for one person showed that the district nurse had been attending for three weeks to dress a sore on her foot. Her pressure area care plan said there were no skin breaks or sores at this time. This demonstrated that communication between senior staff and proactive care planning can both be further improved to help protect residents. One person who has fallen several times had three different falls assessments in her care plan. The notifications reported to us show there have been a high number of Care Homes for Older People Page 14 of 31 Evidence: falls at the service. Mrs Milward said she does analyse these and most occur in bedrooms. The company forms do not include how people are being helped to stay safe in their bedroom. A risk assessment had not been completed for this person even though she had fallen out bed more than once. Her daughter raised this as a concern in her survey and felt there was a policy to not use bed rails, which was putting her mother at risk. Senior staff explained that because the person has dementia she is likely to climb over rails and would therefore be at greater risk of harm. Staff said because the person lacks some mental capacity the daughter had been consulted and she had purchased a bed alarm, but this was not successful. A record of any Best Interest meetings with peoples representatives should be made. An assessment would demonstrate the issue has been explored and show that all avenues have been considered e.g. a lower bed, a padded mat on the floor etc. Staff said the person is not usually very mobile, but when she has a water infection her behaviour changes. The care plan did not make this association clear. Staff said they report behaviour changes quickly so the GP can be told, but they are not able to provide close supervision because they work alone on the unit. Risk assessments are not being completed regarding people having open access to the large urns in the kitchenettes that permanently contain many litres of boiling water. As mentioned risk assessments are not being completed regarding the hazards to people with dementia from wandering outside alone. Health professionals visit the home when requested. Senior staff said they get good support from district nurses, community psychiatric nurses and the stroke team. A chiropodist and opticians visit regularly. Mrs Milward said the dental arrangements are being improved as visits to the home are now going to take place rather than people having to attend the local surgery. Many incidents relating to residents health have been appropriately reported to us. Those from the last year were reviewed prior to this inspection. These showed that appropriate action had been taken. Feedback from residents, relatives and staff indicated that peoples health needs are taken seriously. One said, They have worked hard at improving my health, especially when I arrived with terrible bed sores. The daily notes showed staff record when health professionals have been involved and what the outcome was. Mrs Milward said she tries to keep a good working relationship Care Homes for Older People Page 15 of 31 Evidence: with the local GP survey and district nursing team by meeting with them every two months. One GP said the home provides good support to people who are dying and try hard to enable people to stay at the home when their needs change. They suggested the management team takes a more flexible approach to issues and spends more time working directly with residents to increase their knowledge of individuals needs and issues. The medication storage and records in one unit were sampled. The storage is suitable and the keys are held securely. A Monitored Dose System is used and a pharmacist visits the home to monitor the arrangements. The records for two and a half weeks were seen and errors were found on three peoples records. Some doses had been signed for but not given. No explanation had been recorded on the administration chart. In another case medication doses had been given but staff had not signed for them. These would not occur if the procedures were being accurately followed. There have been two medication errors reported during the year. One recently was potentially serious as a medication change was not implemented correctly. The resident was given the old and new doses combined for nine days, before one worker questioned this. Staff are being provided with in house training and a competency assessment before being allowed to give medication. They then progress to accredited training. As staff are appropriately trained this may be an indication that they do not have enough time to carry out this important task properly. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to live the style of life they prefer and participate in a wide range of in-house and community activities if they wish. They are provided with a choice of good quality meals that they enjoy. Evidence: Feedback from residents showed that they are able to make personal choices through their daily lives. One man said he declines outings and prefers to sit quietly in his lounge and draw. His art was very good and some of this and others is on display. One person commented in their questionnaire, I feel at home here, they have built up my confidence, they provide company for me and new things for me to do. People are asked for their meal preferences for the following day and there is always a choice. A Wish Tree has been set up where requests from residents are recorded. The worker in charge of this is then tasked with making arrangements. Some tags showed that ideas had been actioned, such as, providing new coloured pencils and locating one persons old friend. Information is displayed to promote choice making, such as, dates for the monthly Communion service, the talking books and DVDs available, activity sessions and outings. People felt that staff were pleasant and respectful. Residents meetings are held regularly to give people the opportunity to give their Care Homes for Older People Page 17 of 31 Evidence: views and ideas. The receptionist was observed to inform people that they had post and this would be delivered to them later. Residents said their families are always made welcome. The conservatory has been fitted with smart cane furniture and visitors were seen spending time with residents in this pleasant area. Staff said visitors are being encouraged to join residents here for meals and a few people are now doing this. A member of staff is employed full time to provide a wide range of activities. On the day bingo and quiz were being held in the activities area. Three people present were residents, the rest were people who attend the day care facility. In the AQAA Mrs Milward listed many activities and special days that have been arranged. These included men only trips to the pub, Mothers Day lunch that relatives were invited to, a fish tank set up with a donation from a previous resident, Sherry and mince pie morning, visits to a donkey sanctuary, pamper sessions, film show twice a month, summer fete, regular bingo games, visiting children and dogs, poetry reading and an evening fashion show. The home shares ownership of a mini bus that has a tail lift, with a sister home. Regular trips out are arranged. On the day a group went for a ride to see the autumn trees. They did not get off the bus, but took flasks and a snack to have while out. The cook arranged for lunch to be early to give more time for the outing. Residents confirmed both in the questionnaire responses and in person that they liked the food and they are given a choice. The menu showed that a good variety of meals are offered, including the option of a cooked breakfast each day. Special diets are provided for and staff said if people need liquidised food each part of the meal is served separately. A white board is in each unit with the menu for the next meal written on it to help remind people. Mrs Milward said in the AQAA she plans to develop a pictorial menu for each day to aid some peoples understanding. The dining areas were laid out nicely for meals with good quality crockery and glassware. The meals were sociable occasions and the atmosphere pleasant and unrushed. Care Homes for Older People Page 18 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. People feel they can raise concerns and these will be taken seriously. Systems are in place to help safeguard people but reporting of incidents, staff recruitment practices and risk management can be further improved. Evidence: Information about making a complaint is included in the welcome pack and Service Users Guide. It was also seen on display in the home. The wording was positive and encouraged people to raise concerns so the service can be improved. It may help some residents if the information on display is written in larger print. Feedback indicated that people felt able to raise concerns and thought these would be taken seriously. Mrs Milward reported in the AQAA that eight complaints have been received in the last year, five of which she upheld. Records sampled showed that she takes complaints seriously, investigates them and reports back to the person. The home continues to hold a Having Your Say award, issued by Worcestershire Adult and Community Services. Information is available in the home about independent advocacy and Independent Mental Capacity Advocate (IMCA). As detailed in the staffing section, a sample of two recruitment files showed that one worker had been started before all appropriate pre appointment checks had been carried out. This and the shortfalls highlighted in the Health section can potentially put vulnerable people at risk. Care Homes for Older People Page 19 of 31 Evidence: Policies are in place relating to abuse and whistle blowing, these were not viewed. Mrs Milward appropriately reported two cases of residents money going missing in 2008 and the police were informed. She informed all residents and met with each staff member. Three of the complaints were from residents about one worker. They had made allegations about the workers conduct and care practice. Mrs Milward had taken statements, one of which included an allegation of verbal abuse. Mrs Milward had suspended the worker while she investigated but had not referred this under the local multi agency safeguarding procedure. She had then returned the person to work with greater supervision following retraining. The outcome may well have been the same but any allegations of abuse should be promptly referred to social services. The recent incident when a person choked was also investigated internally without a safeguarding referral being made. In this case positive action had been taken to ensure systems were improved, however, Mrs Milward needs to make prompt referrals when incidents occur and work in partnership with other agencies to ensure the best outcomes are achieved in each case. Staff spoken with confirmed they have attended safeguarding training. Feedback indicated that staff would feel able to report any concerns to one of the senior team. Care Homes for Older People Page 20 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 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 comfortable, clean and homely building. They have single bedrooms and access to the pleasant garden. Evidence: A partial tour of the building was undertaken. The grounds have level access and there are several sheltered areas where people can sit and enjoy the flower beds. There is a well equipped main kitchen and storage areas. The Environmental Health inspection in March 09 rated the arrangements as 5 Star, which is very positive. All four units have kitchenettes that are open plan so accessible to all. These are next to the lounge/diners with the bedrooms and communal toilets and bathrooms nearby. As mentioned there is also a conservatory and activities room. Each unit has nine bedrooms, none of which have en suite facilities. There are two bedrooms near reception that are used for respite care. The occupants spend their time in one of the units bringing the number sharing this units communal space to eleven. There did not seem to be enough seating for eleven around the dining tables. A worker said not everyone wants to eat at the table so to date this has not caused a problem. The baths are fitted with chair hoists and one is more specialised to cater for people with significant physical disabilities. The bedrooms are all single, have sinks and are Care Homes for Older People Page 21 of 31 Evidence: lockable. Those seen were comfortable and were fitted with lockable storage area. Permanent residents have personalised their rooms with items such as photographs. One person had supplies of intimate care equipment on display under her sink. She felt this was not very dignified, and would be embarrassing if she took visitors into her room. There is a team of domestic staff and the home was clean, tidy and homely. Cleaning schedules are in place. The laundry is a suitable size and the assistant said the equipment was sufficient and in good working order. She was able to explain the infection control arrangements in place. Care staff also confirmed they have access to aprons and gloves and are aware of good hygiene practices. Mrs Milward reported that all staff are given infection control training. The home is one storey and has wide corridors and doors for help disabled access. There is a mobile hoist and a standing hoist has now also been purchased. A senior worker said hospital beds can be arranged through the district nurses if people become very frail. Mrs Milward reported that the current call bell system is not compatible with cord free handsets. There are call bell cords in the bedrooms and communal areas, however, the layout of the lounges means the chairs with the best views of the television and the gardens are the ones away from the walls so there is no access to the call bells. People were seen to choose to sit in these central chairs. One person who appeared quite frail was sitting by the wall but had not been given the call bell lead. With only one carer based in each unit they are not able to closely supervise people so access to call bells or a pendant should be made a priority to help reduce the risk of falls. The current system does not have the capacity to provide information on how long people are having to wait when they use the call bell. Feedback about the environment was positive, however, several people said they would prefer to have en-suite facilities. Two people spoken with complained that the doors bang loudly. One person was seen to jump as a door near her banged shut. She said the noise also wakes her at night. Mrs Milward reported in the AQAA that redecoration and maintenance programmes are in place. Many improvements have been made in the last year, including, re-carpeting of the main hallways, a bathroom has been converted to a wet room, new bedroom furniture provided for two units, new conservatory windows, carpet and furniture, 24 new mattresses and improved lighting in the bedroom hallways. The AQAA included dates showing that equipment has been serviced and Mrs Milward informed us of the most recent dates. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People like the staff who support them. Staffing levels in the afternoon and evening do not allow for close supervision of those with dementia or those at risk of falling. There is positive team morale and staff feel generally well supported. They are given training for their role but feel they could become more knowledgeable about dementia. Staff recruitment practices are not fully protecting people. Evidence: The staff are not based in a particular unit so residents have to get used to all the staff. If female residents do not want to be assisted by a male carer this is respected. One carer is based in each unit and a senior carer is also on duty for administrative tasks and giving medication etc. There are two shifts during the day and at night a senior sleeps over and two carers are awake. Senior staff said there is good flexibility and carers will cover gaps in the rota so no agency staff are used. Domestic staff work in each unit during the morning and they have a brief to help at meals. Mrs Milward reported that they have all been trained to support with the meals service and to assist residents to eat. Their presence increases the level of social interaction with residents and the level of supervision available on each unit. In the afternoons care staff work alone with nine residents, and on one unit with eleven. Staff feedback indicated that they call each other or the senior carer when they need help and so can manage to meet residents physical needs. However, because some people have dementia they felt they do not have much time to spend with the more able people. Care Homes for Older People Page 23 of 31 Evidence: Some staff reported in surveys that they felt the management team needs to spend more time on the units to improve their understanding of current issues and peoples needs. Feedback from residents indicated that they found the staff helpful and friendly. One resident said, They look after me very well, take care of my possessions, provide good and varied entertainment, they are very friendly and often go the extra mile for me. They communicate well with my family and I. Positive interactions between staff and residents were observed. Staff spoken with said there is a good team spirit and communication systems such as shift handovers are usually effective. There are now some male staff which makes the team more balanced. Mrs Milward said staff turnover has decreased. Seven staff have left in the last year but she said only one of these was a regular worker. This is positive as greater consistency helps residents build relationships with staff and enables them to know the residents preferences. A sample of two staff recruitment files showed that one person had been started with only one reference in place. This is contrary to the Regulations and the homes own procedure. It potentially puts people at risk of being supported by unsuitable staff. Mrs Milward said there is a check list to help ensure everything is in place before a start date is given but these are not being used. Mrs Milward reported in the AQAA that the induction given to new staff includes the Common Standards set by Skills for Care. Of the care team of 28 staff 14 hold an NVQ award in Care. Six others are working towards an award. Staff feedback showed that staff felt suitable training is provided. Some felt that the dementia training could be further improved. One worker spoken with had been in post for a year but had only had brief information on the subject during the induction. Mrs Milward said senior staff have attended additional training and there is a plan to role this out across all staff. A training matrix in her office showed this plan was in place and a senior carer was on a dementia course that day. There is also a plan to train staff on personal relationships and sexuality. Staff confirmed they are provided with periodic supervision sessions with a line manager. Staff meetings are also held. One worker described receiving good support and flexible working arrangements during a period of ill health. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run to promote a good quality of life for residents. Some areas need to be given greater priority to help ensure residents safety and wellbeing. Evidence: Mrs Milward is suitably experienced for her role and she and the deputy hold the NVQ Registered Managers award. The senior team have taken steps to keep their knowledge up to date by attending training on areas such as Mental Capacity Act, a five day dementia course and a two day fire management course. The AQAA was completed well and showed that Mrs Milward has made improvements during the last year and is planning further developments. The inspection shows that there is a positive approach to enabling residents to keep their independence and have good social opportunities. The home also served the community well with respite care, day care and a new lunch club. Mrs Milward needs to balance these aims with the need to closely monitor how risk areas in the residential service are being managed. Feedback was mainly positive about the service. Comments from relatives included, Care Homes for Older People Page 25 of 31 Evidence: The home is wonderfully run and a pleasure to visit. It provides our family with huge peace of mind by the way they care for our grandmother; I would recommend the home to any family wishing for a caring and efficient environment for a vulnerable relative. There is a quality assurance system that included routine audits. Surveys are distributed to residents. These have not yet been circulated to relatives and health care professionals. Compliment cards that have been received are kept at reception. The company carry out the required monthly monitoring visits. This year an in depth Quality Assurance audit has also been carried out by a company representative across several services. Mrs Milward said the process was helpful and the recommendations that applied to her service have been actioned. There is an annual home management plan and Mrs Milward says residents, staff and the catering team all contribute to this. The AQAA indicated that most company policies have not been reviewed since 2007. Reviews should be more frequent to reflect changes to the legal framework the service is operating in, for example, the Mental Capacity Act, Deprivation of Liberty Standards and the Independent Safeguarding Authority. External and company auditors also check on the financial records for the home including residents monies. Mrs Milward said only one action point was raised at the last audit as one person had not signed to show they had been to the hairdresser. Residents are asked to sign a log sheet when they receive cash. A balance is kept on computer records and a print out is given when needed. Mrs Milward reported in the AQAA that systems are in place to manage health and safety, such as, routine water temperature checks. Currently there are 7 staff who are are fully qualified First Aiders and 25 who have attended a one day course. These means there can always be a trained person on duty. The fire risk assessment has been kept under review and fire systems are regularly checked and drills carried out. Staff receive fire safety and other health and safety training. As reported under the Health section, some shortfalls were identified in how risks to residents are being identified and managed. An urgent action letter was sent to the providers regarding the action they need to take to address these areas to better protect people. Care Homes for Older People Page 26 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 27 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 8 12 The risks to each residents 31/10/2009 health and wellbeing must be clearly identified in their care plans along with actions staff must take to address these. Staff must consistently implement these actions. This is to help protect residents by ensuring their needs are met and their wellbeing promoted. 2 9 13 Medication must be 31/10/2009 administered as prescribed and in line with the homes policy and good practice procedures. Accurate records must be kept as part of this process. This is to help protect residents by ensuring they are offered the correct medication. 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 3 29 19 New staff must not start work until satisfactory background checks have been received in line with the Regulations. This is to help protect vulnerable residents from being supported by unsuitable staff. 31/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Consider using an assessment tool to help senior staff ensure they consider if the home can meet the persons needs and manage any risks. Expand the moving and handling assessments so they include clear guidance for staff on how to carry out the handling task safely and the equipment that must be used. Keep a clear record about how people have been consulted about their care arrangements. If they lack mental capacity this record needs to show how a decision has been made in their best interest. Include a medication profile in the care plan or with the administration charts so care staff are clear what the residents are taking each medication for. A system should be developed that helps ensure situations that fall under the remit of adult safeguarding are reported promptly to Worcestershire Council and CQC and worked through under the local multi agency procedure. Review the practice of the public being able to walk straight into the home. Make arrangements to ensure doors close without banging. Consider if any bedrooms can be fitted with en suite Page 29 of 31 2 7 3 7 4 9 5 18 6 7 8 19 19 21 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 facilities. 9 10 23 25 Arrange for intimate care supplies to be stored discretely to safeguard residents dignity. Review how the systems for calling for assistance can be improved to try to help prevent falls and enable monitoring of staff response times. Circulate feedback surveys to residents relatives, visitors and external professionals to inform the quality assurance process. Review policies more frequently to ensure they reflect changing legislation and care practice. Complete an assessment of the risks to people with dementia from the open door and nearby car park and roads. 11 33 12 13 37 38 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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