Care Home: Bluebrooke Residential Care Home

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What the care home does well People who live in this home are supported to stay in touch with friends and loved ones. Family members told us that they always feel welcome when visiting the home. A proactive approach is practiced in respect of consulting external professionals, such as, doctors, social workers, community mental health nurses and district nurses so that people have the support to stay healthy and well. Medication practices are satisfactory which ensures people receive their medications as prescribed by their clinicians by staff who have received training to complete this task so that people are protected from harm. Meals are nutritious and varied. People using the service tell us that they enjoy the food. Important checks are carried out to make sure that staff working in the home are fit for the job. Staff have regular supervisions and meetings which makes sure they are aware of how to support people using the service and their changing needs. Other checks are carried out regularly on equipment around the home, to protect the health and safety of the people living and working there. People are encouraged to personalise their rooms with items that are familiar and hold `meaning` to individual`s. Staff try to make sure that the house is clean and tidy, so that people can feel comfortable and safe at home. What has improved since the last inspection? The manager is working hard to ensure improvements are made and that all the requirements from the last key inspection are being met. The manager is reviewing all care plans and risk assessments so that they are clear and regularly reviewed providing staff with the information they need to support people using safe methods or practice. We were assured that the histories of people who live in this home are being sought and this needs to continue as they can be crucial in gaining insights into the requirements and needs of each person. This process should continue. We saw staff interacting with people who live in the home in a kind and respectful way. Staff have received further training in different subject areas since we last inspected the home so that people can have the confidence that they are in `safe hands` at all times. This needs to continue. Staff files that were sampled have all the relevant checks which confirms that they are not banned from working with vulnerable people. What the care home could do better: The manager must be registered to manage the service, so people can feel confident their service is in reliable and capable hands. Information about what the service provides needs to be updated. This is so people have current information to help them decide if the service is right for them. Improvements to the care planning and reviews should be completed so that people using the service receive a personalised and consistent level of support. Opportunities and individual records about the activities people are able to do need to be further developed. Doing this will help to make sure that people can do the things that are important to them, and achieve their goals. The service must ensure that people are kept safe by ensuring that manual handling care plans and risk assessments detailed which type of equipment and aids are suitable for each person. Improvements to the garden should be completed together with the improvements to the environment for the benefit of people with cognitive impairments. Staff training team could be better organised. This would make sure that staff have the knowledge, skills and support they need to do their jobs well. Action should be taken to make sure that the views of the people who use the service guide the way in which it is developed. This is particularly important at this time as the manager is trying to move forward in their role of improving the outcomes for people who live at Bluebrooke. Key inspection report Care homes for older people Name: Address: Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcestershire B61 9LE     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: Sally Seel     Date: 2 3 1 0 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 39 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 39 Information about the care home Name of care home: Address: Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcestershire B61 9LE 01527877152 01527557409 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oldfield Residential Care Limited care home 46 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: Age: Dementia (DE) age 55 and above. The maximum number of service users who can be accommodated is: 46 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: Physical disability - over 65 years of age (PD(E)) 46 Old age, not falling within any other category (OP) 46 Dementia (DE) 46 Date of last inspection Brief description of the care home Bluebrooke Residential Care Home is registered to provide personal care for up to forty-six older people who are frail, or who may have a physical disability. The home may also accommodate people over the age of 55 years who have a dementia illness. Care Homes for Older People Page 4 of 39 Over 65 0 46 46 46 0 0 2 8 0 4 2 0 0 9 Brief description of the care home The total number of people who can live in the home is forty six. The large, detached property, standing in its own grounds, is situated in a pleasant residential area, approximately two miles from Bromsgrove town centre. There is also a small enclosed garden that is accessible to residents. This is not safe for residents to use without supervision by staff. The home was purchased by Oldfield Residential Care Limited in April 2004. The Responsible Individual is Mr Anastasis Kayiatou, and the Company has several homes in the group. There is no registered care manager in post. There is an acting manager , Ms Lianne Sturmey. We have not received an application from Ms Sturmey for registration as the manager of the home when we inspected the home on the 23rd October 2009. Interest parties who would like to request the up to date fees that are charged for living at this home should make contact with the home. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This is the second key inspection at the home for the year 2008-2009 and it is recommended that this report is read in conjunction with the previous report for the home. The visit to the home was undertaken on the 23rd October 2009 by one inspector over one full day and an Expert by Experience spent part of the day at Bluebrooke. Ms. Spiwe Takura, an Expert by Experience is a person who, because of their shared experience of using services, and or ways of communicating, visits a home with an Care Homes for Older People Page 6 of 39 inspector to help them get a picture of what it is like to live in or use the service. The manager, deputy manager and director for operations assisted us throughout. The management team and staff did not know that we were visiting on that day, when there were forty- two people living in the home with one person currently in hospital. Information was gathered from speaking to and observing people who live at the home. Three people were case tracked and other peoples care records were briefly looked at. Case tracking involves discovering individuals experiences of living at the home by meeting or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus on outcomes. Comments gained from relatives and staff working at the home on the day we visited where appropriate have been included in this report. Staff files, training records, maintenance and complaints records were also reviewed. Reports about accidents and incidents in the home were reviewed in the planning of this visit. The manager completed an Annual Quality Assurance Assessment (AQAA) earlier this year. This told us how well the management team think they are performing and gave us some information about staff and people who live there, improvements and plans for further improvements, which we have taken into consideration. We would like this opportunity of thanking people who live in this home, their relatives, the manager and all staff for assisting us with this inspection and making us feel welcome. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? The manager is working hard to ensure improvements are made and that all the requirements from the last key inspection are being met. The manager is reviewing all care plans and risk assessments so that they are clear and regularly reviewed providing staff with the information they need to support people using safe methods or practice. We were assured that the histories of people who live in this home are being sought and this needs to continue as they can be crucial in gaining insights into the requirements and needs of each person. This process should continue. We saw staff interacting with people who live in the home in a kind and respectful way. Staff have received further training in different subject areas since we last inspected the home so that people can have the confidence that they are in safe hands at all times. This needs to continue. Staff files that were sampled have all the relevant checks which confirms that they are Care Homes for Older People Page 8 of 39 not banned from working with vulnerable people. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 39 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 39 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. Information about what the service provides is available, but this needs to be updated so that people can make informed choices about whether or not the home is right for them. Individuals needs are considered prior to moving into this home which should make sure that each persons care and support can be properly planned from day one. Evidence: People who are considering living at Bluebrooke are given information about the home including facilities and services that are offered to meet individuals needs. This information is contained in a statement of purpose and service user guide. We are aware that these information guides have been reviewed by the current manager but there are some small inaccuracies. For example, in the statement of purpose it refers to Holy Communion services being held at the home and that the vicar visits. We were told that this used to be the case but these visits have not happened since April 2009. It is confirmed that the garden is safe but we were told that some further work is needed to make sure this is the case and that the garden area is truly secure. Also the Care Homes for Older People Page 11 of 39 Evidence: deputy managers name has changed but this is not reflected in the information supplied to us. The manager may wish to take another look at the statement of purpose and service user guide. In completing this task it would be beneficial to focus upon information shown in Schedule 1 of the Care Homes Regulations 2001 which is in relation to the statement of purpose. The service users guide should be reviewed with reference to National Minimum Standard 1.2 (Care Homes for Adults). The statement of purpose and service user guide could be made more accessible to all people regardless of their abilities if they were made available in different formats, such as, larger print, pictorial and audio visual. We were told that the statement of purpose can be found by the front door in the entrance hall of the home for people to pick up and read as they choose. In the Annual Assurance Assessment (AQAA) it tells us that the service user guide is in each persons room in a folder. This practice makes sure individuals are able to refer to it as they please to check their rights and responsibilities whilst living at Bluebrooke. There are ways to visit the home that assist individuals to meet people who live there and staff, view the facilities or experience a respite or trial stay. The statement of purpose says, Friends and family visit at their convenience and are able to spend as much time with their relative as they wish, creating a pleasant, family atmosphere at the Home. We spoke to one family member who told us that they had visited the home and it was the best one for their mum that they had visited. We were told the manager visits each person before they come to live at the home. At this visit the manager collects information about individuals needs in relation to their personal care, health, mental health and social needs. This is generally referred to as a preadmission assessment and makes certain that each persons needs are able to be met. Also staff have the practice guidance required before each person moves into the home. At the time of the last inspection there was not enough information for staff to follow so that individuals needs could be met appropriately and safely by staff on day one of them moving into the home. We looked at a preadmission assessment of a person who had recently moved into the home. We found that the preadmission assessment has some details about the persons needs but these could be expanded upon when transferring to care plans. This will be discussed further in the next section of this report, Health and Personal Care. It needs to be acknowledged that the manager is trying hard to make certain preadmission assessments hold all of the information required for each area of meeting an individuals needs. These also need to be dated each time they are completed with the managers and or assessors signature together with the persons and or their representative. This will make certain that all of the persons needs are agreed to be met at the time of assessing these and Care Homes for Older People Page 12 of 39 Evidence: is a useful tool for monitoring and reviewing purposes. It was positive to see that the persons dependency levels were documented in the care records we looked at and some have since been reviewed. These assessments assist the manager in making decisions about whether there are sufficient numbers of knowledgeable and skilled staff to meet each persons needs effectively from day one of the person moving into the home. This is an area of practice that is improving as on the records of the last person who went to live at the home the dependency levels of this individual was documented on the day the manager completed a preadmission assessment. All of the staff we spoke with told us that in the main individuals needs are met by enough staff being on duty at all times. We looked at the staffing rota and found that numbers of staff on each shift are maintained. We also examined the staff training matrix and found that there are some shortfalls in areas of planning and developing training to be certain that all staff are able to meet each persons range of needs, examples are given in the Staffing section of this report. Expert by Experience reported:- I also spoke to a relative who was full of praise the home has been wonderful I believe my mom is getting the best from the staff I am here everyday...the staff are supportive and we had an opportunity to discuss my mothers needs prior to her coming here. People who live in this home are older people who experience physical disabilities, dementia and learning disabilities. We were told that the home can accommodate up to forty three people and on the day we visited we were told that there were forty two people living in the home with one person in hospital. We saw that the homes registration certificate which was displayed for people to read if they choose confirms that it is registered with the Care Quality Commission (CQC) to accommodate forty six people. However, the manager told us that due to room sizes this has changed to forty three. If the provider wishes they can apply to CQC to have their registration details amended. Care Homes for Older People Page 13 of 39 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. Care plans and risk assessments need to be developed, to make sure that peoples needs are met and risks are fully assessed. This will help to ensure that people get the care they need in ways that suit them best, and be supported to stay safe from harm. People are supported by respectful staff to maintain their abilities and dignity. Evidence: As reported above, the manager is reviewing care management practice in the home and seven members of staff including the manager have completed risk assessment training in May 2009. At the last inspection it was noted that care plans did not hold sufficient details to be able to meet individuals needs and keep people safe. Aspects that required continued attention included staff having sufficient information to meet each persons needs short and long term, setting clear goals for staff to put into practice, developing person centred approaches and reviewing care plans and risk assessments. Sampling of peoples care records showed that some progress has been made and we found that the manager has highlighted individual care records with coloured tags where work is still in progress. Care Homes for Older People Page 14 of 39 Evidence: Three personal care and health records were looked at in detail and several further records were partially sampled. Each person has an individual plan, some detail what they are able to do independently and the assistance required for staff to help them maintain their health, wellbeing, independence and dignity. For example we saw, likes to choose their own clothes, uses own toiletries, hair is done by hairdresser weekly and so on. We spoke to several members of staff who were able to describe peoples needs well and show understanding of areas such as dementia. Staff also confirmed that when they come on to duty they are given information about each person which includes any concerns and or issues in relation to individuals health and wellbeing. In the AQAA it also tells us, Residents care is discussed at staff meetings, senior meetings and staff supervisions. We also saw in the care records we looked at that a named member of staff is assigned to each person who lives in the home and records their interactions with people which is discussed in the next section of this report. Relatives told us that staff provide good care to people. Some care should be taken to make sure that all care plans are completed in a timely manner. In one persons care records we noticed that the person has some mental health needs but a care plan for staff to follow in relation to their specific needs was uncompleted. This could result in the persons mental health needs not being met appropriately by staff practices due to lack of information in the care plan. However, it was positive to find that some information about supporting a person with behaviour that may challenge was in place for staff to read but this should not be used as a substitute for individual care plans. One person had a detailed care plan in relation to sore skin and this was dated two days after the person came to live at the home. We saw that district nurses visit the home to apply dressings to the persons skin to make sure it heals appropriately. However, if the dressing comes off in between the nurses visiting the home staff are requested to complete this task. We discussed this with the manager and confirmed that there needs to be guidance for staff to follow to make certain that the persons sore skin is redressed appropriately and consistently by all staff. Without this practice confirmed in the care plans then we cannot be certain that the persons sore skin is being redressed appropriately by all staff to aid the healing of their skin. A care plan for a person who has diabetes was in place but this should have some guidance for staff in relation to this persons dietary needs when they have a medical condition, such as, diabetes. We discussed this with the manager because whilst they are reviewing care plans and risk assessments details can be added to enhance staff members knowledge to promote individuals needs. This is particularly important as we could not see that any staff members have received any training in the area of Care Homes for Older People Page 15 of 39 Evidence: diabetes and or nutrition. A care plan for a person who needed pureed meals was detailed and provided staff with some information. This could now be expanded in the section which refers to care need and problem to include the reasons why the person has these nutritional needs as the plans we looked at just said nutrition as the care need and problem. This would mean that all staff have this detailed information to hand when following care plans and or risk assessments. While we could not identify a poor outcome for this person, care should be taken that all relevant information is entered into all sections of peoples plan to prevent any oversights and mistakes. The plans provided some details of peoples individual needs, likes and dislikes but this was not consistent. For example, the Expert by Experiences observations told us:I was somewhat worried about a resident who was in the activities room for the whole time I was on site.... This resident did not join the others at the table...I believe she was fed in the activities room...I also noticed that this particular ladys clothes could also have been better looked after, they appeared to be not pressed and maybe a size too big making them look droopy. Although this person has care plans it was unclear from these as to the preferences of this person in relation to their dressing. Also another person who lives in the home referred to a regime that was linked to having specific showering days. Some plans were based around tasks rather than about the person. Therefore it is recommended that all staff receive training in person centred care. This should help them to plan peoples care in a way that meets their individual needs. To assist this process preadmission assessments, care plans and risk assessments should be in appropriate formats so that people living in the home and or their representatives are able to take part in each process. For some people who live in this home it is important that their family members and or representatives confirm the persons choices and goals in meeting their needs. This is because some people are unable to verbally express their own view points without a lot of support from staff due to their mental health needs and or being unable to communicate verbally. We looked at the care records of a person who requires staff to support them with their behaviour. These contained information to support the manager in being proactive in contacting external professionals, such as doctors, community mental health nurses, social workers and so on. Therefore gaining other professionals assessments in helping staff to assist this person in managing their behaviour appropriately. The care plans for this person reflected that they had been reviewed at Care Homes for Older People Page 16 of 39 Evidence: differing stages so that any changes to the care and risks to this person were documented for staff to follow. There needs to be some care in making certain that these are all dated and signed so that they can be monitored and reviewed in a purposeful way. We also observed this person and how staff responded to them throughout the time we were at the home. Staff interactions with this person were seen to be done in a respectful way, such as, taking time to acknowledge the person. We also saw staff actively listening to this person in a way that supported the management of their behaviour with strategies used from the persons past life to gain an understanding of any anxieties they may have. Documentation includes a number of risk assessments which help staff to determine the level of risk and then decide the actions to be taken to minimise this risk. The risk assessments we saw included, risk of sore skin, nutritional needs, falls, stiff joints and limbs, isolation and moving and handling. We saw one moving and handling assessment which detailed staff practices in relation to two members of staff needing to use a hoist and sling. However, as discussed with the manager there should be specific details about the type of equipment staff need to be using with each person. For example, type of hoist and size of sling so that people can be confident that the equipment staff use to assist individuals promotes their safety at all times. It should be noted that the manager did write these details on one persons records at the time of our visit once we had discussed these key points. As reported the manager is rewriting care plans and risk assessments where appropriate so that any omissions or changes can be rectified to provide staff with current information. The manager should make this a priority so that people living in this home can be confident that all of their needs will be met in a consistent manner to promote their health, wellbeing and safety at all times. As at the last inspection most aspects of the management of medication were carried out in a satisfactory way. Medication is supplied to the home in blister packs. This means that the pharmacist supplies medication in a sealed named pack. There are electric medication trolleys where some medications are stored. The electric trolleys cannot be moved without a key to start this operation. Following the last inspection it was noted that there was no thermometer to monitor the temperature medications are stored to ensure these are stored in compliance with their product licenses. However, we saw that there was a new thermometer which the manager told us had been purchased due to the old thermometer not working. We looked at the administration of medication for three people who live in the home. Care Homes for Older People Page 17 of 39 Evidence: Reasons for administrations of medications looked accurate apart from one persons specific medication which we could not clearly audit due to needing the previous Medication Administration Records (MARS). The manager assured us that they would make certain the previous MARS is now checked so that all medication can be accounted for. Since our inspection the manager has told us that this persons medication has been audited and it does tally with the MARS so that we can be sure the person is receiving their medication as directed by their clinician. An area of practice that has improved since our last inspection is the protocols for medicines that have been prescribed,As required. The manager showed us that these were now in place for each person. These guide staff about when these type of medicines should be administered and in what doses so that staff have consistent protocols which they all follow to ensure people are not placed at risk. We were told that untrained staff do not administer medication but they are allowed to countersign that a medication has been given. Upon studying the staff training matrix that was given to us we saw that seven members of staff had completed medication training in August 2009 and the staffing rotas confirmed that staff who have received training cover all shifts. We were told that if staff have forgotten to record any administration of medications on the MARS then this is picked up by the manager and or deputy manager who audit the MARS daily. This practice ensure people remain free from any potential risks in relation to the administration of their medications by staff. In the main staff were observed to assist people discreetly in order to maintain their dignity and to be respectful to each person. It was reported at the last inspection that this was not observed to be always the case and there were shortfalls in staff practice in these areas. However, the staff training matrix told us that seventeen staff completed dignity and care training in July 2009. We saw that there has been some improvements in staff practices which now need to continue and be sustained to uphold each persons rights to good care together with valuing each person who lives at Bluebrooke. Care Homes for Older People Page 18 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities for activities are currently being developed. Therefore we cannot be confident that each persons lifestyle experiences match their expectations and satisfy their social, cultural, religious and recreational interests. Each person is assisted to maintain contact with family and friends. The food is nutritious and well balanced. Evidence: At the last inspection it was reported that activities for people living in this home were lacking but an activity co-ordinator had been employed. We spoke with the activity coordinator to find out how the planning and arranging of activities was now achieved for each person who lives at the home. The activity co-ordinator told us that they work from 08:00 until 16:00, Monday to Friday. We asked the activity co-ordinator who provided activities at weekends. The activities co-ordinator told us that staff would normally do this unless there is a planned event and then the activity coordinator would come into the home at weekends. Individuals birthdays are sometimes celebrated on Saturdays. The activities co-ordinator told and showed us the separate records they are developing for each person who lives at the home. These records are accessible to staff at weekends so that they have information about a persons preferences and are Care Homes for Older People Page 19 of 39 Evidence: able to record the activities each person has participated in. The activities co-ordinator is continuing to get to know each person who lives at the home and is requesting that life stories are compiled with the help of people, their relatives and friends. These can then be used by staff to get to know people and help them retain their memories. The activities that are provided include, music, games, knitting, nail care and one to one time for people who cannot or do not wish to participate in group activities. Local school children have visited the home to join in celebrations for harvest festival. Some people who live in the home have recently been on a trip to Western-Super-Mare and brought back some fish and chips together with sand to enable people who did not go, to enjoy some of their day. This was a nice touch and photographs were taken to preserve the memories for all. The Expert reported:I observed a group of residence with the activities co-ordinator in one of the lounges. Residents appeared content to with retail therapy of their mini car boot activity. Residents interviewed indicated that there was a variety of activities offered by the home...the co-ordinator explained that there was always a schedule of activities on the Notice board. I was not sure how the residents accessed this schedule in order to make informed decisions. From our discussions with some staff it is clear to see that activities do need to be further developed so that these are based upon individuals aims and goals as well as groups. The Expert also made this observation, Socially, I observed residents interacting with each and sharing jokes. The staff also interacted with most residents. My thoughts are that interaction is work in progress as the residents could use more one to one interaction. We are confident that the activities co-ordinator will look to do this so that peoples aspirations and self esteem are promoted by individuals being supported to lead meaningful lives. We will of course look at all progress in this area for people who live in the home when we next complete our inspection visit as a measurement to ensure good outcomes for people in relation to social activities and stimulation. We looked at the minutes from a residents meeting and saw that people wanted to have a trophy which could be presented to the person who won at bowls. The person could then keep the trophy in their room until the next person won it. It will be interesting to see if this idea is developed further for people so that individuals aspirations are helped to be achieved. Care Homes for Older People Page 20 of 39 Evidence: The manager shared with us that a shop has now been set up and has been named after the handyman as, Humphries. People who live in the home are able to purchase items with the use of vouchers. We were told how this is helping to assist the staff in managing individuals anxieties about going shopping and or buying certain items for family members as they once did in their past lives. This shows a real sense of initiative on the part of the manager and staff which has become an important part of peoples lives. There are further plans which relate to the garden area which will be discussed in the Environment section of this report. The statement of purpose tells us that people can receive Holy Communion and the vicar visits. We were told that these religious services have not happened since about April of this year. Therefore we asked the activities co-ordinator if they were aware of any person who lived in the home that would need support to follow in their chosen religion. The activities co-ordinator was uncertain about this but assured us that this will now be looked at as it may be important to some people who want to follow their chosen religion. This is a further example of the shortfalls in connection to staff taking a person centred approach to meeting each persons needs. It is important for some people to have the support to meet their religious, spiritual and cultural needs. The hairdresser visits each week and we saw in the care records that we looked at that peoples preferences were documented in relation to having their hair dressed. As mentioned earlier in this report each person has a named member of staff who forms a close relationship with individuals and regular records are maintained which reflect peoples likes, dislikes, moods and personal routines. These records also confirm when the staff member has spoken with relatives, or the person needs some toiletries, assisting the person to tidy their drawers to sewing buttons onto garments for the person when needed. We also saw daily recordings where staff have noted what type of day a person as had, how they have assisted the person in relation to their personal hygiene needs, meals, drinks and whether there have been any concerns that day which all staff need to be aware of. We saw that staff try to maintain flexible routines for each person although people may need familiar routines to settle in and for orientation. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. We saw relatives visiting on the day we were at the home. Relatives told us that they regularly visit the home four or five times per week or sometimes more and shared with us:- Care Homes for Older People Page 21 of 39 Evidence: I am always greeted with a cup of tea. Staff are always friendly and obliging. The home is able to cater for diets for medical or cultural reasons and for personal preferences. As we discussed earlier in this report we saw care plans and nutritional assessments for a person who required a liquidised meal with assistance from staff. One relative said, I am able to spend some time over Christmas here and share in the meals offered. We also noted in another persons records that their family member visits the home regularly to and is able to support their relative with meals. The Expert reported:I opted to have food with the residents in the dining room. Staff serving the meal were appropriately dressed in line with Food Safety Guidelines. The Chef was exemplary in her dress code they also maintained hygiene and safety on the equipment used. The staff offered a choice menu for both the main meal and everyone was offered dessert, one of the residents said that she always enjoyed her meals. I would describe meal as adequate. Most of the residents that I observed appeared to enjoy their meal. During meal time I went round to 4 tables and spoke to about 10 residents. They indicated that they were happy with the food and said the menus were varied and they were consulted. There was one person who said that they would be appreciative if they had access to the kitchen to make their own hot drinks. He same resident also said that they had been promised curry night and they were looking forward to it. Care Homes for Older People Page 22 of 39 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. Some people are happy that their concerns are listened to and taken seriously. Others may need more support to ensure that any concerns they have are raised and dealt with. People feel safe in their home and are generally protected from abuse, neglect and self harm. Evidence: As was reported at the last inspection we were told that the complaints procedure is displayed in the home and is included in the statement of purpose. The Expert reported, Of the residents that I interviewed none of them appeared to have made a complaint at any point regarding the service. It was not clear to me as to whether the complaints procedure was clear to them. The home could experiment with a more accessible complaint format for people with little communication to use. This is to ensure that people are actively encouraged to voice any concerns they might have, and get the support they need to do this. It is suggested that this could be a standing item on the agenda for every residents meetings. Also, that individuals named staff members could ensure that this was taken up with people on a one-to-one basis at regular intervals, and formally recorded. In this way, people who might be unsure or lack confidence to raise issues could be helped to speak up about anything that concerned them. It should be acknowledged that relatives spoken to during the inspection appeared to be aware of who to speak to if they were concerned about anything. Care Homes for Older People Page 23 of 39 Evidence: There have been no complaints received by the manager since the last inspection. However, the recording of complaints can be found in the file that is used to keep these in which we were shown. The manager confirms in the AQAA that they have a copy of the Worcester Multi Agency Guidelines and this should ensure that staff have guidelines to follow in the event of any allegations of abuse. Also the AQAA confirms that abuse and adult protect is discussed in staff supervision. The training matrix confirms that eighteen members of staff have received training in Protection Of Vulnerable Adults on the 22nd September 2009. This is positive as there was a lack of staff having received this training was noted at the time of our last inspection at the home. Further training should now be planned and dates placed on the training matrix, (this will be discussed further in the section referred to as staffing), so that all staff will have received this training so that they have the knowledge to safeguard people from harm. The service notifies us of any incidents affecting the welfare of people using the service and staff are able to say what they would do if they saw any abusive situations. In the main the recruitment procedure has improved so that people are protected from harm. It would be good practice if all staff files were audited and organised so that information can be easily found. In the statement of purpose it tells us, A resident may have a lockable door on their bedroom if they wish, providing staff hold a master key in case of emergencies. We were told that no person holds their own room keys. In three case tracked records we could not find an assessment about people holding their own room keys or a consent form which shows people have been given this choice. The manager confirmed that these were in place. The training matrix does not confirm which staff have received training Deprivation of Liberty Safeguarding (DOLS) but we did see a date of 31st July 2009. This training examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves. This practice should be followed to ensure that their liberty is not denied. This training is important as some people living in the home have some form of cognitive impairment. It needs to be acknowledged that whilst sampling care records we did find that care is not forced and appropriate people are consulted when best interest decisions are needed. However, it is suggested that whilst care plans and risk assessments are being reviewed the checking on individuals throughout the night period should be fully documented. Documentation should reflect that the person has agreed to night checking practices, if they have the capacity to make this decision and or their Care Homes for Older People Page 24 of 39 Evidence: representative. It was reported at the last inspection that, We were not confident that staff always understood the physical and verbal aggression displayed by the people living in the home and that they dealt with this in a way that safeguarded people appropriately. We did not observe any incidents of physical and or verbal aggression on the day we visited the home. However, there are some people who live in this home that do have mental health needs, such as, dementia, who may develop aggression and may not be in control of their actions and can pose a risk to others. We saw one persons risk assessment which provided staff with information about managing this persons behaviour. There were possible triggers identified so that staff can intervene at early points to prevent aggressive incidents as well as respond to them. We also looked at the staff training matrix to see what training staff have received to manage peoples mental health needs and found a date of 21st October 2009 for dementia training. However, this date was not placed by any of the staff names and no staff apart from the manager has been indicated as having received this training. Therefore we recommend that all staff have training in this important area to give staff more skills and be confident so that individuals needs are met in an appropriate way that safeguards the person and other people who live at this home. It should also be acknowledged here that the training matrix may need to be further updated if staff have received this training. Individual care plans and risk assessments are reviewed after falls and incidents. As referred to in the section, Health and Personal Care, care plans and risk assessments must continue to be developed so all needs and risks are identified with the appropriate equipment and or aids specified to keep people safe. However, as reported earlier in this report care plans and risk assessments are currently being reviewed and this practice must continue so that we can be confident that all people are safeguarded from harm. Care Homes for Older People Page 25 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean, comfortable and safely maintained. People are able to bring their own possessions, and equipment is provided for their needs. Improvement must continue in the areas of signage, decoration and a garden that is secure to meet individuals needs. Evidence: There have been a number of improvements to the environment since our last visit and the home has further plans to enhance the living environment for the people who live there. The home is three storeys high with a lift so that all people can access rooms where necessary. There is a large dining room with several smaller rooms where people can choose to sit to chat with other people, watch television, listen to music or just sit in a quieter area. There is a kitchenette area where refreshments can be made. Staff are employed to complete domestic duties in the home and there is a dedicated person who tends to the laundry. Staff spoken with told us that positives are that there are no smells in the home, new carpets and redecoration have been completed. On the day we visited there were no offensive odours. One relative said, It is spotlessly clean and always smells fresh and this was also confirmed by another relative. We saw paper towels and liquid soap in toilets and bathroom which promote Care Homes for Older People Page 26 of 39 Evidence: good infection control practices. We looked on the staff training matrix to see how many staff had received infection control training but this was not indicated on the matrix apart from a date of 29th October 2009. We looked at the AQAA and this did not confirm how many staff had received infection control training. However, at the last inspection it was reported that only eight staff had received this training. In the AQAA the manager has stated, Go further with adapting the environment for people living with dementia. We found that communal areas have been redecorated in more neutral colours and there is a homely feel where we saw a variety of chairs for people to sit in. It was pleasing to see that some walls had pictures on them of advertisements for, pears soap, bisto and so forth which people would be able to remember from their past lives. We also saw some rooms now had signage displayed on them letting people know that this is a toilet or bathroom as this was lacking when we last inspected the home. The corridors are sufficiently wide enough to allow people at the home freedom to move around with any equipment they are assessed as needing. We saw that a corridor was being repainted. The home has equipment and aids, such as, hoists to assist people to change their position and have special mattresses for people who are at risk of developing sore skin. There are both walk in showers and assisted baths so that people can choose what they prefer. Call bells are in place so that people could use them if they needed to call for help. As mentioned earlier in this report there is a handyman who is employed to complete any repairs and we were told that this person goes the extra mile to make sure that people live in a home which is comfortable. We looked at the bedrooms of some people we case tracked and found that these were personalised with items that reflected individual choices and preferences. People had the equipment that they had been assessed as needing. Also some of the bedrooms now had signage on them to guide people in recognising their own room which is important as some people experience varying levels of dementia. This now needs to continue to make certain that all rooms have signage that people who live in the home can recognise when looking for their own rooms. We discussed the use of memory boxes with the activities coordinator which could be displayed by each persons room with items that are personalised to reflect individuals past lives, experiences and interests. Care Homes for Older People Page 27 of 39 Evidence: Work had been completed in making the corridors themed, for example, names of streets. We also saw photographs displayed of people enjoying their days and events that happened. Corridors could be further improved by placing items with different textures on shelves for people to touch and feel. All of these improvements will enhance the environment in which people live and make certain that it meets all of individuals needs including their mental health together with their sense of well being. The Expert reported:One resident commented on the beautiful gardens but sometimes there was no chance to get out and enjoy it as much as they would have wanted to as that would need an escort for health and safety reasons. It was reported at the last inspection that the garden area was not secure so that people could use this as they choose. We discussed this with staff and there is ongoing work being done in the garden area and it will be made secure so that people can choose to use this area to gain some fresh air. We were told about the shop and that projects that are being discussed. For example, sectioning parts of the garden into different areas, such as, to transfer garden shed into a tea room and another part of the garden as a memorial dedicated to people who have died. There is also a rabbit. We were told the area where the rabbits hutch is could be fenced around so that this can be used by all people without the need for constant supervision by staff which can often limit the options for people to use the garden as was found at the previous inspection. Care Homes for Older People Page 28 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training needs to be further developed so that it is planned and provided in an organised way so people can be confident that all staff have received the training required to meet individuals needs. The recruitment process make certain that people are protected from harm. Evidence: Staff surveys were not returned to us, so we examined four staff files and interviewed two staff and sampled rotas. It was reported at the previous inspection that the provider may need to review the levels of staffing in the late afternoons as we were told by staff that some people became particularly unsettled at this time of day. There were five staff covering the late shifts. Some staff said that sometimes there is a shortage of staff. We were told that the current staffing is:AM - 4 care and 2 senior care staff members PM - 4 care and 1 senior care staff members Night- 2 care and 1 senior care (waking night staff). We noticed on the staffing rota that was given to us for the period, 19th October to the 15th November that in the main staffing levels were met as detailed above. Although it is acknowledged that at times staffing does decrease by one member of Care Homes for Older People Page 29 of 39 Evidence: staff on some of the shifts. The AQAA tells us, We employ a rigorous employment programme in the home staff hours are calculated using the residential forum from service user dependency. However, as mentioned earlier in this report in some of the care records we looked at the dependency assessment which informs the manager how many staff the person needs to meet their needs has not always been completed in a timely manner but this is improving. As mentioned earlier in this report in addition to the care staff there are also laundry, domestic, kitchen, maintenance to meet all the needs of the people who live in the home. We observed good interactions between staff and people who live at the home during our visit and there was a pleasant atmosphere in the home. The Expert who also shared their observations:On the whole the environment appeared to be welcoming for visitors and conducive for the residents. There appeared to be a relaxed work environment. I also thought that the residents seemed to get adequate care based on their responsiveness to questions around food and staff involvement with residents. We looked at three staff files and these were found to have all the required checks prior to employment beginning to ensure that people were safeguarded from harm. It is acknowledged that one staffing file was of a person who had not as yet commenced their employment at the home so some documents were still being sought. When we next inspect the home we will look at this file again. However, the files we looked at showed that the information required was now in place which is an improvement. We saw copies of completed applications, two written references and evidence of checks with the Criminal Records Bureau (CRB). Examined files also contained copies of job descriptions, declarations of medical fitness to perform allocated duties but we did find that there was a lack of copies of staff members training certificates. Good auditing of staffing files would make sure all of the information was indexed and organized to make documents easier to retrieve. It is recommended that peoples qualifications and training certificates are properly indexed on their personal files, for ease of reference. We spoke to several staff members who told us they have had access to a lot of training recently and the manager is very supportive of training. The AQAA shows that twenty-five staff are trained to National Vocational Qualification (NVQ) Level 2 or above, and that training provided meets national standards and statutory guidelines. Care Homes for Older People Page 30 of 39 Evidence: It should be acknowledged that the training matrix only indicates that six staff are trained to NVQ Level 2 or above. As reported above, sampled files contained evidence of peoples qualifications and some training. We saw that some staff have received training in moving and handling on the 5th January 2009 for 25 staff, first aid on the 12th May 2009 for 5 staff, dignity and care on the 2nd July 2009 for 17 staff, medication training on the 18th August 2009 for 7 staff, risk assessment training took place on the 13th May 2009 for 7 staff. However, the training matrix does not provide a true picture of individuals training and development plan for the staff team. For example, there was gaps in infection control with just a date of 26th June 2009, food hygiene date of 5th November 2009 and fire training 28th September 2009. We found that on one staff members file it indicated that they had received health and safety training in January 2009 but health and safety training is not indicated on the matrix. However, the lack of a proper training and development plan for the staff team makes it difficult to assess fully the effectiveness of the training programme. We do acknowledge that we saw some staff certificates being organized. It is recommended that a spreadsheet or chart covering staff training and development should be set up. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including refreshers, and dates when outstanding training is to be delivered. It is suggested that doing this could provide the manager with an effective tool for monitoring and updating the training and development needs of the staff team. Staff who we spoke with confirmed that they were receiving regular supervision. Without exception staff said that supervision sessions were now supportive and staff felt comfortable in sharing any issues as in the past supervision was sometimes used as a form of punishment by former management. In the AQAA the manager confirms, I offer an open Managers door and staff can speak to me at any time with problems or concerns. Staff spoken with confirmed that this was the case. Care Homes for Older People Page 31 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is striving to provide a person-centred service, which people benefit from and their financial interests are safeguarded. Management systems and procedures need to develop and staff competence, so that peoples health and wellbeing are proactively protected. Evidence: As reported at the last inspection of this home there is a manager who came into post in January 2009 and previous to this they were deputy manager at the home. The manager told us that they have completed Registered Managers Award (RMA) and is now undertaking NVQ Level 4. As was reported at the last inspection the manager is not as yet registered with us. However, the manager did show us that they have documentation ready to send but are awaiting further documentation from their doctor. The manager is supported by a deputy manager and on the day we visited the director Care Homes for Older People Page 32 of 39 Evidence: for operations was present for some of the inspection. A Regulation 26 report, which tells us about the quality of the home, was seen for October 2009. The manager stated that these were completed monthly as required and we found this to be the case. Subject areas that are covered are, environment checks, speaks with residents and staff, audits care plans and medications. We saw some questionnaires that had been completed by people who use the service, their relatives and or representatives. Comments, such as, friendliness of staff, the home from home feel, friendly atmosphere, relaxed, appeared very clean and odour free. Minutes of residents and committee meetings were available for inspection. These show that meetings take place regularly and we saw that residents raise improvements they would like to see and what activities they would like to see. We saw that staff meetings are held regularly and these are in differing forums, such as, seniors, general staff and housekeepers. All of these processes should help and provide the manager with some direction when considering further improvements within the home and what areas need further work. It would also be good practice for the manager to use this information to create an annual development plan for the service. We did review some peoples personal money on this visit and found that there is a robust system in place which meant that peoples money was held safely. Safety records were sampled. The fire alarm and emergency lighting systems have been checked regularly and a written record of tests maintained. Fire fighting equipment has been serviced. Fire drills have been carried out on a regular basis with the names of staff who took part. The Landlords Gas Safety and Electrical Circuit Certificates are both in date. The Control of Substances Hazardous to Health (COSHH) cupboard was secure, as required. We looked at how accidents are reported and recorded. One recorded accident reported that the person had experienced a fall in the home. It told us what injury the person had experienced but it did not tell us what staff did in relation to injury sustained. It is recommended that all sustained injuries to include grazing and or bruising all staff should record what they did whether it was observations and or cleaning and dressing an area for the person involved in the accident. In the AQAA the manager states what their plans are for improvement in the next twelve months as, Lots more ideas to improve Bluebrooke further. It is clear from our visit that many areas in the service have been improved and requirements from the Care Homes for Older People Page 33 of 39 Evidence: last inspection have been met. However significant areas for improvement remain. Therefore the manager now needs time to sustain improvements and work on other areas that still need improving. We have provided examples throughout this report. This should ensure that people living in this home are receiving person centred care and support. This means promoting individuals diverse needs in personal and health care, mental health, physical needs together with social stimulation including personalised activities. Care Homes for Older People Page 34 of 39 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 35 of 39 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 7 13 All risk assessments must 04/12/2009 provide staff with all of the detals and gudiance required to meet a persons needs. This must include specific details of the type of euipment and or aids used. Where hoists are concerned the type of hoist and size of sling. This will make certain that staff have the specific gudiance required to meet individuals needs and minimise all areas of risks whilst doing this. 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 Written information in the statement of purpose and service user guide should be updated to reflect factual details. This will make sure that any changes in the service are detailed so that people can make an informed decision Page 36 of 39 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 about the home. 2 1 The registered person should ensure the statement of purpose and service users guide are made avaliable in accessible formats to suit individuals needs, such as, large print, pictroial and audio visual. You should ensure that all care plans reflect peoples personal goals, which should have outcomes that can be clearly measured. This is so that people can see whether or not goals set have been achieved, when plans are reviewed. Develop the use of person centred approaches in order to make this happen. Once care plans have been reviewed the manager should undertake a regular audit of care plans to ensure that all relevant information is entered into all sections of peoples plan, to prevent oversight and mistakes. It would be good practice to gather a life story about a person during their assessment and after they have moved in, which would help personalise the care and support they receive and improve their quality of life. You should ensure that recording of peoples activities is done in sufficient detail to show how choices were made, the purpose of the activity and what was gained from it. Show clear links between activity opportunities and peoples agreed goals and care plans. Doing this will help people achieve their goals and improve their quality of life. Information about activities, meals etc provided for people living in the home should be avaliable in larger print and if needed in other formats. You should ensure that everyone using the service is actively encouraged to voice any concerns. Having this as a standing item on the agenda for residents meeting could help to achieve this. This is so that the service can make sure that concerns are being addressed. Action should continue so that there is unrestricted safe access to the garden area and that the garden environment is safe to use without continual staff supervision. Improvement must continue to provide additional visual clues and orientation aids so that people can find their bedroom easily. 3 7 4 7 5 12 6 12 7 12 8 16 9 20 10 22 Care Homes for Older People Page 37 of 39 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 11 30 You should continue to develop the staff training and devlopment programme and keep clear records of this to provide evidence of the training staff have acheived together with any refreshers needed. The manager must continue to progress their application to be registered manager of the home with CQC to demonstrate their commitment to providing commitment and stability for the benefit of residents and staff. You should ensure that the system for evaluating the quality of the services at the care home is fully implemented, and a written report of the outcomes made available to all interested parties. This is so that it can be seen that the views of people who use the service underpin the way in which it is reviewed and developed. All reporting of accidents should be confirm what actions staff have taken in relation to any injuries to people liviing in the home so that evidence can be found to show approrpiate actions were taken at the time of the incident. 12 31 13 33 14 38 Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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