Care Home: Brownhills Nursing Home

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What the care home does well The home makes sure that people have the information they need in order to make a choice about living there. The manager will always visit people at home to complete an assessment of needs. This gives people the opportunity to ask questions and be reassured the home can meet their needs. There are good systems in place for managing people`s individual health care needs. People told us "my relative is better shape now than he has ever been and it`s thanks to the home". There are plenty of opportunities to take part in organised activities both in and out of the home. People`s concerns, complaints and suggestions are welcomed by the home and they will try to resolve people`s issues promptly. One person said "I would have to think long and hard about anything that I wasn`t happy about here, I have never had to complain". The environment is pleasant, well maintained and people like living there. We were told "my room is great but we have had new furniture all over now". The staff team in this home are friendly, knowledgeable and were observed interacting with people in a very positive manner. People said "the staff at this home are the best ever". What has improved since the last inspection? The home has been decorated and refurbished in most places since our last visit. The home continues to offer good standards of care for people What the care home could do better: We issued two immediate requirements during this inspection. This means we require the home to take urgent action to address certain problems. In this case we have required the home to review the risk assessment process and the supply and fitting of people`s bed rails. We have done this because we were concerned that some people`s bed rails were not safe. In addition to this we have recommended the home considers the use of alternate methods of managing people`s safety when they are in bed if the risk assessment highlights bed rails should not be used. We have also told the home about our concerns in relation to insufficient hot water in some bathrooms, toilets and people`s bedrooms. We have said the home must rectify this situation promptly. We have recommended the home reviews care plans more thoroughly and where there is any possibility that a person may be deprived of their liberty the home must take action to address this. Since our inspection we have been told by the home the hot water temperatures have been satisfactorily addressed. There is now a consistent supply of hot water throughout the home. We have also been told that new beds, bed rails and risk assessments have all been introduced to the home. This should offer greater protection to the people living there. Key inspection report Care homes for older people Name: Address: Brownhills Nursing Home 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mandy Beck     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Brownhills Nursing Home 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS 01543374114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): None Kidderminster Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 50 Dementia (DE) 6 Physical Disability (PD) 50 Date of last inspection Brief description of the care home Brownhills Nursing Home is located in a pleasant residential area on the outskirts of Brownhills, not far from Chase Water Country Park. The home is accessible by public transport. A shop and day club for the elderly are close by. Care Homes for Older People Page 4 of 31 Over 65 6 50 50 0 0 0 Brief description of the care home The home is registered to provide nursing care to a maximum of 38 people. The external appearance is attractive but unusual. It was transformed some 15 years ago from a nightclub to its present form. It has good size car park at the front and a generous size, attractive garden to the rear. The home has seven double bedrooms, most have en-suite facilities. There are twenty six single bedrooms within the home. There is a large lounge with a clearly defined dining area on the ground floor and a smaller lounge with dining area on the first floor. There are assisted bathing and toilet facilities throughout the home. The ground and first floor are accessed by passenger lift. The home currently charges between £466.60 and £500 per week for residency. These fees do not include extras such as hairdressing, newspaper and chiropody services. This information is included in the Service User Guide for the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection of the home, they were given no prior notice that we were going. The inspection was completed in one day by one inspector. We looked at all the information that we have received, or asked for, since the home was last inspected in November 2006. This included the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical about the service. Information we have about how the service has managed any complaints and any safeguarding issues that have required investigation. Care Homes for Older People Page 6 of 31 What the service has told us about things that have happened in the home, these are called notifications and are legal requirement. We spent time talking to the people who live in the home and to some of the relatives and visitors. We also asked people to comment on the service by completing our surveys. We have included their comments in the body of this report. We also looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We issued two immediate requirements during this inspection. This means we require the home to take urgent action to address certain problems. In this case we have required the home to review the risk assessment process and the supply and fitting of peoples bed rails. We have done this because we were concerned that some peoples bed rails were not safe. In addition to this we have recommended the home considers the use of alternate methods of managing peoples safety when they are in bed if the risk assessment highlights bed rails should not be used. We have also told the home about our concerns in relation to insufficient hot water in some bathrooms, toilets and peoples bedrooms. We have said the home must rectify this situation promptly. We have recommended the home reviews care plans more thoroughly and where there is any possibility that a person may be deprived of their liberty the home must take action to address this. Since our inspection we have been told by the home the hot water temperatures have been satisfactorily addressed. There is now a consistent supply of hot water throughout Care Homes for Older People Page 8 of 31 the home. We have also been told that new beds, bed rails and risk assessments have all been introduced to the home. This should offer greater protection to the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given all of the information they will need in order to make a choice about living in this home. They can feel confident their needs will be assessed in full prior to admission. Evidence: The home has both a Statement of Purpose and Service User Guide that give people all of the information they will need to know about the service the home provides. It includes the range of fees people are expected to pay and the additional extras that will not be included in the weekly fee. This information is displayed in the reception area of the home along with information and photographs about activities the home provides and menus. The information is available in printed format and also as a DVD for people to access. The home also displays the most current inspection report and results of their own internal quality assurance surveys. Before people agree to move into the home the manager will spend time with them Care Homes for Older People Page 11 of 31 Evidence: completing an assessment of their needs. This is done to make sure the home is able to meet peoples needs and that it will be the right place for them. We looked at the needs assessments of four people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for people. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. One person told us I had been to several places but chose this one. The home does not provide intermediate care facilities at this time. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home do have their healthcare needs met. They can be confident their medication will be given as the doctor has prescribed it. People will be treated with respect and dignity in this home. Evidence: We looked at the care records of three people during this inspection. This is part of our case tracking process. We found that each person had their own individual plan of care. The home makes sure that each person is assessed for their risk of developing pressure sores, being malnourished and falls. Where risks are highlighted the home completes a risk management plan and records what action they will take to reduce the risks to people. All care plans are kept under regular review and are updated to reflect any change in a persons condition. We have made recommendations that moving and handling risk assessments are updated to include the type of hoist and sling so that staff can be sure of the equipment they need to use when moving people. Care Homes for Older People Page 13 of 31 Evidence: We looked at how the home manages peoples need for pressure relief and pressure area care. Care plans were in place, along with risk assessments to show how peoples needs were to be met. We also checked pressure relieving equipment in use and found that this is appropriately supplied for each person. We have made a recommendation that the home records the correct setting for inflation for mattresses so that staff can be sure that people are having the correct pressure relief. Peoples weights are recorded monthly or more frequently if their needs dictate. It was possible to see the home takes action to address any unplanned weight loss/gain. The home also receives regular support from the dietican and the speech and language therapist for those people who have swallowing difficulties and unexplained weight loss. People who answered our surveys told us we always get the care and support we need, the staff here are wonderful and nothing is ever too much trouble for them, I am never rushed by them, they always take their time and give me the support I want. We spent time talking to staff during this inspection and they were able to give us a detailed account of peoples needs and the support they wanted. They told us We are told by the nurses who needs what care but most of the time its nice to sit and ask them. We also had the opportunity to talk to relatives and visitors during this inspection. They told us this is the best home I have ever been too, my relative is now in better health than I am and its all down to the care he gets here. my mother gets the best care and attention I could ever wish for I have no concerns about her care at all, I know she is happy. The home is also supported by community services such as doctors, psychiatrists and community mental health nurses. People also have access to dentists, chiropodists and opticians, as they need it. People told us if I feel under the weather there is no hesitation in calling for the doctor. We looked at the systems in place for the ordering, safe storage and administration of medication. We found the home has good systems in place and medication is administered as the doctor has prescribed it. There are safe systems in place for the storage and administration of controlled drugs. We have made some good practise recommendations to further improve practise in the home. Care Homes for Older People Page 14 of 31 Evidence: We spoke to some of the people living in the home during this inspection. They told us staff here are very good. We asked if staff paid particular attention to their dignity and need for privacy. They said, Oh most definitely they are very caring. We saw staff talking to people in a polite manner and when they were giving assistance to people they did so sensitively and did not rush people. We saw that the home is making progress with the end of life care planning for people. The home is also arranging for some of its staff to attend training in end of life care pathways and palliative care. This will help add more structure to the homes end of life planning for peoples care once completed. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to lead active lives and are supported by the staff in doing this. Meals are nutritious and well balanced. People will have the assistance they need during this time. Evidence: The home encourages people to take part in activities throughout the year and also on a daily basis. Recent events have included a fund raising evening for BBC Children in Need, Valentines Day, Easter and Halloween themed parties and at the present time there is a raffle being run for the activity fund. The home has been decorated in preparation for Christmas, people told us the decorations are beautiful, the staff helped put them all up and we think they are beautiful. People had requested the decorations be put up and the type of decorations they wanted during a meeting. These meetings are held on a regular basis and do give people the opportunity to say what they feel could be improved, what the home is doing well and suggestions for activities. Recently people have asked for a change in the menu and additional hot meals during the week. The home has now introduced this up to three times a week for people. The home does employ an activity coordinator whose job it is to plan and carry out Care Homes for Older People Page 16 of 31 Evidence: meaningful activities for people both on a group and one to one basis. In house entertainment also includes, bingo, playing cards, card making and karaoke. Information about activities is put on the information board in the home, it is also available in the reception area for visitors to see. The home also offers a fortnightly communion for those people wishing to take part. We spent time during this inspection talking to peoples relatives. They told us this home is the best home you could ever wish for, the staff here are the best anywhere. I never worry about my brother in this home I know that he is looked after, you can visit whenever you want and the staff are wonderful. The home has open visiting times and people are support to have visitors whenever they want. People can have the privacy of their own rooms for visiting but most people prefer to sit in the communal areas during this time. Visitors are encouraged to spend time with people living in the home at meal times, they are able to dine with them if they choose to do so. We looked at peoples bedrooms during this inspection, we saw that some redecoration and refurbishment has taken place. It was also noted that people are encouraged to personalise their rooms with small items of furniture, ornaments and pictures from home. Meal times are relaxed and unhurried. We were told by people living in the home, those dining tables and chairs are new, they only came the other day, they make such a difference dont they. The tables were attractively laid. The home has also introduced picture menus and picture place mats. There is always a choice of meals on the menu for people and they told us the food is very nice and I have no complaints about it. We noted that people were assisted by staff sensitively and discreetly as their needs dictated. As a result of a recent meeting in the home there have been changes to the menu. People had requested a hot meal at evening time. This is now being provided up to three times a week by the home. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to make their views known and they can be confident their views will be listened to and acted upon. The home has suitable arrangements in place to keep people free from harm and to take action should an allegation be made to them. Evidence: The home has a complaints policy and procedure which is included in the service user guide. We spoke to people during this inspection who told us I would go to matron and tell her if anything was wrong, yes I do know who to talk to if I am unhappy about anything. Relatives we spoke to said I would have to think really long and hard about finding things to complain about this is the best home, my brother has been here for more than three years, they have nursed him back to health and he is better than me now. The home has told us in the AQAA that there have been no complaints about the service provided in the past twelve months. We have been notified of one concern about the care of one individual and this was referred to the local safeguarding team. The investigation concluded that there had been no shortfalls in the care the home had provided. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff Care Homes for Older People Page 18 of 31 Evidence: about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had witnessed an act of abuse. The manager of the home understands what is expected of her in relation to reporting of incidents and allegations to the safeguarding team. We have already commented on the safe use of restraint in the form of bed rails in the environment section of this report. We looked at recruitment practises and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, relaxing and welcoming environment. Evidence: The home has been refurbished and redecorated in places. The communal areas are very pleasant and welcoming. At this time of year the home has been decorated for Christmas and people told us the decorations are lovely arent they, the girls put them up at the weekend they are so good. We were also told that new dining tables and chairs had recently been delivered. The communal areas have also benefited from new seating, as well as the dining tables and chairs. The whole area looks very relaxing. One person said its the best place to live other than your own home of course. There are still a number of shared rooms in the home and not all have an en suite facility. The home has recently been extended but the new rooms are not yet registered for use. It is hoped this will happen early 2010. We checked bed rails during the inspection to make sure their use was appropriately risk assessed and they were fitted correctly. We found that there was improvement needed. We saw three sets of bed rails that were not safe. We also noted the risk assessments currently in place were not in sufficient detail to protect people using the Care Homes for Older People Page 20 of 31 Evidence: equipment. In another persons bedroom we saw that there were bed rails on the bed and the bed had been turned round. We asked why this had happened and we were told its to stop xxx (the person) from climbing out. We looked at the care plan for this person, we could not find any information to tell us that this type of restraint should be used. We could not find any bed rail risk assessment for the use of bed rails. We asked the manager to find the information for us. We were told it doesnt look like it has been done. The home must take action to address this. We left the home with an immediate requirement to address this. This means the home was given a very short timescale to put this right because of the risks posed to the people using this equipment. When risk assessments indicate that bed rails are not suitable for use then the home must consider alternate methods of managing peoples safety whilst in they are in bed. There are a number of bathrooms and shower rooms for people to use, however we did find that some of the bathrooms are out of use at this time. In one bathroom on the ground floor we found boxes and a petrol lawn mower. We bought this to the managers attention and we were told the home had experienced a break in to the shed and this had not yet been repaired. The home must address this. It is not appropriate for a pertol lawn mower to be stored in the home. Another bathroom upstairs is also unused. We were told that only the hairdresser uses it when she visits. If this is the case the home should consider refurbishing the bathroom and making it a hairdressing room altogether. This would add to peoples experience of having their hair done. We also noted in a couple of bathrooms, toilets and one persons bedroom there was no hot water. We looked at the homes records for water testing and found this had been a recorded problem since February 2009. We left an immediate requirement with the home asking them to take urgent action to remedy this situation. We looked at peoples bedrooms and saw that they were pleasantly decorated and had been personalised by them and their families. We also noted that people had the right equipment in place for their pressure relieving needs. There is a large garden to the rear of the home, although not used much in the winter months, there are summer fetes and outdoor activities organised in better weather. Infection control practises appear to be good. The home has its own laundry and there are good systems in place for managing infected/soiled linen and clothing. Around the home there is alcohol rub, gloves and aprons for staff to use. These practises will help reduce the risk of cross infection to the people living in the home. We have been Care Homes for Older People Page 21 of 31 Evidence: appropriately notified of one outbreak of an infectious condition. This was responsibly addressed by the home with the advice of the Health Protection Agency. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate numbers of staff on duty to meet peoples needs. Staff are trained and have the knowledge and understanding to meet peoples needs. Evidence: The home has a skill mix of both trained nurses and care workers on duty to meet peoples needs. In addition to the care staff there are housekeeping, kitchen, laundry and maintenance workers all working hard to keep the home running smoothly. We had the opportunity to observe staff through this inspection and noted the very positive interactions between them and the people living in the home. We have also received some very positive comments from people about the staff, they included they are the best people ever, the staff have nursed my relative back to health, its all down to them they are wonderful. The home supports all care staff through training in National Vocational Qualifications. Staff we spoke to confirmed that they had completed both their level 2 and 3 NVQ training in Health and Social Care. This means that staff have the knowledge and understanding to be able to meet the peoples needs who live in the home. We looked at the recruitment processes in the home. We saw the staff files of four people. All of them contained the required information and security checks such as previously mentioned Protection of Vulnerable Adults (PoVA)first, and CRBs. This Care Homes for Older People Page 23 of 31 Evidence: means the home has systems in place to prevent unsuitable people from working with vulnerable adults. We looked at the training records for some staff. The home has supplied us with information of training that has been arranged. It is clear that staff will be trained as required. We spoke to several staff on duty during the inspection who confirmed they regularly take part in training and keep their knowledge and skills up to date. New workers are supported through an induction that meets the Skills for Care common induction standards. This induction will provide staff with the basic skills needed for completed their NVQ training. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live there. The home is managed well and peoples health and safety is promoted. Evidence: There has been a change in management of the home following the promotion of the registered manager Dawn Whitehouse. The new manager is currently going through the registration with us and it is hoped this will be completed soon. The manager has demonstrated throughout this inspection a good understanding of peoples needs, how the home is run and how to manage staff. The new manager is also supported by the area manager on a regular basis. The home does take steps through its own quality assurance systems to highlight areas for improvement and take action to address this. The manager continues to complete monthly audits of health and safety, the environment and care plans. In addition to the managers audits the company also completes a Regulation 26 visit. This visit is unannounced and is a requirement of the Care Homes Regulations 2001. Care Homes for Older People Page 25 of 31 Evidence: During these visits the person will spend time talking to people and staff and generally making sure that things are satisfactory for them. The home also surveys people so that they have the opportunity to respond in questionnaire format. The results and any action plan that the home has completed as a result of these surveys is published and is included in the service user guide. There is a copy of this available in the reception area of the home. The home has completed the AQAA. All sections were completed and the information gives a reasonable picture of the current situation in the home. There are areas where more supporting evidence would have been useful to illustrate what the home has done in the last year or how it is planning to improve. The ways that they are planning to achieve this are briefly explained. We also spent time talking to the manager about her role and responsibility in understanding the principles and practise of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Both the area manager and the manager have received training in this area and told us they understand their role in making applications to the appropriate authority should they feel that peoples liberty is being deprived. The manager also told us there are further plans to arrange training for all staff. The home needs to be able to recognise when a deprivation is occuring. For example, turning a persons bed around to prevent them from climbing out, could potentially be considered a deprivation of liberty if the situation has not been appropriately risk managed and discussed with all relevant people involved in their care. The home takes charge of some personal monies on behalf of people living at the home. The monies are kept securely and written records are kept of all transactions. A random sample of the monies and accompanying records were seen during our inspection and there was one discrepancy. We have made a recommendation to the home that they obtain individual receipts for peoples spending. This will make auditing peoples individual spending easier. Staff training in ongoing, recent training has included moving and handling and fire safety. Training is completed at least yearly and this gives staff a chance to keep their knowledge up to date and make sure that peoples safety is promoted. There is a Fire Risk Assessment in place and a fire drill takes place at least every six months. The Fire Alarms must be tested each week (a test took place during our inspection). The Emergency Lights are tested on a monthly basis and records were seen to verify this. Records were seen to verify the regular servicing and maintenance of various systems, including, the emergency lighting system, the gas system and boiler, the hoists, the lift, the electricity system and all electrical equipment. The water Care Homes for Older People Page 26 of 31 Evidence: system is regularly tested for legionella and the tanks disinfected. We found that there were times when some of the hot water taps were not getting up to the required temperature. These shortfalls had been recorded by the home since February 2009. This is a potential risk to the people living in the home. We left the home with an immediate requirement to take action to address this. People living in the home must have access to a consistent supply of hot water. There are policies and risk assessments in place with regard to safe working practises. Staff receive training in safe working practise topics during their induction. Since our inspection the home has told us that the problems with both the insufficient hot water and bed rails has been addressed. There are new systems in place to reduce the risks to the people who live there, new beds have been supplied to those who needed them and the hot water is now consistently available Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 25 13 The home must make sure that there is a consistent supply of hot water at all times. The home must tell us what action they will be taking in order to achieve this. This is for the protection of peoples health and safety. 02/12/2009 2 38 12 People must have a comprehensive risk assessment in place that details the need for them to have bed rails. Where bed rails are fitted they must be compatible with the bed they are supplied to. This will reduce the risk of people being harmed or unsuitably restrained. 02/12/2009 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 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Staff should consider more detailed reviews of care plans. The review should take into account any changes that may have happened to a persons condition the previous month. The home should consider the removal of care plans that are no longer relevant to a persons healthcare needs. The home should include the inflation details of pressure mattresses into a persons care plan that is appropriate to their weight. Staff should record the amount of medication that is carried forward each month onto the MAR sheet. This will allow the home to conduct an accurate audit of medication. Two staff should sign the handwrtten entries on the MAR chart. This will reduce the risk of errors in transcribing occuring. The home should repair the shed promptly and remove the petrol lawn mower from the ground floor bathroom. The home should consider converting the unused bathroom on the first floor into a hairdressing salon for people to enjoy. Staff need to be aware of their role in supporting people under the deprivation of liberty safeguards. The home needs to develop ways to make this happen. The home should complete regular audits of the money it holds for people. This will help the home keep track of any discrepancies and to take action to remedy this. The home should also consider obtaining individual receipts for each persons expenditure for audit purposes. 2 3 7 8 4 9 5 9 6 7 19 19 8 33 9 35 10 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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