Care Home: Court House Nursing Home

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What the care home does well The home provides writen information for people so that they can make an informed decision about moving into Court House. People can be confident that their needs will be fully assessed before they move in, so that the home can be sure that staff will be able to meet people`s individual needs. Care plans are detailed and give accurate information to staff, so that they can provide a high standard of care. People have access to a variety of social and leisure opportunities which meet their individual needs and wishes. The home provides food of a high standard, which gives a varied and nutritionally balanced diet. People can be confident that any concerns will be listened to and resolved promptly. Staff are kind and caring. The home provides a range of training. Recruitment helps to protect the people who live at the home, by making sure that only suitable staff are employed. What has improved since the last inspection? The home works hard to ensure that people and their families are involved in planning and reviewing their care. Risk assessments clearly show the level of risk, and care plans tell staff how any identified risks can be reduced. What the care home could do better: Medication is not always managed safely, so that people cannot be fully confident that they will receive their medication as prescribed. Staff may not always know how to protect people from the risk of neglect or abuse. The home is in need of some redecoration and refurbishment to bring it up to an acceptable standard. The poor management of infection control puts people at risk. Staff training needs to be backed up by assessments of competency, to make sure that staff are putting their training into action. The Registered Manager is not always aware of issues within the home. The environment may not always be safe for people, as improvements to health and safety procedures need to be put in place. Key inspection report Care homes for older people Name: Address: Court House Nursing Home 3-5 Court Road Barnards Green Malvern Worcestershire WR14 3BS     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: Sarah Blake     Date: 2 2 0 6 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Court House Nursing Home 3-5 Court Road Barnards Green Malvern Worcestershire WR14 3BS 01684561276 01684577949 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.bupa.com BUPA Care Homes (CFHCare) Ltd Name of registered manager (if applicable) Justine Hewitt Type of registration: Number of places registered: care home 79 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: A maximum of 16 people may be accomodated in Beacon House (categories OP and PD(E)) A maximum of 19 people may be accomodated in Bredon House (category DE(E)) A maximum of 19 people may be accomodated in Hollybush House (category PD) A maximum of 25 people may be accomodated in Midsummer House (categories OP and PD(E)) The maximum number of service users who can be accommodated is: 79 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 Homes for Older People Page 4 of 31 Over 65 19 41 19 19 0 19 care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 41 Dementia (DE) 19 Dementia - over 65 years of age (DE(E)) 19 Physical Disability (PD) 19 Physical Disability - over 65 years of age (PD(E)) 41 Date of last inspection Brief description of the care home Court House provides care in individual houses for the elderly frail, people with dementia and young physically disabled people. Some bedrooms have an en-suite facility, and all are single occupancy. Most bedrooms are located on the ground floor, while the two units with accommodation on the first floor level possess a central passenger lift. The home is situated in a residential area, close to local shops and with views towards the Malvern Hills. The home is operated by BUPA, and is managed by Justine Hewitt, the registered manager, who is a registered nurse. Each of the units within the home is managed by a unit manager, all of whom are registered nurses. Information relating to the fees charged for the service is available on request from the home. Fees do not include toiletries, hairdressing, chiropody, newspapers and specialist equipment not available through the NHS. A copy of the latest inspection report for the service can be viewed at the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was an unannounced inspection. Two inspectors visited the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the records for three people living at the home. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the comments from the AQAA have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and staff who work at the home. The information from these sources helps us Care Homes for Older People Page 6 of 31 understand how well the home is meeting the needs of the people using the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 31 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides writen information for people so that they can make an informed decision about moving into Court House. People can be confident that their needs will be fully assessed before they move in, so that the home can be sure that staff will be able to meet peoples individual needs. Evidence: We spoke to a relative of someone who lives at Court House, and they told us that they had been given plenty of information to help them decide if they wished to move in. In the AQAA, the Registered Manager told us comprehensive written information is provided to all prospective clients, and we saw that there was a copy of the Service User Guide in each bedroom. The Service User Guide contained useful information about life at the home, and about peoples rights and responsibilities. We looked at the records for someone who had recently moved into the home. We saw that a senior member of staff had visited the person before they moved in, and Care Homes for Older People Page 11 of 31 Evidence: had carried out a full assessment of their needs. The assessment was very detailed, and included good information about their care needs, and also their preferences, such as preferred time of getting up and going to bed. It is important that the home is sure that it can meet peoples individual needs, and a thorough assessment like the ones carried out at Court House means that people can be confident that the home is able to meet their needs. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed and give accurate information to staff, so that they can provide a high standard of care. Medication is not always managed safely, so that people cannot be fully confident that they will receive their medication as prescribed. Evidence: We looked at care plans for three people who live at the home. We saw that each person had a very detailed plan for their care. These plans were being reviewed every month and updated as peoples needs change. Records showed that the home had contacted peoples relatives to discuss some of the changes, where the people involved had not been able to make decisions for themselves. We saw that the home carries out risk assessments for any identified risk. For example, one person had been assessed as being at high risk of falling. There was a clear plan in place to reduce this risk, and staff were able to describe how this worked in practice. Another person was at risk of choking, and the care plan included detailed instructions for staff about how to ensure that this risk was reduced as far as possible. Care Homes for Older People Page 13 of 31 Evidence: Care plans were written in a person-centred way. Person-centred planning has been described in Valuing People Now as a process for continual listening and learning, focussed on what is important to someone now and for the future, and acting upon this in alliance with family and friends. The information in the care plans gave a clear picture of each persons wishes and preferences. For example, we saw that the care plan for one persons communication needs gave clear instructions about how they prefer to communicate. Many people who live at Court House are not able to mobilise independently, but need specialist equipment, such as a standing aid or a hoist. We saw that there were clear plans in place to explain to staff exactly how to carry out each manoeuvre. We saw some staff transferring people safely using a hoist and a standing aid. However, on two occasions we saw that two staff had positioned a sling in an unsafe position, so that the person being transferred was at risk of injury. We immediately made sure that the sling was positioned safely. The Registered Manager has since informed us that retraining on a one to one basis has been planned for the staff involved, and that staff will be regularly observed to ensure that all moving and handling is carried out safely. We observed that one person had a large bruise on their arm. We looked in the care records to see how this had occurred. Although the care notes recorded the fact that the person had a bruise, there was no information about how this could have been caused. The manager of the unit was able to explain that the bruise had probably occurred because of some medical treatment the person had been having in hospital. However, the records which the hospital had provided did not include any details of the bruise. Whilst it is probable that the bruise occurred as the manager suggested, there was no evidence to show when the person sustained the bruise, and no care plan in place to give staff the information they might need when caring for the person. We would also expect the home to make a photographic record of any such injuries, and this had not been done. During the afternoon of the inspection we saw that there were fluid record charts for several people on the desk in Midsummer unit. We checked to see how much fluid people had been given, as it was a very hot day. We saw that there were no entries on the charts since 11.00 am, although it was now 3.30 pm. From the charts, it appeared that most people had only taken in a maximum of 250 ml of fluid since the early morning. The unit manager assured us that people had been given regular drinks, and that the charts should have been completed at the end of the morning shift. We would expect that charts should be filled in as soon as each person has a drink, so that the charts are an accurate record of peoples fluid intake. Care Homes for Older People Page 14 of 31 Evidence: We saw that there were no drinks available in the lounge for people to help themselves to. The unit manager explained that staff would readily get drinks for people if asked. However, it would be better practice if drinks were placed so that people could reach them at any time, especially in hot weather, when there is a real risk of dehydration. The Registered Manager has since informed us that drinks are now freely available in the lounge at all times. In a display rack in the dining room of one of the units we found a document with very sensitive and confidential information about a person living at the home. The unit manager was unable to explain why it was there, rather than being stored securely with the persons care plan. The information in the document had not been transferred into the care plan, and therefore staff might not have known some important information about the person. The unit manager herself told us that she was not aware of this information. This shows that, not only was the persons confidentiality not being respected, but that there was a risk that the person might not have received the care that was required. We have referred this matter to the Local Authority under its procedures for safeguarding vulnerable people. Hollybush unit cares for younger people with very complex physical needs. The unit manager was able to describe how specialist healthcare professionals such as clinical psychologist, tissue viability nurses and behaviour therapists are involved in peoples care. She also demonstrated an understanding of the psychological and emotional needs of the people living in the unit. We checked the storage and administration of medication, to ensure these are managed safely. We found that most medication was stored securely in locked cabinets or trolleys, and that stock control and ordering systems were generally efficient and effective. We saw that one person had been assessed as being able to administer some of their medication themselves. The assessment showed that the person was administering their own eye drops. We found that the eye drops were stored in an unlocked drawer in their bedroom, which was also unlocked. The eye drops were in a bottle which had been opened over six weeks previously. The bottle clearly stated that it should be disposed of 28 days after opening. In the unlocked drawer, we also found two tubes of cream, a steroid cream and an anti-inflammatory cream, which were partially used. We looked at the Medication Administration Record (MAR) chart and saw that both these creams had been Care Homes for Older People Page 15 of 31 Evidence: discontinued by the GP. This places the person at risk of harm, as they might use creams which are not prescribed for them any more. The Registered Manager has since informed us each room will have a plastic container locked in the residents drawers. They will be disposed of at the end of every month and replenished each month by the night staff. Supervision sessions will assist implementation. We observed part of a medication round, and saw that medication was administered safely and hygienically. The home makes sure that there are instructions in place for all medications given on an as required basis. Some of the instructions were not as detailed as they should be, and the Registered Manager has since told us that they are being rewritten to include the required information. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a variety of social and leisure opportunities which meet their individual needs and wishes. The home provides food of a high standard, which gives a varied and nutritionally balanced diet. Evidence: Court House provides a range of social and leisure opportunities for the people who live at the home. In our surveys, people told us that there are always or usually activities which they can take part in. Records showed that people have the opportunity to go out locally, and that staff can access local Community Action transport to enable people to travel further afield. We saw that people visit Malvern theatre regularly, and one person works part time in a local charity shop. The home was planning to celebrate Wimbledon by holding a Wii tennis party with strawberries and cream. People who live at another BUPA care home had been invited to join in. People told us that the home makes sure that birthdays are celebrated, and that Care Homes for Older People Page 17 of 31 Evidence: festivals such as Easter are celebrated. A local vicar visits for Holy Communion on a regular basis. We spoke to a relative of someone living at the home, and they told us that they are always made welcome. Records showed that the home encourages peoples families to be involved in the life of the home. In the AQAA, the Registered Manager told us we have developed our menus to allow for resident choice and preferences. We saw that the menu for the day was displayed on the dining tables. There was a choice at lunchtime of lasagne or vegetable curry for the main course, with fresh vegetables, followed by jam and coconut sponge with custard. Supper was a choice of homemade vegetable soup with bread roll, beans on toast or sandwiches. We saw staff supporting people who needed assistance with eating. This was done sensitively and staff allowed people plenty of time to eat, and spent time chatting with them. Lunch time was a sociable occasion with a friendly and unhurried atmosphere. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 any concerns will be listened to and resolved promptly. Staff may not always know how to protect people from the risk of neglect or abuse. Evidence: We saw that the homes complaints procedure is available to everyone living at the home. In our surveys, everyone who responded said that they knew who to speak to if they had any concerns. The Registered Manager told us that the home has received several complaints within the last year, all of which were resolved satisfactorily. We, the Commission, have received one complaint about the home in the past year. We referred this complaint to the provider to investigate, and received a full response, which showed that a thorough investigation had been carried out. During the past year, the Registered Manager has made appropriate referrals to the Local Authority under its procedures for safeguarding vulnerable people. However, we were concerned to learn that staff have not yet been trained in the protection of people from neglect or abuse. We were told that one of the unit managers has been asked to provide this training to all staff, but we found that the unit manager herself has not been trained in this area. The Registered Manager has since told us that all the unit managers will receive training in the protection of vulnerable adults. Care Homes for Older People Page 19 of 31 Evidence: We have already described in the section on Health and Personal Care how we found sensitive information about a person living at the home which had not been reported correctly. This put the person at risk of harm. If staff had been trained in the protection of vulnerable adults, they should have understood the importance of passing on any information through the correct channels of communication. One of the ways in which services can help to protect the people who live there is by making sure that only suitable staff are employed. BUPA has its own robust recruitment and selection procedures, and new staff told us that all the required checks, such as Criminal Records Bureau (CRB) checks, were carried out before they started work at the home. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is in need of some redecoration and refurbishment to bring it up to an acceptable standard. Staff are trying to make sure that the environment is pleasant for people. The poor management of infection control puts people at risk. Evidence: Court House is made up of three units, which are housed in separate buildings. Each unit has its own lounge and dining area, and all the bedrooms are single rooms. We saw that people had personalised their bedrooms with their own ornaments and items of furniture. The home has very pleasant gardens, with patio furniture and garden umbrellas to protect people from the sun. Two years ago, at the previous key inspection, we were told that a major programme of refurbishment would be taking place. We saw very little evidence inside two of the units that this has happened, although Midsummer unit has had extensive redecoration work. The paintwork throughout the other two units was shabby and chipped. This is unsightly and is also an infection risk. Some staff have decided to take matters into their own hands, and have got together a working party to repaint some of the walls in Hollybush unit. Whilst it is admirable that staff are willing to give up their time in this way, it is the providers responsibility to ensure that the home is kept in good decorative order. Care Homes for Older People Page 21 of 31 Evidence: We found that many of the bathrooms and toilets were visibly dirty, with soiled and stained shower chairs, toilet seats and bath seats. Many parts of the home were dusty and grimy, including doors, curtain rails and pedal bins. We saw that, in one bathroom, skirting boards were hanging away from the walls. All this means that there is a real danger of cross-contamination and therefore infection could spread. People who live at Court House are vulnerable to infection, and the service should be making much more effort to ensure that the home is kept clean and hygienic. Hand washing facilities throughout the home were not always adequate. For example, in one sluice room, the wash basin was obstructed by a laundry bin and a waste bin. This means that staff who have been dealing with dirty items need to go out of the sluice room and find the nearest wash basin before they can wash their hands. We saw that there were some containers of hand gel around the home, and we saw that some staff had their own supply of hand gel, but evidence shows that hand washing with soap and water is the most important way to prevent the spread of infection. In the AQAA, the Registered Manager told us infection control is of a high standard, but this was not borne out at the inspection. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are kind and caring. The home provides a range of training, but this needs to be backed up by assessments of competency, to make sure that staff are putting their training into action. Recruitment helps to protect the people who live at the home, by making sure that only suitable staff are employed. Evidence: In our surveys, people told us that staff at the home are always or usually available when needed. We saw that two of the units had adequate levels of staffing, and that staff had time to talk with people and spend time with them. On Beacon unit, there were two care staff on duty in the morning, and one nurse. One of the care staff had only just started care work, so needed support and guidance. There were eleven people living in Beacon unit, of whom only one was able to mobilise without the use of specialist equipment, requiring two people to use it. Staffing rotas showed that, on the previous Sunday, there had only been two staff on duty in the unit. This level of staffing could put people at risk. The Registered Manager told us that the staffing levels in this unit were already under review and would be reassessed by BUPAs Quality Team. On the day of the inspection, we saw staff working in a respectful and caring way, and taking time to explain things to people. They showed a good rapport with people and were kind and cheerful. People at the home described staff as lovely and helpful and Care Homes for Older People Page 23 of 31 Evidence: really kind. BUPA has a comprehensive training programme, although the evidence at the inspection was that some staff have not understood their responsibilities in relation to some aspects of care work, for example moving and handling (as described in the section on Health and Personal Care) and infection control (as described in the section on Environment). The Registered Manager needs to make sure that staff are competent to carry out all their duties. As already described in the section on Complaints and Protection, the home makes sure that recruitment is carried out safely, so that only suitable staff are employed. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager is not always aware of issues within the home. The environment may not always be safe for people, as improvements to health and safety procedures need to be put in place. Evidence: The home is managed by Justine Hewitt, who is registered with the Commission. This means that she has been judged to have the skills and knowledge necessary to manage the home. As described earlier in the report, each unit is managed by a unit manager, supported by a team of nursing and care staff. The Registered Manager completed the AQAA and sent it to us when we asked for it. It was detailed and showed that she has identified areas where the home needs to make improvements. However, as we have mentioned in the report, we found some areas of concern which had not been identified by the Registered Manager. It concerned us that the Registered Manager had delegated some training, for Care Homes for Older People Page 25 of 31 Evidence: example the protection of vulnerable adults and infection control training, to staff who were not proficient themselves. This demonstrates a lack of understanding of the importance of high quality training, and could place people at risk of harm. The general shabbiness and grime which we found at the home, and the lack of effective infection control measures, indicate that the manager may not always be keeping a close eye on events within the home. Although the Registered Manager needs to be able to rely on the unit managers to a certain extent, it is her responsibility to ensure the safety and wellbeing of the people who live at the home. The Registered Manager has shown that she communicates well with the Commission, and has appropriately notified us of incidents within the home, as she is required to do. The home works hard to gain the views of the people who live there, and each month the home holds a meeting with afternoon tea so that people can discuss any issues with senior staff. We found many aspects of the home which lead us to the conclusion that issues of Health and Safety are not always managed well. These include some of the concerns mentioned in the section on the environment. We were shown a maintenance book in which staff write any repairs which need doing. We saw that some repairs had not been signed off, although they had been in the book for a long time. These included a large crack in the ceiling of a bedroom, which the unit manager told us had been in the maintenance book for over a year. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 8 12 (1) You must ensure that records of fluid intake are accurately maintained. This is so that people can be confident that their care needs in respect of fluid intake are being met. 03/08/2010 2 8 12 (1) You must ensure that an 03/08/2010 effective system is in place to manage peoples mobility needs. This is to ensure that people are not at risk of harm or injury. 3 9 13 (2) You must put an effective system in place to ensure that medication is disposed of, following the instructions of the manufacturer and/or prescriber. This is to ensure that people are not at risk of harm. 03/08/2010 Care Homes for Older People Page 28 of 31 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 4 9 13 (2) You must put an effective system in place to ensure that all medication is stored securely at all times. This is to ensure that people are not at risk of harm. 03/08/2010 5 10 12 (4) (a) You must ensure that 03/08/2010 confidential information is stored securely. This is so that people can be confident that their privacy is respected. 6 18 13 (6) You must put an effective system in place to ensure that appropriate referrals are made of any suspected abuse or neglect. This is to ensure that people are protected from the risk of neglect or abuse. 03/08/2010 7 19 23 (2) You must ensure that 03/08/2010 the premises and equipment are maintained in a good state of repair. This is so that people are not at risk of harm, and so that they can live in a pleasant environment. 8 26 13 (3) You must put an 03/08/2010 effective system in place to ensure that the home is kept clean and hygienic. Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that people are not at risk of infection. 9 30 18 (1) You must put an effective system in place to ensure that staff are competent to carry out their duties. This so that people are protected from the risk of harm. 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 03/08/2010 1 9 You should ensure that, for all medications prescribed to be given as required, there is a detailed protocol in place. This is so that people can be confident that staff know when to give the medication. You should ensure that all staff are trained in the protection of vulnerable adults. You should review the levels of staffing in Beacon unit to ensure that there are sufficient skilled and competent staff on duty at all times, to meet the needs of the people who live in the unit. 2 3 18 27 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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