Care Home: Bradley House Nursing Home

What the care home does well We found the atmosphere in the home to be relaxed, comfortable and informal and those residents spoken to said that they enjoyed living in the home and that they were `well cared for`. Following the last key inspection the manager had made a concerted effort to act upon the requirements and recommendations made in that report. We think that most staff know the needs of the residents well and encourage people to remain as independent as possible within the boundaries of their capabilities, offering gentle encouragement where needed. Discussion with the staff on duty demonstrated that they felt the home was well managed and that residents received an `excellent service`. When asked what they felt the home did well they told us,"Residents get the best care possible", "We always have enough staff on duty to make sure residents are looked after" and "We support our residents and their families as best we can". Other comments included, "We have a good manager who is very supportive", "Everyone works well together and we have a manager who is supportive" and "The manager is really helpful and is trying to make things in the home better". What has improved since the last inspection? The ways in which care plans and risk assessments were developed and recorded had improved due to the hard work of the manager. Comments about the new care plans were received from visiting healthcare professionals who told us, "The owner/manager is striving to do well. Standards have improved tenfold and care plans are 100% better". The availability of activities in the home had improved and the manager was looking at further ways of developing the programme already available. We were told that consideration was being given to employing an activities co-ordinator. Since the last inspection, parts of the home had been re-decorated and re-furbished to varying degrees. All staff had received practical fire drill training, including night staff. What the care home could do better: It is acknowledged that the manager had spent a lot of time and effort in developing a new care plan and risk assessment format and each resident had a care plan in place. Looking closely at a number of care plans demonstrated that, in some instances, not all relevant information about a persons needs had been transferred into the care plans and, therefore, some identified needs could be `missed`. Medication to be given `as and when required` was not always being audited and balances of this type of medication was not being recorded. All medication within the home should be accounted for at all times.Some medication was being given covertly because the resident would not take their medication under normal circumstances. No care plans were in place for administering medication in this way and no evidence was on file to show that all parties, including the residents` GP had agreed to this. Although on-going training was taking place, including moving and handling, some staffs practice was not good. The use of wheelchairs without footrests increases the risk of accidents happening. On checking the personnel file of one new member of staff is appeared they had commenced working in the home before all relevant pre-employment checks had been completed. It is important that robust recruitment and selection procedures are followed and adhered to at all times to minimise the risk to people living in the home from unsuitable people being employed to work in Bradley House. Formal inductions for new staff had not been carried out. It is important that all new employees receive a thorough induction into their new role to ensure they are clear about the expectations and responsibilities their job roles involve. Some improvements had been made to the way staff receive one to one supervision but further work needs to be done to demonstrate that the registered nurses employed at the home receives the required clinical supervision and have their practice monitored to make sure they are of a good standard. Key inspection report Care homes for older people Name: Address: Bradley House Nursing Home Bradley House Nursing Home 2 Brooklands Crescent Sale Cheshire M33 3NB     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: John Oliver     Date: 2 7 0 1 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) 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 33 Information about the care home Name of care home: Address: Bradley House Nursing Home Bradley House Nursing Home 2 Brooklands Crescent Sale Cheshire M33 3NB 01619732580 01619053425 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: bangenursinghome.com Bange Nursing Homes Ltd T/A Bradley House Nursing Home care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE The maximum number of people who can be accommodated is: 36 Date of last inspection Brief description of the care home Bradley House is a care home providing nursing care and accommodation for 34 service users who have been diagnosed as having dementia or long-standing mental health needs. The home is a Victorian house with an extension. Bedrooms are on four floors with access by a passenger lift. The home has a conservatory, well kept grounds and a designated parking area. Bradley House is situated near the centre of Sale. The home is close to local amenities such as shops and public houses. Main bus routes and the metrolink station are a short walk away from the home. Care Homes for Older People Page 4 of 33 Over 65 0 36 0 4 0 2 2 0 0 9 Brief description of the care home The current scale of charges at the home range from four hundred and eighty five pounds and ninety pence to five hundred and ninety two pounds and twenty pence per week. Fees are dependant on a number of factors and are discussed individually for those who are privately funded. Additional costs are incurred for hairdressing and chiropodist. 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: This inspection was undertaken as part of key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen took place on January 27th 2010. Bradley House is owned by Mr and Mrs Bange, with Mrs Helen Bange being the registered manager of the service. We looked closely at the information held on two people living at the home, this means that we looked in depth at their records, including care plan information. During this visit we spent some time sitting with residents and watching the day to day routines of the home and how support was being offered to residents by the staff on duty. Doing this helped us to get a better view about how staff interacted with people living at Bradley House and the standard of care and support they received. Care Homes for Older People Page 6 of 33 Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. In this document the manager has the opportunity to tell us what they feel they are doing well, how they had improved in the last 12 months and their plans for further improvements and development within the next 12 months. The manager had taken time to fully complete the AQAA and this gave us a lot of information about how she had managed and further developed the service since the last key inspection. Following the completion of the inspection we offered the manager some verbal feedback on our findings from the day. 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: It is acknowledged that the manager had spent a lot of time and effort in developing a new care plan and risk assessment format and each resident had a care plan in place. Looking closely at a number of care plans demonstrated that, in some instances, not all relevant information about a persons needs had been transferred into the care plans and, therefore, some identified needs could be missed. Medication to be given as and when required was not always being audited and balances of this type of medication was not being recorded. All medication within the home should be accounted for at all times. Care Homes for Older People Page 8 of 33 Some medication was being given covertly because the resident would not take their medication under normal circumstances. No care plans were in place for administering medication in this way and no evidence was on file to show that all parties, including the residents GP had agreed to this. Although on-going training was taking place, including moving and handling, some staffs practice was not good. The use of wheelchairs without footrests increases the risk of accidents happening. On checking the personnel file of one new member of staff is appeared they had commenced working in the home before all relevant pre-employment checks had been completed. It is important that robust recruitment and selection procedures are followed and adhered to at all times to minimise the risk to people living in the home from unsuitable people being employed to work in Bradley House. Formal inductions for new staff had not been carried out. It is important that all new employees receive a thorough induction into their new role to ensure they are clear about the expectations and responsibilities their job roles involve. Some improvements had been made to the way staff receive one to one supervision but further work needs to be done to demonstrate that the registered nurses employed at the home receives the required clinical supervision and have their practice monitored to make sure they are of a good standard. 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 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 10 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. Peoples needs were assessed prior to admission so that the management of the home could decide whether they could support those needs. Evidence: Discussion with the registered manager confirmed that all prospective residents are given enough information about the service before moving in to help them make a positive choice about where they want to live. Information supplied included an up-todate statement of purpose and service users guide and details of how to access the homes website which provides supporting information about Bradley House. It is important that people have enough information provided to them to help them decide if Bradley House is the place they would like to live. The manager or deputy manager meets with the prospective resident in their own home or placement setting, which gives the potential resident the opportunity of discussing any concerns they may have and to ask any questions they may have Care Homes for Older People Page 11 of 33 Evidence: about the service. Such a meeting enables the manager to carry out an assessment of the prospective residents current needs and to discuss with them what support they need and how they would like that support to be provided. Once an assessment has been completed the registered manager would write to the prospective resident to let them know if Bradley House can or cannot meet their needs. On the files we examined we saw that pre-admission assessments had been completed, along with assessments from local authorities and confirmation that Bradley House could or could not meet assessed needs. Care Homes for Older People Page 12 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. People were supported with their personal care, but systems for monitoring safe medication practice were not being followed. Evidence: We arrived at Bradley House at 7am and we were welcomed by the night staff on duty who checked our credentials and asked us to sign the visitors book. It is important that visitors to the home are vetted before being allowed access to parts of the home used by residents in order to safeguard the people using the service and to minimise the risk of unsuitable people having access to the premises. On our arrival we saw that two residents were sat in the downstairs lounge in their night clothes and dressing gowns. Both were asleep in chairs, one being covered by a blanket, indicating she had been there for some time. The home was quiet and we had opportunity to speak with the nurse in charge. She told us that the resident covered in a blanket had been asleep in the chair all night which, is the usual routine for this person as she remains very unsettled when in bed. The other resident had been up and down throughout the night and had finally settled and fell asleep in the chair. Care Homes for Older People Page 13 of 33 Evidence: Both residents had been given drinks throughout the night. We later checked the care plan for the resident who spends the full night asleep in the chair and this confirmed the action to be taken by staff to make sure she remains comfortable and checked on a regular basis. As more residents were assisted to get up members of the staff team were heard to ask people if they would like a cup of tea whilst they waited for their breakfast. We observed staff assisting people to get ready for breakfast and this was done calmly, with some residents needing more encouragement than others. At breakfast people had various choices of food, including cereals, toast and a cooked breakfast if they wished. When asked about food choices at breakfast time one resident on the first floor told us, I like my Kelloggs and some toast, but I can have egg and bacon when I want. Most staff were seen to assist people sensitively and with patience and where residents received support it was given to a good standard with consideration for peoples differing needs. Since the last key inspection the registered manager has spent a lot of time and effort in developing a new care plan and risk assessment format and time has been spent in putting them into place. All residents had a care plan in place and we examined the details of one in particular. This person had a poor dietary intake and we looked for information about how this was to be managed and monitored. Background information on the person told us that the resident could be resistive to staff intervention, and requires 2 members of staff to attend throughout washing, dressing and toileting. This information had not been transferred to the care plan relating to personal hygiene and no care plan was in place regarding toileting. The diet and fluid intake for this resident can be poor and....can become aggressive and agitated when staff attempt to encourage. Again, no care plan was in place for this. We also saw that this person had been prescribed diet supplements by the GP and although staff spoken to during the visit were aware of this and were ensuring the resident was receiving them, care plan information and a risk assessment was not in place. Daily records were written up for each resident giving an overview of how they had been during any 24 hour period. Most were seen to be repetitive in their comments Care Homes for Older People Page 14 of 33 Evidence: and did not give much detail about the actual care delivered or if the care plan had been met. We looked at the daily records for the person whose care plans we examined. The record for 25 January 2010 read, Assisted with showering and dressing, diet very poor, but fluids good, a very settled day. Poor dietary intake was mentioned most days but there was no indication of what action had been taken for example, if food supplements given. Medication was administered by nursing staff who had received safe handling of medication training and had also completed a distance learning course. There was a policy for the safe receipt, handling, administration, storage and disposal of medication in place which was available to staff. On checking medication we noticed that some residents were on medication to be taken as a variable dose and as and when required. We checked this type of medication for one particular resident. This medication was Co-codamol, 1 or 2 tablets to be given as and when required. We saw that some of this medication had been carried over from the previous month, but no balance had been recorded. Where staff had administered this medication, no record had been made whether one or two tablets had been given and it was therefore difficult to ascertain if the total number of tablets that were left balanced with the total number of tablets administered. It is important that all medication in the home can be accounted for at all times to minimise the risk of errors occurring. A number of residents were being administered medication in a covert manner because they would not take their medication under normal circumstances. A policy and procedure was in place for this. One particular section of the policy read: Covert medication should only every be seen as a last resort and as an emergency procedure, rather than routine, and care staff should discuss the case with the service users GP and relatives and obtain their written consent and approval prior to any covert administration of refused medication. All cases must also be discussed fully with the pharmacist prior to administration. There was no written evidence on files from GPs or relatives other than one relatives signature although the manager assured us that all GPs had agreed. No care plans had been put in place for administering medication in a covert manner. It was explained to the manager that the home was in breach of its own policy and procedures regarding administration of covert medication. Lack of clear details and records regarding any medication currently being given covertly could place the resident and member of staff at risk of inappropriate or incorrect procedures being followed. Care Homes for Older People Page 15 of 33 Evidence: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were encouraged and supported to maintain contact with family and friends and to participate in social activities. Mealtimes were relaxed and the menu provided a varied well balanced diet. Evidence: Social activities were discussed with the manager, who at the time of our visit, was in the process of developing an activities programme that was suitable to meet the needs of people with varying needs, ranging from mobility and dexterity difficulties and dementia related illness. The manager also told us that she was considering employing an activities coordinator with experience of working with people within the range of needs Bradley House caters for. We saw that regular entertainers visited Bradley House, and residents were encouraged to sing and dance and to generally enjoy socialising with each other and visiting relatives. To further encourage residents to socialise, animals such as dogs, rabbits and birds are brought into the home for them to pet, which also has a therapeutic effect for some of the residents. Specially adapted games and jigsaws were available, which were more suited to meet Care Homes for Older People Page 17 of 33 Evidence: the needs of those residents who had various dependency levels including dementia related illness. We were told that staff know the residents well enough to encourage them to participate in activities the staff know they will enjoy or would want to participate in and this was confirmed by the staff we spoke to during our visit. People could receive visitors at any time that was convenient to them and one visiting relative told us that they were free to visit at any time, and staff were very helpful and respectful towards the residents and any visitors. Where residents receive support to make choices and decisions about what they would like to do, or where decisions are made for them, an accurate record should be kept to demonstrate how or why decisions are made and to ensure that residents have varied and enjoyable routines which support them to live meaningful lives as far as possible. We observed a main meal being served and watched the interaction that took place between staff and residents during this time. As a number of residents had a dementia related illness, some were not able to make informed choices about what foods they preferred and were unable to tell staff of their choice of meal. The kitchen staff and carers used their knowledge about peoples likes/dislikes to offer them foods that they thought they would like and enjoy. In most instances this worked well and residents enjoyed the meal offered to them. We saw that staff monitored the dining room and observed what each resident was having throughout the meal time. Where help was needed, this was done sensitively and discreetly. Efforts had been made to orientate people when using the dining room by the use of signs and pictures. On the walls of the dining room was framed pictures of meals such as fish and chips, sausage and mash and eggs and bacon. Although tables had been laid with tablecloths, no condiments had been put out and people did not receive a drink with their meal, this was offered afterwards. No residents were asked if they wanted the use of salt or pepper and only one resident was offered a drink of water during the meal time. Consideration should be given to ensuring residents receive a drink with their meal and are offered the use of condiments depending on the meals being served. Discussion with the cook and kitchen staff confirmed that all residents were offered the choice of a freshly cooked breakfast should they wish and that regular hot and cold drinks were provided throughout the day. One resident spoken to on the first floor told us, Meals are very good and the staff do ask you what you would like. You can have egg and bacon when you get up if you Care Homes for Older People Page 18 of 33 Evidence: want. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and training were in place to ensure that people were protected and that their health and safety was maintained. Evidence: Details of the homes complaints procedure were displayed in the hallway along with details of advocacy services that can be contacted who can offer a range of advice on different issues, including any financial queries a resident or their relatives may have. Having such information available is good practice. Within the annual quality assurance assessment returned to us by the manager, she tells us that all residents are assumed to have the capacity to make an informed decision, with the assistance or guidance from families or staff. Staff are aware that the capacity of a resident may change on a daily basis, depending on the decision to be made. It is important that staff recognise that people suffering with various stages of dementia may need support to make a complaint or raise a concern in a timely manner. Bradley House had a Protection of Vulnerable Adults policy that had been written in conjunction with the Local Authoritys policy and guidance, including No Secrets. All new staff were given a copy of this policy to read prior to attending training arranged by the local authority. Care Homes for Older People Page 20 of 33 Evidence: Staff spoken to were fully aware of their responsibility for reporting any suspicions or allegations of abuse. We were told that one complaint and no safeguarding referrals had been received by the home in the last 12 months. We (the Commission) had received no concerns about the home in that time. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of Bradley House were in need of further upgrading to make sure people continued to live in a safe and well-maintained home. Evidence: At the time of our visit, upgrading of the home was ongoing although this was being limited by financial restraints. The main hallway was being repainted and new carpet was due to be laid the following week. The conversion of bedrooms into a large new lounge on the ground floor had been completed since the last key inspection visit with new seating and furnishings, giving residents an additional lounge area to use during the day. Other improvements to the environment included the complete refurbishment of the ground floor dining room and adjoining communal lounge. Within the annual quality assurance assessment (AQAA) returned to us before this visit took place, the manager tells us that advice was sought from a company dealing with interior designs. Risk assessment were carried out regarding electrical appliances and wherever possible, appliance have been wall mounted for safety. Lighting has been improved in communal areas. Various carpets throughout the home were showing signs of wear and tear and some Care Homes for Older People Page 22 of 33 Evidence: were badly stained and would probably benefit from deeper - cleaning. All these were pointed out to the manager. Other areas of the home would benefit from redecoration and repainting, especially around door frames where wheelchairs have caught and chipped the paintwork. The manager told us that this work was all part of the ongoing progamme of refurbishment and maintenance for Bradley House. It is important that all areas of the home used by residents are safe, comfortable, clean and fresh. At the last inspection it was noted that a number of gates were used around the home to restrict residents access to certain areas or prevent them from falling down stairs. The manager told us that some gates had been removed, and where others remained, did so, following advice from a Health & Safety specialist. We looked at a number of bedrooms throughout the home and all were found to be personalised to varying degrees. On the lower ground floor, all bedrooms had been upgraded with new furniture of good quality. New blinds had been fitted in the conservatory on the lower ground floor. This was one area where the carpet was badly stained and would possible benefit from being deep-cleaned. Since the last key inspection, doors in communal areas had been fitted with magnetic closures, linked directly to the fire alarm system. It is important that risks from fire are minimised to people living and working in the home should the fire alarm be activated. Care Homes for Older People Page 23 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. People were being supported by sufficient numbers of appropriately qualified and experienced staff. Recruitment and selection procedures did not fully protect people using the service. Evidence: When we arrived at Bradley House the night staff were on duty and we had an opportunity to speak with the nurse in charge and one of the carers. Both considered that enough staff were employed during the night time hours to safely meet the needs of people currently receiving a service. Although some training had taken place for night staff, this appeared to be minimal and included moving and handling and fire awareness training. The nurse in charge had also completed a safe handling of medication course via distance learning. It is important that all staff, irrespective of working day or nighttime duties receives training that is relevant to the jobs they do in order to maintain their skills and knowledge. We were told by the night staff that regular checks of all residents are carried out throughout the night and that a new electronic scanner system is now in place to show that all rooms have been entered. Care Homes for Older People Page 24 of 33 Evidence: We looked at three staff files of people that have recently been employed to work in Bradley House. Two of the files we looked at contained enough information to demonstrate that appropriate recruitment procedures had been carried out. The other file contained only one reference and, according to the dates recorded, the employee had commenced working in the home before a POVA First check had been received. It is acknowledged that this member of staff was not providing direct care to residents and was working under close supervision of trained staff at all times. It is important that robust recruitment and selection procedures are followed and adhered to at all times to minimise the risk to people living in the home from unsuitable people being employed to work in Bradley House. We saw that no inductions had been carried out with the new staff although induction paperwork was on each file and this was confirmed by the manager. We spoke to one new member of the staff team who confirmed that no induction had been carried out but also told us, I worked with a mentor for the first few weeks. It is important that all new employees receive a thorough induction into their new role within the home to ensure they are clear about the expectations and responsibilities their job roles involve. We saw that staff continue with their training, and records seen indicated that some staff had received training in moving and handling, safeguarding vulnerable adults, dementia care, nutrition, infection control and general health and safety. 72 of staff had completed National Vocational Qualification (NVQ) training at level 2 with another six staff nearing completion of NVQ training at level 3. Staff spoken to confirmed that they received training, but new staff had not completed all the required mandatory training and this should be arranged for all new staff sooner rather than later. Staff confirmed that supervision had started to take place but was not yet being conducted on a consistent basis and was of an informal nature rather than being structured to look at specific issues. We saw evidence that the manager met with the registered nurses and discussed ways to improve standards within the home but no information was available to demonstrate how clinical practice, training and development was monitored and arranged for the nursing staff. Comments from staff included, I have done some training, but no clinical training or updating my clinical practice and I have not yet received supervision, I had supervision two weeks ago with the manager, but this was mainly verbal, but we do Care Homes for Older People Page 25 of 33 Evidence: get good, clear direction from the nurse in charge, I have done dementia training, moving and handling, fire awareness and POVA. Supervision is adhoc and informal and Ive not had any induction but worked with a mentor for the first few weeks. We looked at the staffing rota for Bradley House and although this identified the hours all staff were working in the home, it failed to identify their roles, their full names and the start and end times of each duty. This meant we were unable to clarify how staff time was allocated including ancillary staff members. Care Homes for Older People Page 26 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. Bradley House was being managed by a person with suitable knowledge and skills to do so and the home continues to develop. However, there are still a number of areas which need further development to make sure that residents receive support from staff who are supervised and trained in all safety aspects of the service and make sure it is a safe place to live at all times. Evidence: Since the last key inspection the registered manager has continued to further develop and improve the service being offered to residents living in Bradley House. To try and improve staffs knowledge and skills she has arranged various training programmes and is encouraging staff through supervision. In discussion with the manager it was acknowledged the amount of time, effort and progress she has made so far, but, as mentioned is various parts of this report, further work is required to ensure consistency in both management practice and service delivery. For example, even though members of the staff team had received training in moving Care Homes for Older People Page 27 of 33 Evidence: and handling, we saw that some staff were transferring residents incorrectly when using wheelchairs. Footrests were not always attached to wheelchairs and when they were they were not always used. Of concern was that on one occasion, a senior carer observed this practice taking place but did nothing about it, leaving the resident to remain in situation of risk. Incidents such as this, demonstrated that perhaps the manager should consider a more direct approach in monitoring service delivery by spending some time monitoring staff and the way staff members work together. This should help the manager to assess what staffs further training needs were and whether all staff were fulfilling their job roles efficiently and in line with expected good practice. We were told by the administrator for the home that residents monies were mainly managed by themselves or by a family representative. Only small amounts of money were held at the home and were recorded and regularly audited. Since the last key inspection the manager had carried out a quality review of the service by way of sending out questionnaires to families and friends of people living in Bradley House. 16 surveys had been returned to the home of which a high proportion had extremely positive comments about the service provided and the standards of care delivered. During this inspection we had an opportunity to speak with a visiting manager from a health care trust involved with Bradley House. Comments were positive and included, The owner/manager is striving to do well. Standards have improved tenfold and care plans are 100 better. Staff are welcoming and interaction with residents is excellent. (There) is good clinical leadership in qualified staff. Staff spoken to about the management of the home also told us, We have a good manager who is very supportive, Everyone works well together and we have a manager who is supportive and The manager is really helpful and is trying to make things in the home better. We are just starting to get our supervisions, although I still find the care plans difficult to follow. Within the annual quality assurance assessment (AQAA) the manager told us that equipment used in the home was regularly maintained and serviced by approved contractors. We randomly selected a number of servicing records and found them to be satisfactory. At the time of this report the homes workplace risk assessments were being reviewed and updated by the maintenance person. Care Homes for Older People Page 28 of 33 Evidence: Care Homes for Older People Page 29 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 30 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 9 13 Medication must be handled and administered following relevant policy and procedures and guidelines from the Royal Pharmaceutical Society. To minimise the risk to residents from errors occurring in the administration of medication in the home. 05/03/2010 2 28 19 New staff must not 31/03/2010 commence working in the home until all preemployment checks have been satisfactorily completed and details are on file. To protect and minimise the risk to people living in Bradley House from unsuitable people being employed to work in the home. 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 Care plans, including risk assessments, should fully reflect each residents current identified needs, including medication administration and how those needs are to be met in an appropriate and safe manner. Where it is practicably possible, residents should be enabled to make decisions for themselves. Where decisions have to be taken for them, an accurate record should be kept to demonstrate how or why such decisions have been made. Hot or cold drinks should be offered with each meal and tables should be set appropriately including relevant condiments. After a full assessment of the building, a detailed plan of proposed upgrading over the next twelve months should be compiled, with timescales for each part of the upgrading. A copy of this plan should be sent to the Care Quality Commission. Deep cleaning should take place of those carpets in the home identified to the manager. If deep cleaning does not resolve the issue, consideration should be given to replacing those carpets in order of priority and in accordance with the proposed upgrading programme for Bradley House. The staffing rota should contain all the required details to enable accurate monitoring of staff hours. This should include the full names of staff, job role, and times of working. All members of staff should receive appropriate induction training within 6 weeks of appointment to their posts, and foundation training within the first six months of appointment. The manager should ensure that safe working practices, including moving and handling techniques are carried out at all times to ensure so far as reasonably practicable the health, safety and welfare of residents and staff. 2 12 3 15 4 19 5 26 6 27 7 30 8 38 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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