Care Home: Broomhill

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What the care home does well Broomhill gives people a warm, comfortable and homely standard of living. People are free to do what they choose and benefit from regular contact with the community. Staff know peoples` individual needs and care for them well. People told us they enjoy good relationships with staff. Staff we surveyed also commented on what the home does well: `Everything`, `I think we give a good environment for service users and try very hard to make it a happy home for them and to try and make them feel safe`, `Support the service users to live as independently as possible. To action changing health needs quickly and to call on additional support services where required`, `To provide emergency care when needed and a homely environment. Support families and service users on admission`, `We make sure our home is their home with individual touches in their rooms and lounges` and: ` Cares for residents to the best of ability, keep the environment clean. Staff socialise with residents`. What has improved since the last inspection? Progress had been made in meeting requirements and good practice recommendations from the last visit. Requirements included making sure medication is properly recorded, staff get training in how to care for people with dementia, mental health issues or challenging behaviours, and staff supervision. Three out of four good practice recommendations had been adopted. These included: writing more about people`s enjoyment of activities, dealing with issues of quality by regular meetings with people and better recording that treats people with respect. What the care home could do better: Cooking of meals should be more consistent to give people a good standard of nourishing and tasty meals. Further, menus should be looked at to make sure they offer healthier options so that people get a healthy and nutritious diet. The issue of how peoples` bedrooms are labelled in more person-centred ways must be dealt with quickly. This will make sure they are treated with respect and are able to find their rooms easily. Night staff must be given and attend the same training as day staff. This will make sure people get consistent care that they need and be looked after particularly in respect of their mental health and behavioural needs. Supervision still needs improving. In particular, making sure that all sessions and yearly appraisals are recorded and improving the recording to show that issues raised by either staff or managers are properly addressed and followed through. This will make sure people continue to get good quality of care by staff that are able to think about and discuss their work regularly. The manager must make more effort to make sure her planning and management properly meets the needs of people in her care. This will make sure the home is run in the best interests of people living there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broomhill 92 Eastwood Road Brislington Bristol BS4 4RS     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: Sandra Garrett     Date: 1 5 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 34 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 34 Information about the care home Name of care home: Address: Broomhill 92 Eastwood Road Brislington Bristol BS4 4RS 01179779802 01179724091 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) : Bristol City Council care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Broomhill is a home for 40 older people run by Bristol City Council. Its situated in the residential area of Brislington. The nearest shops are approx 300 yards away. These include a post office, newsagent, pub and supermarket. The home is on 3 levels with 2 lifts that give access to all areas of the building. There are 4 lounges around the home and a large, spacious dining room on the 1st floor. All bedrooms are single and each has its own washbasin. Toilets and bathrooms are close by. The garden is accessible with rails to assist people on to the patio area and includes a rockery with a water feature. A recent addition has been a summerhouse so that people can enjoy sitting in the garden comfortably. A first floor balcony offers people the opportunity to sit and look at views across to Bath and surrounding countryside. Care Homes for Older People Page 4 of 34 Brief description of the care home Fees payable for care at Broomhill are 471.24 pounds per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk /www.oft.gov.uk . A copy of the last inspection report was pinned up on the notice board outside the dining room on the first floor. Care Homes for Older People Page 5 of 34 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: Before the visit, all information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. This included the Annual Quality Assurance Assessment (AQAA) that we require services to fill in each year, copies of incidents notified to us, copies of quality assurance visits to the service and any other documents such as newsletters that the manager sends us. We then drew up an inspection record to plan for the visit. This record is used to focus on and prepare for all inspections so that we concentrate on checking the most important areas. We also visited the home before the inspection to fill in a number of our Have Your Say surveys with people to gain their views on the quality of care they get in the home. We talked with ten people who filled in surveys and also talked to a further five at the visit. Their comments are included in the body of the report. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Cooking of meals should be more consistent to give people a good standard of nourishing and tasty meals. Further, menus should be looked at to make sure they offer healthier options so that people get a healthy and nutritious diet. The issue of how peoples bedrooms are labelled in more person-centred ways must be dealt with quickly. This will make sure they are treated with respect and are able to find their rooms easily. Night staff must be given and attend the same training as day staff. This will make sure people get consistent care that they need and be looked after particularly in respect of their mental health and behavioural needs. Supervision still needs improving. In particular, making sure that all sessions and yearly appraisals are recorded and improving the recording to show that issues raised by either staff or managers are properly addressed and followed through. This will make sure people continue to get good quality of care by staff that are able to think about and discuss their work regularly. The manager must make more effort to make sure her planning and management properly meets the needs of people in her care. This will make sure the home is run in the best interests of people living there. Care Homes for Older People Page 8 of 34 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 34 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 34 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. Detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. People are looked after well in respect of their specialist needs by experienced staff. Evidence: Comments received from our Have Your Say survey done just before the visit were as follows. (Re whether people had contracts), comments included: Yes I think I did I remember signing something anyway, I cant remember, I cant remember one but I should imagine I have received it. My son dealt with all of that anyway and: I dont really remember. On whether they received enough information about the home before they came into it, people commented: I had to come here after having a fall and because I could no Care Homes for Older People Page 11 of 34 Evidence: longer look after myself, I came here after a long stay in hospital, I had a really good look around before moving in, I came here after a 4 month stay in hospital so there wasnt really time for me to have a look round or anything, My family brought me here and thought it was a nice place and that was it and: I was here temporary to start with while waiting for sheltered housing but Im more than happy to stay here now. We looked at three peoples assessments that had been done before they came to the home. These are done by Social workers or trained staff such as a physiotherapist from the intermediate care team. Assessments were detailed and gave enough clear information for staff at the home to decide whether they could meet a persons needs. Assessments have some equalities information such as gender, religion and culture so that staff are aware of and can make arrangements to meet any specialist needs associated with them. Reviews of assessments were also seen particularly if there was a question of whether the home was the most suitable place, or if the person her/himself had decided otherwise. Assessment information was checked against peoples individual care plans (that are started during the four week trial period). Needs had been transferred into the plans. Where assessments picked up things e.g. risk of falls, this had also been put into the care plan and a risk assessment done to make sure a person is kept safe. We asked staff in our survey if they were given enough information about people when they move into the home. Four staff said they were always given up to date info about the needs of people cared for. Two said usually and one said sometimes. One staff member commented : On admission occasionally information is out of date Where people had specialist needs i.e. use of oxygen, challenging behaviours or a special diet these were picked up and managed properly with clear instructions for staff on how to meet the individual needs. People confirmed to us that this was happening. We had required that staff do training in caring for people who have behaviour that challenges and also in caring for people with dementia. We saw a sheet that showed training that had happened. Seventeen staff, including some of the management team had done training in challenging behaviour. However nine hadnt. These included all the night staff. All staff had done dementia training except some kitchen and domestic staff. Care Homes for Older People Page 12 of 34 Evidence: From the AQAA we saw that currently the home has eleven vacancies (kept because of the closing of other local authority care homes). Of the twenty-nine people living there at this visit, three people have dementia, five have specialist communication needs and twelve people have some degree of sight difficulty. However it wasnt clear if staff are given training in caring for people with communication, sight or hearing impairment needs. We met one person who was able to show us how s/he communicates with staff. We later saw the manager communicating well with this person. Currently the home doesnt look after people that need rehabilitation before going back to their own homes, although it does offer respite care and short stay places. Two people were having respite care at this visit and one told us that s/he loves it here. Ive been before and wanted to come back again. Care Homes for Older People Page 13 of 34 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. Keeping of good and detailed care and health records shows that people are well cared for and can comment regularly on the care they get. Satisfactory management of peoples medication makes sure theyre kept safe and well. Being treated with dignity and respect benefits people living at the home. Evidence: People told us about the care and support they get including medical and healthcare support. Comments were wide ranging and included: Ive got no complaints here whatsoever, I do (get the care) but youve got to keep tabs on things though because my clothes go missing quite a lot, Yes I do and Ive got no doubts about it, Im very well looked after, the district nurse comes in everyday to give me my injection, Yes I do if I need it. I had the nurse the other week because I had terrible stomach pains, If I ask the staff to get my doctor they will but I had an appointment with the nurse Care Homes for Older People Page 14 of 34 Evidence: once and she didnt turn up, I dont feel I see the doctor a lot and I havent had my blood pressure done since I came in and: I know I would if I needed it but I dont think Ive ever seen the doctor as I dont like to make a fuss. We looked at three peoples care records and case tracked their care. This means looking at all records associated with the person and by talking with both them and staff caring for them. Care plans were detailed and included care needs that had been picked up in the pre-admission assessments. Plans cover personal care i.e. washing, bathing, continence etc as well as mobility, leisure interests, family and friends and other issues that affect the person e.g. one persons plan gave information to staff about reminding her/him of meal times and activities because of short term memory difficulties. Care plans were signed by people using the service and/or their relatives plus key workers or members of the management team. Some people had personal history sheets at the front of their plans that give details of their previous lives, interests and work. This information is useful to help staff understand people better. However not all the sheets seen were filled in. From a staff meeting held in August 2008 we saw that one of the management staff had been on a course about how to write care plans. She went through this at the meeting and covered personal histories and use of outcomes. All care plans we saw were written from the persons own view e.g. the use of I makes the plan personal and gives good information about what the person themselves wants or needs and what the likely outcome is for them. However personal history sheets need more work. Care plans are looked at by staff each month and records were seen of these. Six monthly care reviews are held to give people and/or their relatives an opportunity to discuss their plans and whether they need changing. Following the review meeting care plans are amended, peoples comments are recorded and they sign the amended plan. Copies of the reviews were seen in peoples files. Manual handling risk assessments and those for things such as falls and use of oxygen were seen. From the Annual Quality Assurance Assessment (AQAA) that managers have to send to us each year, the manager had stated that in the last twelve months improvements had been made e.g. cross referencing between records is improving i.e care plans, risk assessments and manual handling care plans. From records seen we would agree that care record keeping is improved. The manager also stated that Key mover (the person responsible for supporting staff with moving and handling issues) to plan and implement briefing sessions with staff group regarding updated manual handling techniques. This will be good practice. Healthcare issues were also recorded on the plans together with daily records of GP Care Homes for Older People Page 15 of 34 Evidence: and district nurse visits and those from other healthcare professionals. From notices required under regulation about events that affect people living in the home, we note that prompt action is taken when people become ill, have falls or experience other injuries. We followed up a requirement made at the last visit about making sure medication record sheets are properly filled in. Record sheets were all filled in except one where there was a gap for a whole day. As the person was taking a medication that needs careful follow up this could have been serious. However, the manager sent us information and copies of record sheets later that showed the giving of the medication had happened. From our observations and speaking with people we saw that they are treated with dignity and respect. We asked people if the staff listen and act on what they say. One person said: More or less yes they do but if they get busy they cant help straight away and I have to wait. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to give people living at the home opportunities to have a stimulating and varied life where various formal and informal activities happen regularly. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. People living at the home have lots of choice and are able to live their lives in a relaxed way with few restrictions. Inconsistency in the standard of meals provided daily could stop people from being fully satisfied with them. Evidence: To the question Are there activities arranged by the home that you can take part in? people commented: I just sit and watch television but thats my choice as I dont want to do anything else, The staff make a lot of effort to make sure were not just sat around bored,There are a few activities but I wish there was something a bit more Care Homes for Older People Page 17 of 34 Evidence: meaningful to do, Yes there are odds and ends, There are but I quite like doing my own thing. Ive got my knitting, reading and my own television to watch,Theres always something going on. The staff make a lot of effort and: Yes but I dont want a lot to do though - I brought up 3 children! We asked staff in their own survey what they thought the home could do better. One person commented: have an activity worker who is employed to provide personcentred, co-ordinated variety of activities and entertainments. The atmosphere at the home was quiet and subdued on the first day of this visit. People were mainly in their rooms. A few people were seen in lounges just sitting without TV or radio on and not speaking to each other. There are many vacancies at the moment as the City Councils home closure programme has started. This means that homes like Broomhill that wont be closing will be expected to house people that have to move from other homes. However on the second day of our visit more was going on and the atmosphere was good. On the second day of inspection a staff member told us three people were going up to the local pub for the lunch club. This happens regularly and people tell us they enjoy it. Activities and outings feature in both residents meetings and staff meetings and minutes of both were seen. Staff at Broomhill do lots of fundraising, both individually and as a group. One staff member had done parachute jumps and was planning to do a wing walk. From residents meeting minutes it was clear that people enjoy trips out of the home. In 2008 trips had included visits to Cadbury World and Longleat that people enjoyed but found quite long. Other trips to Horseworld and Bristol Zoo were planned. People had also commented on a 40s and 50s night that had been held and made suggestions for other theme nights such as an Irish night and Country and Western night. At the latest meeting held in January this year people discussed trips for this year as well as fund-raising events. One person had spoken on behalf of everyone and thanked the staff team for a lovely Christmas with a special thank you to the cooks for lovely meals over the festive period. The home now has its own newsletter and copies are regularly sent to us. These give information about the home, peoples birthdays, events and outings. The newsletter is a good way of keeping them in touch with what goes on. Activities records showed the in-house events as well as trips that people had enjoyed. Notice boards outside the dining room had photographs of people enjoying some of the events. Its clear that entertainment and trips are provided from peoples own wishes Care Homes for Older People Page 18 of 34 Evidence: and choices and theyre free to join in or not as they wish. One to one keytime happens regularly and this can mean people have a chance to go out with their keyworker or stay in and chat. Sometimes however staff said it was a struggle to find enough staff to cover e.g. if they wanted to take people out to the lunch club. Because of keytime contact with the local community is kept up. The local pub, supermarket, newsagent and other shops are all within a short walk of the home. The manager has arranged for church services to be held at the home. From the AQAA however the manager had identified what they could do better for people. Examples were: better recording of peoples experience/enjoyment of activities, putting on more activities to suit peoples specialist needs i.e. for people with dementia or sight difficulty and to increase fundraising for outings and events. We sampled lunch with people on the first day of this visit. We saw staff showing people meals so that they could choose. The menu was written up on a whiteboard in the dining room and had two choices. People with difficulty eating were given soft or pureed meals. No-one needed help with eating. Squash, water or cranberry juice was available. Vegetarian options are now on offer at each meal if people want them. Cultural diets can be prepared if people need them. The home did have two people with cultural needs but they have now moved to other homes. We saw from residents meeting minutes that people enjoy the meals and have lots of choice. We asked people if they like the meals at the home. Comments included: The food is fantastic, They provide me with a diabetic diet and its always nice with a lot of variety, The food I cannot fault its always nice, I really enjoy my meals and have managed to put a bit of weight on since being here and: The food is very good and there is plenty of it. However one person commented: The food is alright but Ive cooked better myself in the past. Unfortunately on the day we had lunch with people the meal of chicken curry was below standard. The chicken, though well-cooked, was in a thin sauce that looked and tasted synthetic. The rice was overcooked and bland with no seasoning. No vegetables were prepared for people to have with the curry. One person had curry and mashed potato but only ate the potato and left the curry entirely. The other choice was of fishcake, chips and peas. The fishcakes werent home made. The dessert was apple and blackberry crumble or cold desserts. The custard wasnt sweetened at all which made the dessert taste bland. The outcome for people was that they didnt have a meal that they could enjoy or met their need for a wholesome nutritious diet. We discussed our findings with the manager and team manager. Both said that food at the Care Homes for Older People Page 19 of 34 Evidence: home is usually excellent although the manager did agree that sometimes meal quality is inconsistent. The manager suggested that we sampled lunch with her on the second day of inspection (the following week). This was of much better quality, being Irish stew with dumplings and followed by chocolate pudding and custard. Both dishes were made with fresh ingredients, were tasty and well prepared. We looked at menus. In common with other local authority homes in Bristol the menus are of traditional fare that older people like and are used to. However the menus are heavily red-meat based and are likely to have high fat content. Coupled with cooked breakfasts and evening meals with cakes and desserts, the menus may not offer healthy eating for older people. Care Homes for Older People Page 20 of 34 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. Satisfactory complaints management and recording ensures people living at the home can be confident in raising concerns about any aspect of their care. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. Evidence: We asked people if they knew how to make a complaint and what to do if they were unhappy about anything. They commented: I probably would but Ive never had to so its never really come up, I know how to make one but I dont think it always works, Yes if I needed to, I would talk to someone down in the office and: I do know but I dont like to grumble though. About what to do if they were unhappy people told us: Oh yes Id tell them, I got a bit tearful last night and the staff were really there for me, Id speak to Mrs Fry the manager or if not her one of the officers and: Id speak to my carer first because I really get on well with her and then go from there. We also asked staff if they knew what to do if a service user or relative raised any concerns: Six staff said yes to this question. Since the last inspection two complaints had been made. One was about a persons Care Homes for Older People Page 21 of 34 Evidence: stay at the home and one was about an accident to a visitor. Both had been properly dealt with by the management team within reasonable timescales. Where necessary meetings had been held to discuss the concerns or complaints made. No concerns or complaints were seen recorded in individual care records or the homes communication book. A few concerns had been recorded in the book about the performance of the pharmacy used to supply medication to the home. We had been told about the issues by the representative of the registered provider and a new supplier had been appointed. We had been given information about one of the medication issues that was raised as a safeguarding incident. A full investigation had taken place and we met with management staff and the safeguarding adults co-ordinator to decide on a protection plan. Two abuse incidents had been received since the last visit and both had been quickly referred to the proper authorities i.e. police or local authority safeguarding coordinator. Staff had received safeguarding adults from abuse training and were clear about reporting any incidents that may happen. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. However failure to deal with the issue of nameplates on bedroom doors doesnt show respect for people. Evidence: We toured the premises and followed up a good practice recommendation about name plates on bedroom doors. These had been stuck on with sellotape at the last visit and looked institutional. It was disappointing to note that the situation hadnt changed. Each room has large sized numbers on for people to be able to see. There is also a narrow strip plate to hold a name. Those we saw had printed paper names stuck on with sellotape. We later spoke with the manager who said she had been trying to get new nameplates for some time. She had found some that were more suitable but they were expensive and she was unsure about whether they could be afforded. We also spoke with the homes team manager about the issue. We again gave advice on suitable ways for people to be able to find their rooms and more respectful ways of displaying their names. Care Homes for Older People Page 23 of 34 Evidence: The home was clean and fresh smelling at this visit. Staff were seen cleaning peoples rooms and other areas. Toilets had been redecorated and looked fresh and clean. From our survey people had commented: Its kept clean as much as they can but Id do it a bit different myself though and: Yes theres always someone cleaning. From the AQAA the manager had written: our home and gardens are maintained to a high standard. Staff keep records of daily cleaning on file. Health and safety issues are addressed and records are maintained i.e. risk assessments are in place. From the last independent quality assurance survey 86 satisfaction on the environment was recorded by both people living at the home and their relatives. However, the manager had acknowledged that the issue of nameplates could be done better together with a continuing redecoration programme and putting a call bell in the smoking lounge. Care Homes for Older People Page 24 of 34 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 numbers of staff are available to meet peoples care and social needs and match their dependency levels. Progress with training in National Vocational Qualification in Care and other care issues makes sure people are looked after properly. However, insufficient training for night staff in dealing with behaviours that challenge doesnt make sure peoples needs for support with these issues are met. Evidence: We looked at rotas, staff meeting minutes and training records. We had sent out our Have Your Say surveys to staff before this visit and had received seven completed ones. To the question Are there enough staff to meet the individual needs of all the people who use the service? four staff said usually and three said sometimes. One person commented that only priority needs are met and that time limits too much. Another commented some of the service users that come into our home now tend to need a lot more help with everyday things so times like this we need more staff. A third staff member commented: Because of sickness and such we use agency staff, then if theyve never been to the home before its quite hard, as we have to help them as well. Staff also commented on what the home could do better: employ more staff on our busy shifts and: more staff for more one to one. Care Homes for Older People Page 25 of 34 Evidence: To the question: Do you feel you have the right support, experience and knowledge to meet the different needs of people who use services? Five staff said always and two said usually. The manager talked through the weekly staff rotas with us. A care staff member now starts at 7am which makes day staff tasks easier to manage. One person is rotared to do activities each day. The manager said that peoples dependency levels are low at the moment so staff have enough time to meet needs. Adequate numbers of care staff were seen on the rotas and in the home at the visit. People told us that sometimes they have to wait for staff to come to them and that they feel there arent always enough staff. However as the home wasnt full at this visit staff should be able to meet peoples needs in good time. However peoples comments about staff behaviour and their relationships with them were all very positive. The manager had written in the AQAA we received: Residents feel confident and secure and have good relationships with the staff team. Progress with training in the National Vocational Qualification continues. The manager showed us a sheet of staff names. There are currently eighteen care staff. From this group six staff already have the qualification at Level 2. Four staff are doing it and two are waiting to do it. Assistant managers are doing Level three. Therefore the home is well on the way to meeting the minimum of 50 staff with the qualification as recommended in the National Minimum Standards. From the AQAA the manager also stated that there is a better awareness of policies around taking on casual staff, new staff training needs are addressed more quickly, making sure regular agency staff are used to give continuity of care and using permanent part time staff to pick up additional hours. However, she also stated that what the home could do better is to make sure recruitment policies are followed particularly with regard to making sure people are protected and to work better to check and reduce staff sickness. We asked staff about induction and training . Seven said yes to the question on whether their employer carried out recruitment checks. Five staff said induction fully covered everything they needed to know about how to do the job very well. One said mostly and one said partly. Six staff said they were given training relevant to their role, which helps them understand and meet individual needs and keeps them up to date with new ways of working. One staff member commented however that: I think it would be better to do more in-house training. Care Homes for Older People Page 26 of 34 Evidence: We followed up a requirement about training for staff in dealing with challenging behaviours and dementia awareness. The manager gave us a sheet that showed all managers and care staff had done the dementia awareness and mental health training. However other staff such as domestic, cooks and gardener handyperson hadnt. The sheet showing details of the challenging behaviour training showed that some of the management team, day care staff and all domestic staff had done it. However, none of the night staff had and no planned dates were seen for them to do it. As challenging behaviour can sometimes happen more at night, staff working during those hours must do the training and indeed any other training thats essential for good care of people living at the home. The requirement is therefore reworded to make sure night staff do the training. Care Homes for Older People Page 27 of 34 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. Whilst the manager is trained and experienced, failure to deal with specific issues doesnt make sure peoples rights or property are respected. Satisfactory management of peoples money makes sure they are protected from financial risk. Lack of regular opportunities for supervision fails to help staff to reflect on their working practices. Insufficient recording of supervision could lead to poorer quality of care given to people. Satisfactory management of health and safety matters keeps people safe and protected. Evidence: The manager Mrs Penny Fry, was on duty for the second day of our visit. Mrs Fry Care Homes for Older People Page 28 of 34 Evidence: showed that following comments made at previous inspections, she is more openly available to people living at the home. She has started to hold open mornings once a fortnight. She told us that she uses one of the lounges and people are able to meet her there, have coffee and discuss any issues they may have, either as a group or one to one. Only one session has been held so far and Mrs Fry said four people had turned up. She told us about issues they had raised that she had recorded in individual peoples files. We recommended that Mrs Fry keeps her own separate file of issues raised at the meetings as people may want to discuss things in confidence with her that they may not want recorded in their care files. Further, a separate file is easier to keep for inspection purposes. One person we spoke to during the inspection commented: Ive got no grumbles here at all. From our survey of staff five said the manager meets regularly with them and they get support and are able to discuss how they are working. We discussed a forthcoming dinner dance thats due to be held to raise funds for the home. The manager told us that because of the small budget shes given for activities and outings, its necessary to raise money to cover both essentials and luxuries on trips that help give people a good quality of enjoyment. The manager and her officer team had come up with the idea of the dinner dance so that it would raise a large amount of money. This is commendable. However, in discussing the event it was clear that the manager hadnt given full consideration to the effect that holding such an event could have on people living at the home. Mrs Fry said she had consulted with people about using the dining room but hadnt made any records of this or of peoples views. We therefore werent sure as to how in-depth the consultation was and whether people were clear about the effect of such an event on them. People living at the home arent invited to the dance as its being held to raise money for them. We discussed this together with security and protection for people, fire safety, noise and other health and safety issues. It was clear from our discussion that Mrs Fry hadnt thought through the implications of holding the event. We required her to do a risk assessment for it and a plan of how people are to be protected. We received these shortly after our visit. However, we remain concerned at the lack of essential planning and adequate management that hadnt been considered, to make sure people are involved and kept safe. We also discussed other issues at the home that were due to happen shortly. The manager hadnt told us about these. We also discussed them with the team manager Care Homes for Older People Page 29 of 34 Evidence: for the home and later the service manager, who is responsible for overall management and supervision of all Bristol local authority care homes. It was clear that there had been a lack of communication from Mrs Fry about the issue. We did a random check of peoples cash that the manager keeps for them. All amounts checked were correct and cash sheets are balanced weekly. We saw new sheets for staff to use when they take peoples money to buy things for them. The new sheets make sure staff keep peoples money safe. We followed up a requirement from the last inspection about staff supervision. We looked at four records including day and night staff. Only one person had six sessions recorded for the year. Two people had three sessions and one person had four sessions. However there were long gaps between some sessions e.g. none held between early October 08 and end of January 09. We did see copies of staff meetings that had a supervisory part to them. Each staff member also has a yearly performance appraisal called a PMDS. We saw updates to these in some staff files but not copies of the actual appraisals. We also saw a message from the manager reminding management staff to make sure they do them with staff. Some supervision records were brief and didnt show any actions to deal with issues staff had raised. The deputy manager said that for one person extended leave had meant that supervision sessions couldnt be held. We looked at leave records but couldnt see long gaps that might have explained this. We advised the manager that work must continue to make sure all staff get regular supervision (at least every two months) that helps them in achieving a good standard of care for people living at the home. We looked at health and safety records. The fire safety officer had inspected the home in January 08. A fire safety risk assessment was in place that was clear and detailed. Four fire drills had been held in 2008. Twenty staff had done fire safety training in February 09. Fire safety equipment is regularly checked and fire alarms are tested weekly. Care Homes for Older People Page 30 of 34 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 31 of 34 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 30 18 Night staff must have 26/07/2009 training in caring for people with behaviour that challenges them. Night staff must also do both essential and good practice training whenever this is needed and required. This will make sure people get consistent care both day and night from a well trained staff group. 2 32 9 The manager must put 26/09/2009 peoples needs first and show clear evidence at all times that she runs the home in the best interests of people living there. This will make sure that people are kept safe and protected by a manager who is clear about her regulatory responsibilities and puts them first. Care Homes for Older People Page 32 of 34 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 15 Consideration should be given to looking at ways of offering a consistent standard of cooking together with healthier options for the main meal of the day. This will make sure people get good quality meals that benefit their health. Work to make sure people can find their rooms easily, taking into account their individual needs, must be finished. This will make sure they are able to use the environment easily and it meets their needs. Staff supervision records should be properly kept and show that issues are followed up in a timely manner. This will make sure that people are protected by staff that are confident and well supported in their work. 2 24 3 36 Care Homes for Older People Page 33 of 34 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. 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