Care Home: Brooklands Nursing and Residential Home

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What the care home does well The home provides accommodation in a pleasant environment. Furnishings and decor are good and a programme of improvement continues. What has improved since the last inspection? Some improvements have been made to the management of medications but further improvements are required. What the care home could do better: The care plans require to be updated following a review of each individual service user to identify needs, abilities and preferences. Care plans should provide staff with clear information regarding the care required and of how that care should be given. The assessments of service users should include nutritional needs, together with information regarding special dietary needs and preferences. Clear and accurate records in relation to medications should be held. A programme of activities should be prepared following discussion with service users to ensure that a stimulating programme is provided for both groups and individuals. A review of the menus, following discussion with service users, should be undertaken to ensure that a varied and nutrition diet is offered with a choice of meals available. Staff training in relation to care planning, record keeping and medications would ensure that service users are provided with safe care practices. Records relating to the equipment and the premises would benefit from reorganisation to ensure that all records are readily available. Key inspection report Care homes for older people Name: Address: Brooklands Nursing and Residential Home 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ     The quality rating for this care home is:   zero star poor 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: Jeanette Fielding     Date: 3 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brooklands Nursing and Residential Home 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ 01512520080 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rosewood Care Services Limited Name of registered manager (if applicable) Miss Charlotte Aspinall Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Brooklands is a large home providing both personal and nursing care to older people over the age of 65 years and is located in the Old Swan district of Liverpool. Local amenities such as shops and churches can be found within a short walking distance and good transport links are available to local communities, nearby towns and Liverpool City centre. The home is purpose built with accommodation on two floors. A Care Homes for Older People Page 4 of 32 Over 65 49 0 Brief description of the care home passenger lift provides full access to the upper floors of the home. There is wheelchair access and parking at the front of the premises. A pleasant, private garden is located to the rear of the building. 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: zero star poor 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 unannounced key inspection was undertaken over two days and the Lead Inspector spent thirteen hours in the home. In addition, the Pharmacy Inspector spent seven and a half hours in the home during one day. As part of the inspection process, all areas of the home were viewed including some of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. The care files of eight service users were case tracked to evaluate their care. The Pharmacy Inspector inspected all aspects of medication including the records held by the home. Discussions took place with the Responsible Individual, Partner of the business, Registered Manager, nurses, care staff and service users. This inspection was undertaken following a random inspection of 21st January 2010 when a number of concerns were raised in relation to care planning, maintenance of documentation and medications. Requirements were made following this inspection Care Homes for Older People Page 6 of 32 for care plans to be improved, docmentation to be maintained and a statutory requirement notice issued for medications to be dealt with safely. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessments on prospective service users are currently inadequate and require improvement to ensure that their needs, abilities and preferences are clearly identified prior to admission to enable these to be met. Evidence: The home has produced a Statement of Purpose and Service User Guide to provide current and prospective service users with details about the services and facilities provided by the home. These documents are displayed in the foyer together with copies of recent inspection reports. One service user said that she would like her own copy of the documents so that she could refer to them and this request was referred to the manager who said that she would arrange this. It would be of benefit if each service user were given a copy of these documents to give them access to full information about the home. Since the random inspection of 21st January 2010, no new service users have been Care Homes for Older People Page 10 of 32 Evidence: admitted to the home. At that inspection, the manager stated that pre-admission assessment forms would be improved to ensure that full information regarding prospective service users needs, abilities and preferences would be identified. Staff who undertake these assessments would benefit from additional training to ensure that they are aware of the information that needs to be gathered to enable the initial plan of care to be produced. At the random inspection, the assessment of the most recently admitted service user showed that insufficient information had been gathered or recorded to enable the plan of care to be produced. Care Homes for Older People Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Evidence: During this key inspection, a total of eight care plans were inspected. Much of the necessary information needed by staff to provide the appropriate level of care was not recorded in the care files. The home provides care for service users who require personal care or nursing care. The files do not clearly identify which category the service users are accommodated for and one member of staff who was asked which category a service user was to accommodated for was unable to clarify this. Care files should clearly identify what the service users are accommodated for to ensure that their needs are provided by appropriate care professionals. One service user had a wound but there was no assessment of the wound, body map or plan of care to inform staff of the treatment required. Little evidence was seen of Care Homes for Older People Page 12 of 32 Evidence: the actual care given to the wound. Care plans inspected did not have nutritional assessments or details of special diets required by the service users. No preferences are identified. One service user has diabetes and the care file states that the service user is at risk of being hyper or hypo. No explanation regarding this terminology is given and no information available for staff as to what to look for. The record states that if the service user is hypo, to give sugary/glucose based products but is not specific as to they type or quantity to give. This has the potential for placing the service user at risk. The file for one service user did not contain a photograph for identification purposes. A record of Activities of Daily Living had been prepared in January 2009, but the monthly reviews did not identify any changes in the needs of the service user over a period of a year. There is a lack of evidence that the needs of service users are reviewed effectively each month to identify changes. Care plans should be re-written when the service users needs change to provide up to date information for staff. The file for one service user who requires the use of a hoist and a wheelchair did not contain sufficient information regarding the use of these to inform staff. No details regarding the weight and hight of the service user are recorded on the form which would impact on the type of hoist and method of moving. Full information should be recorded to protect both the service user and the staff who undertake the task. One service user had requested that they take a bath twice each week but the daily records could not confirm that this was respected. None of the files inspected provide sufficient information regarding personal care, bathing preferences, moving and handling or dietary needs. There is a lack of information regarding wound care, tissue viability and risks. The care file for one service user states that they should take one and half to two litres of fluid each day but there was no evidence that this amount of fluid was given. Staff must ensure that they complete the documentation accurately and follow the plan of care to demonstrate that identified needs are being met. Agreements to the care plans are signed by the manager. This is not acceptable as agreements should be signed by the service user or their representative to indicate that they have read them and agree with them. Agreement to the use of bed rails should also be agreed by the service user or their representative. Care Homes for Older People Page 13 of 32 Evidence: It was evident that care plans have been re-written since the last key inspection and much of the necessary information has not been included resulting in a lack of instruction for the staff. Reliance has been placed on the staff knowledge and would present as a problem for new staff who would not be able to identify needs, abilities or preferences. Considerable time was spent with the manager to explain the necessary information required for one service user to enable her to produce care plans which identify needs and preferences. Benefits would be obtained through training on assessment and care planning by the manager and senior staff. Previous visits to the service found weaknesses in medicines handling and we had issued a legal notice requiring the home to make improvements in this area. We looked at medicines management to see how requirements of our previous visit had been met. We looked at care documentation within the home and the medication systems that were in place. We spoke with nurses and the manager about the arrangements made for peoples medicines. Overall, we found some improvement in the way medicines were being handled that meant the requirements of our legal notice were met. However, there were some inconsistencies in following the homes policies and NMC (nurses) good practice guidance that increased the risk of mistakes when handling medicines. We found that medicines stock control had improved helping to reduce the risk that doses of medication will be missed because there are none left to give. But, we were concerned to find that clear records were not always made when medication was discontinued (stopped). This meant that on occasion it was not possible to tell whether further supplies should be ordered and administered. We compared a sample of medicines stocks and records. With the exception of a rare discrepancy we were generally able to account for (track) medicines handling in the home but as previously seen, although it was evident that creams were being used, their use was not always supported by clear record keeping. We similarly found that it was not always possible to account for (track) the use of prescribed nutritional supplements because any quantities received into the home or carried forward to the next month were not always clearly recorded. Arrangements for handling and recording external preparations e.g. creams and prescribed supplements need to improve to better support and evidence their correct use. We looked at medicines administration. We saw that records were referred to and completed at the time of administration but were concerned to find some Care Homes for Older People Page 14 of 32 Evidence: discrepancies that indicated this good practice was not consistently followed. For example, at our previous visit we found examples where the controlled drugs register had not been completed, when the medicines administration records showed that a controlled drug had been given. A similar example was seen at this visit, a stock check indicted that a dose had been missed. We also saw one example where nurses had signed on several occasions to show the administration of a medicine that had been stopped. No stock of this medicine was found indicating that nurses had incorrectly completed the medicines record. We again saw occasional examples where nurses had signed against the wrong date when administering medicines, reducing the clarity and accuracy of these records, so increasing the risk of mistakes. As seen at our previous visit only very basic forms had been completed to show people self-administered some medication. Written risk assessments or written information about how safe selfadministration is supported still remained to be completed. This puts people at risk of not receiving any support they may need with their medicines. Daily medicines stock counts were being carried out but a wider audit (check) of medicines handling was not completed by staff at the home. This needs to be addressed to help ensure that the homes policies are consistently followed and that should any weaknesses arise, they will be promptly identified and addressed. Care Homes for Older People Page 15 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Little consideration has been given to supporting service users social preferences and the lack of social activities means that they do not have the opportunity to participate in stimulating activities of their choice. Evidence: The home does not employ an activities co-ordinator although the manager stated that an advertisement has been placed to recruit one. At present, the staff provide a very limited activities programme for groups in the lounges. Photographs were displayed of an event that took place on Mothers Day when all ladies were involved in the celebrations. A raffle basket was displayed in the foyer and service users, relatives and visitors to the home can purchase tickets. No record of social events are recorded in the daily records of service users and no separate activities file is held. Service users spoken to said that there was the occasional game of bingo in the lounge but nothing else was provided. Service users who spend considerable time in their rooms said that they did not use the lounge as there was no-one to have a conversation with or any other stimulation. They said that they preferred to sit in their room to watch television programmes of their own choosing without having to negotiate what was showing. They also confirmed that all activities took place in the lounge with no one to one activities being provided. Two ladies said that they had become friends and visited Care Homes for Older People Page 16 of 32 Evidence: each others room to chat. Discussion with service users and examination of care files showed that little stimulation or social activities take place within the home. Ministers visit the home on a regular basis and provide services for those who wish to participate. The records do not contain sufficient information to identify which service users wish to participate or any action required to enable them to participate in groups or on an individual basis. Visitors are welcome at the home at any time. Service users are free to meet with their visitors in the communal lounge, dining room or in the privacy of their own bedroom as they wish. No evidence is held in the home to demonstrate that service users are helped to exercise choice and control over their lives within the home. Individual preferences are often known by staff but the records do not provide the necessary information required by all staff. The menu follows a four week rota and shows that a balanced diet is provided. No alternative meal is shown on the menu to demonstrate that service users are offered a choice. No nutritional assessments are made and there is no evidence that individual preferences and dislikes are identified. The cook was able to show that a choice of evening meal is offered through lists which were on sheets of paper and put into a drawer. The lists were only available for a few days and were extremely disorganised. The cook explained that the care staff go to each service user during the day to ask them the meal of their choosing but two service users spoken to said that they were not offered a choice. No record is held of the actual meals taken by service users. One service user said that the meal served is placed before them and if they do not like what is offered, they can request an alternative, although they have to wait for some time for the alternative meal to be provided. It is therefore not possible to assess whether service users take a varied and balanced diet. The menu is placed in the foyer, but is not clearly displayed as it is placed on a table. The menu refers to week 1, week 2 etc and the service users are not aware of the which week it is on the rota. Service users would benefit from the meal of the day, and the alternative meal, being displayed to enable them to make an informed choice. One service user said that the quality of the meals was poor and the portions were small. Special diets can be provided but, again, there is no choice of meal. A list of special diets is listed in the kitchen and the cook said that she was aware of each service users likes and dislikes, although service users said that they had not been asked of these. Service users should be consulted regarding their dietary preferences and a record held on their care files, and in the kitchen, to ensure that these preferences can be Care Homes for Older People Page 17 of 32 Evidence: met. Service users should be offered a choice of meal and the choices displayed on the menu. Service users should be involved with the review of the menu to give them the opportunity to be involved in decisions regarding the meals offered. Food stocks in the kitchen were adequate and some fresh fruit and vegetables were available. Thermometers are required for the refrigerators and freezers as the temperatures shown on the current thermometers did not vary when ambient temperatures changed. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are fully aware of the complaints procedure and of action to be taken in the event of abuse being suspected. Evidence: The home has a complaints procedure which is displayed on the wall in the foyer and also detailed in the Service User Guide. No complaints have been made to the home or to CQC since the Annual Service Review. Policies and Procedures are in place to protect service users from abuse and encourage staff to raise any concerns. Some concerns have been referred to Liverpool City Council Adult Protection and Quality Assurance Unit who have investigated these matters and responded directly to the home. Service users spoken to during the inspection said that they were happy to speak with staff or the manager on any matter that gave them cause for concern. Staff are given training on abuse during their induction training and further training has been given. Staff spoken to during the visit were able to demonstrate that they were aware of the different types of abuse and of the action they should take in the event of it being suspected. The care planning and record keeping within the home means that service users could be placed at risk through failure to provide the appropriate level of care and support. Care Homes for Older People Page 19 of 32 Evidence: The failure to maintain medication records accurately places service users at risk. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Brooklands provides a clean, bright and comfortable home which is decorated and furnished to a good standard to provide a pleasant environment for all who live there. Evidence: Brooklands is a purpose built care home which provides accommodation in single bedrooms. Some double rooms are available and are only available for shared occupancy on request. The home is decorated and furnished to a good standard and improvements to the home continue, together with the planned programme of redecoration and refurbishment. Some minor maintenance issues were identified. The overbed table in room 6 is worn and damaged and requires replacement. The bathroom opposite room 41 requires to have appropriate window covering. The corners of the bath in the bathroom adjacent to room 24 are extremely sharp and require to be repaired. The home does not employ a maintenance person and so some issues have to wait for a few days before they can be addressed. Lounges and dining areas are provided on both the ground and first floors and service users are free to choose the area where they spend their day. A number of service users choose to spend their day in their own bedroom. Bedrooms are decorated and furnished to a good standard and efforts have been made to personalise their rooms. Care Homes for Older People Page 21 of 32 Evidence: Service users are encouraged to provide pictures, photographs, small items of furniture and items of memorabilia to provide a more homely and familiar environment. Discussion took place with the owners with regard to the possibility of providing a shower facility to aid service users who have mobility difficulties or dislike using the hoist. Consideration will be given to this in the future. The hot water at one washbasin was found to be extremely hot. The water in this toilet is heated in the room and the thermostat had been turned to maximum. The manager turned the thermostat down at the time of the visit. Arrangements should be made to ensure that the temperature of the water can not be raised to an unsafe level which would place service users at risk. A passenger lift provides access to the first floor and grab rails and access for people with mobility difficulties or requiring the use of a wheelchair is provided. The garden provides lawns bordered by plans and shrubs and will provide a pleasant place for service users to spend time during the summer months. Seating is provided and service users are free to use the garden at any time. All areas of the home were clean and fresh. Appropriate disposal arrangements were in place for clinical and general waste. Care Homes for Older People Page 22 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. Service users are supported by a team of staff who have been recruited and vetted to ensure their safety. Evidence: The home employs qualified nurses and care assistants to provide nursing and personal care to the service users. The staff rotas provide evidence that sufficient staff are deployed appropriately. During the day, a qualified nurse works on each floor and supported by care assistants. The manager is required to work as part of the nursing staff for much of the time and has few supernumerary hours to enable her to undertake management duties. Service users said that the care and housekeeping staff had more time to spend with them and were always very friendly and supportive. They said that they did not always have the opportunity to chat with the nurses as they were too busy. Discussion with staff confirmed that they were aware of each service users individual needs and preferences and said that they had obtained this information from discussion with the service users and from other members of staff. Many of the staff have worked at the home for a number of years and staff turnover is low. Care Homes for Older People Page 23 of 32 Evidence: The home has a robust policy and procedure for the recruitment of staff which is accordance with equal opportunities. All prospective staff are required to complete an application form prior to interview. Two references are taken and checks are made with the CRB and POVA. Evidence of training and qualifications is required to be produced. The procedure was seen to be followed in the file of one prospective member of staff who is currently being recruited. The files for six members of staff were inspected and all found to contain the required information. A separate training file is held to provide evidence of the training that staff have undertaken. All staff have undertaken training in Customer Service, Adult Protection, Moving and Handling, Infection Control and Fire Safety. It was identified that all staff require training in Food Hygiene. It was found that the cook also requires training in this and it is strongly advised that she undertake the Advanced Food Hygiene course. A staff handbook has been produced and was issued to all staff when they commenced work at the home. Some of the information in the handbook is outdated and no longer relevant. The handbook should be reviewed and updated and a copy issued to all staff to ensure that they are aware of the policies and procedures relating directly to them. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management arrangements so not ensure the efficient running of the home and the ongoing improvement of the service. Evidence: The registered manager is a qualified nurse who is experienced in managing care services for older people. She has continued to develop her knowledge and understanding through continued training. Since the last key inspection, the number of hours devoted to the management of the home have reduced as she works as one of the named nurses on duty. This has has an impact on the management of the home resulting in some areas not being monitored effectively. Care plans lack some of the essential information and audits have not identified this. Since the random inspection of 21st January 2010, some improvements have been made to the medications but shortfalls in recording still exist. The home does not employ an administrator and so considerable time is spent dealing with administrative duties by the manager or nurse in charge which impacts on the time spent on nursing and management duties. Care Homes for Older People Page 25 of 32 Evidence: The manager is responsible for providing supervision and annual appraisals to the qualified nurses and for identifying training needs. The records show that supervisions have been given but there is a lack of individual training needs being identified. Training is provided on a range of subjects relevant to the service users needs, but it is clear from this inspection that additional training is required in respect of care planning, record keeping and medications training is required by some of the qualified nurses. The home does not deal with service use personal monies as this is dealt with by relatives or advocates who are invoiced for costs such as hairdressing and chiropody. Certification in relation to tests made on equipment and the premises proved difficult to find due to the disorganised method of storing these. Many of the records are old and need to be archived to ensure that only current records are readily available. Tests are made on the fire detection equipment but again, the records are disorganised. A dedicated book for the recording of tests should be obtained and all tests duly recorded. Some incidents in the home which affect the welfare of service users have not been reported to CQC as required. The passenger lift was out of order for some considerable time over Christmas but this was not reported. It is essential that all incidents, safeguarding issues, deaths and events detailed on the appropriate form are sent to CQC as required. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 4 7 Detailed assessments of service users needs are required to be underaken and kept under review. To ensure that the needs and preferences of the service users are clearly identified. 05/03/2010 2 7 15 Comprehensive care plans 05/03/2010 are to be prepared for all service users and these plans kept under review. To inform staff of the individual needs and preferences of the service users to ensure that the appropriate level of care and support is provided. 3 9 13(2) Complete, clear and accurate 14/12/2009 records of medicines received, administered and of unwanted medicines sent for safe disposal must be maintained to support and evidence the safe handling of medication. 4 9 13(2) Where people self-administer 14/12/2009 medication written assessments must be completed to help ensure they receive any support they may need to do so Page 27 of 32 Care Homes for Older People 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 safely. Care Homes for Older People Page 28 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 12 16 A programme of activities 07/05/2010 should be prepared following an assessment of service users abilities and preferences. To provide stimulation and social interaction. 2 14 12 Service users must be encouraged to exercise personal autonomy and choice in all aspects of care and daily living. To provide them with care and support in a way they would like. 07/05/2010 3 15 16 A choice of meals should be offered in accordance with service users preferences and nutritional needs. So that service users can have meals that they will enjoy and will meet their needs. 07/05/2010 Care Homes for Older People Page 29 of 32 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 4 18 17 To ensure the protection of service users, records must be accurately maintained. To prevent the risk of inappropriate care or maladministration of medications. 07/05/2010 5 30 18 Staff training in Care 25/06/2010 Planning, Medications, Record keeping and Food Hygiene should be provided. To ensure that staff can provide care and support to service users safely and to evidence the care given. 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 3 The pre admission assessment form should be reviewed and amended to ensure that all information about prospective service users needs, abilities and preferences are identified together with information regarding any specialist equipment or dietary needs that are required. Sufficient supernumerary time would enable the manager to devote herself to the management tasks within the home. The views of service users should be sought with regard to the home and their lifestyle within it. Certification regarding equipment and the premises would benefit from reorganisation to ensure that documentation is accessible and available. The manager is responsible for informing CQC of all Page 30 of 32 2 31 3 4 33 37 5 38 Care Homes for Older People 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 incidents within the home as detailed in Regulation 37 and should submit these in a timely manner. Care Homes for Older People Page 31 of 32 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. 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