Care Home: Burton Lodge EMI Nursing Home

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What the care home does well Needs assessments were in place in the files of both people that were case tracked. These assessments were detailed and were used to formulate the care plans. The needs assessments looked at all areas of personal and health care needs and history. There was social profile`s in place that informed the staff of the persons relationship with their family and friends and the level of support and involvement they had with the person using the service. From these assessments detailed care plans were in place to ensure people`s health and personal needs were met in a safe way. Redecoration is ongoing in the home and improvements to the home have been completed this year. This provided a clean, well decorated and comfortable home for the people that lived there. Both the people living at the home and visitors to the home were very positive about the standard of care provided and the staff team. Comments included, "Now, it is lovely. Really nice. Staff are lovely." and "They look after you, that is the main thing" And "If I want something done, the staff come quickly and do it." The staffing levels were good and ensured that there was sufficient staff to meet the needs of everyone. What has improved since the last inspection? Seven of the nine requirements left at the last inspection have been met. The other two requirements have been partially met. One requirement was about staff receiving training that related to their jobs. The manager said the training matrix had not been completed, leaving gaps in staff training records and the manager had been unable to find evidence of staff training in some areas. For staff that were unable to provide evidence of training such as certificates, training had been re booked.The manager said that once this training had been undertaken all staff would be up to date with their training requirements. The other related to the Quality assurances processes in place. There was some evidence that these had been introduced, but they required further development to ensure the views of the people using the service, their representatives and other interested parties were involved in assessing the service and ensuring their views and opinions were incorporated into the development of the home. What the care home could do better: The service user guide needs to be amended to match the information within the Statement of purpose.This will ensure that people using the service have up to date information about the home. Records of the medications brought into the home,should be recorded upon receipt. This should include the quantities of these medications. This is to ensure that audits can be undertaken to determine that medication is administered as prescribed and that there is sufficient medication available for that person.At least 50 percent of the care staff team should be qualified to NVQ 2 or above in care to ensure that care staff have the qualifications they need to support them in their work. Key inspection report Care homes for older people Name: Address: Burton Lodge EMI Nursing Home 410 Burton Road Derby DE21 6AJ     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: Angela Kennedy     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Burton Lodge EMI Nursing Home 410 Burton Road Derby DE21 6AJ 01332365240 01332725588 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.redrosecare.co.uk Redrose Care (Derby) Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 31 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Burton Lodge is a 31 bedded care home situated close to the centre of Derby. The property was originally a private dwelling that has been converted and extended into a care home. Bedrooms are located over 2 floors. All floors are accessed via a passenger shaft lift or staircase. There are a number of lounge areas that are all well used. People living at the home have access to a patio area and garden to the rear of the home. Information about the service is provided through the Statement of Purpose and Service User Guide, although the service user guide needs updating. The current fees for the home at the time of this visit ranged between £470 to £600. Care Homes for Older People Page 4 of 35 Over 65 0 0 0 0 Brief description of the care home The manager confirmed that some fees could be higher and this would be dependent on the needs of the individual and the level of support required. Care Homes for Older People Page 5 of 35 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 key unannounced inspection took place over one day.An expert by experience came with us for part of the inspection. An expert by experience is a person who because of their shared experience of using services or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Information from the findings of the expert by experience has been included in this report. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken is upon outcomes for service users and their views on the service provided. This process considers the providers capacity to meet Care Homes for Older People Page 6 of 35 regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment had been completed by the service. This is a self assessment for providers, which is a legal requirement.This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the Annual Quality Assurance Assessment is reflected within this report. At this inspection we looked at the files of two of the people living at the home to see if the information about them told the staff how they liked to be supported and what kind of support they needed.This is called case tracking and is referred to within this report. We looked at other records to make sure that the people living at the home were kept safe and were supported to do the things they liked. We talked to some of the people that lived at the home and one visitor that was at the home. Their views of the service and the care and support provided are include within this report. We also talked to some of the staff working at the home. Their views and opinions of the care provided, the support and training given to them is included within this report. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide needs to be amended to match the information within the Statement of purpose.This will ensure that people using the service have up to date information about the home. Records of the medications brought into the home,should be recorded upon receipt. This should include the quantities of these medications. This is to ensure that audits can be undertaken to determine that medication is administered as prescribed and that there is sufficient medication available for that person. Care Homes for Older People Page 8 of 35 At least 50 percent of the care staff team should be qualified to NVQ 2 or above in care to ensure that care staff have the qualifications they need to support them in their work. 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 35 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 35 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. Peoples needs were assessed before admission was agreed to ensure the home was right for them. Evidence: A revised statement of purpose has been provided. This was seen and ensured that those considering the service and those already using the service will have up to date information which sets out the new providers details and includes the required information. A copy of the homes Service user guide was provided. The information within this did not clearly reflect the service provided and needs to be updated to match the information within the Statement of purpose. For example it stated that the home was specially designed and built care home for the elderly. This could be misleading as it does not state that the home is registered to provide care and support for people with Care Homes for Older People Page 11 of 35 Evidence: dementia or that nursing care is provided. Infact the information regarding the staffs qualification was limited to a general statement that said Highly trained and experienced staff are on call 24 hours a day, most of who are working towards an NVQ level 2 and 3. There was information regarding the acting manager in post. However this information did not inform the reader that the manager was not a qualified nurse and the clinical arrangements in place regarding this. There was no information regarding the communal areas provided. The complaints information regarding the contact details for the Care Quality Commission were out of date and gave the previous address. One of the people living at the home told the expert by experience they had a booklet about the home in their room. The providers self assessment stated that anyone requesting a possible placement to Burton Lodge is assessed prior to admission by the manager or Clinical manager to ensure all their needs can be met and to agree an initial care plan during an extended assessment period. Needs assessments were in place in the files of both people that were case tracked. These assessments were detailed and were used to formulate the care plans. The needs assessments looked at all areas of personal and health care needs and history. There was social profiles in place that informed the staff of the persons relationship with their family and friends and the level of support and involvement they had with the person using the service. From the information gathered risk assessments were undertaken to determine the level of risk and the support required to minimise the risk. Evidence was also in place to demonstrate that reviews of care had been undertaken in one persons file. The other person had recently been admitted to the home and therefore a review of their care had not yet taken place. In the information we received from the four surveys returned by the people living at the home they all confirmed that they received enough information to help them decide the home was the right place for them. They also confirmed that they had been given terms and conditions of their residency at the home. The eight staff surveys returned told us that the staff were given up to date information on the needs of the people they supported. This was also confirmed by the staff that were spoken with on the day of this inspection visit. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detailed plans in place enable peoples health and personal needs to be met in a safe way. Evidence: The providers self assessment stated that each person has an individual plan of care reflective of their health and social needs and their preferences in meeting these needs, including any cultural, religious and dietary requirements. One of the people case tracked has moved into the home the day prior to this inspection visit. From the needs assessment a draft care plan had been developed. The manager stated that this would be further developed over the coming days and weeks. The draft care plan covered all areas of personal and health care and although there was a care plan in place regarding this persons social interests the information provided was limited. Stating that they were unable to interact due to their cognitive ability and frailty. However there was information in this persons life history regarding their previous career and family , this could be used to develop their social interests care plan. Care Homes for Older People Page 13 of 35 Evidence: No social care plan was seen in the file of the other person case tracked. There was information within their social profile that provided details of family links and support along with this persons medical history, however this did not include any social interests or hobbies they had in the past or at the present time. A new care plan format was in the process of being introduced and the majority of care plans seen were on this new format. The information in both peoples care plan was detailed and addressed personal care, health care needs and medical history, communication needs, mobility and any prescribed medication. There were risk assessments in place that linked with care plans. The risk assessments identified areas of risk clearly and instructed the staff on the actions that were to be taken to minimise the risks. Risk assessments included mobility, falls,pressure ulcer assessment and skin condition, nutritional assessments and malnutrition screening and a physical and social assessment. There was no written evidence seen in the care plans that were looked at to demonstrate that residents or relatives were involved in the care plan development. However one relative that spoke to the expert by experience did say I see my mothers care plan regularly. The expert by experience spoke with some of the people that lived at the home and with one visitor. The comments received were very positive regarding the care and support provided. Such as I have been looked after very well up to now. And They look after you, that is the main thing And If I want something done, the staff come quickly and do it. One relative spoken with told the expert by experience that they had noticed improvements at the home, they said Now, it is lovely. Really nice. Staff are lovely. The providers self assessment stated that healthcare professionals were involved in individuals care to ensure a multi disciplinary approach. Records were in place to demonstrate that health care needs were being met. This included records of visits from health care professionals, such as chiropodists, dentists, optician, G.P and District Nurses.At the last inspection visit it was confirmed that district nurses were performing some clinical procedures such as catheterisation as the nurses at the home were not trained to do. The manager confirmed at this inspection visit that two nurses Care Homes for Older People Page 14 of 35 Evidence: were now trained to undertake catheterisation and and four nurses were now trained to take bloods. One person that lived at the home confirmed that they received health care services when needed.They said. The chiropodist comes regularly. I am sure they would sort out a dentist or optician straight away if needed. They are good at that sort of thing. One relative also said, There are regular visits from the chiropodist and hairdresser, which has to be paid for as an extra. The providers self assessment stated that each person had a named nurse and key worker following assessment and discussion, to ensure an appropriate person is allocated that will enhance the relationship. This information was recorded in the files of the two people case tracked. In the information we received from the four surveys returned by the people living at the home, they all confirmed that they received the care and support they needed. They also confirmed that staff were available when needed and that staff listened and acted on what they said. All of these surveys confirmed that these individuals got the medical care they needed. The medication practices were looked at. This included the medications held and the records in place regarding these medications for the two people case tracked.The person that had recently moved into the home did not have a photograph on their medication administration record to ensure they could be identified. This is a safe practice to ensure each person is clearly identified, especially if the person is unable to confirm their identity. This is particularly important when the person is new to the service and therefore not familiar to staff and when new staff administer medication who are not familiar with the people living at the home. The records seen indicated that people were given their medication as prescribed by the doctor. However some information had been omitted on the medication administration record of the person that had recently moved to the home. Such as confirmation of any allergies or no allergies known and their G.P. information. This persons prescribed medication had been handwritten by staff at the home onto their medication administration record, as they had only moved into the home the previous day. However only the signature of the nurse that wrote this information was recorded. When prescribed medications need to be handwritten these should be checked by a second person to ensure that no errors have been made, the second person should sign the record to demonstrate that this has been done. Care Homes for Older People Page 15 of 35 Evidence: It was also noted that on this persons admission the balance of their medication had not been counted and recorded. This means that the nurses could not check that this medication had been taken as prescribed, as there was no balance was in place to audit this against. The medication records in place for the other person case tracked were satisfactory and the information available meant that the nurses could check that this medication had been given as prescribed. Controlled drugs were stored appropriately and in line with the current law. The records of one persons prescribed controlled drugs was checked against the medication held and was found to be correct. The providers self assessment stated that a pill counter had been purchased. This ensures that when pills need to be counted this can be done in a hygienic and accurate way. However the nurse on duty was not aware of any pill counter available at the home and was unable to locate one. A clinical fridge was in place in the room where medication was stored. This fridge had a built in thermometer and was locked to ensure medications within it were stored safely. However no records were available to demonstrate that the temperature of this fridge were monitored daily, to ensure the fridge was working at the correct temperature. The last record available was dated 7.11.09. Care Homes for Older People Page 16 of 35 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. Peoples social and recreational needs were met. People were supported to maintain contact with family and friends. The quality and variety of meals provided was enjoyed by the people using the service. Evidence: The providers self assessment stated that there was a full and varied activities programme and regular outings. An activities coordinator has been employed since the last inspection visit but was not on duty on day of this visit. The activities coordinator worked four days a week for four hours a day. The manager said that the care staff followed the activities programme when the activities coordinator was not on duty.Staff were observed undertaking one to one activities with some people. The manager stated that the staff had attempted to undertake a group activity on the day of this visit but this was not met with any interest by the people living at the home.The manager did confirm that the activities planned were not always followed as activities were led daily by the choices of the people living at the home. In the entrance area of the home there was an activities board on display, activities included an old time quiz,dominoes, bingo, old time music, indoor golf, shopping, gardening, arts and crafts.exotic animal holding and a vocalist. The manager said that Care Homes for Older People Page 17 of 35 Evidence: the people at the home had also been visited by the salvation army and a VE day celebrations party had been held at the home. The expert by experience asked all of the six people she spoke to about the activities that were provided. Four of the six people that were spoken to could not tell the expert by experience anything about activities.One person said that they usually had a sleep in the afternoon and didnt know what activities took place. Discussions took place with the manager who felt that the people spoken with may not have understood what was meant by activities. The one relative that was spoken with said that in terms of activities, she was aware of the visit to the Assembly Rooms last year and entertainers visiting over Christmas period. There was a party on New Years Eve, which this lady had enjoyed, although she said that she had not specifically been invited, but just happened to turn up at the right time. There had also been a Christmas Fayre to raise funds. The information in the surveys returned by the four people living at the home told us there was activities arranged that they could take part in. The expert by experience through her observations felt that the staff on duty appeared very helpful and showed caring attitudes and treated the people living at the home with dignity and respect. The relative that was spoken with said, The food looks really good. Visitors are allowed at any time. All the staff are welcoming. I am given a cup of tea. Once when I was here at lunchtime, I was offered lunch too, but I did not have time to stay. Advocacy services were advertised within the home. This means that the people living at the home and their relatives have information about this service and how to access it, should they wish to. The Cook insisted that the expert by experience tried his cooking, which was cottage pie and this was reported to be good. Someone else dining at the same table as the expert by experience had macaroni cheese.The expert by experience reported that the dining tables had tablecloths and flowers on, the portions served were large. The cook confirmed that he provided diabetic diets and soft diets for those that needed them. The cook told the expert by experience that he included vegetables in some dishes like the cottage pie to ensure that people ate vegetables to give a balanced diet. He said that the people living at the home preferred traditional meals. He had tried offering things like curry but these types of dishes were not wanted. Care Homes for Older People Page 18 of 35 Evidence: The menus were looked at and alternative choices were available. The manager said that staff informed people of the choices available each day. One person living at the home that spoke with the expert by experience also confirmed this. The manager said that their had been improvements to the meals and that meals were prepared from fresh ingredients rather than chilled or frozen foods. The comments from the people spoken with on day of this inspection visits were positive regarding the food provided. Such as The food is very good. And The food is always nice. Nothing bad about it. And Food is always good. I could have a meal in my room, but I am happier at the table with the others. There is always sufficient to eat. The expert by experience observed staff assisting some people throughout the lunchtime meal and confirmed this support was provided in a sensitive way. The expert by experience said that squash was offered with the lunchtime meal. It was observed that the glasses used were large and that staff helped some residents to have a drink. This was discussed with the manager and it was confirmed that these were not the same cups as referred to in the previous report as these had all been thrown away. It was confirmed that risk assessments had been done regarding the suitability of the drinking vessels used to ensure the correct ones were used. The manager said that she would reassess the lunch time glasses that were used through observation over the lunch time period over the next few days. There was evidence within the care records seen to demonstrate that individuals choices were discussed with them or their representative. For example their preferred name, their preferred time of getting up and going to bed and where they preferred to eat their meals. The visitor that was spoken to told the expert by experience that their mother definitely chooses when to go to bed, as she had stayed up until midnight the previous night. Staff had told this visitor that this was the reason why this lady was still in bed when her visitor arrived . This visitor confirmed that their mother does sometimes not want to go to bed until quite late. Care Homes for Older People Page 19 of 35 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. Peoples concerns are responded to in a transparent way, which enables them to see that they are listened to and that their concerns are addressed.The manager of the home has taken the appropriate action to ensure that staff have the skills and knowledge they need to ensure the people using the service are safeguarded. Evidence: The providers self assessment stated that all complaints were responded to within the 28 days timescale. The complaints policy and procedure was displayed in the home.The manager stated that she operated an open door policy when Managers were on site.There was also a comments and a suggestions book displayed in the reception area. The home had received one complaint since the last key inspection. We were aware of this complaint prior to this visit as issues relating to this complaint had been discussed with us by the local authority and the manager of the home.This complaint had been investigated by the home and the appropriate actions taken. . The manager told us that the training matrix had not been completed, leaving gaps and the manager had been unable to find evidence of staff training in some areas. For staff that were unable to provide evidence of training such as certificates, training had been rebooked.The manager confirmed that this training was being provided by the Care Homes for Older People Page 20 of 35 Evidence: companies training manager. The matrix showed that 8 staff were booked onto safeguarding and Deprivation of liberty safeguards training in either February or March of this year. The manager stated that once this training had been undertaken all staff would be up to date with safeguarding training. Of the three staff files that were looked at, one had a training certificate in place that showed they had undertaken Safeguarding training in October 2009. Staff that were spoken with said that they undertaken Safeguarding training and had a good understanding of the safeguarding procedure. The manager confirmed that the home used the Local Authority policy regarding safeguarding and that the Whistlblowing Policy was displayed and issued to all staff. One incident at the home had been referred to the Derby City Safeguarding team . However this was not investigated by them as the home had taken the appropriate actions, which in turn removed the element of need to safeguard the person concerned. The expert by experience spoke to one visitor about complaints. They said, If I had a complaint, I would go to the nurse in charge. I am sure that I would get co-operation. If not, I would go to the Care Manager in Social Services. But, I have had no reason to complain so far. One person living at the home told the expert by experience that if he had a complaint, he would tell the staff. The staff are very good.Another person said I would go to the office. They would listen and carry out what was needed. Information within the surveys received from the people living at the home confirmed that they had someone they could speak to informally and all knew how to make a formal complaint. Information within the eight staff surveys received confirmed they knew how to manage complaints. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements,refurbishment and maintenance of the home ensure that a well maintained and homely environment is provided to keep people safe and comfortable. Evidence: As stated in the providers self assessment redecoration is ongoing in the home and improvements to the home have been completed this year. The expert by experience was given a guided tour of the building and was shown the areas that had been refurbished and the areas that are to be done. The standard of decoration and furnishings in the areas completed was to a very high standard. The owner told the expert by experience that the work was being carried out in a way that caused minimum disruption to the people living at the home, as it was their home. All areas of the building looked clean. All areas were warm. There was a small garden with seating, a fountain and bird table.The manager discussed plans to develop the garden area to make it more user friendly for the people living at the home. The owner showed the expert by experience several bedrooms. It was confirmed that all bedrooms would be refurbished and people could personalise their rooms if they wished. The expert by experience reported that peoples bedrooms were personalised Care Homes for Older People Page 22 of 35 Evidence: with their own belongings. Most rooms had en suite toilet and washbasin. One further room was to have a new en suite installed. It was confirmed that one person did not want their room refurbished, so it was confirmed that this will not be done while they live there. Discussions held between the expert by experience and the people living at the home regarding their bedrooms included It is quite all right here. My room is lovely. Good. The manager told us that everyone living at the home was given their own bath towels and hand towels, which were exclusively for them and were destroyed when they left the home. All of the bedrooms seen had radiators that were thermostatically controlled. These radiators could be controlled to suit individual taste but the thermostat was set to a safe temperature to ensure that rooms could not become too hot. Radiators were covered to prevent the risk of scalds. The bathrooms seen were recently refurbished to a high standard. One had had an air drier installed. The manager confirmed that this was used as an aid to drying but not used in isolation to dry people as this would not promote dignity. The manager also stated that this air drier was found useful in promoting skin integrity. All rooms and general areas had call buttons. These could be taken off the wall and could be used around the home. This increased independence as people were able to move around freely and still call for staff assistance if needed. The expert by experience noted that the doors to the rooms had a sheet of paper on them giving the room number but did not have names on the doors or photographs to assist people in finding their bedroom. It was felt that this may be because the work is not completed. Lights in corridors were to be activated by a motion detection system so that people living at the home or staff did not have to find light switches. At the last inspection visit the lounge area, which at that time was the only lounge in use, had a television screen that was not easily accessible to everyone. Although this television remains in the same place, due to the layout of this lounge, there was now a second lounge that was available.This lounge had a large flat screen television that was easily accessible for viewing. The expert by experience observed cups of tea that were being served at 11am. When a lady needed somewhere to put her cup, the staff member went and got a small table Care Homes for Older People Page 23 of 35 Evidence: for her. It was also observed that two people who required one to one care had a member of staff with them throughout the observation. The manager confirmed that floor sensors were in place for anyone that may wander at night who would be at risk from doing so. These sensors alerted the staff that this person was out of bed, enabling staff to investigate this. The laundry area was seen and housed sufficient equipment to meet the laundry needs of the people living at the home. Off the laundry area was a area that was used to store any dangerous substances, such as cleaning products. This area was secure and ensured all materials were stored safely. The laundry and domestic staff were on duty each day from 9 am to 3pm. In addition to this, once a week an additional member of staff was on duty from 2pm to 6pm for deep cleaning throughout the home. Discussions held between the expert by experience and the people living at the home regarding the housekeeping of the home were positive. Comments included, Always kept clean. And My room is nice and clean. In the surveys received from the people living at the home all of them confirmed that the home was always fresh and clean. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff are on duty enabled them to support the people living at the home. The recruitment practices were robust and ensured people living at the home are protected from abuse. Evidence: As stated in the providers self assessment the staffing levels were sufficient to meet the needs of the people living at the home. Discussions with staff on duty and observation of the rotas demonstrated that one registered nurse and five to six care staff were on duty throughout the day. At night one additional carer was on duty until 10pm and then two carers were on duty with one registered nurse until 8am the next day. The registered nurses working at the home were either qualified general nurses or mental health trained. Six nurses were trained in General nursing and two were trained in Mental Heath nursing. At the time of this inspection visit two registered nurses were trained to undertake catheterisation and 3 were trained to take bloods. The manager confirmed that a further two staff were in the process of training to take bloods. Discussions held between the expert by experience and the people living at the home regarding the staffing levels and the staff conduct were positive. One person said they Care Homes for Older People Page 25 of 35 Evidence: thought there were plenty of staff around if she needed anything. Other comments included If I want something done, the staff come quickly and do it. Staff are always good to you. If they can do it, they will, if at all possible. They help in every way. They do their best for you. Discussions held between the expert by experience and a person visiting their relative also confirmed this. Comments included I think there are enough staff on duty. And it is lovely. Really nice. Staff are lovely. In the surveys received from the four people living at the home all said that staff were available when needed and listened and acted on what they said. In the eight surveys received from the staff they all confirmed recruitment checks were carried out and that their induction covered everything very well. They confirmed that the training provided to them was relevant to their role and they had enough support, knowledge and experience to meet the needs of the people they supported. They all said there was enough staff to meet individuals needs. Comments included provides adequate staffing levels, provides high quality care due to staffing being offered training and hence improving quality of care. Staff that spoke to us on the day of this inspection visit also confirmed this. One member of staff said they were doing an NVQ 2.This person talked about some of the training they had done, such as Moving and Handling, First Aid, Hygiene, Dementia, Challenging Behaviour. They confirmed that certain training has to be refreshed annually. Another staff member was doing an NVQ 3 and said that the Manager has changed their shifts to enable them to attend college. The manager confirmed that out of the eighteen care staff employed four staff had achieved an NVQ at level 2 or above and that eight were in the process of gaining this qualification at either level 2 or 3. The recruitment records of three staff were looked at. All of the documents required by law were in place.Full employment history were in place . This ensures that any gaps in employment can be identified and investigated to ensure they are accounted for.References from last employers were in place, as were medical health declarations and Criminal Records Bureau checks and identification documents. This information enables the provider and manager to ensure the people employed at the home are safe to work with the people living there. There was evidence in place to demonstrate that staff received satisfactory induction Care Homes for Older People Page 26 of 35 Evidence: training. This was also confirmed by staff that were spoken with. As stated earlier in this report the training matrix had not been completed, leaving gaps and the manager had been unable to find evidence of staff training in some areas. For staff that were unable to provide evidence of training such as certificates, training had been rebooked.The manager said that once this training had been undertaken all staff would be up to date with their training requirements.. This will ensure that staff are working in a safe way, following uo to date practices. The training booked between now and March 2010 included safeguarding adults, moving and handling, malnutrition, infection control and pressure area care. In the staff files that were looked at there was evidence of some training that had been undertaken since the last inspection visit. This included food hygiene, fire safety, infection control, moving and handling, dementia awareness and Care of Substances Hazardous to Health. At the last inspection the the cook had not undertaken a food hygiene course. This has now been undertaken and their training certificate was seen to demonstrate this. The manager did confirm that the cook had not attended any training in nutrition to further enhance his skills and confirmed this would be arranged. Care Homes for Older People Page 27 of 35 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. Further development and monitoring of practice has improved the standard of care provided. Further development of the quality assurance processes will ensure that the home is managed in the best interest of the people using the service. Evidence: The manager started employment at the home in March 2009. The manager stated that she was in the process of applying for registration with the Care Quality Commission. As the manager is not a registered nurse, a Clinical lead had been appointed that was responsible for issues regarding the nursing care at the home. Documents were seen regarding the Clinical Leads qualifications and experience. Comments made to the expert by experience regarding the running of the home were positive. Staff spoken with were positive regarding the support provided to them by the manager. Care Homes for Older People Page 28 of 35 Evidence: In the four surveys received from the people living at the home the comments included, its all good, I like it here the way it is and they look after me very well they speak to everyone and get those involved that can in doing things of interest and the home is a number one home. In the eight surveys received from the staff they all said they were given management support and supervision. Satisfaction questionnaires had been sent out to people living at the home and their relatives in December 2009. Some of these surveys had been returned at the time of this inspection visit. These had already been audited and actions had been taken as a result of the information given. This involved changing the routine at meal times. The manager confirmed that a meeting for relatives was organised in December 2009. However nobody attended this meeting. The manager said that some people had rang to confirm they wouldnt be attending as they felt it wasnt necessary and said they had no concerns and would come to the Christmas Fayre instead. The monies held in safekeeping were checked for one person that was case tracked. No monies were held for the other person case tracked. Therefore the monies held for another person who had monies held in safe keeping was checked also. The records corresponded with the monies held and this demonstrated that all monies spent and received had been accounted for.Two signatures were in place for all transactions. This further enhances individuals financial protection. Staff that were spoken with confirmed that they received formal supervision sessions from the manager. The manager confirmed that some supervision had taken place and there were records available to demonstrate this. The manager stated that at the time of this inspection visit not all supervision was up to date. She discussed how she intended to ensure this was done through delegating some supervisions for the qualified nurses to undertake. A sample of health and safety service certificates and checks was undertaken and all but one were found to be satisfactory. In the providers self assessment it was indicated that the home did not have premises electrical circuits. However following discussion with the manager at this visit it was confirmed that she had been unable to find a certificate, to demonstrate that electrical circuits at the home had been serviced within the last five years. Therefore this has Care Homes for Older People Page 29 of 35 Evidence: been re booked and a visit was planned for the Thursday following this inspection. At the time of writing this report we have received confirmation that the electrical circuits service has been planned for February 2010. Care Homes for Older People Page 30 of 35 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 35 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 1 4 The service user guide must be amended to match the information within the Statement of purpose. To ensure that people using the service have up to date information about the home. 12/04/2010 2 9 13 A record of the medications 15/02/2010 brought int the home, including the quantities/ balance of these medications must be recorded upon receipt. This will ensure that audits can be undertaken to determine that medication is administered as prescribed and that there is sufficient medication available for that person. 3 30 17 All staff must be up to date in all areas of mandatory training and evidence must be in place to support this. 19/04/2010 Care Homes for Older People Page 32 of 35 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 This will ensure that staff are working in a safe way,following up to date practices. 4 31 9 The manager must complete 01/03/2010 her registration application with the care quality commission. In order to ensure that the service is operating within the provisions of the legislation 5 38 13 Evidence must be provided 12/03/2010 to demonstrate that Electrical systems within the home have been serviced by a suitable trained person. This is to ensure the safety of people using the service, the staff and visitors to the home is protected. 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 There should be written evidence to demonstrate that people using the service or their representatives are involved in their care plan development. Daily records should be undertaken of the clinical fridge temperatures. This should include the minimum and maximum temperatures to monitor that the clincal fridge is working correctly. 2 9 Care Homes for Older People Page 33 of 35 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 3 9 When prescribed medications need to be handwritten these should be checked by a second person to ensure that no errors have been made, the second person should sign the record to demonstrate that this has been done. Nurses should be made aware of the pill counter available this will ensure that pills counted can be done so in a hygienic and accurate way. Photo id should be in place on each persons medication administration records to support staff that are administrating medication to identify the individual. All care staff should undertake NVQ training to level 2 or above in care. This will ensure they have the qualification required. The Quality Assurance processes need to be further developed to ensure that the home is managed in the best interest of the people using the service. All staff should receive formal supervision at least six times a year. This to ensure they are supported in their job and any development and training needs are identified. 4 9 5 9 6 28 7 33 8 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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