Care Home: Bretby House

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What the care home does well The home had a relaxed atmosphere and people were seen to be able to make some decisions about how they spent their time. The relationships between the staff and the people living in the home were good. The people living in the home described staff to us as `very good` and `all very good`, one person said `we have a laugh with them`. Visitors that were spoken with were happy with the staff team and felt they offered a good service to the people living in the home. Care plans were generally well detailed and documented how people were to be cared for, what they were able to do for themselves and where they needed to be reminded about things. The medication system was well managed and ensured people received their medication as prescribed. The people living in the home had access to health care professionals when needed. Staff were able to identify health care needs and these were followed up. The menus were varied and nutritious and offered choices at each meal. The people living in the home were satisfied with the meals being served. The staffing levels in the home were appropriate for the needs of the people living there. The home was generally well maintained and the people living there appeared quite comfortable. The manager was ensuring the home ran smoothly and was very committed to continually improving the service for the people living there. What has improved since the last inspection? The information available for people considering moving into the home had been updated and would enable people to decide if the home was right for them. Staff were generally following the care plans and risk assessments for the people living in the home ensuring they were cared for safely and in a way that suited them. Practice at meal times had improved and ensured that the people living in the home generally got the assistance they required. Staff had received further training to ensure they could care for the people living in the home safely. There had been some further improvements to the home such as new flooring, additional handrails, redecoration and some new bed bases. This showed the environment was being continually upgraded for the benefit of the people living in thehome. What the care home could do better: To ensure people were being cared for safely at all times risk management plans needed to be put in place for any risks as soon as they were identified. The range of activities available for the people living in the home could be further developed to ensure people were leading fulfilling lives. Any supplementary heaters needed to be risk assessed and guarded if necessary to ensure people could not burn themselves. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bretby House 253 Boldmere Road Wylde Green Sutton Coldfield West Midlands B73 5LL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Bretby House 253 Boldmere Road Wylde Green Sutton Coldfield West Midlands B73 5LL 01213736562 F/P01213736562 jd012g3610@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care First Class (UK) Ltd care home 24 Number of places (if applicable): Under 65 Over 65 0 24 dementia old age, not falling within any other category Additional conditions: Age: Dementia (DE) age 55 and above. 10 0 The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 24 Dementia (DE) 10 Date of last inspection Brief description of the care home Bretby House is a large, extended house with parking space available. It is close to public transport routes with Wylde Green station being a short walk away. The home is on a bus route. Boldmere shopping centre is also close to the home. The home provides care and accommodation for up to 24 older people. Accommodation for the people living in the home is spread over three floors with a Care Homes for Older People Page 4 of 32 Brief description of the care home mixture of single and double rooms, some of which have en-suite facilities. There are several toilets, one shower room and three bathrooms in the home, however not all of these are in use. Communal areas are located on the ground floor and comprise of one large lounge/diner and two further lounges. Also located on the ground floor are the kitchen, laundry, office and staff facilities. There is a large and well maintained garden to the rear of the home that is accessed via a ramp. The range of fees charged at the home were detailed in the service user guide as being between three hundred and fourteen and four hundred and six pounds per week. Care Homes for Older People Page 5 of 32 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: The last key inspection at the home was carried out On April 8th 2008. This inspection was carried out over one day. The home did not know we were going to visit. The focus of 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, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information Care Homes for Older People Page 6 of 32 about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent 6 Have your Say surveys people who use the service, 6 to staff and 3 to health care professionals. Surveys were returned from, 4 of the people living in the home, 2 staff and 1 health care professional and these views have been included in this report. What the care home does well: What has improved since the last inspection? The information available for people considering moving into the home had been updated and would enable people to decide if the home was right for them. Staff were generally following the care plans and risk assessments for the people living in the home ensuring they were cared for safely and in a way that suited them. Practice at meal times had improved and ensured that the people living in the home generally got the assistance they required. Staff had received further training to ensure they could care for the people living in the home safely. There had been some further improvements to the home such as new flooring, additional handrails, redecoration and some new bed bases. This showed the environment was being continually upgraded for the benefit of the people living in the Care Homes for Older People Page 8 of 32 home. 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 set out 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 32 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 32 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. There was information available for people wanting to move into the home to enable them to make an informed choice about where they lived. The assessment procedures in the home ensured the needs of the people moving in were known to the staff prior to admission. Evidence: The service user guide for the home had been updated and included all the current information that people would need to help them decide if the home was suitable for them. The pre admission assessment procedure was looked at for two people who had been admitted to the home since the last inspection. The manager had obtained information from the social workers involved in the admissions. Both files included copies of the care plans drawn up by the social workers which detailed some of the needs of the Care Homes for Older People Page 11 of 32 Evidence: people being admitted. The manager also carried out her own assessments. These were quite thorough and covered all the required areas. At the end of the assessments there was a summary sheet which detailed the needs of the person and any issues that it was felt needed intervention by other professionals. For example, needs to see the optician and chiropodist. It was evident from the forms that the individuals had been spoken to and asked a number of questions about their lives and any difficulties they were having. The manager was being very careful about who was admitted to the home to ensure they were able to meet peoples needs. She gave an example of where she had refused an admission due to the challenging behaviours of the individual. She felt this would put the other people living in the home and the staff at risk. People were able to visit the home prior to admission if they wished and if it was appropriate to see if they liked it. One of the assessments seen was undertaken at the home on the pre admission day. One person spoken with said she chose not to visit the home and someone else had been to look around for her. The files sampled during this inspection included copies of the terms and conditions of residence that had been issued to people. These had been further improved and included the number of the room to be occupied. These documents ensured people knew what to expect from the home. The was evidence on one of the two files of the people recently admitted to the home that their placement there had been reviewed after the 28 day trial period. The person and their representative had not raised any concerns about the service. The other person had only been in the home for a very short time. Care Homes for Older People Page 12 of 32 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. The systems in place for care planning and risk assessments ensured people received person centred care and that generally any risks were reduced. People were satisfied they had access to health care professionals as needed. The medication system was well managed and the people living in the home received their medication as prescribed. Evidence: The care for four of the people living in the home was looked at. Three in some depth and another less so. Three of the people had been admitted to the home since the last inspection. The other person had lived in the home for some time. The care plans in the home were entitled Individual Service Statements (ISS). One person had only been in the home for a week and did not have an ISS. There was information on the file for staff so that they were aware of the individuals needs in the form of a needs assessed on admission action plan. This gave staff information to enable them to care appropriately for the person whilst continuing to assess their Care Homes for Older People Page 13 of 32 Evidence: abilities. The ISSs that were seen covered numerous areas of the individuals lives. They included all aspects of personal care, communication, mobility, dietary needs, behaviour and motivation and activities. Generally these were quite well detailed and documented how people were to be cared for, what they were able to do for themselves and where they needed to be reminded about things. For example, does not like to wear glasses all the time and remind to take dentures out. For one of the people recently admitted to the home the ISS was not as well detailed. It included statements such as assistance with personal care but there was no indication what this assistance was. The ISS did not indicate what the person was able to do for themselves. This was discussed with the manager and she was advised that it was important to include these details particularly where people had any short term memory loss and would not be able to guide their own care. Issues were raised at the last inspection about staff not following the guidance given on the care plans. This had improved at this inspection and staff were able to tell us how people liked to be cared for and what was on their care plans. Observation made generally showed that staff were following the care plans. For example, staff were seen to move people as described in their care plans. However there was still the odd occasion where guidance was not fully complied with. For example, one person who had adapted cutlery and a specific cup for drinks was not given these utensils straight away at lunch time. The adapted cutlery was given after the meal started but the cup was not given at all and the person was struggling with an ordinary glass. When a drink was given later in the day the specific cup was given. Files included a variety of risk assessments including manual handling, tissue viability, nutrition and personal risk assessments. These were generally well detailed and showed how staff were to reduce any identified risks to ensure people were safe. The manual handling risk assessments included details of how people were to be moved if they fell and were uninjured. Generally the manaul handling risk assessments were updated as the needs of people changed. One person had deteriorated very recently and staff were using a standaid on occasions, this had not been included in the risk assessment. It was evident from one persons daily records that he was being turned at night and staff were entering this on a turn chart in the persons bedroom. There was no indication on the persons ISS or tissue viability assessment that this was needed or why. The manager stated that it was due to recent deterioration and as a preventative measure to avoid the person developing pressure sores. This needed to be included on the care plan so that all staff had access to the information. Care Homes for Older People Page 14 of 32 Evidence: There were some good personal risk assessments in place detailing how staff were to manage behaviours and how they were to monitor health concerns and reduce the risk of any deterioration. For example, one person had an ongoing health concern with swollen legs, the management plan clearly detailed what staff were to observe for and when to report issues to senior staff. Another management plan described how staff were to try and distract the person when they became agitated and that they should take the person for a walk. Falls risk assessments detailed ensuring walking aids were accessible at all times and observing people when getting up as they were known to go dizzy. One person who had been admitted to the home very recently was clearly very distressed at being there and saw the placement as a punishment. There was no management plan in place for this to show how staff were to reduce this distress due to the short time the individual had been in the home. However staff were observed trying to console the individual and explaining the reasons for the placement. Staff spoken with were able to tell us about the needs of the people living in the home and how they liked to be cared for, what there risks were and how they had to monitor people for any deterioration. They were able to give us examples of where peoples appetites and physical conditions had deteriorated and what they had done about this. Staff were completing sheets that stated they had read, understood and agreed to follow the care plans and risks assessments. The people living in the home were receiving medical attention when required from G.Ps and district nurses. Staff were able to identify health care needs and these were referred on. Records also showed that the people living in the home had access to opticians, dentists, chiropodists and so on. People were being weighed regularly and where there was any weight gain or loss this was noted and the frequency of being weighed was altered where necessary. The home had purchased a pair of sit on scales since the last inspection which meant everyone could be weighed more accurately. Satisfaction surveys returned to us indicated people got the medical support they needed. One person spoken with said she can see the GP when she needs to and has her toe nails cut. Another person spoke to us about having a bad leg but it was getting better as he saw the nurse to do his dressing. The system in place for administering medication continued to be generally well Care Homes for Older People Page 15 of 32 Evidence: managed ensuring people received their medication as prescribed. All staff that were administering medication had received training. A random audit was undertaken of some of the medication. All the balances of the medication remaining in the home tallied with what had been received and administered. Eye drops were dated on opening so that staff knew when to dispose of them. Controlled medication was being recorded and administered appropriately. Two relatively minor issue were raised at this inspection. One person was having some medication for pain relief and this could be given as necessary. There needed to be a protocol in place detailing or staff when they should administer this. It was also recommended that any hand written instructions on the MAR (medication administration records) were verified by two staff as being correct. No issues were raised during this inspection in relation to privacy. People were seen to be offered assistance with personal care discreetly, be spoken to appropriately and by the name of their choice. People could spend time in their rooms in privacy if they wished and could lock their doors. Privacy screening was available in double rooms. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were activities available in the home but it could not be evidenced that these met the needs of all the people there. People could have visitors when they wished. People living in the home were satisfied with the food being served to them. They received a varied and nutritious diet. Evidence: There was quite a relaxed atmosphere in the home throughout the day. Staff interacted well with the people living there and there was a lot of friendly exchanges and laughter. People were clearly able to get up when they wished and were seen having breakfast throughout the morning. People were seen to wander freely around the home, go into the garden, sit chatting, read newspapers and books, watch television or spend time in their rooms. The activity records indicated there were some activities facilitated by staff such as bingo, hoops, cards, manicures and watching television. Where people had declined an activity this was also recorded. There was an activity programme on the notice board which indicated a daily activity however records did not evidence that all these were taking place, for example, walk to the shops and baking day. Care Homes for Older People Page 17 of 32 Evidence: Surveys returned to us by the people living in the home indicated there are sometimes activities they can take part in. Comments from the people living in the home about activities varied and included: Dont do anything really play games sometimes and listen to television. Dont do much talk to X. I read a lot of books. Im o.k. dont get bored. Staff told us they facilitated an activity every day usually in the afternoon. The surveys returned to us by staff indicated they thought activities could be improved and people should go out more. The care plans seen included some information about peoples preferred activities but these were quite brief, for example, has paper delivered takes part in activities, visits wife in X uses ring and ride. Care plans for social activities needed to be more specific and personalised indicating what people preferred to do with their time and how staff were to support them with this. This will ensure that people are doing the things they like and what they are able to do dependent on their abilities. The daily records and activity records showed that visitors were able to go to the home at varying times. Visitors were seen to come and go throughout the day and were made welcome. We spoke with two visitors. Both were satisfied with the care their friend/relative were receiving. One stated she was a frequent visitor for short periods of time and was very happy with the care, have a lot of confidence in the manager she is very approachable. Two of the people living in the home spoke of how they had made friends with each other and another person (who was not well on the day of the inspection) and that the three of them spent a lot of time with each other. They spoke of one being hard of hearing another not being able to see well and how they compensated for each other. There did not appear to be any rigid routines in the home and people were enabled to make some choices. For example, when to get up and go to bed, how to spend their time, what to eat and what to wear. Several issues were raised at the last key inspection in relation to meals and meal Care Homes for Older People Page 18 of 32 Evidence: times including ensuring people had enough vegetables and ensuring staff followed care plans that were in place. Observations made during this inspection indicated that these had generally been addressed. As previously mentioned staff did need to ensure people had the correct utensils to ensure they could eat their food independently. The menus in the home were varied and offered choices at all meals. The records of food served indicated people received a varied and nutritious diet and also gave some indication of the amounts people were eating. The manager needed to ensure that where people were being offered alternatives they were recorded even if they were refused. This will ensure there are records of staff trying to meet the dietary needs of people living in the home. For example the care plan for one person stated he was to be offered alternatives such as soups and custard if he did not have his meal as his appetite had recently diminished there was no evidence of this on the food records. People seemed generally happy with the food. Food seen being served looked appetising. People were seen to be encouraged with their food. Comments received about the food from the people living in the home and visitors included: Food very good enjoyed my lunch Too much food favourite is fish and chips. Food seems fine. The cook was seen to go around after the lunch time meal and ask if people were happy with what had been served. Staff spoken with indicated the food served in the home was good and there was plenty of choice for people. Care Homes for Older People Page 19 of 32 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. There was an appropriate complaints procedure on site and it appeared that any complaints were listened to and acted on. Staff had a good understanding of the procedures in place for adult protection ensuring the people living in the home were safeguarded. Evidence: There was a complaints procedure for the home and the people living there received a copy of this in the service user guide. We had not received any complaints about the home since the last inspection. The complaints log at the home did have some issues documented in there but they were really details of conversations the manager had had with relatives mainly about medical issues. These were not complaints and included personal details and should have been in peoples personal files to ensure their confidentiality. The surveys returned to us indicated people knew who to complain to and that staff listen and act on what they say. People were comfortable in the presence of the manager and staff which would give them the confidence to raise any issues. Visitors indicated issues they raise are resolved, for example, lost clothing. One visitor stated the manager is very approachable. Care Homes for Older People Page 20 of 32 Evidence: It was recommended at the last inspection that staff record any minor complaints or niggles that the people living in the home make to evidence they listen to them and take action. This had not been addressed. The manager and proprietors of the home have shown in the past that they are clearly aware of their responsibilities to report any allegations of abuse. There had been one adult protection issue raised by the home since the last inspection which led to a staff member being referred to the POVA register. Some issues were referred to Social Care and Health by an ambulance crew that had been called to the home. The issues were around the circumstances when one of the people living in the home fell. After the social worker had visited the home the issues were not deemed as being adult protection issues. Some actions were taken by the home to try and avoid any further falls. Staff spoken with were able to tell us what they would do should they witness or suspect any abuse. They were well aware of the whistle blowing procedure, the importance of reporting any issues straight away and who they could report issues to if they did not want to report in house. The training matrix for the home indicated some staff had received training in POVA since the last inspection. Some staff still needed to undertake this. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided people with a generally safe, comfortable and well maintained environment in which to live. Evidence: The home was suitable for its stated purpose, was generally well maintained and safe. The AQAA returned to us indicated that further improvements had been made to the environment including, further hand rails fitted, redecoration, some new commodes, bed bases, linen and curtains had been purchased and four sensor mats purchased to minimise falls at night. During the tour of the home all these improvements were seen. There was ample communal space with one combined lounge/diner and two further lounges. All communal areas were comfortable and adequately furnished and decorated. There was also a large garden to the rear of the home with seating available for the people living in the home. There were some aids and adaptations throughout the home to assist those people with mobility difficulties including shaft lift, mobile hoist, assisted bathing facilities and a ramp for going into the garden. The home also had an emergency call system. Care Homes for Older People Page 22 of 32 Evidence: Some bedrooms were seen on the day of the inspection. They varied in size and the majority of the required furnishings and fittings were evident. All rooms had a lockable facility and the people living in the home were able to have keys to their bedroom doors if they wished. Rooms seen were appropriately personalised and double rooms had adequate screening. Some new bed bases had been purchased however there was still the odd one that needed to be replaced. It was noted that in one bedroom there was a supplementary heater which was on and quite hot to touch. This needed to be risk assessed and guarded if necessary to ensure people could not burn themselves on it. The bathing, showering and toilet facilities appeared to meet the needs of the people living in the home. The proprietor told us of plans to have a further walk in shower installed in the home. The home was generally clean and odour free. The laundry was appropriately located, albeit very small. There was a sluice washing machine and two tumble driers installed. The storage of COSHH substances had improved ensuring they were not accessible to the people living in the home. A mechanical commode pot washer was due to be installed at the home to assist with the effective cleaning of the many commodes in the home. Some general issues were raised in relation to good infection control in the home. These included a soiled incontinent pad had not be disposed of appropriately, there were some personal toiletries left in bathrooms and the bath hoist seat needed to be thoroughly cleaned. The kitchen was not inspected. We were told that at a recent visit from the environmental health officer the home had been give 4Hs which indicated very good procedures were in place for safe food handling. Care Homes for Older People Page 23 of 32 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. Adequate staffing levels were being maintained to ensure the needs of the people living in the home could be met. Staff were receiving the appropriate training to enable them to care for the people living in the home safely. Staff recruitment procedures were robust and ensured the people living in the home were safeguarded. Evidence: There had been some staff staff turnover at the home. This was relatively low and the staff team appeared more stable than at previous inspections which was good for the continuity of care of the people living in the home. The staff told us they thought the staff team was more settled and that their team working had improved due to this. We were told and the rotas indicated there were three care staff on duty throughout the day and two at night. The managers hours were supernumery to the care rota. The home also employed domestic and catering staff who were included on the rotas. It was recommended that the person who would be termed as shift leader when the manager was not on duty was highlighted on the rota. This would ensure staff were aware of this and show there was always someone responsible for leading the shifts. The staffing levels at the time appeared to be adequate to ensure the needs of the people living in the home could be met. Care Homes for Older People Page 24 of 32 Evidence: The surveys returned to us indicated that the people living in the home had staff available to them when needed. Friendly relationships were evident between the staff and the people living in the home. People described the staff as very good and all very good, one person said we have a laugh with them. Visitors that were spoken with were happy with the staff team and felt they offered a good service to the people living in the home. Staff we spoke with were aware of the needs of the people living in the home and how they wanted to be cared for. Issues were raised at the previous inspection about staff not following care plans and risk assessments. This had improved and staff were aware of the need to follow care plans and risk assessments. The recruitment files were checked for two staff who had been employed since the last inspection. All the required checks had been undertaken before the staff commenced work at the home to ensure they were safe to work with the people living there. One minor issue raised with the manager was to ensure all references were dated so that it could be shown they were all received before people commenced work. New staff were undertaking induction training in line with the Skills for Care specification and evidence of this was seen on their files. Staff were able to tell us about their induction training and that it included them shadowing more experienced staff until they were confident in their roles. The staff we spoke with told us they were satisfied with the training they had and were receiving which was ongoing. The training matrix indicated staff had undertaken manual handling, fire, POVA, health and safety, first aid and food hygiene training since the last inspection. There were some gaps on the training matrix but we were told these staff had just returned from maternity leave and these would be addressed. Some staff had also undertaken training in other topics such as challenging behaviour, nutrition and the Mental Capacity Act. Many of the staff had also undertaken a distance learning course in dementia which we were told was quite in depth. NVQ training was not detailed on the training matrix but the AQAA indicated that over 50 of the staff were qualified to NVQ level 2 or the equivalent. Care Homes for Older People Page 25 of 32 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. The manager ensured the smooth running of the home in a competent manner. The home was being run in the best interests of the people living there. The health and safety of the people living in the home and the staff were well managed. Evidence: The manager at the home had been in post for a little under two years at the time of this inspection. There had been a lot of improvements in the home since she started she had brought some stability to the home and was overseeing the running of the home well. Staff said the manager was approachable and that relationships with her were good. People living in the home were aware she was the manager but were very comfortable in her presence. One visitor told us she had great confidence in the manager and she was very approachable. She demonstrated a good knowledge of the needs of the people living in the home and how they liked to be cared for. Care Homes for Older People Page 26 of 32 Evidence: Since the last key inspection the manager has shown she is able to develop the home and is very committed to improving the service offered. She was very receptive to the comments we made throughout the inspection. Her past efforts have shown us she will do all she can to meet any requirements we make to improve the service for the people living in the home. The proprietor of the home was also present throughout the inspection. She was a regular visitor to the home and staff and the people living in the home knew her well. There was a new system in place for monitoring the quality of the service. One of the directors of the company was auditing various areas of the service against the National Minimum Standards. Any corrective actions were detailed and then the manager had to action these. This was then rechecked by the assessor. The system involved satisfaction surveys being issued to the people living in the home, staff and visitors. A sample of these were seen and comments about the service were quite positive. There were also regular meetings with the people living in the home where such things as menus, activities, the comfort of bedrooms and how to raise any issues were discussed. Staff meetings were also being held. It was recommended that the home had an annual development plan for the home detailing how they intended to improve the service for the people living in the home and that the report was made available for interested parties. The home continued to manage some of the finances on behalf of the people living there. Some records were sampled. Family members brought the money for these individuals into the home. The written records were appropriate and recorded all income and expenditure and all balances of cash held were correct. Receipts were available for any expenditure made on behalf of the people living in the home. There was evidence on staff files to show they were receiving individual supervision sessions with the manager at the required frequency to oversee their practice and identify any training needs they may have. The health and safety of the people living in the home and the staff were well managed. The AQAA indicated that all the equipment in the home was serviced as required. Staff had training in safe working practices. The in house checks on the fire system were sampled and found to up to date. Fire drills were also being undertaken. There was also evidence on site that the manager was checking water temperatures on a regular basis to ensure they were not too hot for the people living in the home. The manager continued to notify us as required of any accidents or incidents in the Care Homes for Older People Page 27 of 32 Evidence: home so that we could assured these were being managed in the best interests of the people living in the home. Care Homes for Older People Page 28 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Risk management plans must be put in place for any risks as soon as they are identified. This will ensure people are not exposed to any unnecessary risks. 21/05/2009 2 24 13 Any supplementary heating in bedrooms must be risk assessed and guarded if necessary. This will ensure people cannot burn themselves. 22/05/2009 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 7 Care plans should include all the needs of the people living in the home and how they are to be met by staff. This will ensure people living in the home receive person centred care. The guidance in the care plans should be followed at all times to ensure people have their needs met. Page 30 of 32 2 7 Care Homes for Older People 3 9 Any hand written entries on MARs should be verified as correct by two staff. This will ensure people receive their medication as precribed. There should be protcols in place for medication to be adminsitered as and when necessary to ensure people receive the medication when necessary. The range of activities offered should be further developed to ensure people are leading fulfilled lives. Care plans for meeting social needs should be more personalised to ensure people are enabled to do what they want to do and what is within their capabilities. Staff should ensure people have the appropriate utensils at meal times to enable them to eat independently. The manager should ensure that where people are being offered alternatives at meal times they record these even if they are refused. This will ensure there are records of staff trying to meet the dietary needs of people living in the home. To ensure the confidentiality of the people living in the home personal details must not be entered in the complaints log. It is recommended that any minor concerns or complaints raised by the people living in the home are recorded to show they are listened to and that concerns are acted on. All staff should receive training in adult protection issues to ensure the people living in the home are fully safeguarded. The manager should ensure that good infection control procedures are implemented throughout the home. This will ensure people are not exposed to unnecessary risks. It is recommended that the home has an annual development plan for the home detailing how they intend to improve the service for the people living in the home and that the report is made available to interested parties. 4 9 5 6 12 12 7 8 15 15 9 16 10 16 11 12 18 26 13 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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