Care Home: Bowburn Care Centre

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What the care home does well The home provides prospective residents with whatever length of time they need to decide if they wish to live at the home. Detailed information is collected about a new person coming to live at the home to help ensure staff can provide the necessary levels of care and support to the person. There are good arrangements for people to maintain contact with their family and friends. People have the opportunity to follow their religion if they wish to. The home is spacious with a well tended garden for people living at the home to enjoy. People enjoy a varied and nutritious diet and home baking. What has improved since the last inspection? There is an on going programme of decoration and refurbishment around the home. The staffing levels within the home are being increased to help ensure there are enough staff to meet the needs of people living in the home. A deputy manager has been employed to help the manager in the running of the service. A mini bus has been purchased for the use of people living in the home and the day service. Extra moving and assisting equipment has been purchased to help meet the moving and assisting needs of people living in the home. Some low beds have been bought for people at risk of falling to help reduce risk of injury to them. An activities organizer is employed to work at the home and there are plans to recruit an additional activities organizer. Some staff have received training about providing activities for social stimulation. The level of staff training is continuing to improve. Over 90% of carers have achieved National Vocational Qualifications (NVQ) at levels 2 or 3. What the care home could do better: The care plans for people living at the home must follow clinical guidelines including those people at risk of falls or who have behaviour that is difficult to work with. Risk assessments must be carried out for all people at risk of falls or who have behaviour that may be difficult to work with. Care records of people living at the home must contain all the information as detailed in Schedule 3 of the Care Home Regulations 2001.This includes evidence of referrals or visits by health professionals such as G.Ps, consultants,psychologists and occupational therapists. Capacity and consent forms should be completed for people who are unable to make decisions recording any decisions made by staff on their behalf. Life histories must be completed for all people living at the home to provide staff with more information about people for when they are unable to give this information themselves e.g.likes,dislikes,events of importance. Staff must be able to interact with people living at the home and engage in activities and provide meaningful interaction. Carers should receive more in depth training about working with people with memory loss. This should help them understand the support needs of people with dementia and memory loss to help involve them in decision making in their daily lives and help protect them against possible abuse. Challenging behaviour training must be provided to all staff to help ensure individualized care and support is provided to people living at the home. The environment must be suitable for people with memory loss in order to maintain their independence as far as possible. If people move to temporary accommodation some of their personal possessions should be moved with them to help reduce confusion to the individual. Menus should be available in large print and in different formats to remind people of the food available daily. Staffing levels should be kept under review as people become more dependent and to provide the necessary supervision if people on the units are in their bedrooms as this is on a different floor of the home from day time accommodation. Health and safety and risk assessment training must be provided to staff to help ensure the health and safety of people living in the home and staff. Moving and handling training must be up dated for staff after taking advice from the safe guarding occupational therapist. Regular staff meetings should take place within the home in order to help communication. Systems must be put in place to help ensure the smooth running of the home and to help improve communications within the home. Quality assurance systems need to be introduced to help give feedback about the quality of care provided and to help ensure the health and safety of people living and working at the home. Key inspection report Care homes for older people Name: Address: Bowburn Care Centre Durham Road Bowburn Durham DH6 5AT     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: Karena Reed     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Bowburn Care Centre Durham Road Bowburn Durham DH6 5AT 01913778214 01913778063 bowburn@guardian-care.com www.guardiancarehomes.co.uk Guardian Care Homes (UK) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Keith Garside Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category of service only: Care home with nursing - Code N 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 - Code OP, maximum number of places: 34 Dementia - Code DE, maximum number of places: 44 Physical disability - Code PD, maximum number of places: 5 Date of last inspection 44 0 5 Over 65 0 34 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Bowburn Care Centre is a purpose built two-storey building situated in the village of Bowburn on the outskirts of Durham. The home was registered 16th February 2005 with the Commission for Social Care Inspection to provide accommodation for 80 service users and provides residential and nursing care for older people. The home is divided into 5 separate named units, Harvey, Tilley, Hutton, Low Main and Brockwell. Sleeping accommodation is on both floors with service areas, communal lounges and dining areas located on the ground floor. There is a large courtyard garden for service users to sit in and enjoy. The home also have a separate day care facility that shares its main entrance with the home but is separate from the homes facilities once inside. A Statement of Purpose and service user guide are available at the home. The guide describes the services and facilities provided by the home and how staff are trained to meet the care and support needs of people living at the home. CQC inspection reports are also available at the home detailing the quality of care provided. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit: We looked at information we have received since the last inspection, how the service Care Homes for Older People Page 6 of 33 dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people and the views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on March 25th 2010. During the visit we talked with people who use the service and staff. We looked at information about the people who use the service and how well their needs are met.We looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for,looked around the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The care plans for people living at the home must follow clinical guidelines including those people at risk of falls or who have behaviour that is difficult to work with. Risk assessments must be carried out for all people at risk of falls or who have Care Homes for Older People Page 8 of 33 behaviour that may be difficult to work with. Care records of people living at the home must contain all the information as detailed in Schedule 3 of the Care Home Regulations 2001.This includes evidence of referrals or visits by health professionals such as G.Ps, consultants,psychologists and occupational therapists. Capacity and consent forms should be completed for people who are unable to make decisions recording any decisions made by staff on their behalf. Life histories must be completed for all people living at the home to provide staff with more information about people for when they are unable to give this information themselves e.g.likes,dislikes,events of importance. Staff must be able to interact with people living at the home and engage in activities and provide meaningful interaction. Carers should receive more in depth training about working with people with memory loss. This should help them understand the support needs of people with dementia and memory loss to help involve them in decision making in their daily lives and help protect them against possible abuse. Challenging behaviour training must be provided to all staff to help ensure individualized care and support is provided to people living at the home. The environment must be suitable for people with memory loss in order to maintain their independence as far as possible. If people move to temporary accommodation some of their personal possessions should be moved with them to help reduce confusion to the individual. Menus should be available in large print and in different formats to remind people of the food available daily. Staffing levels should be kept under review as people become more dependent and to provide the necessary supervision if people on the units are in their bedrooms as this is on a different floor of the home from day time accommodation. Health and safety and risk assessment training must be provided to staff to help ensure the health and safety of people living in the home and staff. Moving and handling training must be up dated for staff after taking advice from the safe guarding occupational therapist. Regular staff meetings should take place within the home in order to help communication. Systems must be put in place to help ensure the smooth running of the home and to help improve communications within the home. Quality assurance systems need to be introduced to help give feedback about the Care Homes for Older People Page 9 of 33 quality of care provided and to help ensure the health and safety of people living and working at the home. 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 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service are carried out before they move into the home to ensure all their needs can be met. Evidence: The Statement of Purpose and service user guide were examined. The Statement of Purpose is a pre-printed document which requires the provider to input individual information about the service. It contained the necessary information as required by the Care Homes Regulations 2001. They were available in a different format for people who had difficulty seeing the written version. A disk was available which contained important information to help people make an informed choice about the home. Records for eleven people who live at the home showed that when they were admitted to Bowburn an assessment of their care needs had been carried out before their admission by a social worker or health professional. This assessment is forwarded to the home for the manager to look at to determine if the needs of the person can be Care Homes for Older People Page 12 of 33 Evidence: met. The manager or senior staff carry out a pre-admission assessment to ensure that the staff can meet each individuals needs. The person living at the home and relevant people are involved in the assessment. These initial assessments are used to create care plans. The manager said that any person interested or needing to use the service or relatives are encouraged to visit the home to have a look around and meet the staff. People have the opportunity to visit the home as often as they need in order to decide if they want to live there. A prospective resident may come for meals, have overnight stays and be introduced to other people who live at the home at a pace suitable to the individual. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate arrangements in place to ensure the health and personal care needs of people living at the home are met by staff. Evidence: The care files of eleven people that use the service were looked at during the visit. New care planning documentation was being introduced. There was not a consistent standard of record keeping amongst the care records of people who live at the home. Only one file looked at contained comprehensive and completed documentation to help staff meet all the needs of the person. Files did contain a detailed assessment of needs for the person. One file looked at showed clear evidence of nutritional and continence screening, moving and handling assessments,risk assessments for falls and pressure care,well being indicator, a pain assessment tool, a history of the person including interests, family details and other important and useful information. However this was not available on all care files. Care Homes for Older People Page 14 of 33 Evidence: Files looked at did not contain activity records, or a record of GP or out patient and other professional visits on the care file of the person. There was no capacity assessment including use of a capacity and consent form for people who may require decisions to be made on their behalf. There was not clear evidence of the involvement of GPs, District Nurses and other health care professionals, such as chiropodists. This information was not routinely available on the care records of people living at the home but rather had to be tracked from elsewhere. People living at the home confirmed that if they were feeling unwell, the GP would be called. There was evidence of several recorded falls of people living at the home especially on the high dependency unit, which is a unit providing care to people with severe memory loss, but there was no evidence of an audit of these falls. The manager did state that a new reporting system had been introduced so he would be made aware of any falls which occurred which would then require managing. The issue regarding the lack of observation of falls on the high dependency unit is one of the areas which has been investigated by the local authority safeguarding team and the necessary advice is being given to the home about how to manage this. Some referrals have been made to the falls clinic to assess people more at risk of falling. Care plans were not in place to show staff how to work with people who may have behavioral needs and were placing themselves on the floor for other service users to fall over. Seven low beds were being purchased to help in the reduction of falls from bed and appropriate bed wedges were also being used to help reduce the risk to people who may be inclined to fall out of bed. People who use the service are assessed on a regular basis by nurses working at the home to determine if they are at risk of developing pressure sores. Pressure relieving mattresses are available for those people assessed at risk or who have developed a sore. People who use the service looked cared for and staff showed respect in their actions and in the way they spoke to people they were attending to. During the inspection arrangements for receiving, storing, administering, recording and disposing of medication were observed and examined. The complaints log showed that there had been some complaints regarding medication errors. These included Care Homes for Older People Page 15 of 33 Evidence: MARS sheets not being signed for after medication had been administered,inaccuracies in medication available, medication not being administered when it should have been. These complaints had been investigated and some disciplinary action had been taken. Examination of medication records and observation of a medication round took place. Appropriate records of medication coming into the home and those that are destroyed are kept. An inspection visit is to be carried out by a pharmacist from the Primary Care Trust. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have limited opportunities to make choices about activities,daily routines and menus so that they may lead a lifestyle that matches their social care needs. Evidence: The care plans of people living at the home did not record much information about their social and leisure needs, their likes, dislikes,personal history, things that are meaningful and of interest to the person. This information is essential to ensure all the needs of the person can be met by staff, their social as well as their health care needs. The activities organiser had collected this information for three people at the time of inspection. Information for a life history book could also be collected from someone who knew the person well if the person was no longer able to speak or give this information themself. An activities organiser is employed to work on the unit for people with severe memory loss. The person tends to work with people on an individual basis rather than organize group activities. Some staff in the home have had training about activities but at the Care Homes for Older People Page 17 of 33 Evidence: time of inspection there was no evidence of any staff interaction with service users. On one unit two staff members were standing outside lounges watching people as they sat sleeping or doing nothing. A weekly activities plan is available for people on the different units and these include:baking, memory skills, pamper sessions, armchair exercises, washing up, quizzes, exercise, movies,family visits,arts and crafts and sing along. The home also has a mini bus to take people for trips when the weather improves. A monthly church service also takes place for people living in the home to attend. Entertainment is also arranged for people in the home and day centre such as themed events e.g St Patricks,1940s and Robbie Burns Night. Monthly coffee mornings also take place, sherry mornings,bingo ,choir and dvd afternoons. People living at the home may also attend the day centre which is located within the Care Centre. Staff ask each person about their wishes,interests and choices. This could be further extended if the non qualified staff team had some intensive training about memory loss and dementia care. This training should help ensure people are given some choice in order to keep some control in their lives. Staff support people to keep in touch with relatives. There were some relatives visiting at the time of inspection who had positive comments to make about the service. People living at the home are asked daily what they wish to eat from the menu selection. A menu was not available to display the daily choices available.Cooked breakfast is available daily. Lunch on the day of inspection was chicken breast or steak casserole, potatoes,turnip and cabbage followed by apple crumble. People living at the home also enjoy home baking. People were very positive about the food provided. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints and protection system, but it does not protect all people who live at the home from abuse. Evidence: Information about how to make a complaint is provided in the Service Users Guide. There is a complaints procedure on display within the home. The home keeps a record of complaints. There have been six complaints received and investigated since the last inspection and any necessary action taken. Three safeguarding incidents have also been reported under Durham County Councils safeguarding procedures, one is still being investigated under these procedures. The home has a copy of the Local Authorities Vulnerable Adults procedures. Staff have received training about Protection of Vulnerable adults. Some non qualified staff have received training about behaviour that is difficult to work with although this was not current. Only 4 staff members having received this training in the last year.Care plans also did not show any interventions required due to behavioural problems. Non nursing staff have not completed a short course about dementia care to give them more insight into the needs of people with memory loss. The manager was Care Homes for Older People Page 19 of 33 Evidence: advised about a twelve week Dementia Care course that is currently available. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for those living there but it is not environmentally appropriate currently for people with dementia care needs. Evidence: On the site is a day centre and a home which is divided into 5 units which can accommodate up to 80 people with different needs. The home has never been at full capacity since it opened 4 years ago as one unit on the top floor has never been used. At the time of inspection a programme of refurbishment was taking place in the home which should take approximately 12 weeks to complete. There were plans to decorate all the units. Harvey Unit which accommodates people with severe memory loss was being decorated to make the decor and signage more appropriate for people with memory loss. People from this unit had moved upstairs to the empty Brockwell unit. There were plans to carry out some physical alterations to the memory loss unit so peoples living and sleeping accommodation were on the same floor. This would be beneficial and help reduce confusion to people. There were plans to make a coffee shop and gym for the use of residential and day care clients. The home is accessible and placed in the centre of a local community. Care Homes for Older People Page 21 of 33 Evidence: A maintenance person works at the home. The home has an appropriate amount of sitting,recreational and dining space. Furnishings and fittings were domestic in design. Room sizes meet the minimum required . People all enjoy their own bedrooms. There was emergency lighting around the home. The washing machines have the specified programme to meet disinfection standards. There are well maintained gardens in the home for the use of people. There is a green house and pergola and garden furniture for people to sit out when the weather is fine. The gardens have recently won an award for Best Business Garden in Durham. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff for the current occupancy levels of the home,they are appropriately recruited but more training is required to ensure they can provide personalized care to people living in the home and to ensure their health and safety. Evidence: There are currently 52 people living at the home over 5 units. Each unit accommodates 10-16 people with different needs. Harvey unit accommodates 10 people with severe memory loss and staff cover is 1 Registered Mental Nurse (RMN) 8:00am-8:00pm, 2 carers 8:00am-8:00pm and 1 activities organizer 9:00am -3:00pm. Tilley Unit provides nursing care to 16 people and is staffed by 1 Registered General Nurse(RGN) 8:00am-8:00pm and 2 carers 8:00am-8:00pm. Hutton Unit provides residential care to 13 people and is staffed by 1 senior carer 8:00am-8:00pm and 2 carers 8:00am-2:00pm and 2 carers 2:00pm-8:00pm. To staff the home there are 2 qualified nurses and 9 carers during the day for 59 people and overnight there is 1 nurse and 4-5 carers. Care Homes for Older People Page 23 of 33 Evidence: A staffing formula has been worked out so that staff numbers increase as occupancy levels increase, taking into account the layout of the building. Currently the lay out of the building means that people on different units may be in bed on a different floor from where there daytime accommodation is. Therefore this causes difficulties for staff supervision on the different floors.Other members of staff are employed for duties such as food preparation, cleaning, gardening and organizing activities for residents. Since the last inspection a new deputy manager with a mental health background has been employed, an activities organizer has also been allocated to work in the home specifically on the Harvey Unit. Another activities organizer is to be recruited to work in the home.A senior carer is also available each shift to work as an extra member of staff between the residential units. A sample of staff records were examined and it was evident all the necessary checks are being carried out prior to workers being appointed or starting work at the home. Two written references were available on staff files examined. An application form had been completed for each staff member. Employment histories were available. CRB checks are carried out before a person is appointed. Staff photographs were available on staff files examined. At least 28 of the 30 care staff have achieved or are studying for National Vocational Qualifications at levels 2 and or 3. As the home provides nursing care for people with dementia and general nursing,specialist nurses with mental health qualifications and general nursing qualifications are employed. Staff have received most of the necessary statutory training apart from moving and handling needs to be more intensive as advised by the safe guarding occupational therapist. Health and safety and risk assessment training is also required. Developmental training is required to ensure staff can meet the specialist needs of people with memory loss. Training carried out includes literacy and numeracy,safeguarding, catheter care, continence, diabetes,prevention of pressure Care Homes for Older People Page 24 of 33 Evidence: sores,medication training,infection control,mental capacity act and deprivation of liberty. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that needs to be better run, to ensure the their health and safety and to ensure the welfare of all is promoted. Evidence: The manager has several years experience working in care and with this service user group. Areas are being addressed through safeguarding which should ensure more personalized care is given to people with memory loss. The building is undergoing some refurbishment to ensure environmentally the design is appropriate to help maintain the independence of people with memory loss. Decor is being made lighter and signage improved. As refurbishment is carried out,especially on the unit for people with memory loss, disruption should be kept to a minimum and care taken to ensure that people remain as orientated as possible e.g when moving bedrooms even if temporary to ensure Care Homes for Older People Page 26 of 33 Evidence: some personal effects are moved with people to their new room to help maintain their orientation. Staffing levels have been increased across the home and an extra tier of management has been put in to assist the manager in running the centre. It was evident that there was a lack of systems and auditing processes. Essential care records were not in place for all people living at the home. A new care planning system was being introduced to help ensure personalized care was being given to people but training should also be provided to help ensure the care planning task is understood by all staff. Inappropriate moving and assisting of service users by staff was also being addressed through safeguarding. Staff have received moving and handling training but this was not in sufficient detail as advised by the occupational therapist. More moving and handling equipment had been purchased, such as more slings and the home was waiting to take delivery of another hoist . Safeguarding has also highlighted lack of analysis of falls of people living at the home when there was such a high incidence on Harvey Unit and lack of follow up action. Risk assessments are not in place to deal with behaviour that may be difficult to work with and there seems to be a lack of understanding about ensuring the safety as far as possible of people with severe memory loss e.g leaving someone unsupervised to lie on the floor together with someone moving around the room with visual impairment. Communication is not cascaded effectively from top to bottom or from front line staff to the manager. Staff meetings are held but not regularly as routine but rather as required. More have been held recently due to the restriction on admissions into the home. When a person does not keep control of their own money,the home is able to provide the facility to hold a small amount on behalf of the person for everyday living. The home has a suitable system for accounting any monies on behalf of a person living at the home. Documents detailing fire safety, risk assessments in the environment, water temperatures and maintenance contracts were all up to date . Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Each service user must have 18/06/2010 a plan of care drawn up according to relevant clinical guidelines. This includes any interventions required to work with the behavioural needs of the person. This is to ensure the correct support is given by staff to people living at the home. 2 7 13 Risk assessments must be carried out for all service users including those at risk of falling to help ensure the health and safety of people living at the home. This is to help protect the health and safety of people living at the home. 21/05/2010 3 8 17 A record must be kept for 18/06/2010 each service user including any health needs as detailed in Schedule 3 of the Care Home Regulations 2001. Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure the home complies with the Care Home Regulations 2001 4 12 12 Staff must be able to 23/04/2010 interact with people living at the home and engage in activities and provide meaningful interaction. This is to ensure the social needs of people living at the home are met. 5 12 16 Life history books must be 18/06/2010 completed for each person to help ensure activities provided are meaningful and of interest to the person. This is to ensure the social and communication needs of the person are met. 6 18 13 All care staff must receive 18/06/2010 training about dementia care and memory loss in order to give staff more insight into the needs of people with memory loss and help involve them in decision making in their daily living. This will help to ensure that staff have more understanding of the needs of people who display behaviour that is difficult to Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action work with and so help prevent abuse. 7 18 13 All staff must receive updated training about challenging behaviour. This will help to ensure that staff have more understanding of the needs of people who display behaviour that is difficult to work with and so help prevent abuse. 8 30 18 Staff must all receive the necessary identified training to ensure they are able to meet the care and support needs of people living at the home and to ensure their safety. This is to ensure that staff can meet the care and support needs of people living at the home and ensure their safety. 9 38 13 The necessary level of 18/06/2010 moving and assisting training must be provided to ensure the health and safety of people living at the home and staff. This is to ensure the health and safety of staff and people living at the home. 18/06/2010 14/05/2010 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Capacity and consent forms should be completed for people where decisions are made on their behalf if they are unable to make their own decisions. Menus should be available in large print and in different formats to remind people of the food available daily. The manager must continue to seek advice about the best environmental design and decoration within a home for people with dementia care needs. Staffing levels should be kept under review taking into account the increased dependency levels of people living at the home.Also to ensure the necessary supervision of service users taking into account sleeping accommodation is on a different floor to day time sitting areas of people living in the home. Staff meetings should take place regularly throughout the year in order to assist with communication throughout the home. As refurbishment of the home takes place there should be minimum disruption to people living there and people with memory loss should be helped to remain orientated. 2 3 15 22 4 27 5 32 6 32 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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