Care Home: Bloomsbury House

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What the care home does well The findings on our visit echo the many positive views we received in surveys and from people we spoke to on our visit. People told us: "the home keeps me warm, clean, well fed and safe."; "keep my son informed and my room is always clean"; "I am very happy and content."; "The home is well run." Relatives said: "she looks far better than when she was in her own home"; "I find the home very clean, tidy and well run"; "the staff are caring and friendly"; " keep her physically healthy, clean and well turned out"; "staff show care and consideration to our mother and treat her with respect." Staff said that they "work well as a team"; "Bloomsbury House is an enjoyable place to work"; "we try to encourage independence where possible"; "management and the owners are always looking to improve the service...we provide training for staff, equal opportunities and a quality of life for the residents in a safe environment"; " a good standard of care and comfort". People have the personal care and support they need and independence, access to a wide range of health care, and there are consistent and qualified staff, available at peak times. . There were no complaints or safeguarding concerns. The home is warm, very clean, comfortable and safe. People and families can have confidence in management. There are a variety of ways people are consulted to develop the service Bloomsbury House are seeking continued improvement of quality. What has improved since the last inspection? Information for the public about the home now has all legally required information. There is a new pre-admission form and a more thorough assessment of people`s needs, risks, and mental capacity to make their own decisions. A life history profile was introduced to learn more about people. People were registered with Ring and Ride so that they can go out by themselves. Photo menus help people make food choices. The Safer Food Better Business scheme was introduced and Environmental Health found that food hygiene improved to excellent. Water temperatures are now regularly checked to protect people from water that may be too hot. Radiator risk assessments have been put in place. Three staff enrolled for NVQ 2 qualifications which will ensure that 50 percent of care staff are qualified. Staff records were audited and further action was taken to ensure pre-employment checks safeguard people Staff and the manager undertook research, training and updated the home`s policies, procedures, systems and practice to improve nutritional care, falls prevention, safeguards for people`s rights under new mental capacity laws, equality and diversity. This has provided people with more access to specialist health advice and advocates, stroke recovery, stabilised weights and improved diabetes care. There is a new medication policy, and sexuality policy. What the care home could do better: The home`s public information could improve to answer people`s questions, clarify the boundaries of the service and steer the gathering of information to make decisions about whether needs can be met. The medication system needs to account for medication to protect people`s health, and have lawful storage. Staff knowledge and competence in handling medication needs to be regularly confirmed. When people are overly sleepy in the daytime or have sleep disturbance, their stimulation and medication should be proactively reviewed to prevent undue restraint. People need to have confidence in the accountability of the service through the complaints procedure. Equipment to be introduced to the home must be fit for purpose, and staff trained in its safe use. Key inspection report Care homes for older people Name: Address: Bloomsbury House Anchorage Road Sutton Coldfield West Midlands B74 2JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 7 1 1 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 27 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 27 Information about the care home Name of care home: Address: Bloomsbury House Anchorage Road Sutton Coldfield West Midlands B74 2JP 01213553255 01213088091 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Senex Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 15 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) 15 Date of last inspection Brief description of the care home Bloomsbury House is a three storey Victorian house, providing personal care for 15 older people. It is near public transport and has car parking at the front and rear. The entrance is at the side of the home where there is a ramp, and there is an enclosed garden. There are 15 ensuite bedrooms, communal bathroom or shower on each floor. The large lounge and dining room have toilets nearby. There is no hoist other than for assisted bathing, and this is a no smoking home. Fees in the service user guide range from £410 to £475 per week. This applied at the time of our visit; up to date enquiries should be made to the manager. Care Homes for Older People Page 4 of 27 Over 65 15 0 1 8 1 1 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We last inspected the home on 18/11/08 when the quality rating was adequate. Prior to our visit, the home sent us their Annual Quality Assurance Assessment (AQAA), with information about running the home, what has improved and is planned for the future. The self assessment shows analysis and improvement. Information from the AQAA and from other sources was also used when forming judgments on the quality of the service. We received 21 surveys from people, relatives and staff. The home sends us notifications about legally required events and we received three reports with concerns from other sources. One inspector visited the home between 11am and 10pm. The home was not expecting our visit. We looked around, observed a meal and checked the medication system. We spoke with four people, staff on duty and saw care and health records. There were 13 people living in the home. Care Homes for Older People Page 5 of 27 Records and certificates were checked about: registration and insurance, staffing and training, maintenance, quality monitoring, complaints and incidents. Policies and procedures were seen or discussed about Deprivation of Liberty Safeguards, infection control, complaints and human resources. We discussed our findings with the manager and responsible individual who were present for most of our visit. No immediate requirements were made as people were well cared for and safe. Two requirements from the last inspection were met; two were replaced. Requirements and recommendations are at the end of this report. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? Information for the public about the home now has all legally required information. There is a new pre-admission form and a more thorough assessment of peoples needs, risks, and mental capacity to make their own decisions. A life history profile was introduced to learn more about people. People were registered with Ring and Ride so that they can go out by themselves. Photo menus help people make food choices. The Safer Food Better Business scheme was introduced and Environmental Health found that food hygiene improved to excellent. Water temperatures are now regularly checked to protect people from water that may be too hot. Radiator risk assessments have been put in place. Three staff enrolled for NVQ 2 qualifications which will ensure that 50 percent of care staff are qualified. Staff records were audited and further action was taken to ensure pre-employment checks safeguard people Staff and the manager undertook research, training and updated the homes policies, procedures, systems and practice to improve nutritional care, falls prevention, safeguards for peoples rights under new mental capacity laws, equality and diversity. This has provided people with more access to specialist health advice and advocates, stroke recovery, stabilised weights and improved diabetes care. There is a new Care Homes for Older People Page 7 of 27 medication policy, and sexuality policy. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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. Consistent staff meet peoples needs. Recruitment checks are robust and protect people. The staff development plan ensures that staff have qualifications and training for their roles. There are no staff meetings but information is shared in other ways. Evidence: Staff surveys said that there are always enough staff and management support, and induction and training covers all their needs. They also felt that the way they pass information about people and any changes works well. There are no staff meetings so handovers between shifts and supervision sessions are used for this purpose. Relatives told us that: the staff are caring and friendly; the staff seem to be generally kind and well meaning; staff show care and consideration to our mother, treat her with respect. Staff turnover is low and temporary staff are not used, which means that people have consistent staff who understand them. During the past year two vacancies arose which are being recruited to. We checked rotas and saw that Care Homes for Older People Page 10 of 27 Evidence: there are sufficient staff at peak times and no gaps in staffing levels. However on our visit people were not lively until 6pm. There is a new cook and a new activities coordinator, and domestic staff. The AQAA told us that staff files were audited to check pre-employment info and action taken was taken on any deficits. We saw three staff files, including the newest staff, and found recruitment checks are robust so that people are safeguarded. There are good initial inductions. A longer Skills For Care induction was completed in one record but not in another as it was being worked on. Mandatory training is undertaken and refreshed. There are two levels of first aid training and it is planned to extend this so that people have the help they need in an emergency. With two staff enrolled on NVQs, the home will meet the minimum standard of half of the workforce having care qualifications. They have a track record of ensuring qualifications are completed. Staff had additional training in nutrition during the past year. A relative questioned the training staff have about dementia, so we checked and discussed this with the manager. Staff all have dementia awareness training at Level 1, but the home is not registered to provide specialist dementia care. The manager is enrolled in a Level 3 dementia care course, to gain more understanding and creative ideas. Staff have quarterly appraisals of their work performance. One worker was dismissed during the past year for their performance, which shows us that management have high expectations of staff to sustain quality of the service. There is a recruitment strategy. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and health care needs are met; independence and dignity is promoted. The medication system improved but we could not confirm medicines are given as prescribed or when required. People were very sleepy during the daytime and need their stimulation and medication proactively reviewed. Evidence: Eight surveys from people said that they usually receive the care and support they need, always have the medical care they need, and staff are usually available when they need them. On our visit people also confirmed this. One person said the home keeps me warm, clean, well fed and safe and looks after all my medical needs. A relative said she looks far better than when she was in her own home. People were well groomed and had good personal hygiene. Their privacy, dignity and independence was respected and promoted. People can bathe or shower as often as they prefer and they have privacy in ensuite and communal toilets and in shared bedrooms. Care plans have staff instructions that matched assessments of what people are able to do for themselves, such as shower independently or wash their own Care Homes for Older People Page 12 of 27 Evidence: face and hands. The home told us about a high number of falls, none of which resulted in fractures or lasting injury, and last year nutritional care could improve. We wanted to see the effects of considerable efforts described in the homes AQAA - staff training about nutrition, manager research with dieticians about diabetes and menu planning, and falls prevention training for staff by health professionals, for instance. We looked at three care and health records, medication, activity and food intake records. These show that people have access to a variety of health care specialists, including falls clinics, speech and language therapy, dieticians, district nursing, phlebotomist, doctors, dentists, chiropody and optician. District nurses attend the home twice daily; GPs see people frequently. Some people have physiotherapy exercises or communication exercises undertaken with staff. This has led to speech improving and stroke recovery. Best practice safeguards are in place, careful monitoring and evaluation with specialists to stabilise weight loss where there is risk of malnutrition, and about unstable diabetes under medical investigation. To prevent falls, care plans detail how to support mobility, sensory needs, night time checks and continence care, foot wear and foot care. The same was true of nutrition plans about specific dietary needs, nutritional supplements, thickened drinks and feeding assistance to prevent choking. We also wanted to see what the home did to make the medication system safer as the AQAA only told us that people managing their own medication had risk assessments and monitoring of health and safety. A medication administration record (MAR) for someone managing their own medication had a safe variable dose countdown system and coloured tablets. Medication is stored at temperatures within the safe range but we advised that the thermometer is put in the cabinet to check further as there is no temperature control in the room. No one was prescribed controlled drugs, but an appropriate cabinet was not fitted in accordance with drug regulations. One medication prescribed by a hospital when required was not on the MAR, and another medication did not have the quantity received by the home as well as carried forward from the previous month. The stock did not tally with the MAR. So we were unable to confirm that people had all their medication for their health. However the manager audits medication regularly and we saw an audit from a Primary Care Trust pharmacist showing accurate MAR in November 2009 so we know these were not recurrent issues. Care Homes for Older People Page 13 of 27 Evidence: People were sleeping excessively during the daytime. It was very warm in the home and there were no activities on our visit. We saw records of two people who had sleep disturbance when first admitted to the home. GPs prescribed sedatives only after the home first tried putting people to bed later. However when their sleep pattern improved, the home did not proactively seek a medication review to minimise the use of sedation. This is a chemical restraint that may not be in best interests long term or if it causes risk of falls. We had no cause for concern from the medication records we saw, but we asked the Primary Care Trust to check on this after our visit. Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead lifestyles they choose and retain important relationships. There is some stimulation to take part in. No one currently wants arrangements made for worship. People have support to eat if this is needed. Food is nutritious and weekly menus are decided with people so that their preferences and dietary needs are met. Evidence: People and relatives told us that the home helps them to keep in touch. The service user guide says that visiting times are flexible and a relative said there is good access to residents at convenient times. Families are encouraged to accompany people on hospital visits, although staff escorts will also do so if they are unable to. Care records appropriately note Powers of Attorney so that they are consulted about best interest decisions. Care records and the AQAA show that there are no visiting clergy because no one wants this, but services have been arranged in the past. Peoples religious needs should be regularly reviewed. The service user guide does not explain what could be arranged so that people have access to opportunities for worship. Eight surveys from people told us that there are sometimes activities they can take Care Homes for Older People Page 15 of 27 Evidence: part in and they usually like the meals. We saw records of a range of activities that took place to help people retain their physical and mental abilities and interests. For example sing-a-longs, painting, making Xmas cards, chair aerobics, reminiscence, jig saws and dominoes. There is a new activities coordinator but staff also undertakes activities with individuals and groups. There was a poster about a Christmas party with an entertainer. So there are some opportunities for activities but we were concerned about a culture of boredom or sedation. The TV or music is only put on if people respond favourably, and staff did ask. However at 6pm, after tea in both the lounge and dining room, people became very lively and wanted to watch their favourite soap on TV. Although the home attempted to make it easier for people to go out more on their own, when we asked about this we found that the Ring and Ride service has not been used. Some people go out with relatives, and one care record showed a stroke club is attended. We recommend further evaluation of how the home assists people to have contact with the local community, and why people do not want to take part in activities put on, as we were told. We spoke to the cook, who consults people when deciding on weekly menus so preferences are catered for. There are choices at each meal and when we sampled menus and food stocks we saw that people are having a balanced diet with a mixture of fresh and frozen produce. In the kitchen we saw a list of the complex dietary preferences they are catering for, which is good practice. On our visit provision was made for diabetic diets, soft and pureed food and fortification. Snacks and drinks are provided three times a day in addition to mealtimes, and are available on request at any time. The cook keeps food records about choices and portion size. There are protected mealtimes without distractions so that people eat well. Posters explain how visitors can help, and 6 Steps staff need to take. We saw that people have individual support as necessary, and one person ate in the lounge at the request of a dietician so that eating was less stressful for them. Staff were patient, promoted self-feeding and mealtimes were unrushed. We complimented good practice. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel safe and relatives say that the home responds appropriately to any concerns they have. No complaints or safeguarding concerns arose. The home promotes peoples rights and best interest decisions are made in accordance with codes of practice and local protocols. Evidence: Most people and relatives knew how to make a complaint but three did not know how to find out about this. We found the complaints procedure in the service user guide. It has an appropriate timescale for response by the manager but did not reflect improvements the AQAA told us about. People are advised that if the manager cannot resolve the complaint that the Commission could be contacted rather than an owner, but the telephone number is out of date. Currently people will not know how to raise a concern about the manager. It could be clearer that individuals funded by councils also have access to council complaint procedures. Relatives told us that any concerns they have are appropriately responded to. There have been no complaints or safeguarding concerns since our last visit. The adult protection procedure includes reports to the council. Staff are trained to recognise and report abuse during their induction, showing us that abuse is taken seriously. There are robust staff recruitment checks to safeguard people. The manager will be training staff about peoples rights and their legal duties under mental capacity laws. There have been no Deprivation of Liberty Safeguard authorisations. The Care Homes for Older People Page 17 of 27 Evidence: manager assesses mental capacity; care plans encourage people to make their own daily decisions. A new policy on sexuality respects sexual orientation and sexual expression but also protects vulnerable people. This was well written and is in accordance with various laws. The Commission had concerns expressed about the home from various sources. We looked around the home and found no basis for an anonymous report about the environment. We discussed with the manager concerns from social workers we had in August and in October 2009, about the admission and discharge process referred to earlier. We saw archived records about a concern that medical attention was not sought soon enough when someone became ill. We were satisfied that doctors were involved by the home several times in the period concerned. In this report we expressed concern about peoples best interests in respect of long term sedation. In other respects the home avoids restricting freedom of movement and everyone has active family or representatives. There was a poster on display about local advocacy services so that people have independent support to make decisions or express their views. Since our last visit the manager and owner undertook a high quality analysis of incidents. It identifies where falls take place, whether furniture was involved, footwear and how the fall occurred. Action was taken to review peoples needs and plans in a timely way to prevent recurrence, and to identify and act upon any patterns in the environment or practices that could improve. This means that management has achieved balance in managing risk while still promoting risk- taking. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm, comfortable, safe and has high standards of cleanliness and infection control. People choose colour schemes and personalise their rooms. Any proposed equipment needs to be suitable for people and planned for. Evidence: Bloomsbury house is in a residential area. People bring furniture and possessions to personalize their rooms. When due for decoration, people are consulted about colour schemes. Privacy is maintained in shared rooms by screens. Bedrooms and toilets have door locks. There are sufficient bathing facilities. The third floor bathroom tends not to be used; there is an assisted bath with a hoist on the ground floor. People have mobility aids they need, and two wheelchairs are maintained for general use. The home is warm, comfortable and secure from intruders. There is a safe enclosed garden. The AQAA told us which maintenance and servicing checks had been done and which were due so we checked these and received a clear gas certificate after our visit showing us that all was in working order. Water temperatures show that they are in the safe range to prevent scalds. It is well maintained with timely repairs. We were told in the AQAA that there is an inflatable lifting device in case people fall and have difficulty getting up. However when we asked to see this we learned it is not kept in the home and has never been used or tried by staff. There is no risk Care Homes for Older People Page 19 of 27 Evidence: assessment or training planned. The home has an infection control policy and we saw that extra steps were taken to prevent swine flu. Cleaning schedules are kept up to date and the home is very clean. The manager introduced the Safer Food Better Business scheme, and on their 2009 visit Environmental Health gave the home a 5H award for excellence in food hygiene. Care Homes for Older People Page 20 of 27 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. There is a low turnover of staff and temporary staff are not used, so that peoples needs are consistently met. Recruitment checks are robust and protect people. Half the staff have care qualifications, and staff have mandatory and additional training in dementia care. Evidence: Staff told us they have good relationships with residents. There are always enough staff and management support, and induction and training covers all their needs well. The ways they pass information work well. The AQAA told us that staff files were audited to check pre-employment info and action taken so that people are fully protected. Relatives told us that: the staff are caring and friendly; the staff seem to be generally kind and well meaning. They keep her physically healthy, clean and well turned out; staff show care and consideration to our mother, treat her with respect. Staff turnover is low and temporary staff are not used, which means that people have consistent staff who understand their needs and support. A relative survey questioned the training staff have about dementia, so we checked and discussed this with the manager. Care Homes for Older People Page 21 of 27 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 well managed and runs smoothly. Health, safety and quality is taken seriously and is checked regularly. The manager ensures practice is up to date to benefit people. Views are sought to develop the service. Evidence: The manager has long experience, holds the required managers award and is registered by the Commission. They have undertaken a great deal of learning in the past year to update systems and practice, and make new community links to benefit people Policies and procedures were reviewed and new assessments introduced to protect peoples rights. The complaints procedure needs a link to the responsible individual so that people have confidence that there is full accountability for the service. The AQAA provided mostly accurate information we asked for, showed understanding Care Homes for Older People Page 22 of 27 Evidence: of value for money and had a positive approach to address barriers. The self assessment shows action taken to comply with requirements and commitment to continual improvement and sustaining high standards. There are a variety of ways in which the views of people and stakeholders are sought to develop the service. Quality Assurance surveys from 11 people and relatives October 2009 were in the home, which the manager explained will be analysed, given to people and relatives, and put on display. This is good practice and surveys showed that people are consulted about the running of the home, privacy and food. CQC is kept well informed about falls and hospital treatment but not deaths and unexpected discharges as required. The reports we receive could improve by telling us the homes actions to prevent recurrence and harm, especially when people have multiple falls. However we saw a high quality incident analysis, and also provider reports about spot checks which show us that management take health and safety seriously, prevent avoidable accidents and improve practice and the environment. A more risk-based approach must be taken to equipment the home is thinking of introducing, in accordance with health and safety law as well as care regulations. We asked about an inflatable lifting device mentioned in the AQAA and found that it is not kept in the home. Equipment must be determined to be fit for purpose and staff must have appropriate training to use it safely. Otherwise there were good systems for health and safety. Fire safety involves everyone in a weekly exercise so that they know what to do in an emergency. Fire training for staff takes place during induction, renewed 6 monthly; full drills twice yearly and weekly checks of precautions and magnetic closing doors. Health Protection Agency advice about swine flu led to extra infection controls to protect people, visitors and staff. Relatives who manage peoples affairs are provided with written statements when personal allowance needs to be topped up. Financial interests are protected by staff knowledge of the code of conduct prohibiting their involvement in peoples financial affairs. Care Homes for Older People Page 23 of 27 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 24 of 27 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 9 13 13(2): The quantity of all 17/02/2010 medicines received and any balances carried over from previous cycles must be recorded on the MAR to enable audits to confirm that medicines are administered as prescribed. The medication system needs to protect health and ensure medication is available when needed. 2 9 18 18(1)(a): The competence of staff to administer and manage medication must be periodically checked and reconfirmed. People need confidence that staff protect their health. 17/02/2010 Care Homes for Older People Page 25 of 27 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 The service user guide and statement of purpose could be improved in respect of matters raised in this inspection report to answer peoples questions. Sufficient information should be gathered to determine whether people with dementia, or nursing needs can be managed by the home and community nursing. Stimulation and medication should be proactively reviewed with the doctor if people are excessively sleepy during the daytime. Sedation for sleep disturbance should be kept under review so that its use is minimised. The controlled drugs cabinet must be fitted in accordance with the Misuse of Drugs Act. It is recommended that the home evaluate opportunities for people to have contact with the local community and opportunities for worship. The responsible individual should review whether the complaints procedure has sufficient ways in which people and families can report and resolve concerns. Regulation 37 reports should be made in accordance with the latest CQC guidance, including deaths in the home or hospital, and unexpected discharges. All manual handling equipment must be determined to be suitable for peoples needs, risk assessed and staff given appropriate hands-on instruction so that it is used, fitted and maintained safely to avoid injury. Equipment must be available on the premises. 2 3 3 8 4 5 9 12 6 16 7 33 8 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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