Care Home: Carr Green Nursing Home

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What the care home does well People are assessed before they move in, this is to make sure that their needs can be met at the home. There is plenty of information for people to take away that gives details about the service provided, this helps people decide if it is the right place for them to move to. The staff know people very well, they have a good understanding of individual needs and preferred daily routines. People look well cared for and they told us they were happy with the service provided. People living in the home like the staff, they enjoy good relationships with them. They are friendly and make visitors to the home feel welcome. We asked people to tell us what they think the home does well. These are some of the comments people made in the surveys they sent to us: "They provide a warm, friendly welcome with good quality care". "Care staff always provide a good service". "Many of the residents I visit feel well looked after". "It`s a happy friendly environment". "There`s good team work". "Everything`s fine as the home goes, they look after my Mum". What has improved since the last inspection? Care plans are being reviewed regularly and people living at the home and their relatives are actively involved in review meetings. This means that people can comment on their care and say if it needs to be improved. A budget has been made available for staff training, this is a positive improvement that needs to be maintained if staff are to keep their care practice up to date. Training records are much improved. This means it is possible to see at a glance what training staff have received and when refresher training is due. There is a monthly improvement plan for decorating and maintenance. This means that repairs are dealt with quickly and the home is better maintained. Records for the servicing of equipment are better organised and easier to find.Staff recruitment procedures are better. Application forms have been improved and checks on prospective staff are more thorough. This is to make sure that newly recruited staff are suitable to take up post. People using the service and their families are now invited to comment on the performance of the home by completing a quality assurance questionnaire. The management team plan to give feedback on the results of the surveys at one of the regular meetings they hold with resident and relatives. The requirements made in the last report have all been addressed. The improvements to the service now need to be maintained. What the care home could do better: The range of activities on offer should be improved when the activities coordinator takes up post. An alternative and more dignified means of protecting clothing from spillages should be offered to people at meal times. People should be shown the choices of food at mealtimes so that they can decide what they would like to eat. All areas of the home must be checked to make sure the call bell system can be accessed by everyone who can use it. This is so that people can summon help from staff as soon as they need it. Bathrooms could be improved so that they look more inviting and less institutionalised. The service would benefit from internet access so that the management team do not have to download information in their own time, using their own home computers. Key inspection report Care homes for older people Name: Address: Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT     The quality rating for this care home is:   one star adequate 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: Lynda Jones     Date: 1 9 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 32 Information about the care home Name of care home: Address: Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT 01484710626 01484710626 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Flowertouch Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: Can provide accommodation and care for seven named services users - category DE(E) Date of last inspection Brief description of the care home Carr Green provides both personal and nursing care for 31 older people in what was once a school. The home is located in Rastrick, close to local amenities. There is a small, safe garden area at the side of the home and car parking is available in the grounds. All of the accommodation is on one level and there is level access to the building. There are single and double bedrooms available. None of the bedrooms have en-suite facilities. Bathrooms and toilets are near to the bedrooms. There is one large lounge and a dining room. The kitchen and laundry are in the basement. The fees Care Homes for Older People Page 4 of 32 2 0 0 7 2 0 0 9 0 0 0 Over 65 3 31 2 Brief description of the care home at the time of this inspection on 19/1/10 were between four hundred and fifty pounds and five hundred and thirty pounds a week. In addition to the weekly fee there is an extra charge for hairdressing, chiropody and personal newspapers. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The purpose of this inspection was to assess the quality of the care and support received by people who live at Carr Green. The last key Inspection was in July 2009. This is what we used to write this report: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We sent surveys to people using the service, staff and health care professionals before we carried out the site visit. Care Homes for Older People Page 6 of 32 We received 6 completed surveys in total, these were from people who are using the service, from staff and from health care professionals who have contact with the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened, these are called notifications and are a legal requirement. Relevant information from other organisations. A site visit was carried out by one inspector between the hours of 9:45 am and 5:30 pm and what we call an Expert by Experience. This is a person that has experience of services similar to the one Carr Green provides. The expert talked to people using the service and helped us get a picture of what it is like. We have included extracts from the report that the expert sent to us. The visit was unannounced. During that time we spoke to people using the service and to staff and management. We looked at various records, looked around the building and observed staff as they carried out their duties. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care plans are being reviewed regularly and people living at the home and their relatives are actively involved in review meetings. This means that people can comment on their care and say if it needs to be improved. A budget has been made available for staff training, this is a positive improvement that needs to be maintained if staff are to keep their care practice up to date. Training records are much improved. This means it is possible to see at a glance what training staff have received and when refresher training is due. There is a monthly improvement plan for decorating and maintenance. This means that repairs are dealt with quickly and the home is better maintained. Records for the servicing of equipment are better organised and easier to find. Care Homes for Older People Page 8 of 32 Staff recruitment procedures are better. Application forms have been improved and checks on prospective staff are more thorough. This is to make sure that newly recruited staff are suitable to take up post. People using the service and their families are now invited to comment on the performance of the home by completing a quality assurance questionnaire. The management team plan to give feedback on the results of the surveys at one of the regular meetings they hold with resident and relatives. The requirements made in the last report have all been addressed. The improvements to the service now need to be maintained. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they move in to make sure that their needs can be met and it is the right place for them to move into. Evidence: In the AQAA, the manager said Our admission procedure is quite thorough anyone making an enquiry with a view to coming to stay with us is invited to come and have a look around the home, we have a no appointment call in anytime method so the home is seen as it is. They are shown around by either the manager or deputy manager and are free to ask any questions or queries. There is plenty of information available for people to take away with them about Carr Green. There is a brochure, statement of purpose and service user guide in the entrance area which gives information about the service and accommodation provided. Copies of these documents can be made available for people to take away to Care Homes for Older People Page 11 of 32 Evidence: read. Most people are referred to the home via the local authority and copies of their care needs assessments are always requested before any agreements are made about moving in. The manager also carries out her own assessment. These are important because they should indicate whether the home is suitable and can meet each persons needs. We looked at care plans for two people who moved in recently and there was evidence to show that pre admission assessments had been carried out. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are met and people are protected by the homes medication administration systems. Evidence: In the AQAA the manager said All service users have their own individual care plan and risk assessments which the resident and next of kin are involved with. Care plans are reviewed monthly if any service users are at risk we act upon findings to reduce risks and also if care needs change we document and make the changes required.We also do a 3 monthly review involving next of kin and resident allowing them to voice any changes or anything they are not happy with We looked at three care plans because we wanted to see what individual needs had been identified and what action staff have to take to meet these needs. In previous reports we said there was insufficient detail in the plans to guarantee that people were receiving the care and support they required in a way that suits them. However, at the last inspection in July 2009 we saw signs of improvement in the care plans and note that on this visit this improvement is continuing. Care Homes for Older People Page 13 of 32 Evidence: There is information about the level of support people need and about their preferences, for example whether they prefer baths or showers and whether they need help from staff or just prompting. The plans include information about the sort of assistance people require to help them to wash, dress and mobilise on a daily basis and we could see from the care plan who wore dentures, hearing aids and glasses. We noted that they were all in use and that people looked well dressed and well cared for. People living in the home that we talked to and those who completed surveys for us said they get the care and support they need. Two health care professionals who completed surveys for us said the home is good at meeting peoples health care needs. We observed the staff providing people with care and support throughout the day. As we have noted on previous visits, they treated people with respect and ensured that personal care was always delivered with discretion, and in private. The staff were patient and always took time to explain what they were doing. For example, when they were assisiting people to move and using the hoist they talked through the moves they were about to make and they were all very positive and encouraging in their approach. In the AQAA, the manager said We have good communication with outside professionals and residents are seen on a regular basis by for example dentists, chiropodists, optician, doctors if required also if any special intervention is required like a dietician or tissue viability nurse, or CPN we go through the correct channels and get residents seen as promptly as possible and seek advice on the telephone in the meantime. There is evidence in the records which shows that people have contact with a wide range of health care providers and the staff are good at asking for advice when they need it. Details of visits and telephone contacts are documented in the individual care plan and show the advice that has been given. We talked to staff about peoples care and support and they described the care that was written down in the care plans. This means that staff understand what they need to do to make sure peoples needs are met. The daily records could be improved upon. These records should provide the evidence to demonstrate the care that staff deliver on a daily basis. Some staff tend to be repetitive in their comments and they record the same information each time they are on duty, such as good diet and fluid intake had a good day, sat in lounge. From Care Homes for Older People Page 14 of 32 Evidence: our observations of staff interacting with people throughout the day, these records do not reflect the actual level of care and support the staff provide. We discussed this with the manager during the visit. The records show that systems are in place for people living at the home and their relatives to be involved in regular reviews of the care plans. This enables people to comment on the care they receive and to say if it can be improved in any way. This has been implemented recently and is an improvement since the last time we visited the service. Medication is safely stored within the home and improvements in the medication administration records (MAR) have been maintained. Medication is being booked in correctly when it is delivered to the home and the records indicate that people are getting their medication at the prescribed times. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have plenty of contact with people and they respect their preferred routines however, people need more opportunities to take part in activities of their choice. Evidence: At the last inspection we said there was insufficient information in the care plans about peoples past life experiences. Since then there has been a big improvement in this area. The plans we looked at relating to people who moved in recently contained some good life histories. These provide information about peoples families, about their work and life experiences and about their hobbies and interests. This is useful because it helps staff to support people to pursue their interests and to follow the sort of day to day routine that suits them. Carr Green is a friendly home, everyone makes visitors feel very welcome. Throughout the day the staff were available where people were sitting. When they were busy they always made time to talk to people as they carried out their tasks. In the AQAA the manager said We involve residents in what they wish to do giving Care Homes for Older People Page 16 of 32 Evidence: them choices of all daily and social activities such as what to wear, meals time they would like to go to bed , what they would like to do, activities etc In the surveys we asked people if there were activities for them to take part in if they wanted to. Two people replied and they said usually. One of the health care professionals who completed a survey said they could provide more stimulating activities suitable to residents capabilities. I believe this is left to care staff who do not have the time. They could employ an activities coordinator. This is what our Expert by Experience said The activities for people living in Carr Green are limited. There is no activities person, but the manager said that an activities coordinator is in the process of being employed at the home who will be working 12 hours a week over four days, sometimes this will include a weekend. However there was an activities notice displayed in the lounge. Activities were shown to take place in the afternoons of Monday - sing a long, Wednesday - cake decorating, Friday - Board games - the care staff have the task of organising these. Nothing was organised for the other four days, unless staff had available time to organise something. They have a karaoke machine which proves very popular with some of the people. Some outside activities came into the home such as a donkey from a local childrens activity farm, an entertainer visited before Christmas and children visited from the local primary school. Some people enjoyed a day out to Blackpool last year. Three peoples comments on activities in the home were, I like singers the best who come to see us, but that doesnt happen a lot. Theres not a right lot to do. I enjoyed the children coming in. There should be more opportunity for people to take part in meaningful, stimulating recreational activities when the Activities Coordinator takes up post in the very near future. The Expert by Experience said I observed various staff displaying positive interactions with people, which brought positive experiences from them. One carer was sat with a person holding their hand and singing along with them. Another person was enjoying a game of snap with a carer. Friendly banter was observed being exchanged between the staff and people there. People were referred to by name and staff were comfortably close when speaking with people, so they could hear and see them. Care and respect was given by staff when assisting people. Carers were interacting with people in a friendly manner. In the surveys, people said they usually like the meals provided. We asked people about the meals whan we visited and these are some of their comments: Care Homes for Older People Page 17 of 32 Evidence: The foods good here, they feed us well. I like most things they serve. you get plenty to eat. At feedback to the manager at the end of the inspection, we said the mealtime experience needs to be improved so that people are treated with dignity and offered a genuine choice of menu. Our Expert by Experience joined everyone for lunch and made the following observations: The main meal of the day was tea-time; a lighter lunch was served at midday.I had the opportunity and experience of eating with people in the dining room. This was laid out with tablecloths, condiments and serviettes or bibs. When people were first sat at the table, some were asked if they wanted a bib or a serviette. Some answered their preference, others did not. Most people wore white paper bibs around their necks. I brought this to the attention of the manager at feedback and asked if there was a more dignified form of protection. She said she would order some tabards for this purpose. Some people were asked a choice of what they would like. When asked if they would like assorted sandwiches, no explanation of what they contained was given. Some were asked choice on dessert; others were brought one to their table without being asked. Whilst staff may be aware of peoples likes and dislikes, people should be given choice at every opportunity as they are entitled to change their mind or appetite. I brought this to the attention of the carers to address in future. These are some comments from people there. I like this semolina, I never used to eat it. Whats in the sandwiches I dont like chips without bread and butter. People in the dining room were spoken to in a friendly manner; the staff readily acknowledged people in conversation and friendly banter went on between the carers and people. People were given time to eat their food, it was not rushed and the carers were attentive to the needs of most people. However, further encouragement by staff would be beneficial for those people losing concentration to eat or having difficulty picking up their food. I saw one person lose concentration and stopped eating; another person was having difficulty locating the food. Hot drinks or juice were served after the meal. Care Homes for Older People Page 18 of 32 Evidence: Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and adult protection issues are being dealt with correctly. This means that staff are listening to people and keeping them safe. Evidence: There is a complaints procedure on display in the home and it is outlined in the statement of purpose and service user guide. In the surveys people said they know how to complain and they said they had someone to talk to if they are ever unhappy. We have not received any complaints about the service since we carried out the last inspection. In the AQAA, the manager said All complaints are documented. All complaints are dealt with immediately were possible and fully investigated within 2 weeks. All staff have received training about safeguarding vulnerable adults. This is important training because it tells staff about their responsibility to ensure that people in their care are safe and protected from harm. In the AQAA, the manager said All staff are updated annually in Safeguarding vulnerable adults. We now have in house training for safeguarding vulnerable adults which is tailored for each individual member of staff. This means if a member of staff does not understand something it can be broken down and simplified until they are fully aware of signs and what action to take. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers people a homely, comfortable and clean environment. Evidence: The home is registered to accommodate 31 people, when we visited there were only 18 people in residence. In recent years the the home has not been fully occupied because the double rooms in the home are now all used as singles, unless two people make a positive request to share a bedroom. As part of this visit we looked round the accommodation. We looked at the communal areas, bathrooms and some of the bedrooms. This is what the Expert by Experience said: Carr Green nursing home is a former primary school building because of this the exterior does not give a welcoming appeal. There is double secure entry to the home by electrically controlled gates, along with an inner door security code and a TV monitor inside the home for staff to see anyone wishing to gain entry. I was informed that this sometimes can cause delays for visitors to enter the home if carers are busy and are unable to give access straightaway. This home is simply and basically furnished with decorations and furniture. As it was a Care Homes for Older People Page 21 of 32 Evidence: former primary school; the benefit being that nearly all areas are large and spacious, all rooms are on one level. I observed peoples rooms which easily accommodated small items of their own furniture; this personalisation was beneficial to their environment and made it homely. There was a lockable drawer in each of the rooms for their personal possessions. People had space to wander as they chose or were able; handrails are fitted in most areas of the home to assist people. All radiators throughout the home are covered to protect people from harm. There is a parker bath for assisted bathing in one of the bathrooms, wherein there was a stained old rubber bath mat in the bath which I suggested to the manager should be discarded and which she did. The bathrooms needed more embellishments by way of wall pictures, flowers etc., to give a more homely feel, the manager agreed to this being done. There are no en suite facilities, but toilets are located nearby to rooms. The toilet basins are quite low and the toilet seats need adaptations to make them suitable for the people there and in some of the toilets a grab rail for support. Some toilets and bathrooms had no shades thereby exposing the light bulb; this was brought to the attention of the manager. All areas of the home were warm and at a comfortable temperature for the people who lived there There were slight unpleasant odours in the lounge, bathrooms and toilets; the latter areas more likely to be the drains. On looking through the kitchen there was a small flood on the floor which the maintenance man was busy working on. A small wooden gate which gave access downstairs to the kitchens and laundry was unsecure, the bolt was not working correctly, the manager said the maintenance man would attend to this and fit further security. There is a large lounge with television and comfortable high chair seating, also a table displaying containers of water and orange juice but there were no cups or glasses in evidence. The corridors are exceptionally wide with some seating areas in the corners. The kitchen and laundry is downstairs in the cellars. The laundry was organised and had a full time laundry person. The manager said each person has a Keyworker who has responsibility for sewing labels in their clothes. The few examples we looked at in the laundry unfortunately had no name labels in. However, it was good to evidence no lost property section. Most of the bedrooms are spacious and all of them are at ground level. People have personalised their rooms with assistance from staff and relatives and every room is set out to meet each persons needs. We were concerned to note that the pull cords on the emergency call system were not always accessible to people. This means that people may not be able to summon help from staff when they need it. We brought this to the Care Homes for Older People Page 22 of 32 Evidence: immediate attention of the manager and we have made a requirement later in this report for all of the call points to be checked so that people can reach them at all times. In warmer weather, people have safe access to the outdoors and fresh air. An enclosed, secure accessible outside area was observed, where people were able to sit or walk. Patio tables, chairs, sunhats and sun cream are all supplied. These are some of the suggestions for improvements made by the Expert by Experience: Lampshades in the bathrooms and toilets. Easy access to nurse call system pull cords. Adaptations to toilet seating and grab rails. A photo board with staff photographs and names. A colourful poster, for people to see denoting the day of the week, along with a large clock. Decoration/embellishments to be introduced into the bathrooms, toilets and communal areas to give a more homely look. Pictures to aid recognition on peoples room doors. Because some communal areas and peoples rooms had no or limited access to views outside the home, people should be given opportunities to have more access to the outdoors. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of trained staff on duty during the day and night to meet peoples needs. Evidence: At the time of our visit there were 18 people living at the home. Between 7:15am and 1pm there are 4 care staff and 1 or 2 members of qualified staff on duty. Bewteen 1pm and 9pm there are 3 care staff and 1 or 2 qualified staff on duty and during the night there are 2 care staff and 1 qualified member of staff on duty. In addition, there are 2 catering staff on duty 7 days a week, domestic cover is also provided 7 days a week and the the handyman is present at the home 5 days a week. This means that care staff can concentrate on delivering care and support to people and are not taken away to do other duties. The manager assured us that staffing levels would be adjusted to meet any changes in individual needs or if the number of people accommodated increased significantly. The staff we spoke to told us that there are enough staff on duty to meet peoples needs. We looked at some of the records relating to recently recruited staff to see if staff are appropriately checked before they start work at the home. Recruitment procedures have improved since we last visited, references are always taken up and checks are Care Homes for Older People Page 24 of 32 Evidence: always made with the Criminal Records Bureau and against the Protection of Vulnerable Adults register to ensure that new staff are suitable to work with older people. There is a training matrix in place for each member of staff, which shows what training staff have received and what training they need to do. Creating the matrix and managing to secure training in all mandatory areas for all staff is a major achievment for the management team. The manager told us that funding had been had been made available after our last visit to the home in July 2009 and this enabled her to address training requirements. The owners of the home need to ensure that funds are available for refresher training so that all staff keep their care practice updated. More than 90 per cent of care staff now have a national Vocational Qualification at Level 2. We will monitor progress in this area on future visits to the service. The manager needs to make sure staff complete Mental Capacity Act and Deprivation of Liberty training so that they fully understand this legislation. The manager told us that staff receive induction training when they first start working in the home. There is an induction programme in place for staff to follow. This means that staff are given the training and information they need before they start working alone. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the management of the home means that peoples views about the service are listened to and taken on board, and their health safety and welfare is better protected. Evidence: The home does not have a registered manager at the present time. The last registered manager resigned from the role in May 2009. The current manager has previously worked at the home as deputy manager, she has a number of years experience of working with older people and been employed at Carr Green since 1989. She is in the process of applying to be registered with us. In previous reports we said the management team at the home were not sufficiently supported by the company that owns the home. We found evidence that the home was not well resourced; there were insufficient funds available for staff training; no strategic plan for improving standards and no plan for the maintenance and decoration Care Homes for Older People Page 26 of 32 Evidence: of the home. We have seen signs of improvements in each of these area since we last visited. This improvement needs to be maintained so that the health, safety and welfare of people living and working at the home is promoted and protected. The Responsible Individual (who acts on behalf of the company that owns Carr Green) visits the home every week and each month he completes a monthly report on the conduct of the home. The AQAA that we asked for contained all of the information we asked for and it was returned to us when we asked for it. The home has a limited computer system and does not have access to the internet, the AQAA was completed without support from head office and only by staff using their own home computers. At the time of our last visit there was no mechanism in place for people to be consulted about their views of the service. Since then the management team have introduced a formal quality assurance system, they plan to hand out surveys to relatives when they conduct reviews of care plans. Thereafter, an annual quality assurance will be carried out. There has been an improvement in the maintenance of records relating to the servicing of equipment in the home. The home has provided us with relevant certificates and servicing records since we last carried out an inspection. When we looked round the home we were concerned to see that some of the emergency nurse call points were not accessible to people. This means that people could not summon help if they needed it. This is what our Expert by Experience said The nurse call system was a pull cord usually located over the bed. However these were not always within reach of people when sat in their chairs. One pull cord was broken off and was unreachable. I asked the person who was sat in this room what they did if they needed assistance, they replied I usually shout for someone when they are passing (their door was open). Another person when asked the same question who was also sat in their room and was immobile replied I cant get up, so I cant pull it; the pull cord was out of their reach. We brought this to the attention of the manager who said she would ask the handyperson to check all bedrooms immediately and make sure all of the cords were within easy reach. The accident records must be improved so that they contain more detail. Some of the Care Homes for Older People Page 27 of 32 Evidence: records we looked at did not provide sufficient information about where accidents occured within the home. This information is important because it enables the manager to see if there are any common themes and take appropriate action to reduce further risks of accidents occuring. All staff also need to be following the same procedure when recording accidents. The manager said accident forms should be copied and held in individual care plans so that accidents/falls can be monitored when care plans are reviewed. We found evidence showing that this procedure is not always being followed. The home holds small amounts of money for safekeeping on behalf of people living there. This is money that is usually deposited by relatives to cover the cost of hairdressing and sweets etc. The records show details of all incoming and outgoing money and receipts are obtained for all purchases. The money that is held for safekeeping can be reconciled with financial records. This means that people are protected from from any financial abuse. Care Homes for Older People Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 17 Details of all accidents must be fully recorded in the accident records So that unnecessary risk can be identified and reduced. 26/02/2010 2 38 13 People must always be able 26/02/2010 to access the emergency call system. So that people can call for help when they need it. 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 2 7 15 Daily reports should clearly reflect how peoples needs have been met and how they have spent their day. Mealtimes should be improved to ensure that people are treated with dignity and are offered a genuine choice of menu. Bathrooms need to be improved to provide a warm, pleasant place for people to relax and bathe in. Adaptations should be available in toilets so that they are 3 21 Care Homes for Older People Page 30 of 32 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 safe and easily accessible for people to use. 4 30 All staff should complete Mental Capacity Act and Deprivation of Liberty training. This will make sure that they fully understand the implications in their day to day Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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