Care Home: Bramley Court

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What the care home does well People have the majority of information that they need to enable them to decide if they want to live at the home. People are confident that they can choose how they spend their time, so that they can make decisions about their daily lives. People are supported to keep in touch with their families and friends, so that they maintain relationships that are important to them. The home is sensitive to people`s cultural and religious needs, so that they are supported to live their lives pursuing what is important to them. People living at the home are offered a variety of healthy meals, that meet any special dietary requirements. There is a robust system for checking that people`s money is held at the home in a safe manner. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet their health needs. People told us: "I am very pleased with the care and how they look after my husband". "The staff make us feel welcome. They are like family to us". What has improved since the last inspection? People can be confident that the home will be able to meet their assessed needs. People are involved in writing their care plans, so that care can be provided in the way they prefer. People are encouraged to lead fulfilling lives, that meet their needs, interests and expectations. People told us that they were happy with how the home support them to meet their personal hygiene needs. There is a rolling programme of redecoration and refurbishment in place, so that people are provided with a clean and comfortable place to live, that meets their assessed needs. Systems are in place so that people receive their medication as prescribed. People can be confident that their concerns are taken seriously and their views are acted upon. Systems are in place to protect people from harm. Arrangements are in place so that people are supported during meal times. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People told us: "My wife has had her hair done this morning. The hygiene is very good here". "The home looks better. It has been cleaned up". "I think that there is enough staff on now. They seem to be in the lounge more now". "There is better training now. We have moving and handling training so that we know how to use the equipment properly. All my training is up to date". "All the staff feel supported by the manager. He always listens to us". What the care home could do better: People cannot be confident that they consistently receive pressure area care at the times they require. Systems in place to listen to people living at the home should be further developed, so that they have the opportunity to influence how the home is run. Accident reports need to reflect the actions taken by the staff team, in order to ensure that the appropriate actions have been taken to keep people safe. Key inspection report Care homes for older people Name: Address: Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER     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: Amanda Lyndon     Date: 0 5 0 5 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 30 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 30 Information about the care home Name of care home: Address: Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER 01214307707 01214742944 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.schealthcare.co.uk Southern Cross Care Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 76 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 other category (OP) 39 Dementia (DE) 37 Date of last inspection Brief description of the care home Bramley Court provides nursing care for up to seventy six older people. This includes a thirty seven bedded unit for general nursing care located on the first floor. A separate unit called the dementia house is located on the ground floor. This can accommodate Care Homes for Older People Page 4 of 30 Over 65 0 39 37 0 Brief description of the care home up to thirty nine people with dementia nursing care needs. The home is located in a residential area close to local shops and public transport links. Ample off road parking is provided for vehicles at the front and rear of the home. There is a small enclosed garden/patio area at the side of the home that is suitable for all people to use. A shelter is provided in this area for people who choose to smoke as the home is a non-smoking environment. The home is purpose built and upper floors are accessed via a passenger lift or stairway. All bedrooms offer single accommodation and have en suite bathroom facilities of a toilet and wash basin. In addition assisted baths and showers are available on both floors of the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists to meet the assessed needs of people living there. The home offers communal dining and lounge areas. A separate room is allocated as a hair dressing salon. Kitchen and laundry facilities are based on site. The home employs two activity coordinators so that people have the opportunity to take part in activities. In the reception area there is information that may be of interest. This includes our last inspection report, the statement of purpose and service user guide. Up to date details of fees charged to live at the home are included in the service user guide, and are available from the home on request. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing and newspapers. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on areas that need further development. The last key inspection of this service was undertaken on 16th November 2009. We awarded the service a zero star rating as a result of the findings of the visit. This meant that people living at the home experienced poor quality outcomes. In order to monitor the homes progress we undertook a further visit to the home on 22nd February 2010. This was a random visit and focussed on the requirements that we made during our previous visit to the home. We found that a number of improvements had been made regarding the service provided at that time. Care Homes for Older People Page 6 of 30 This inspection was carried out over one day by two inspectors. The home did not know we were going to visit. There were thirty five people receiving general nursing care. There were sixteen people living in the dementia house and one person was in hospital. Prior to the visit taking place, we looked at all of the information we had received since our last visit. This included notifications about events that have occurred in the home. We did not request surveys or an Annual Quality Assurance Assessment (AQAA) as these had been completed at the time of our previous key visit to the home. Three people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to eight staff members about the care they provided to these people. We sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm clean, and comfortable for them. We gave all people living at the home the opportunity to be involved in the inspection. We spoke with four visitors and one health professional that was visiting the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? People can be confident that the home will be able to meet their assessed needs. People are involved in writing their care plans, so that care can be provided in the way they prefer. People are encouraged to lead fulfilling lives, that meet their needs, interests and expectations. People told us that they were happy with how the home support them to meet their personal hygiene needs. There is a rolling programme of redecoration and refurbishment in place, so that people are provided with a clean and comfortable place to live, that meets their assessed needs. Systems are in place so that people receive their medication as prescribed. People can be confident that their concerns are taken seriously and their views are acted upon. Care Homes for Older People Page 8 of 30 Systems are in place to protect people from harm. Arrangements are in place so that people are supported during meal times. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People told us: My wife has had her hair done this morning. The hygiene is very good here. The home looks better. It has been cleaned up. I think that there is enough staff on now. They seem to be in the lounge more now. There is better training now. We have moving and handling training so that we know how to use the equipment properly. All my training is up to date. All the staff feel supported by the manager. He always listens to us. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Admission processes are thorough so that people can make informed decisions about whether to live at the home. Evidence: A statement of purpose and service user guide had been produced. These were on display in the home for people to read. We saw that these had been produced in a large print format. The manager stated that these could be produced in other formats and languages on request. Information about this was included on the front of the documents. This means that more people can access the information. The documents included information about the services and facilities provided at the home and the current fees charged to live there. Details about arrangements for people that choose to smoke are not included within these documents. This will prevent people from having this information when deciding whether to live there or not. The manager said that this information would be added. We saw that service user Care Homes for Older People Page 11 of 30 Evidence: guides had been distributed to people receiving general nursing care. People told us that they had found it to be informative. The suspension of the contract with the Local Authority had recently been lifted. This means that the home are now able to accept new admissions. There are currently twenty four bed vacancies in the home. The majority of these are located within the dementia house. The manager advised that careful consideration is being given to whether the needs of people that are looking to come to live at the home can be met there. We saw that comprehensive assessments of peoples care needs had been undertaken. The home had declined to offer accommodation to the vast majority of people for whom they had undertaken pre admission assessments on recently. This means that the home are taking measures to ensure that it can meet the needs of all people living there. We saw that pre admission care plans outlining peoples care and support needs are written from the information provided prior to admission. We spoke to people about the pre admission process. They told us that they had the opportunity to view the home prior to coming to live there. This is in order to sample what life would be like to live there. People come to live at the home for an initial trial period of six weeks. We saw that following this a care review is arranged involving the person, people important to them, their social worker and the homes staff. This provides all present with the opportunity to discuss whether the persons care needs are being met at the home and whether they wish to stay there. We saw that actions had been taken in response to suggestions made at this time. Intermediate care is not provided. Care Homes for Older People Page 12 of 30 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. Systems in place ensure that the health and personal care needs of the majority of people living at the home are met. Evidence: We saw that assessments of peoples care needs are undertaken on admission to the home. Care plans are written from this information. These are individual plans written with the involvement of people living at the home and those important to them. They include information about what people can do for themselves and in what areas they require support. This included peoples short term needs for example if they had an infection or sore skin. Since our last visit staff had undertaken training about care planning and we found that improvements had been made regarding the content of these. We saw that care plans had recently been re written in order to include peoples preferences regarding their daily lives. This means that people should receive care and support in the way they prefer. From discussions with the staff team it was evident that they had a good understanding of peoples individual care needs. We saw that a quality monitoring Care Homes for Older People Page 13 of 30 Evidence: system had been introduced so that shortfalls regarding the content of care plans could be identified. We did, however, find that the care plan of one person who had very recently come to live at the home required further development. This was in order to identify the specific needs and preferences of this person. The manager assured us that this would be done as the staff got to know the person better. From discussions with the staff team it was evident that the persons needs were being met at the home. During our previous visits to the home we identified concerns regarding care given to people with sore skin. In response to a request from the community tissue viability team, all pressure relieving equipment had recently been replaced. This should promote the health and well being of people living at the home. Nursing staff told us that they had recently undertaken refresher training about supporting people with sore skin. This should mean that they have up to date skills and knowledge to care for people in this area. We spoke with a community tissue viability nurse who was visiting the home. She confirmed that improvements had been made in care being provided to people who have sore skin. However, she stated that on occasion there continued to be inconsistencies regarding the recording of how often staff assist people to change their positions. This is in order to prevent further skin damage. We also identified shortfalls regarding this documentation. We saw that care plans had been written for people with behaviours that can be challenging to others. These had been further developed. They identified the ways in which people behave and the actual ways that staff can manage these behaviours. This has improved the quality of the lives of people living at the home. Staff told us that they had undertaken some training about supporting people with dementia. Further training was planned about this. We saw that the home complete risk assessments for people. This is so that consideration is given to supporting them to take responsible risks and promote their independence. We saw that moving and handling assessments identified the specific support and equipment required for each person. In addition the majority of staff had undertaken recent training in this area. This should mean that people are supported to transfer in a safe manner. Since our last visit the systems in place for communication between the staff team had improved. For example the system used for staff to handover information to the next shift team had been further developed. One staff member said I report any changes to the trained nurses and I am confident that these are acted upon. Care Homes for Older People Page 14 of 30 Evidence: We saw that regular care reviews are undertaken involving people living at the home, people important to them and their key workers. This provides people with the opportunity to put forward any suggestions for improvements to the service provided and assess whether their care needs were being met. People told us that they were satisfied with the level of care being provided at the home. One relative told us The staff know my wife and her history. She has a hospital appointment tomorrow and they are sending an experienced carer with her. I know she will be in safe hands. Another relative told us I am very pleased with the care and how they look after my husband. We saw that people were clean and hair was neatly styled. People were wearing clothing appropriate to their age, gender, culture and the time of year. One relative told us My wife has had her hair done this morning. The hygiene is very good here. We saw that people can retain their own doctor on admission to the home, if the doctor is in agreement. Advice is also sought as needed from a range of other health and social care professionals. We saw that improvements had been made regarding the management of medication. Staff had recently undertaken further training in this area. We saw that people received their medication as prescribed, thus maintaining their health. From our observations during the visit we saw that staff support people in a respectful manner. We saw that staff greet people by their preferred names. People have the option of having a key for their bedroom doors, so that they can keep their personal items private and secure. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. Evidence: Since our last visit a second activity coordinator has been employed at the home. People told us that there are now more opportunities for them to be involved in activities, both at the home and trips out. Recent activities included a trip out to the cinema. A trip to the Black County Museum was being planned. People and their families had been involved in a recent Cake Bake and St Georges Day celebrations. People told us that they were involved in planning the forthcoming Family Fun Day. Since our last visit the recording of activities arranged had improved. They now included information about the activities that people had participated in and whether the event had been a success. This information will assist in planning future activities. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so that people can follow their religious beliefs, if they Care Homes for Older People Page 16 of 30 Evidence: wish. People are encouraged to maintain contact with their family and other people important to them. People told us that there is an open visiting policy and that they can meet with their visitors in private if they wish. One relative told us The staff make us feel welcome. They are like family to us. We saw that some people go outside of the home with their friends and family at any time that they choose. People told us that they could make choices about how they spend their time. We saw that people were being supported by staff to vote in the forthcoming general election either in person or by post. People have a choice of where they are served their meals. Menus identified a variety of nutritious food and a choice of meals is always available. People have the option of choosing snacks at other times. Special diets are prepared for reasons of health, culture and religion. A variety of adapted feeding aids were available. We saw that both menu choices are presented to each person so that they can choose which they would like to eat. Since raising concerns during our last visit, a new system had been introduced to ensure that staff are available to provide assistance to people during mealtimes. During our visit we saw that this was working well for the benefit of the people living at the home. An environmental health inspection had recently been undertaken. The outcome of this was recorded as excellent. This should mean that food is prepared in a hygienic manner. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can now be confident that outcomes will improve as a result of raising concerns. Systems in place protect people from harm. Evidence: The complaints procedure was on display in the home and was included in the service user guide. This should mean that people know how to make a complaint. The manager told us that he has an open door policy so that people can talk to him at any time. People met during the visit confirmed that this was the case. One relative told us We have no complaints at all. I would say if there were any problems. Since our last visit to the home we have not received any complaints about the service provided there. The manager told us that they had received one complaint and that this was ongoing. We looked at the complaints register held at the home and found that detail about this was included. We saw that the home had requested further information from the person who had made the complaint, in order to investigate the issue further. Since our last visit there have been four incidents regarding people who have lived at the home, that have been raised as safeguarding. Three of these were regarding behaviour displayed by people with dementia. We saw that the home had reported these to the relevant external people responsible for overseeing safeguarding matters. Care Homes for Older People Page 18 of 30 Evidence: This is in order to protect people living at the home and minimise the potential for a similar incident to happen again. The outcomes of these were that the home had put appropriate measures in place to reduce the risk of reoccurrences. The cases are now closed. The staff training matrix identified that the majority of staff had recently received refresher training in safeguarding matters. We spoke with a staff member who had been unable to attend the recent training. It was evident that despite this he had a good understanding of his responsibilities regarding safeguarding adults. Another staff member told us We have abuse training as soon as we start here and then after six to twelve months it is re done. This should mean that staff know how to protect people from harm. A number of staff have undertaken training about their responsibilities regarding the Mental Capacity Act. Further training is planned about this. Since our last visit the homes staff had made a request for a multi agency assessment to be undertaken regarding a person who was resistant to care. The outcome of this was that specific guidelines were put in place for staff to follow about how to support this person. This means that the rights and interests of the person had been protected whilst ensuring that they receive the support they require to meet their care needs. Care Homes for Older People Page 19 of 30 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. People live in a clean, safe and comfortable environment that meets their needs. Evidence: We saw that since our last visit, a number of areas of the home predominantly within the dementia house, had been redecorated and refurbished. This has provided people with a more homely living environment. One relative told us The home looks better. It has been cleaned up. The manager told us that plans are in place to redecorate and refurbish the rest of the home on a rolling basis. The manager told us that consideration is being given to increasing the communal space provided on in the dementia house located on the ground floor of the home. This would mean that people have more choice about where to spend their time. People would have a quieter alternative to the busier communal lounges already in use. People told us that they were satisfied with the choice of communal seating areas on the first floor of the home. One relative told us This is a quiet lounge. We prefer this lounge. People met during the visit stated that they were happy with their rooms. All bedrooms offer single occupancy and an en suite consisting of toilet and wash basin. Communal toilet and bathing facilities are also accessible to people living at the home. We looked at the bedrooms of people case tracked and saw that they had been Care Homes for Older People Page 20 of 30 Evidence: personalised to reflect their age, gender, interests and culture. There is equipment available to assist staff to deliver personal care to people living at the home in a safe manner. This includes assisted baths and moving and handling equipment, including hoists. Staff met during the visit told us that the specialist equipment available at the home met the needs of the people living there. There is a secure rear garden. We saw that since our last visit this had been tidied so that it was ready for people to use. The manager told us that there are plans to create raised flower beds. This means that people living at the home can be involved in caring for these if interested to do so. We saw that actions had been taken in response to the concerns that we raised during our last key visit about the cleanliness of the living environment. Hours provided for housekeeping duties had been increased. This had a positive impact on the living environment for the people living at the home. We found that the home was clean and fresh during our visit. One relative told us They do keep it clean and tidy here. Another person said If I ask for anything to be done for example maintenance, it is done. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are supported by the right number of staff, who have most of the skills and knowledge they need to meet their needs. Evidence: In addition to care staff, administration, cleaning, maintenance, laundry and catering staff are employed. This means that people living at the home receive some support in these areas. People told us that the use of agency staff had reduced and that there was now enough permanent staff to meet the needs of the people living at the home. This should mean that people are supported by staff who have a good understanding of their care needs. One staff member told us At the moment staffing numbers are good. A relative told us I think that there is enough staff on now. They seem to be in the lounge more now. Positive comments were made about the staff team. We saw that they were spending time talking with people living at the home and their families. This promotes a homely and inclusive environment for the people living there. One relative told us The staff are as good as gold here. We have a laugh and a joke. The gender and cultural backgrounds of the staff team reflected that of the people Care Homes for Older People Page 22 of 30 Evidence: living at the home. This means that support could be provided in an understanding manner. We reviewed the staff file of a person who had recently come to work at the home. This included all information required. Two references had been obtained and we saw that the person did not start working at the home until a satisfactory criminal records check had been completed. This should mean that people can be confident that people employed by the home are suitable to work with vulnerable people. We saw that new workers undertake a basic induction working alongside a more experienced staff member. They then work through a nationally recognised induction programme. From discussions with the staff team and sampling of records, we identified that staff had recently undertaken a variety of training in mandatory areas. This included health and safety, fire awareness, food hygiene and infection control. The training co ordinator told us that she is producing a staff training plan for the next six months. This is in order to identify any training and development needs for individual staff members. This will enable further training to be arranged as required. This should mean that staff provide support in a safe manner. One staff member told us There is better training now. We have moving and handling training so that we know how to use the equipment properly. All my training is up to date. Nursing staff had undertaken recent training relevant to their job roles. This included person centred care planning and tissue viability. The manager told us that he is looking to develop a link nurse programme. This will mean that each registered nurse employed by the home will take the lead in a specialist area for example, nutrition and continence. He stated that he will be liaising with the Primary Care Trust about the possibility of providing training in these areas. There are currently 45 of staff who have completed a nationally recognised care qualification (NVQ level 2 in Care). The manager advised that he is aware that the number of people working towards this should increase. This means that more people will have the necessary skills and knowledge to provide a good standard of care. Records identified that staff meetings are held regularly. This means that staff have the opportunity to be involved in the running of the home. We saw that the manager discusses areas of concern regarding the service provided at the home, so that the staff team is aware of the improvements to be made. This is in order to improve the service provided to people living there. Care Homes for Older People Page 23 of 30 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. Systems must be further developed and arrangements sustained so that people living at the home can be confident that the home is being run in their best interests. Evidence: Since our last visit, the management structure within the home has changed. The previous manager left her post in March 2010. Since that time a temporary manager has been in post. (Referred to in this report as The manager). We were told that the organisation were actively looking to recruit a new permanent manager. We found that the manager was very enthusiastic within his temporary role at the home. From discussions with people living at the home, their families and evidence from this visit, we identified that he had instigated a number of improvements regarding the quality of the service provided there. However, we are aware that this is a temporary managerial arrangement and assurances are required to ensure that these improvements are sustained. Positive comments were received by the staff team about the support provided to them by the manager. One staff member told us All the staff feel supported by the manager. He always listens to us. Care Homes for Older People Page 24 of 30 Evidence: The manager is supported by an acting deputy manager. There is also a unit manager responsible for leading the staff team assigned to the dementia house. This means that there is now more time allocated to managerial duties for the benefit of the people living at the home. A clinical manager has also been providing support to the nursing staff team at the home. This is to improve the quality of the nursing care being provided at the home by developing the knowledge, skills and confidence of the nursing staff team. This should ensure that staff provide care and support in a competent manner to the people living there. Quality monitoring visits are undertaken by the external senior management team. We sampled the reports of recent visits. It was not always evident that people living at the home and their families were involved in these. This means that they would miss an opportunity to put forward their views and suggestions about the service provided at the home. Since our last visit, group meetings had been arranged involving the relatives of people living at the home. People met during the visit gave positive feedback about the success of these. One relative told us The meeting was great. Really constructive. Another relative told us The meeting that the manager had was very useful, very informative. We saw that a report based on the findings of previous service satisfaction surveys was on display in the home. This means that people are made aware of the results of these and any actions being taken. There is a system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Money is kept in a bank account, however people are able to access money at any time they require. Receipts were available and this means that it was possible to establish what peoples money had been spent on. From records sampled, we identified that regular checks are taken on equipment. This ensures that it is safe to use. We saw that a fire drill had recently been undertaken involving people living at the home. This is so that people are aware of the actions to be taken in the event of a fire. We saw that accident reports are completed and that the manager regularly audits these. We did, however, identify that on one occasion the information recorded did not accurately reflect the timing of the actions taken by staff following a person falling. This did not reflect the actual care afforded to the person at this time. This means that Care Homes for Older People Page 25 of 30 Evidence: it was not possible to determine that staff had taken the appropriate actions in order to keep the person safe. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Pressure area care records must reflect the care being provided. This is to ensure that people receive pressure area care at the times they require to prevent sore skin and further skin damage. 15/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should include all facilities provided at the home so that people have this information when choosing whether to live there. Staff should have the opportunity to work towards nationally recognised care qualifications, in order to ensure that they have the necessary skills and knowledge to provide care and support in a competent manner. People living at the home and their families should be involved in quality monitoring visits, so that they have the opportunity to put forward their views and suggestions about the service being provided there. 2 28 3 32 Care Homes for Older People Page 28 of 30 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 4 38 Information recorded on accident reports should reflect the actual care and support provided so that it is possible to assess whether appropriate actions have been taken to keep people safe. Care Homes for Older People Page 29 of 30 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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