Care Home: Breadstone House Care Centre

What the care home does well The home has a system in place to make sure prospective people are assessed prior to admission to make sure they can meet their needs. The home provides people with a selection of choices at mealtimes and alternatives. Snacks are provided at frequent intervals throughout the day. The feedback we received about the meals was very good and people were seen to be enjoying the food provided. A safe system for the management of peoples medication is in place. The home exceeds the recommended 50 percent of care staff with an NVQ 2 or above in health and social care. The feedback we received both at the inspection and from surveys is that people`s relatives/representatives are very happy with the standard of care their relative`s receive from staff in the home. What has improved since the last inspection? Since the last key inspection in July 2008 the home has made a number of improvements in all outcome areas. These include; The vast majority of care plans are personalised and contain detailed information for staff about how to meet peoples assessed needs. Care plans are linked to risk assessments and evidence was seen of ongoing reviews and evaluations. The care plans were all up to date with peoples current needs. We felt that the staff are using these as a `working document` which is excellent. The activities provision is much improved. Activities are provided over four days by dedicated staff and these are based on peoples needs, choices and interests. All staff have received training in safeguarding people either in house or have attended the local County Council`s `Alerters` guide training. The cleanliness of the home is much improved. We first found an improvement at the January 2009 random inspection and this has been maintained. No unpleasant odours were found which is excellent. Changes have been made to the communal space with the dining area being moved to the communal room towards the rear of the home. This has provided people and staff with more space. The tables are laid with cloths, condiments and a vase of flowers. A menu board is on display and this is updated each day. An increase in staff training and support has taken place and this has benefited the people who use the service and staff. What the care home could do better: We are concerned about the staffing numbers on the night shift as from 9pm only two staff are on duty. We would recommend that for safety and to make sure people are not having to wait for staff to assist them that this is reviewed and increased. To help sustain the improvements to the home the new manager must now apply to us to be considered for registration. Key inspection report Care homes for older people Name: Address: Breadstone House Care Centre Breadstone House Care Centre Breadstone Nr Berkeley Glos GL13 9HG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright     Date: 0 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Breadstone House Care Centre Breadstone House Care Centre Breadstone Nr Berkeley Glos GL13 9HG 08453455782 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: lucy.msowoya@blanchworth.net Blanchworth Care Homes Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: A condition be imposed on the registration of the providers that there be no further admissions of service users to Breadstone House Care Centre without prior written agreement of the Commission; and The Commission and the registered providers have agreed a procedure, which the registered providers will use when making requests for admissions, the details of which are contained in a letter dated 1st April 2009 from the Commissions solicitors, Anthony Collins Solicitors LLP. Date of last inspection Brief description of the care home Breadstone House Care Centre is a registered Care Home with Nursing. It is registered to accommodate older people with dementia. The home is situated off the A38 Gloucester to Bristol road and is approximately 20 miles from Gloucester. It is a detached house situated in attractive grounds. The communal areas are situated on the ground floor. There are 28 single bedrooms (7 with en-suite) and 6 double bedrooms. The home makes information about the service, including our reports available to Care Homes for Older People Page 4 of 31 Over 65 40 0 3 0 0 1 2 0 0 9 Brief description of the care home people through a Service User Guide and Statement of Purpose available in the home. The fees range from 585 pounds to 800 per week depending on peoples needs. The service has information about how they manage the Funded Nursing Care Contribution (FNC). Additional services not included in the fees are hairdressing, chiropody and toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors on one day in July 2009. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service, staff and health and social care professionals. Because of the medical needs of the people who use the service these surveys will have been filled in with help from relatives/representatives. We received seven back from people who use the service, five from staff and two from health professionals. The results of these have been used in the report. We did not requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection as the home completed one in December 2008 and we only request AQAAs on an annual basis. We looked at other information we have received from or about the service from other Care Homes for Older People Page 6 of 31 stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. Since the last key inspection in July 2008 the service has had two random inspections and we have used some of the findings from the January 2009 random inspection in this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We are concerned about the staffing numbers on the night shift as from 9pm only two staff are on duty. We would recommend that for safety and to make sure people are not having to wait for staff to assist them that this is reviewed and increased. Care Homes for Older People Page 8 of 31 To help sustain the improvements to the home the new manager must now apply to us to be considered for registration. 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 31 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 31 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. Arrangements are in place for peoples needs to be assessed and considered prior to admission so that ultimately their needs are fully met once they are admitted. Evidence: We inspected the information that had been gathered about three people before their admission to the home. This was found on their pre admission assessments and gave a comprehensive description of the persons abilities and needs in each case. In each of the above cases the assessments were carried out by senior company managers, we presume this may have been because at the time there was not a home manager. These assessments, carried out by the home/company staff, allow a decision to be made as to whether the home can meet the persons needs. In all three cases the people had needs that the home is registered to meet. The pre admission assessment also identified specialised needs and risks that needed to be considered before the persons admission. In one case this was a need for Care Homes for Older People Page 11 of 31 Evidence: pressure relief equipment and in another, staff needed to consider someones potential for challenging behaviour. In the surveys that we sent to people who use the service we asked them, did you have enough information to help you decide if this home was the right place for you, before you moved in, all seven people said yes. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are reviewed and care plans are devised in order to give care staff guidance as to how those needs should be met, but, well meaning staff must ensure they adhere to the guidance given otherwise people maybe put at risk. A safe system is in place for the management of medications for people who use the service. Evidence: We inspected the care files of five people. Three were in detail (case tracked) and covered all aspects of the persons care and two focused more on specific areas of care such as pressure sore prevention, nutritional risk and challenging behaviour. All the care plans we saw followed on from the information gathered from the pre admission assessment and additional assessments completed on admission. Both the care plans and the additional assessments demonstrated frequent reviews of peoples abilities and needs. We could see adjustments to the care plans and assessments as the persons health altered indicating that the documentation was very much a working tool/record. Care Homes for Older People Page 13 of 31 Evidence: The guidance to staff within the care plans could at times be generic, for example, in one persons care plan for personal hygiene a statement such as bath weekly does not provide enough information for this to be considered as person centered planning. In such a care plan it would tell us what day the person tends to like a bath, what time of the day maybe, a description of how that person likes to be bathed, what products do they like to use and what maybe specific to that person when bathing. In another care plan relating to the persons challenging behaviour, the instructions were very specific. The care plan told the reader how the person sometimes reacts and then gave clear instructions such as: if the person says no, then staff to retreat and revisit 10-20 minutes later. It was also very specific in how staff should communicate with this person. Where the care plans were less specific about what had taken place information had been recorded elsewhere on fluid charts, food charts, night check charts and sleep charts that demonstrated that the care that was written in the care plan, was being delivered. There was specific evidence that demonstrated continual assessment of someones risk of developing pressure sores. This showed that staff were working alongside external health care professionals to meet these needs. In one case a person was assessed as requiring one level of pressure relief and then later it was thought that this could be lowered. This demonstrates proactive thinking and shows that staff are considering someones changing needs. We saw specific risk assessments for falls and specific records of any bruising or wounds that staff have observed; sometimes the origin was known, such as as the result of a fall and at other times the origin was unknown. We know that senior company managers audit what is written in the assessments and care plans as this has been demonstrated in the homes monthly reports to us under Regulation 26. We did speak to care staff about how they care for various people. It was during one conversation it became clear that, although the carer we were speaking to was carrying out certain personal care tasks to help assist other carers at a certain time of the day, they were in fact doing this alone when the care plan clearly stated two members of staff are required (see Staffing outcome). We did observe that two people who were sat in the communal lounge outside the office had the slings that are used with the hoist left in the chair behind them. We are Care Homes for Older People Page 14 of 31 Evidence: aware that one of these people is very frail and has specific moving and handling needs, but for comfort and to prevent any damage to peoples skin integrity the staff should remove them. We did see evidence in the care records that people have access to external health professionals and these include, General Practitioners, Community Nurses, Nurses from the Care Home Support team, Physiotherapist and Chiropodist. We examined the system the home has in place for the management of medication. Due to the health needs of the people who use the service they are not able to self medicate. Qualified Nurses administer medication and a lockable trolley is used to transport the medication around the home. We did not observe a full medication round taking place but we did see medication being administered at a mealtime and the nurse made sure the trolley was secure when administering medication directly to each person. We examined all Medication Administration Records(MAR)and these had information about peoples allergies on them. No gaps were found in the recording of medication administered. Each person has a medication administration choice form that has details about where people would like to receive their medication. We randomly selected two medications and undertook an audit. This is were we count the tablets and check that they correspond with the records. Both were correct. However for one person it looked like the nurse had signed their initials and then written over the top for a refusal. Nothing had been written on the back of MAR as we had witnessed this for other refusals. We asked the nurse and she confirmed that this person had refused and they disposed of the tablet as per the homes policy. It would appear that in this case the nurse had signed for administration prior to the person taking the tablet. Where a person had been prescribed a variable dose the nurses has documented what dose was given and this is good practice. Dates of opening were in place on boxed medication and eye drops. No controlled medication was being used at the time of the inspection but the home does have a system in place to manage this. One person was having injections and a record was in place to document the injection sites, which is good practice. Monitoring of the medication fridge temperature and rooms where the medication is stored is taking place. A specialist contract is in place for the disposal of any medication that is no longer being used and for any medication that has been refused. We examined the homes policies and procedures for medication at a previous inspection and training for staff that administer medication. We asked people in the surveys, do you receive the care and support you need, six people said always and one person said usually. We also asked does the home make sure you get the medical care you need, six people said always and one person said usually. In the surveys we received from two health care professionals we asked Care Homes for Older People Page 15 of 31 Evidence: them, does the care service support people to administer their own medication, or manage it correctly where this is not possible, one said always and one said usually. We observed staff treating people with respect and always explaining to people when they were about to assist them. We heard staff speak to people in a respectful manner. We asked the health professionals in their surveys, does the service respect peoples privacy and dignity. One said always and one said usually. Care Homes for Older People Page 16 of 31 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 who use the service are able to make decisions about their daily life and have access to an activities programme that is based on their interests, abilities and choices. Evidence: Since the random inspection in January this year there has been a change to the activities coordinator. Previously this person used to help out with the activities on a volunteer basis. The activities coordinator works three days per week and a volunteer covers another one day for activities. The activities coordinator discussed the range of activities they provide to meet the needs and choices of people who use the service. They are able to provide group or one to one activities. On the day of the inspection music was playing in two communal lounges as the activities person said people really enjoy music and they join in. Other activities provided include, music and movement, armchair exercises, quizzes, cakes/bread making, reminiscence and talking to people. One person was being taken out on the day of the inspection with the activities coordinator in a car for a drive around. When the weather is warm and dry the activities person said she takes people outside in a wheelchair for a walk. In one of the communal lounges a snoezelen is in place and the activities person said it is used most days. Outside entertainers also visit the home and they are looking for someone Care Homes for Older People Page 17 of 31 Evidence: to come into the home to play musical instruments. Records are in place for each person listing what activities they have taken part in. Church Services take place at the home and a local Vicar also visits people. One person who is Roman Catholic has communion provided for them in the home. The hairdresser visits the home every Wednesday and people said they enjoy having their hair done. One person who can be resistive to care had allowed the hairdresser to cut their hair, which the staff felt was a big achievement for them. We asked people in the surveys, does the home arrange activities that you can take part in if you want, three people said always and three people said usually. One person had commented More activities are required. Visiting to the home is not restricted and visitors we spoke with said they are made to feel welcome by the staff. During the tour of the home we observed peoples personal belongings on display in their bedrooms. At previous inspections we have been told that the home has information about advocacy services available. We observed staff offering people choices where able, for example people are offered a choice at mealtimes, when drinks are brought round and if they they wish to take part in the activities. Staff were able to demonstrate good knowledge of peoples needs especially people who are not able to communicate their wishes verbally. We asked people in the surveys do the staff listen and act on what you say, one person did not answer this question. Four people said always and one person said usually. We spoke to the cook who confirmed that there were two main dishes being served for lunch on the day of this inspection; one was gammon and the other chicken. She also explained that several alternatives could be prepared such as sausages or salads. This information was on the menu board in the dining room. The cook said they use the menus provided by the Registered Provider but they alter them to meet the likes of people who use the service. The home is able to cater for people who require a therapeutic diet. Health and safety checks are taking place. Food records need to include details about the flavour of soup offered and sandwich fillings. The kitchen has been awarded 4 stars by the Local Environmental Health Department. We observed a mealtime in the dining room which has moved location since the last random inspection. It is now sited towards the rear of the home and provides more space for people and staff. The dining area was very pleasant and each table had a table cloth , condiments and vase of flowers on them. A menu board is displayed in this room. Care Homes for Older People Page 18 of 31 Evidence: People were observed chatting to each and staff during the meal. Staff offered assistance discreetly and sat down with people when helping with meals. Two people didnt want to eat what they were first offered and the staff provided them with an alternative. We observed hot drinks and biscuits being provided at 11am. The cook said people are offered snacks at 2pm and this is normally a fruit salad and milkshake, 3pm is tea and cakes and prior to retiring to bed people are offered sandwiches.We noted on one persons fluid chart that a calorie fortified milkshake was offered in the afternoons. It was explained that this is provided in the afternoon, separately from the afternoon hot drinks, to all those that are assessed as being nutritionally at risk. In the evening we saw two hot choices being provided for the teatime meal, one was homemade soup and the other smoked haddock. There was also a selection of sandwiches, a pudding and fruit. We asked people in the survey, do you like the meals at the home, three people said always and three people said usually. One person had commented food is always good. Care Homes for Older People Page 19 of 31 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 who use the service and their representatives are able to express any concerns and have access to a complaints procedure. Systems are in place to help safeguard people from possible risk of harm or abuse. Evidence: A copy of the homes complaint procedure is displayed on the notice board in the entrance area. Since our last inspection the home has received one verbal complaint and records were in place of the outcome to this. We asked people in the surveys, is there someone you can speak to informally if you are not happy, one person did not answer this question, five people said yes and one person said no. We also asked them, do you know how to make a formal complaint, again one person did not answer this question, four people said yes and two people said no. The home has policies and procedures in place for staff to follow in relation to safeguarding people and these include whistle blowing, abuse and POVA scheme. Staff have received training in safeguarding people either in house or by external training providers for example, the Alerters guide training provided by the local County Council. As the home has a new manager if they have not previously undertaken the Enhanced training provided by the local County Council it is recommended that they apply for this course. Staff are also provided with training in managing challenging behaviour. One member of staff said they have not undertaken the safeguarding training but Care Homes for Older People Page 20 of 31 Evidence: when we checked the training matrix it was recorded that they had undertaken this training. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design of the home is not purpose built but people live in a clean and comfortable environment. Evidence: A tour of the home took place with a number of bedrooms belonging to people seen. Breadstone House is not a purpose care home. Aids have been provided to assist staff in caring for people and these include assisted bathing facilities, shaft lift and lifting equipment for example hoists. The communal areas are all situated on the ground floor and there is an enclosed courtyard where people can sit when the weather is warmer. Gardens surround the home but we did not look around these at this inspection. The majority of people were seen to use the larger communal rooms situated in the main part of the home. Since the random inspection in January the dining room has moved to the larger communal room towards the rear of the property as this provided more space for people and staff. The previous dining space that was situated outside the managers office is now a lounge. We looked around the home accompanied by a Representative from the Registered Provider. The cleanliness of the home has much improved since the last key inspection and we first noticed an improvement at the random inspection in January this year and we are pleased this has been maintained. No unpleasant odours were found which is excellent. The laundry area was seen and this situated outside of the home within the grounds. Care Homes for Older People Page 22 of 31 Evidence: The laundry was well organised and the assistant informed us about the procedure they follow for the management of soiled linen. When the laundry assistant is on duty they collect and deliver the laundry back to the home. Protective clothing is provided for staff to use and this includes gloves and aprons. At the last key inspection we saw evidence that the home has a contract in place for the disposal of continence products. Care Homes for Older People Page 23 of 31 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. With the increased input into staff training provision and support this has benefited people who use the service. However with the reduction in the night staffing numbers it could mean that people may experience a delay in having their needs met. Evidence: The duty rotas were examined and the the home is confident that the numbers and skill mix of staff on duty are meeting the needs of people who use the service. Ancillary staff are available to support the care staff. The duty rota for the day of the inspection indicated that there was two domestics on duty, however one of the domestics was doing laundry for another property owned by the Registered Provider for part of this shift and not actually working for the whole time for this home. This needs to be clearly documented on the duty rota. At the random inspection in January 2009 we had concerns that the number of night staff had been reduced from three to two staff and the change over of the shifts takes place at 7pm. We were informed verbally that an extra member of staff is on duty until 9pm but the duty records did not contain this information. At this inspection the duty rotas now record which staff member is staying on until 9pm. We also witnessed three staff during our evening visit to the home, however the staff member that was on duty to 9pm was not the same as the member of staff written on the duty rota. This would need to be amended. At the time of the inspection the home had 16 people and one of these was in hospital. The night staffing numbers remain at two night staff from 9pm. We are concerned that Care Homes for Older People Page 24 of 31 Evidence: due to the layout of the home and the needs of people who use the service, people may have to wait to receive help from staff. We are aware that two people had been identified as wandering at night in their care plans, however the night nurse said that one person is now having a better nights sleep following a review by their GP. We are also aware that some people require the assistance of two staff to change their positions at night. As the laundry area is sited outside of the home if the staff have to take linen to the laundry then only one member of staff would be left in the home. Breadstone House is large home set out over two floors and peoples bedrooms are spread out. We would recommend that a review of the night staffing numbers is undertaken to make sure people are safe at night and they are having their needs met. Staff spoken with at the inspection and in the five surveys we received all said they enjoy working at the home, comments include we do our very best for the residents and work as a team, Breadstone is a good home, All the staff are committed in helping the home to provide a good service to its residents and keep it running smoothly. Comments we received from people include some of the staff are excellent, the staff are always attentive to all residents and nothing is too much trouble, they are sympathetic to people suffering from dementia. We also asked people, are the staff available when you need them, four said always and three said usually. From the information we received during the inspection the home exceeds the recommended 50 percent of care staff with an NVQ 2 or above in Health and Social Care, which is excellent. We examined the recruitment records of the newly appointed manager on the homes computer system. All the required checks were in place except that for parts of their employment history they had used years and not more specific dates. Following the inspection the Registered Provider said that the new manager had combined all the dates on his application form with his CV and when they are read in-conjunction he has a full employment history. Prior to the new manager starting a full Criminal Records Bureau Disclosure that includes a POVA check (Protection of Vulnerable People) was in place. The new manager was undergoing his induction programme during the inspection. A Representative from the Registered Provider was going through the induction training specifically for managers with him. No care staff were undertaken induction training. We were informed that the induction training programme is under review as they are looking to make sure it meets the Skills for Care Common Induction Standards. Care Homes for Older People Page 25 of 31 Evidence: A training matrix is in place and this lists when staff have completed training and when an update is due. The home managers now book all the training and they use external training providers. The Care Home Support team are involved in the home and are providing training in a number of areas to include, managing challenging behaviour and falls. Training in dementia care has also been provided. The Registered Provider is looking to train home managers to become moving and handling trainers and the new manager said he is already is trained. Staff confirmed they have access to training to include mandatory subjects for example health and safety, moving and handling and other training pertinent to peoples needs. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With a stable management team in place this will help to maintain the improvements to the home and the standard of care people receive. Quality assurance systems are in place to make sure the home is run in the best interests of people who use the service. Evidence: Since the last key inspection in July 2008 the home has had three managers in post. However one manager had to leave just after the inspection in July 2008. The second manager applied to us to be considered for registration but chose to withdraw from the process. The third manager has only been working at home just over a week at this inspection. He told us he is going to apply to us to be considered for registration. The new manager is a qualified nurse and has had experience of working at other care homes in senior roles. The deputy manager was not working on the day of the inspection. We have found at this inspection that the home has made a number of improvements Care Homes for Older People Page 27 of 31 Evidence: to standard of care they provide to people who use the service. A Representative from the Registered Provider said they have just sent out to peoples relatives quality assurance questionnaires. They have had one questionnaire returned to them from a family of a person who was on respite care. The Registered Provider has a number of audits in place for the manager to use. The new manager had undertaken some audits to include bedrooms, care plans and complaints. Accident records are also audited on a monthly basis. Regulation 26 visits are taking place (this is where a Representative on behalf of the Registered Provider undertakes an unannounced visit to the home and completes an assessment and report). We have not received one for every month up to this inspection and a Representative said they will send these to us. As part of these visits audits for the Registered Provider also take place and these include the environment, care plans, medication and complaints. We did not request an AQAA at this inspection as the last one we received was in December 2008 and we only ask for them on a yearly basis. The home has a safe system in place for the management of peoples monies. We randomly selected two people and we found that the records and monies were correct. Receipts are kept of any purchases or additional services used by people. We would recommend that these are also audited as one person was last audited in 2008 and the other in January 2009. A Representative for the Registered Provider said they are audited as part of the Regulation 26 visits every six months. We looked at the system the home has in place for staff supervision. We randomly selected staff files to check that records were in place for any sessions and they were. In the staff surveys we asked does your manager give you enough support and meet to discuss how you are working, three said regularly and one said often. The AQAA contained dates of servicing of equipment and services, for example, hoists, boilers and electrical appliances. Some of these dates are now past a year but we were informed at another home managed by the Registered Provider that all servicing is always up to date. We were shown records of monthly and weekly maintenance checks to include monthly hot water temperature, wheelchairs and fire equipment. Window restrictors are checked on a six monthly basis. The home has a fire risk assessment in place that was examined by the local Fire Service during their visit last July. Care Homes for Older People Page 28 of 31 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 29 of 31 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 31 9 The registered person must make sure that the new manager applies to us to be considered for registration. This will help to make sure the home is run by a suitably qualified and competent person, and in the best interests of people who use the service. 06/11/2009 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 2 15 27 Food records need to contain details about the flavour of the soup and sandwich fillings. The Registered Person should consider having more than two night staff on duty from 9pm until 7am for safety reasons and to make sure people are receiving help when they need it. A full employment history must contain more specific dates than just years, to make sure people who use the service are not put at unnecessary risk. 3 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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