Care Home: Bushbury Court Nursing Home

What the care home does well People have their needs assessed before they move in, which ensures that people are only admitted if the service is confident it can meet their needs. The manager and staff have a good understanding of people`s needs and capabilities and enable people to make choices as part of their daily lives. Staff treat people with dignity and respect. Training opportunities for staff are good and new staff are recruited and selected in ways that ensure safe, skilled individuals are employed. The home communicates well with the families, friends and representatives of people who live at the home. What has improved since the last inspection? At the last key inspection it was found that the home needed to improve how people are assessed for the use of bed rails and that an assessment of their nutritional risk needed to be implemented. At this inspection we found that the home is now assessing people`s nutritional risk and has introduced a new assessment process for the use of bed rails. However we found this had not been implemented for one person who had bed rails on their bed. We found the service has ensured checks are made of health and safety systems, but identified that further improvement is still needed. What the care home could do better: We view that people living at Bushbury Court experience good quality outcomes overall. However there are some areas which need further attention to develop and improve the service. These includeEnsuring medication is stored at the right temperature and that staff complete medication administration record sheets accurately. Consider ways to increase opportunities to enhance people`s social well-being and evaluate the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with people`s expectations and needs. People are provided with an environment which is clean and safe but which needs more attention to ensure it is homely and well-decorated. Consideration should also be given to developing the environment so that it may promote positive responses from people with dementia. The homes policies and procedures should be reviewed and updated. This is to ensure staff have information to refer to which is up to date and reflects current legislation and guidance. We saw that checks on the temperature of hot water had been done, but action had not been taken to reduce the temperature of the hot water. The registered person must ensure there is a robust system in place so that action is taken promptly to resolve the deficit. Key inspection report Care homes for older people Name: Address: Bushbury Court Nursing Home Hellier Road Bushbury Wolverhampton West Midlands WV10 8EE     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: Rosalind Dennis     Date: 2 0 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 29 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 29 Information about the care home Name of care home: Address: Bushbury Court Nursing Home Hellier Road Bushbury Wolverhampton West Midlands WV10 8EE 01902444066 01902444065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Heantun Care Housing Association Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 21 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: Dementia (DE) 21 Date of last inspection Brief description of the care home Bushbury Court is a care home providing nursing care for up to 21 people with dementia who are usually over the age of 65 years, on a continuing care basis. The provider is Heantun care Housing Assocation Ltd and people are generally admitted to the home direct from a hospital setting with fees paid by the local Primary Care Trust. The home is situated in the Bushbury area north Wolverhampton and is within easy Care Homes for Older People Page 4 of 29 Over 65 0 21 0 1 1 2 2 0 0 8 Brief description of the care home walking distance of local shops, which includes a Library, hairdressers, pub, church and doctors surgery. A local bus service stops nearby. The home consists of a single storey purpose built building. Twelve of the bedrooms are single occupancy and four twin rooms. The communal areas are spacious. There is car parking at the front of the building, and an enclosed rear garden. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Older People Page 5 of 29 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 inspection was carried out over one day by one inspector. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care Care Homes for Older People Page 6 of 29 and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. People living at the home were not able to comment on the care they receive and so we observed the support given by staff and how staff interacted with them. We looked at feedback given by relatives and staff when they completed surveys for us and spoke with people visiting the home during the inspection. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff during the inspection to establish their views of working at the home and if anything needs to be improved. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We view that people living at Bushbury Court experience good quality outcomes overall. However there are some areas which need further attention to develop and improve the service. These includeEnsuring medication is stored at the right temperature and that staff complete medication administration record sheets accurately. Consider ways to increase opportunities to enhance peoples social well-being and evaluate the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. People are provided with an environment which is clean and safe but which needs more attention to ensure it is homely and well-decorated. Consideration should also be given to developing the environment so that it may promote positive responses from people with dementia. The homes policies and procedures should be reviewed and updated. This is to ensure staff have information to refer to which is up to date and reflects current legislation and guidance. We saw that checks on the temperature of hot water had been done, but action had Care Homes for Older People Page 8 of 29 not been taken to reduce the temperature of the hot water. The registered person must ensure there is a robust system in place so that action is taken promptly to resolve the deficit. 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 29 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 29 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. People have their needs assessed before they move in, which ensures that people are only admitted if the service is confident it can meet their needs. Evidence: We looked at the care records for two people who have moved to the home since the last key inspection. A representative from the home had fully assessed their needs by meeting them before they were admitted and seeking information about their illness and care needs. This helps to ensure that only people whose needs can be met at Bushbury Court are admitted. The home had also sought information about the persons likes and dislikes, which, along with information from the initial assessment had been used to develop care plans and identify risks to the individuals health, safety and welfare. This helps staff to know how to give care based on the persons needs and preferences. We spoke with three relatives who told us of their satisfaction with the admission Care Homes for Older People Page 11 of 29 Evidence: process and how pleased they have been with how their relative has been looked after at Bushbury Court since they were admitted. The manager told us that there is an information booklet about the home, which is given to the individuals significant others. We did not look at the booklet during the inspection. The manager told us in the AQAA that the booklet needs up dating. The home does not provide intermediate care, a form of intensive rehabilitation, but does provide care to people on a short term or day care basis. Care Homes for Older People Page 12 of 29 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 receive the support and care they need and their dignity is respected by the staff involved in their care. Their health needs are met but some improvements are needed with the homes medication practices and procedures. Evidence: The people living at the home at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation to show how peoples needs are met, speaking with staff and visitors. We observed staff interacting well with people, providing guidance when necessary. There was a calm atmosphere, people appeared content and showed signs of well-being. We looked at the care records for three people we case tracked. Their care plans were clear and assessments of possible risk to their health, safety and welfare were documented. One persons care plan described the risk they pose to themselves and to others and provided detailed guidance to staff on how to manage this risk. We observed staff putting this into practice during the inspection, which shows that staff Care Homes for Older People Page 13 of 29 Evidence: are aware of what is documented in the care plan to meet the persons needs safely. Peoples care plans described how they like to look and dress and we observed that their appearance reflected what was written in their care plan. We saw that care records described the equipment and techniques needed by staff to move people safely. We later saw staff using the equipment safely and as described in the care plan. Staff had good approaches with people, providing reassurance and explanation when using the equipment and maintaining peoples dignity. Since the last inspection the home has introduced a process to show how it assesses peoples nutritional risk at the time of their admission and on an ongoing basis. At the last inspection we advised the home to improve how people are assessed for the use of bed rails. We saw that this had been introduced for one person we case tracked, although it hadnt for another person. Therefore the home needs need to ensure everyone who is assessed as needing bed rails has been assessed on an individual basis for the safe use of bed rails. The risk assessment we saw was a general one and did not take into account factors which may put the individual at risk, such as their body shape and their mental health needs. We spoke with three visitors during the inspection who told us they are very pleased with how their relative is looked after. They told us they are happy with their relatives appearance and described how they always look clean and smartly dressed. They confirmed staff are quick to respond to any changes in their relatives condition, such as seeking medical advice and keeping them informed. They commented that nothing is too much trouble for the staff. We received positive comments in the surveys we received, which included The staff show patience and understanding, my relative is always immaculately turned out in terms of personal cleanliness and clothes, My relative is always very well dressed in his own clothes at all times, Very good care. Any medical concerns are dealt with promptly by regular visits from the doctors practice next door. A survey completed by a healthcare professional described how the service looks after the health and social needs of people and support families very well but could do better by introducing and implementing end of life care plans and introducing clinical pathways. The manager informed us how some staff have been studying for palliative care qualifications and that the home is looking to develop end of life care along with current guidance. The manager told us in the AQAA how relatives are involved in review meetings about peoples care and the visitors we spoke with confirmed these meetings take place and Care Homes for Older People Page 14 of 29 Evidence: they find them very useful. We saw from looking at care records that the home contacts healthcare professionals, such as GPs and district nurses promptly when there are concerns about peoples health and well being. We looked at the medication administration records (MAR) for two people we case tracked and saw that for one person their record had been completed accurately, indicating they had their medication as it is prescribed. The other persons MAR chart had two gaps on the chart, which meant that it was not clear if they had received their medication at that time. Staff had also used a code on another occasion but did not say what the code meant, so it was not clear why the person did not have their medication. We saw that charts were not separated for different people and did not have photographs of the person, to assist staff with checking the identification of the person. The manager confirmed that if the home uses nursing staff from an agency then a permanent member of care staff would assist the nurse to identify people, but acknowledged that improvements could be made. Medication is stored in locked trolleys and a locked cupboard so that people are not at risk of taking medication they are not prescribed. We saw written records showing that staff monitor the temperature of the medication fridge and the temperature of the room where medication is stored. At the last inspection we identified that staff had not been recording accurate temperatures of the fridge. At this inspection we noticed that there have been occasions when the fridge temperature has been too low. This shows that the home needs to ensure staff know the correct temperature for medication to be stored at and when to take action. The manager told us in the AQAA that the homes medication policy needs updating. The manager described how she did start to update the policy, but it appears this has not been adopted by the company. We also noticed that other policies and procedures need updating and a recommendation is made to improve. Care Homes for Older People Page 15 of 29 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. People are provided with some opportunities to enhance their well-being, although further effort is needed to show that all people living at the home are provided with these opportunities and which are based on their needs, capabilities and preferences. People are offered a choice of meals to meet their dietary needs and preferences. Evidence: We spoke with staff who described how they support and enable people with making choices and ascertain their likes and dislikes. We saw this during the inspection when a staff member involved in feeding a person, gave them a small amount of food first and observed their reaction to see if they were enjoying it. The home has a notice board which displays events held at the home and of visits to places outside of the home. We also saw a calendar detailing some forthcoming events. Since the last inspection a member of staff works one day a week as an activities co-ordinator to organise, plan and provide activities. The staff member told us about different activities which have taken place and visitors to the home described how they see staff talking with people, playing music and have seen singers visiting the home. One survey we received commented that the service could do better by providing more exercises and stimulation for residents. Another person commented Care Homes for Older People Page 16 of 29 Evidence: they view their relatives faith is not recognised and more interest in their past life would be appreciated. The AQAA completed by the manager informed us that life history folders mean staff are aware of residents particular interests, however we identified that not everyone has a life history folder, therefore staff may not be fully aware of detailed information about the person before their illness. One member of staff commented in their survey that with more staff more activities could be done to enhance residents well-being. We discussed that the AQAA included the same comment, as it did last year that the service is still to establish links with a local church. The manager told us they have encountered some difficulties but will continue to try and arrange this. The manager confirmed that representatives from a Roman Catholic church visit some people at the home. We looked at written records which have been started to show when activities are provided and they include a refection on whether the activity appeared to benefit the person. This is important as the people living at the home may not be able to say whether they enjoyed the activity. As we identified at the last inspection, the manager acknowledged that records to show what has happened arent always up to date. Therefore there needs to be a more proactive approach by all staff working at the home to demonstrate how people are provided with opportunities to enhance their well-being. Meals in the home continue to offer choice and the meal plans we observed shows that the home offers a wide range of meals and provides many opportunities for people to eat throughout the day. Meals had been prepared to reflect peoples specific dietary needs, such as swallowing and chewing difficulties. We observed staff assisting people to eat and drink and saw that people were provided with regular drinks throughout the day. Care Homes for Older People Page 17 of 29 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. The home has a complaints procedure which ensures people and their representatives know how to raise concerns and complaints. Staff know how to safeguard adults from harm and abuse. Evidence: The complaints procedure is displayed on a notice board in the reception and provides people with clear information on the process to follow and who to contact if people want to complain. Three visitors to the home told us they are very satisfied with the home and would tell the manager and staff if they were not happy with something. They said they feel confident that the staff and manager would act to put things right. The AQAA from the manager stated that one complaint has been received in the last 12 months, which was not in respect of care practices. We looked at the processes used by the company and manager to respond and act on complaints which shows the home deals with complaints effectively. The manager is now keeping written records when concerns are raised by people who may not want formal action taken in response to the concern. We advised the manager that it is good practice to record the action taken to resolve the concern. The training records we looked at and the staff we spoke with demonstrates that all staff working at the home receive training on safeguarding vulnerable adults from the risk of abuse. Staff could describe to us their role in safeguarding adults from the risk Care Homes for Older People Page 18 of 29 Evidence: of harm and abuse. The manager demonstrated a good knowledge of adult protection, the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards and is aware that all staff should have awareness training on the Act. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The staff we spoke with were not aware of their roles in respect of the Act. We saw that staff are provided with training in how to respond appropriately to people whose behaviour may challenge. The manager told us in the AQAA that the homes policy on restraint has not been updated or reviewed for sometime, which means that staff do not have access to up to date information to refer to if they need to. Care Homes for Older People Page 19 of 29 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. People are provided with an environment which is clean and safe but which needs more attention to ensure it is homely and well-decorated. Consideration should also be given to developing the environment so that it may promote positive responses from people with dementia. Evidence: We looked at the rooms for the people we case tracked, which were clean and wellmaintained. We saw that people are able to bring in items which are important to them, such as photographs, pictures and small items of furniture. The general decor in communal rooms and corridors, although clean provides little in the way of sensory stimulation for people, which was identified at the previous inspection. The visitors we spoke with described how they never notice any unpleasant smells but thought the home could be enhanced by improving the decor in lounges and corridors. We received the following comments in two surveys we received the decor at the home is very depressing and for sometime promises have been made that re-decorating was to take place but as yet this has not happened . Another person commented Bushbury Court on the whole is a happy place, but the interior decoration of the building is very outdated and depressing. The comments we received support our findings at inspection and the managers comment in the AQAA that the home is adequately decorated on the whole. Care Homes for Older People Page 20 of 29 Evidence: Since the last inspection the garden has been developed, however we were informed that the flooring which has been used is difficult for people who need to use wheelchairs to move, therefore it is not fully accessible to everyone who lives at the home. We saw the home has equipment to help move people safely such as hoists and there is equipment to help people get in and out of the bath. The AQAA described how the home has increased the amount of beds which can be adjusted to assist with people moving and the home intends to replace further beds. The AQAA also told us that it has introduced a new system to wash clothes and has had new flooring in some areas. An audit was undertaken of the home by an infection control specialist from the local PCT, this identified that the home needed to take some action to improve infection control practices, which it confirms it has done. During our inspection we saw that a bathroom which was being used as a storage room at the time of the last inspection, still had some items in the room, which the manager assured us would be removed. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have the skills and knowledge to meet their needs and who are suitable to work with vulnerable adults. Evidence: Staff we spoke with during our inspection told us that staffing levels are usually sufficient, giving examples of how varying behaviours of people and staff sickness can cause occasional difficulties. This was also reflected in a survey we received. On the day of our inspection staffing levels were reported to be less than usual and a carer who was assisting a person receiving day care, came in early to assist. In the afternoon an agency worker came in to supplement staffing numbers. We spoke with staff, observed them working and discussed staffing levels with the manager which indicated that sufficient skilled care and nursing staff were on duty to meet the needs of people currently living at home. The manager described how the home uses agency staff in conjunction with its own staff when additional staff cover is needed, such as when sickness occurs or because staff have left. Two surveys we received provided comments that the service could do better by trying to avoid using agency staff who may be of variable ability and Whilst the agency carers are very nice it is not the same for residents who get to know the staff employed by the home. The manager told us that the company is considering developing its own team of bank staff, to work within the home at short Care Homes for Older People Page 22 of 29 Evidence: notice. Visitors we spoke with told us when they visit there appears to be enough staff on duty to care for people and described that staff intervene quickly if there are changes with peoples behaviour. We looked at written records which showed the training which has been undertaken by staff and training which is planned. This demonstrates that regular staff training takes place, including training in safe working practice topics such as fire safety and moving and handling as well as more specific training such as dementia care, palliative care, non-violent crisis intervention and awareness of equality and diversity. All staff we spoke with view they are provided with good training opportunities and gave us examples of the training they have done since working at the home. We also saw that new staff are provided with an induction so they know about the home and the care people need. The manager informed us that over 90 of care staff have achieved a recognised qualification in care (National Vocation Qualification) and this should contribute to ensuring the staff team have an effective knowledge of social care. We looked at the process used by the home to recruit two members of staff who have started working at the home since the last key inspection. All parts of the recruitment process were accurately recorded and demonstrated that pre-employment information, such as references and Criminal Record Bureau Disclosures had been sought prior to two of these staff working at the home. The manager confirmed that information is sought from agency staff employers to ensure agency staff who come to work at the home have been checked for their suitability to work with vulnerable adults. Care Homes for Older People Page 23 of 29 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 managed in the best interests of the people who currently live at Bushbury Court and provides people with good quality outcomes. However further effort is needed by the company and the manager to be effective in their role in overseeing all aspects of the service and initiating improvements so that people and staff benefit. Evidence: Mrs Barbara Smith continues in the role of registered manager at the home. Management experience is supplemented by recognised management and health and safety qualifications. Staff told us they are encouraged to work as a team to benefit people living at the home and they described the manager as approachable and supportive. We saw that questionnaires are sent out to obtain feedback from peoples representatives. The information is then brought together into a report for action to be taken if necessary. We looked at the report completed in July 2009, based on the Care Homes for Older People Page 24 of 29 Evidence: responses from seven people and/or their relatives. This showed that people were satisfied with most aspects of the home and the care provided, for example all the people who responded said the staff appear well qualified and able to do their job, that the manager is approachable and the home is well managed. People are also given opportunity to comment on the service through meetings and we saw written minutes of a meeting which had taken place recently involving the representatives for people who live at the home. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken. We noticed that some of the policies and procedures have not been reviewed for sometime, therefore the company needs to take action to ensure staff are provided with up to date information to refer to. We looked at a selection of maintenance and servicing records during the inspection, which shows that staff undertake checks on the home and equipment to ensure it is safe, such as the checking of bed rails and hoist equipment. We saw a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. At the last inspection we found that fire safety checks and monitoring of hot water temperatures had not been taken. At this inspection we saw written records which showed the checks are performed but identified that when the water was last checked, the temperature of the hot water from the sinks in two bedrooms was too hot. We brought this to the attention of the manager who confirmed one of the bedrooms was not currently occupied and in the other bedroom, the persons illness means they would be unable to access the hot water. The manager contacted a company representative and a plumber attended later during the day. These deficits show that closer attention is needed to ensure that when deficits are identified they are acted on promptly. The manager responded to a request by the Commission to complete an AQAA, which is an opportunity for services to share with us areas they believe they are doing well, and where they could improve. The manager provided us with relevant information of what the home does well, improvements which have occurred and plans for future improvement. However scrutiny of the AQAA and comparison with the AQAA submitted prior to the last key inspection also shows that the service has not implemented some of the changes it intended. Care Homes for Older People Page 25 of 29 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 26 of 29 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 9 13 Medication must be stored in 29/12/2009 accordance with manufacturers instructions. This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication. 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 8 The home needs to improve the way people are assessed for the use of bed rails such as ensuring the risk assessment is individualised and based on current guidance. The home should consider increasing opportunities to enhance peoples social well-being and evaluate the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. Staff should be provided with training about the Mental Capacity Act and Deprivation of Liberties. This is so that Page 27 of 29 2 12 3 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. 4 38 The homes policies and procedures should be reviewed and updated. This is to ensure staff have information to refer to which is up to date and reflects current legislation and guidance. When close monitoring of safety systems is required, the registered person must ensure there is a robust system in place so that action is taken promptly to resolve the deficit 5 38 Care Homes for Older People Page 28 of 29 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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