Care Home: Cole Valley Nursing Home

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What the care home does well People have the majority of the information that they need to enable them to decide if they want to live at the home. People have some opportunities to be involved in the running of the home so that they can make decisions about their living environment. People can be confident that they can choose how they spend their time so that they can make decisons about their daily lives. People are supported to keep in touch with their families and friends, so that they do not lose relationships that are important to them People living at the home are offered a variety of healthy meals that meet any special dietary requirements. People are supported by the right number of staff, who have a good understanding of their specific care needs. There is a robust system for checking that peoples` money is held at the home in a safe manner People told us: "I came to look around before deciding to come to live here". "The staff are well organised and take a doctor on a weekly ward round. We are happy as a practice with the care that this nursing home provides for our patients". "We are made to feel so welcome here. I would recommend it here". "I enjoy my Sunday lunch here with my wife". "The staff here are marvellous we couldn`t fault them. If mom asks for a snack they get it. Whatever she asks for day or night they get it for her". "It wouldn`t be a problem if I wanted to have a lie in". "We are not short staffed". What has improved since the last inspection? Admission processes have improved so that prior to coming to stay there, people can be confident that the home will be suitable to meet their needs. There is a rolling programme of redecoration and refurbishment in place, so that people are provided with a clean and comfortable place to live, that meets their assessed needs. People can be confident that care and support is provided in the ways that they prefer and need. People are encouraged to lead fulfilling lives that meet their needs, interests and expectations. People benefit from being cared for by a staff team that are supported in their job roles. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People told us: "The people living here are kept occupied". "The cleaners do a grand job and my room is cleaned every day". " The staff are hospitable and welcoming and always have a nice attitude". "This is a happy home to work in with good team spirit". What the care home could do better: People cannot always be confident that their concerns have been taken seriously, and that actions have been taken in response to any suggestions they make. Systems in place for staff recruitment may place people living at the home at risk of harm. The home does not always tell us about serious events involving people living there. This means that we are not able to monitor these, and safeguard people living at the home. People cannot be confident that they receive their medication as prescribed at all times which may compromise their health. Key inspection report Care homes for older people Name: Address: Cole Valley Nursing Home 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN     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: Amanda Lyndon     Date: 0 6 1 0 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Cole Valley Nursing Home 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN 01214448887 01214411959 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cole Valley Care Limited care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 45 Dementia (DE) 45 Date of last inspection Brief description of the care home Cole Valley provides general nursing care and accommodation for up to forty five older people, who may have additional dementia care needs. The home is located in a residential area close to local amenities including shops and public transport. Off road parking is provided adjacent to the home for up to nine cars. There are two secure gardens that are accessible to all people living at the home. The home is purpose built and the accommodation is spread over two floors. Upper Care Homes for Older People Page 4 of 35 3 1 1 0 2 0 0 8 45 0 Over 65 0 45 Brief description of the care home floors are accessed via a passenger lift or stairway. Forty one bedrooms offer single accommodation and there are two twin bedded rooms. However, one of these is currently being used as a single room. All bedrooms have en suite bathroom facilities with a toilet and wash basin. In addition assisted baths and showers are available on both floors of the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists and pressure relieving equipment to meet the assessed needs of people living there. The home offers communal dining and lounge areas. A separate room is allocated as a hairdressing salon. Kitchen and laundry facilities are based on site. The home is a nonsmoking environment and people that wish to smoke do so outside. A shelter is not provided for this. The home employs an activities coordinator so that people have the opportunity to take part in a range of activities. In the reception area there is information that may be of interest. Thus includes our last inspection report, the statement of purpose, and service user guide. Details of fees charged to live at the home are included in the service user guide and are available from the home on request. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing, and newspapers. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 focus of our inspections 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, minimum standards of practice, and focuses on areas that need further development. The date of the last key inspection at this home was 31st October 2008. The visit to the home was undertaken by one inspector over two days. The pharmacist inspector visited the home on the first day to inspect the systems in place for the management of medication. The home did not know that we were visiting on the first day. There were forty two people living at the home during our visits. Prior to the visit taking place, we looked at all of the information we had received, or asked for. We received an Annual Quality Assurance Assessment (AQAA). This tells us Care Homes for Older People Page 6 of 35 how the home think they are performing in order to meet the needs of people living there. It also gives us some numerical information about staff and people living at the home. Since our last visit, we have received one complaint about the home. We sent out surveys to ten people who live at the home, ten relatives, five staff members, and two health professionals. This is in order to obtain their views about the service provided. One person who lives at the home, one staff member, and both health professionals returned surveys to us. Their comments are included in this report. Three people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to five staff members about the care they provided to these people. We spoke to five additional people who live at the home, six relatives, and one health professional so that they had the opportunity to be involved in the inspection. We sampled care, staffing, and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean, and comfortable for them. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Admission processes have improved so that prior to coming to stay there, people can be confident that the home will be suitable to meet their needs. There is a rolling programme of redecoration and refurbishment in place, so that people are provided with a clean and comfortable place to live, that meets their assessed needs. People can be confident that care and support is provided in the ways that they prefer Care Homes for Older People Page 8 of 35 and need. People are encouraged to lead fulfilling lives that meet their needs, interests and expectations. People benefit from being cared for by a staff team that are supported in their job roles. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People told us: The people living here are kept occupied. The cleaners do a grand job and my room is cleaned every day. The staff are hospitable and welcoming and always have a nice attitude. This is a happy home to work in with good team spirit. 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 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission processes are thorough and people living there can be confident that their care needs will be met. Evidence: A statement of purpose and service user guide had been produced and these were available on display in the home for people to read. The manager stated that these could be produced in other formats and languages on request, so that more people could access the information. Details about the various formats available was not provided and this may prevent people from requesting this. The documents included information about the services and facilities provided at the home, and the fees charged to live there. Details about arrangements for people that choose to smoke are not included within these documents. This will prevent people from having this information when deciding whether to live there or not. The manager said that this information would be added. Care Homes for Older People Page 11 of 35 Evidence: One person who had recently come to live at the home said I dont recall having a service user guide. We did not see service user guides in peoples bedrooms during our visit. The home should ensure that all people are given a copy of the service user guide so that they are aware of what to expect when living at the home. Since our last key inspection the pre admission assessment document has been further developed. We looked at two of these for people who had recently come to stay at the home. We found that they included all of the information required in order to determine whether a persons care needs could be met by the home. One person who had come to live at the home recently said I came to look around before deciding to come to live here. Thus person said that they were satisfied with the admission process. People come to live at the home for a trial period of four weeks. We saw that after this time a care review is arranged involving the person, people important to them, their social worker and the homes staff. This provides all present with the opportunity to discuss whether the persons care needs are being met at the home, and whether they wish to stay there. Intermediate care is not provided. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place ensuring that the health and personal care needs of people living at the home are met. The medicine management had improved since the last inspection. However, further work is required to ensure that people receive their medication at the prescribed times. Evidence: We looked at the care records of people case tracked, and partly reviewed the care records of an additional three people. We saw that comprehensive assessments of peoples individual physical and mental health, and social care needs are undertaken on admission to the home. Care plans are written from this information. These are individual plans about what people can do for themselves, and in what areas they require support. People met during the visit stated that they were satisfied with the care being provided to them and that it reflected their personal preferences. Care Homes for Older People Page 13 of 35 Evidence: Since our last key inspection, we found that improvements had been made regarding care plan documentation. We found that they were personalised and included peoples preferences regarding their daily lives. They identified what the person could and couldnt do for themselves, and gave staff instructions about the support to be provided. They focussed on peoples abilities so that they would be encouraged to maintain their independence as able. Care staff met during the visit confirmed that they had access to the care plans. It was evident that they had a good understanding of peoples individual care needs, as the actual care provided reflected information included within the care plans. Care plans had been written about specific medical conditions, and the nursing care to be provided in these areas. This means that people should be supported by staff to meet their health care needs. Nursing staff met during the visit told us that they had attended recent training on a variety of health care topics, so that they should have up to date knowledge to provide nursing care in a competent manner. This included continence management, nutrition, and infection control. Nursing staff told us that they are given dedicated time to undertake designated responsibilities for a range of care tasks, such as the ordering of medication and the auditing of care plans. This should ensure that care practices are of a good standard. In addition, nurses take the lead on a range of care topics and attend training on their designated topic. As identified further in this report, we were aware of a recent safeguarding referral that was made and upheld regarding the poor management of wound care at the home. It was noted, however, that this was an isolated incident, and we found that there was evidence that the systems in place for the prevention and management of pressure sores (broken skin due to reduced mobility) was overall good. We spoke with a health professional who regularly visits the home who said This is one of the homes who heal pressure sores always. There is an occasional slip up but management of wound care is excellent. We spoke with the registered nurse employed by the home who has a designated responsibility to lead on wound care. She told us that both she and another staff member is due to commence a training course about this later this month. She stated that there was enough pressure relieving equipment at the home in order to reduce the risk of people developing sore skin. We found that this was the case for the people case tracked. The manager told us that people can retain their own doctor on admission to the Care Homes for Older People Page 14 of 35 Evidence: home, if the doctor is in agreement. Two doctors visit the home on a weekly basis in order to see people living there. However medical advice can also be sought outside of these times as required. Advice can also be sought as needed from a range of other health and social care professionals. A survey completed by a health professional that visits the home said The staff are well organised and take a doctor on a weekly ward . A health professional met during the key inspection said The carers, nurses and managers know bang on instantly what care is needed for each person with no hesitation. If I make suggestions the next time I look it has been done. We saw that people were clean, hair was neatly styled, and people were wearing clothing appropriate to their age, gender, culture and the time of year. Information in a survey completed by a local doctor told us that she is currently working with the home to develop an end of life protocol. Staff spoken with during the visit were enthusiastic about the positive impact this would have for people living at the home, and those people important to them. From discussions with people living at the home and our observations during the visits, we saw that people are supported in a respectful manner. Interactions between staff members and people living at the home were good. This will promote peoples self- esteem. A survey completed by a health professional that visits the home raised a concern about the management of medication on occasions. The pharmacist inspection took place at the same time as the key inspection. It lasted three and a half hours. Seven peoples medicines were looked at together with their Medicine Administration Record (MAR) charts, daily records and care plans. Two nurses were spoken with and one person who lived in the home. All the medicines were kept in a dedicated medication room. This was too hot to securely store the medicines within. The excessive heat may affect the medicines stability. A portable air conditioning system had been purchased but following daily monitoring of the temperatures an alternative fixed air conditioning system was being investigated. We, the commission, were assured that the medicines would be stored at the correct temperature to comply with current regulations. The medicine refrigerator range of temperatures were outside the recommended temperatures to store medicines requiring refrigeration. This was to be monitored. Care Homes for Older People Page 15 of 35 Evidence: The medicine trolleys were too small to house all the medicines within. This resulted in some medicines being kept in a separate locked cabinet and taken out at the beginning of each round. None of these particular medicines could be shown to have been administered as the doctor prescribed. We, the commission were assured that a new additional trolley would be purchased to rectify this situation so all prescribed medicines could be stored in the trolley ready to take to the people. The majority of prescriptions were seen prior to dispensing and a copy taken to check the medicines and MAR charts received. Not all copies were available so not all the medicines could be checked for accuracy. One error was seen where staff had recorded the incorrect medicine name and this means that the wrong medication might be administered. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. A few errors were seen. One nurse had failed to record that medicines had been administered for the whole of one medicine round. It could be shown that the majority had been administered but the nurse had failed to record what she had done. Others medicines had not been administered and the reasons for non-administration not recorded. This indicates that the nurse had not followed the policies and procedures in the home or her professional guidance documents. Some medicines were administered via a PEG feeding tube. The nursing staff had no medical information textbooks to check that the medicines were given correctly. The manager was keen to purchase one to ensure that medicines administered via this route were correctly administered and the most appropriate formulation would be prescribed. All the controlled drug (CD) balances were correct and the register had been correctly completed. The cabinet used to store the controlled drugs did not comply with current regulations and other items that were not controlled drugs were also stored within. The CD cabinet should be reserved for the storage of CDs only. The cream management had improved in the home but one cream was mentioned in the care plans that had not been documented on the MAR chart. All prescribed medicines must be recorded on the MAR chart. Many creams had been prescribed on an as directed basis and staff had guessed how many times a day to apply them. In one instance a cream to treat an infection had been applied daily when it should have been applied two to three times a day. This cream would not work as intended. Nursing staff had not clarified with the doctor the exact dose he required. Care Homes for Older People Page 16 of 35 Evidence: Two nurses were spoken with. One had a limited knowledge of the medicines she administered. Training has been sought from the primary care trust regarding what the medicines are for. The other nurse had a very good understanding of the clinical conditions of the people she looked after. This was commended. The care plans were looked at. It was not possible to see why some medicines had been prescribed. Most of the external healthcare professional visits had been recorded but some of the details were sparse. All information should be recorded so all staff who look after the persons clinical needs have a full understanding of all events relating to the person. The home does audit the medication on a regular basis but the system was not refined enough to identify individual nursing staff practice. The manager was keen to install such a system to improve the system further. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live at the home receive support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. Evidence: Since our last key visit, the activities coordinator has increased her working hours to thirty hours per week covering five afternoons and evenings. This means that people are provided with more opportunities to participate in a range of activities. These are advertised in the home so that people can be aware of what is on offer. These include craft sessions, physical activities, Animal in Hands, and bingo. The activities coordinator also spends time with people who either choose not to, or who are unable to join in with group activities. Special occasions are celebrated. During our visit there was a party for people living at the home, their friends and families, and the staff team in order to celebrate the 100th birthdays of two people living at the home. It was evident that hard work had been put in to organise this. The dining room was decorated and there was a large buffet lunch and entertainer. One visitor met during the visit said The people living here are kept occupied. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so that people can Care Homes for Older People Page 18 of 35 Evidence: follow their religious beliefs if they wish. One person chooses to go outside of the home on her own to a local luncheon club. This means that she has the opportunity to meet with people outside of the home. Other people choose to go outside of the home with their families and friends. There is an open visiting policy and people told us that they can meet with their visitors in private if they wish. One visitor met during the key inspection said We are made to feel so welcome here. I would recommend it here. Another visitor said I enjoy my Sunday lunch here with my wife. People told us that there are no rigid routines and can choose how they spend their time and where they are served their meals. A staff member said We put breakfasts aside for the people that are still sleeping. One person said It wouldnt be a problem if I wanted to have a lie in. We saw that the menus had recently been reviewed with the involvement of people living at the home. They identified a variety of nutritious meals,and a choice of meals is always available. Menus were produced in a large print format and reflected the menu choices of the day, so that people could choose what they wanted to eat. Special diets are prepared for reasons of health, culture, and religion and catering staff met during the visit had a good understanding of this. Extra calories are added to the food of people who have been assessed as being at risk of losing weight. We saw that the portions of pureed diets were served separately, so that people could experience the taste of each portion. The majority of comments received about food provided at the home were positive. One person said The staff come to me and ask what I would like to eat. A visitor said The staff here are marvellous we couldnt fault them. If mom asks for a snack they get it. Whatever she asks for day or night they get it for her. People met during the visit said that they had enjoyed the party buffet lunch, and we saw that staff assisted people respectfully with their meal. At the most recent environmental health inspection, the home had been awarded four stars. The staff training matrix identified that staff had recently undertaken food hygiene training. This should mean that food is prepared in a hygienic manner. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to listen to the views of people living at the home, but these do not mean that people can always be confident that their views are taken seriously and that they are always protected from harm. Evidence: The complaints procedure was on display in the home, and was included within the service user guide. it was produced in a large print format for ease of reading. People met during the visit told us that they knew who to speak to if they had any concerns. Information on the AQAA stated that the home have not received any complaints in the past twelve months. In addition we saw that no complaints had been recorded at the home, and the manager stated that none had been received. However from discussions with people living at the home and from records sampled, it was evident that complaints had been made. One person met during the visit said The manager and deputy manager are very approachable. If I talk to them things are dealt with. We discussed this with the manager who stated that she had not considered the issues raised to be formal complaints, therefore a record of them had not been kept. We could evidence that actions had been taken to address issues raised to peoples satisfaction. However a system must be introduced to record these, so that people can Care Homes for Older People Page 20 of 35 Evidence: clearly identify that their concerns have been taken seriously. Since our last visit, we have received one complaint about the home. Issues raised involved the management of a recent outbreak of an infectious illness, and the reporting of people with unexplained injuries. We looked into the issues raised as part of this inspection. From sampling records held at the home, it was evident that they do not always tell us about all deaths, serious accidents, unexplained injuries, and incidents involving people living at the home. These are called notifications and are a legal requirement so that we can monitor events occurring in the home, and safeguard the people living there. We did, however, see that the home report incidents to other appropriate external agencies, and seek medical advice as required. We saw that local multi- agency guidelines about adult protection were available. The training matrix identified that all staff had received recent training about adult protection, and the management and care staff met during the visit had a good understanding of the correct procedures to follow. One care worker said I would report any safeguarding issues to the deputy or manager. The management team had attended awareness training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, and we saw leaflets for staff to refer to. 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 manager told us that plans were in place for the rest of the staff team to receive training in this area. The home had made one referral of this kind regarding a vulnerable person who had attempted to get out of the home on their own on many occasions. As a result of this, a multi disciplinary decision was made and the fire escapes had been adapted so that this person had the freedom to walk around the home safely Since our last visit, we have been aware of one protection of vulnerable adults investigation. This is regarding the quality of wound care provided to one person living at the home, and this was upheld. It was noted, however, that this is the first allegation of this nature. We saw that positive actions had been taken by the homes management team in order to reduce the risk of a further incident of this kind. As discussed in the staffing section of this report, new worker recruitment checks are Care Homes for Older People Page 21 of 35 Evidence: not always robust, and do not always safeguard people using the service. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean and comfortable place to live, that meets their assessed needs. Evidence: The home is purpose built and well maintained. There is a rolling programme of redecoration and refurbishment in place. We saw that the living environment was of a good standard, with the exception of heavy soiling on the carpet in one of the lounges. The manager told us that she is liaising with an external contractor about the best way to clean this. There are two gardens and both are secure so that they are safe for all people living at the home to use. Since our last key inspection, new garden furniture and bedding plants have been purchased. Plans are in place to further improve these areas for people to enjoy. Smoking is not permitted within the building, and people that wish to smoke must do so outside. A shelter is not provided for this purpose, however, we did not receive any negative comments about this. There are three communal lounges and one dining room, and people told us that they can choose where they spend their time. These were decorated in a homely style so that people can relax in comfortable surroundings. Care Homes for Older People Page 23 of 35 Evidence: Accommodation is provided on the ground and first floors of the building. The upper floor is accessed via either a passenger lift or stair way. We looked at the bedrooms of the people case tracked and saw that people are able to bring in items which are important to them such as photographs, pictures, and small items of furniture. There is a nurse call facility in each bedroom, so that people can call for staff assistance as required. The home has forty one single bedrooms and one twin bedded room. People who share a room have a curtain between their beds to provide privacy. We spoke with the people who share this room, and they both expressed their satisfaction about this. All bedrooms have en suite bathroom facilities with a toilet and wash basin. In addition assisted baths and showers are available on both floors of the home and the manager stated that these meet the needs of the people living at the home. Hand rails are provided and corridors are spacious allowing people to move around freely with any mobility aids required. The home has transfer hoists, so that people who are unable to stand or walk can be moved safely. We saw that all staff had recently undertaken training about how to use this equipment safely. Risk assessments had been completed regarding this so that the correct equipment was used for each person living at the home. We found that the home was clean and fresh throughout, and a hygienic laundry system was in place. Since our last key inspection, the home has worked with the Primary Care Trust (PCT) infection control team to ensure that appropriate infection control measures are in place. The result of a recent infection control audit undertaken by the PCT at the home was positive with an overall score of 91 . This means that people are provided with a clean and hygienic place to live. Prior to our visit we received a concern about the way in which a recent outbreak of an infectious illness involving both people living at the home and the staff team had been managed. From care records sampled, and from speaking to staff, we found that the situation had overall been managed appropriately. One person met during the visit said The cleaners do a grand job and my room is cleaned every day. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff have the skills and knowledge they need to meet their needs. Systems in place for staff recruitment do not always protect people from harm. Evidence: In addition to care staff, administration, activity, maintenance, domestic and catering staff are employed, so that people are supported in all areas of their lives. From discussions with staff and the sampling of staffing rotas, we identified that staff turnover is low, and that the use of agency staff had reduced recently. This will promote continuity of care for the people living at the home. It was evident that staff spoken with during our visit had a good understanding of peoples preferences and individual care needs. Staff told us that they were happy working at the home and this will promote a positive environment for people to live in. A survey completed by a health professional that visits the home said The staff are hospitable and welcoming and always have a nice attitude. Another health professional said Senior staff remain in service long term. They know the patients and their families well. Care Homes for Older People Page 25 of 35 Evidence: One staff member who completed a survey said This is a happy home to work in with good team spirit. From discussions with people living at the home and staff, and the sampling of staffing rotas, we identified that there were enough staff on duty to meet peoples needs. One staff member met during the visit said I think that the staffing levels are quite good. Another person said We are not short staffed. One person living at the home said Overall I have not had to wait for carers to answer my buzzer. They are very good. We sampled the recruitment files of three staff members who had worked at the home for varying lengths of time. These included the majority of information required. However we saw that risk assessments are not undertaken should negative information be included about a person once the criminal records check is completed. This means that people can not be confident that people employed by the home are suitable to work with vulnerable people. The management team told us that since our last key inspection the staff induction programme used for training new staff members had been further developed. However we were not able to fully assess this, as an example of the training pack was not available. We saw that the majority of information had been given to new workers over two days and the training matrix identified that they had received other mandatory training in health and safety matters. A new staff member met during the visit said that she felt that the induction training told her what she needed to know,and was now looking forward to working towards a nationally recognised care qualification (NVQ 2). Since our last key inspection at the home, it was evident that staff had undertaken a wide variety of training in order to meet the needs of the people living at the home. A staff training matrix had been developed and this identified that staff had undertaken recent training including nutrition, infection control, diabetes and fire safety. The deputy manager had recently undertaken training about caring for people with dementia. The manager told us that plans were in place for the rest of the staff team to undertake this training in the week after the key inspection. Staff met during the visit said that they were satisfied with the training offered to them. From sampling staff records it was evident that action is taken to address any gaps in individual staff members knowledge. This should mean that care and support is provided in a competent manner. Care Homes for Older People Page 26 of 35 Evidence: Information on the AQAA identified that the majority of staff employed at the home are trained to a National Vocational Qualification Level 2 in care (NVQ2). Some are working towards NVQ level 3. This should mean that they have some of the skills and knowledge necessary to provide a good standard of care to people living at the home. Records identified that staff meetings are held regularly. This means that staff have the opportunity to be involved in the running of the home, and are kept up to date with training and development opportunities. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems must be further developed so that people living at the home can be confident that the home is being run in their best interests. Evidence: The manager is a registered nurse and has been in post for the past six years. She works extra to the rota and this means that she has dedicated management time. Positive comments were received about her management style. One person told us that they had approached the manager and requested to move bedrooms. They said that this had been arranged to their satisfaction. The manager has attended recent mandatory training in health and safety matters and is qualified to deliver moving and handling training to the staff team. Since our last key inspection, a deputy manager had been recruited and positive comments were received about the new management structure. As well as working Care Homes for Older People Page 28 of 35 Evidence: alongside the staff team the deputy manager is given dedicated management time in order to undertake duties such as pre admission assessments, staff supervisions, and deliver staff training sessions. She also provides cover in the managers absence, and it was evident that the additional management support has resulted in improved outcomes for people living at the home. The manager and deputy manager are available during a number of evenings, so that people who are unable to visit the home during the day time have the opportunity to speak with them outside of normal office hours. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This included details about the home, staff, and people who live there. It also included details about what the home hoped to achieve for the benefit of the people living there. The AQAA did not, however identify that improvements were required in respect of the management of medication and the recording of complaints. We saw that there are some systems in place to capture the views of people living at the home. The manager told us that group meetings have not been very popular, however a recent meeting about reviewing the menus had been well attended. We saw that the menus had been changed in response to suggestions made by people living at the home and their families. Confidential service satisfaction questionnaires were available in the reception area of the home for people to complete. In addition to this, questionnaires are periodically sent out to people living at the home and their families. We saw that a report had been written about this however did not identify the actual findings. This means that people would not be able to determine whether actions had been taken in response to any issues raised or suggestions put forward. We saw that senior external managers undertake regular quality monitoring visits at the home, and there was evidence that people living there are involved in these visits. We could not, however, evidence from these records that actions were taken in response to suggestions made by people. The manager however stated that the senior management team are very supportive and willing to provide extra resources in order to meet the needs of the people living at the home. There is a robust system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Since our last visit, a system for formal staff supervision had been implemented. Staff met confirmed that they were taking place, and we saw that detailed records of these were being maintained. These included practical supervisions, observing staff Care Homes for Older People Page 29 of 35 Evidence: members performing their work duties in order to assess their competence. Supervisions also provide staff with the opportunity to discuss their personal development needs. We saw that actions points including gaps in care workers knowledge identified as a result of staff supervisions had been acted upon. This will improve the standard of care provided for people living at the home. The manager had a good knowledge about accidents that had occurred involving people living at the home. We saw that accident records were well maintained and regularly audited so that any trends or patterns in accidents can be identified. This means that measures can be put in place to reduce the risk of further accidents of a similar nature from occurring again. As previously identified, the home do not inform us about all serious accidents involving people living at the home. This means that we are not able to monitor accidents occurring at the home in order to safeguard the people living there. Health and safety and maintenance records sampled were up to date in order to promote the health and safety of people within the home. However, we saw that in the week prior to our visit an external fire safety contractor had identified that the back up battery for the fire panel was not keeping its charge. This means that in the event of a power cut the fire panel would not be activated if a fire occurred. This does not protect the health and safety of people within the building. The manager told us that she had arranged for remedial repair work to be done to uphold peoples safety. Shortly after the visit, the home owner confirmed that an external contractor was in the process of carrying out this work. We have identified a concern about the management of staff criminal record checks. The way in which these are managed must be improved in order to maintain the safety of the people living at the home. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A quality assurance system 13/11/2009 must be installed to assess nursing staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. The medicine chart must 16/11/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and Page 32 of 35 2 9 13 Care Homes for Older People 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 accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 3 16 22 A system must be in place for recording all complaints received by the home. This is to ensure that people can be confident that actions are taken in response to their complaints. 4 18 37 A system must be in place 15/11/2009 so that we are notified of all serious events affecting the health and welfare of people living at the home. This is so that we can monitor events occurring in the home and safeguard people living there. 5 29 13 Robust recruitment practices 15/11/2009 must be in place. This is so people are safeguarded from harm. 15/11/2009 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Arrangements should be in place so that a service user guide is given to all people living at the home. This is so they know what to expect when living at the home. Arrangements should be in place so that people know that the service user guide and statement of purpose can be produced in different formats and languages, so that more people could access the information. It is recommended that medical textbooks are purchased for nursing staff to refer to, to ensure that all medicines administered via a PEG tube are done so correctly It is recommended that a Controlled Drug cabinet is purchased that complies with current regulations and it is reserved for the storage of CDs only. It is recommended that nurses undertake further training in the indications and side effects of the medicines they handle It is recommended that all medicines prescribed as directed have the doses clarified with the prescriber to ensure that they are administered at the correct therapeutic dose A report should be written based on the findings of service satisfaction questionnaires. This should be made available to people living at the home so that they are aware of actions taken in response to these. A system should be in place so that people are made aware of any actions taken in response to quality monitoring visits undertaken by external management. 2 1 3 9 4 9 5 9 6 9 7 32 8 32 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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