Care Home: Glenmoor House Nursing Home

What the care home does well People using the service and their representatives are involved with the objectives of care plans, which are reviewed on a regular basis. Assessments are carried out to identify any problems, such as falls and mobility, pressure area care and nutrition. Staff recruitment is effectively managed this ensures that staff employed at Glenmoor House are suitable to work with older people. The home employs a dedicated activity person social and individual activities are seen as an important aspect of promoting well being. Southern Cross have a comprehensive quality assurance system in place that involves seeking feedback from people using the service and their representatives, Regulation 26 visits take place and records of these visits were available to view, within some of the reports viewed the information was very brief, with no issues identified. Others were more detailed, addressing areas such as complaints, food hygiene standards, redecoration, improvements and refurbishments, staff training and care planning. Cash held on behalf of people using the service is stored securely and records of deposits and withdrawals are supported with receipts and records of balances checked on a regular basis. Concerns, complaints and safeguarding issues are taken seriously and addressed in line with the homes complaints and safeguarding procedures, staff are aware of their responsibilities to ensure people are safe. What has improved since the last inspection? Information within the homes statement of purpose and service users guide is kept up to date. Some redecoration work has taken place within communal areas and individual bedrooms. In response to a satisfaction carried out in July / August 2009 staffing levels had been increased. What the care home could do better: Pre admission assessments would benefit from having more information on the persons background, family and social networks, past occupations, interests, hobbies, religious and cultural beliefs. Having such information at the onset of admission would assist in supporting people, especially those living with dementia and communication difficulties, to maintain a sense of self - identity. The eating and drinking care plans need to detail the level of support required, to ensure that people are fully supported to eat and drink. Assistance given to help people with eating and drinking, needs to be carried out discreetly, and sensitively. Weight gains and losses need to be recorded as directed within the individual care plans. The medication audits need to be sufficiently robust to detect, errors and shortfalls. Records on the makes and models of moving and handling equipment in use and records of maintenance to this equipment need to be kept. This will ensure that equipment is fit for purpose and safe for use at all times. To ensure that people using the service are warm and comfortable at all times, the temperature control throughout the home, especially on the ground floor, needs to be closely monitored. Directives not to resuscitate need to evidence that the person has the capacity to make this decision, where this is not possible due to lack of capacity this also needs to be evidenced. Training planned to take place on the Mental Capacity Act, Deprivation of Liberty and Venepuncture that had been postponed, needs to take place without delay. Key inspection report Care homes for older people Name: Address: Glenmoor House Nursing Home Rockingham Road Corby Northants NN17 1AD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Miller     Date: 1 4 1 2 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 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) 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 31 Information about the care home Name of care home: Address: Glenmoor House Nursing Home Rockingham Road Corby Northants NN17 1AD 01536205255 01536262662 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare Services Limited Name of registered manager (if applicable) Mr Peter Nigel Barlow Type of registration: Number of places registered: care home 59 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: The maximum number of service users who can be accommodated is 59. 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 admision to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Dementia - Code DE(E) Physical Disability - Code PD Date of last inspection Brief description of the care home Southern Cross Healthcare owns Glenmoor House Nursing Home. It is a 59-bedded care home with a registration for 48 nursing care beds. It provides care to elderly Care Homes for Older People Page 4 of 31 Over 65 22 37 0 3 0 20 2 6 1 1 2 0 0 8 Brief description of the care home people (over 65 years of age) and has a further registration category for caring for elderly people with dementia related illnesses and younger adults with a physical disability. The home is a purpose built building and is situated on a main route within Corby. It is well situated to access local facilities and amenities with a complex of shops close by and it is on a local bus route. The accommodation offers a range of communal areas including lounges and dining areas on both floors. All bedrooms are single and the majority have en-suite facilities. Level access to the home is via the main entrance and there are stairs and a passenger lift for access to the first floor. The range fees provided at the time of this inspection are between 383.54 pounds to 616.00 pounds dependent upon assessed needs. The fees include personal care, accommodation, meals and laundry. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include personal expenditure such as newspapers, clothing and toiletries. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and carried out by two regulation inspectors and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of people using the service were sample checked which involved looking through written information available on their care, such as their individual care plans (a care plan sets out how the home aims to meet the individual service users personal, health care, social and spiritual needs). During the visit we spoke with people about their experience of using the service, and Care Homes for Older People Page 6 of 31 staff to gain an insight into the staff support and training provided at the home. We carried out general observations of care practices to enable judgments to be made as to the quality of service provided at Glenmoor House. Records in relation to the homes management and administration systems, quality assurance, staffing and general policies and procedures were viewed. Several weeks prior to this unannounced visit the Care Quality Commission sent out to the provider an Annual Quality Assurance Assessment (AQAA). This document allows the provider to reflect on the service they provide and supply us with written information on how they view their own performance. The AQAA was returned to the Care Quality Commission CQC within the timescale set, and gave an insight into how the home is managed and quality assessed. Throughout this report the term we is used to describe CQC as a collective body. 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: Pre admission assessments would benefit from having more information on the persons background, family and social networks, past occupations, interests, hobbies, religious and cultural beliefs. Having such information at the onset of admission would assist in supporting people, especially those living with dementia and communication difficulties, to maintain a Care Homes for Older People Page 8 of 31 sense of self - identity. The eating and drinking care plans need to detail the level of support required, to ensure that people are fully supported to eat and drink. Assistance given to help people with eating and drinking, needs to be carried out discreetly, and sensitively. Weight gains and losses need to be recorded as directed within the individual care plans. The medication audits need to be sufficiently robust to detect, errors and shortfalls. Records on the makes and models of moving and handling equipment in use and records of maintenance to this equipment need to be kept. This will ensure that equipment is fit for purpose and safe for use at all times. To ensure that people using the service are warm and comfortable at all times, the temperature control throughout the home, especially on the ground floor, needs to be closely monitored. Directives not to resuscitate need to evidence that the person has the capacity to make this decision, where this is not possible due to lack of capacity this also needs to be evidenced. Training planned to take place on the Mental Capacity Act, Deprivation of Liberty and Venepuncture that had been postponed, needs to take place without delay. 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 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. Peoples need are assessed prior to moving into the home. Evidence: Documents containing information about the services provided at the home were available within the front entrance of the home. This included the homes Statement of Purpose, (which provides information on the management of the home and qualifications of staff). The Service User Guide (which provides information on the range of services provided at the home and the local community) and a copy of the most recent Care Quality Commission inspection report (formerly CSCI). We looked at the pre admission assessment information that was contained within the care file of a person recently admitted into Glenmoor House. There was general information on the persons physical needs, but there was very little in the way of knowing the social and cultural needs of the person. Having this information is important in promoting well being a sense of person hood and belonging. Care Homes for Older People Page 11 of 31 Evidence: The pre admission assessment had records that the person was at very high risk of falls, the home had made arrangements for the optician to carry out an eye test which took place on the day of the inspection. The Primary Care Trust (PCT) had been contacted to request the falls co coordinator visit, to assess the person and advise on how the risks of falling for this person could be minimised. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare needs are generally met, though more effective record keeping will ensure that peoples care is not compromised. Evidence: We looked at a sample of care plans and talked with staff to assess how peoples health and personal care needs were being met. Generally records showed that care plans are reviewed on a monthly basis and other opportunities are available for people to get together to discuss their care needs with the staff, families and allocated health and social care professionals. Nutritional assessments informed on the support people required with eating and drinking, special diets,and food supplements. There was records of people being referred to the Speech and Language Therapist (SALT) for further advice and support. Some eating and drinking care plans contained general information rather than being reflective of the individuals current needs, for example one care plans stated the person should have a high protein diet, when daily records showed that the person Care Homes for Older People Page 13 of 31 Evidence: was not eating and drinking. The care plans had information on the frequency of when people are required to have their weight taken. One person recently admitted into Glenmoor House, assessed as nutritionally at risk had no record available of their weight being taken since their admission. This was discussed with staff at the time of the inspection, as it is important that people identified as nutritionally at risk, have their weight gains and losses closely monitored to ensure that appropriate action can be taken. Falls risk assessments informed on the support people required to minimise the risk of falls for the individual, we looked at the care plan of a person recently admitted into Glenmoor House who was assessed to be at very high risk of falls, arrangements had been made for this person to be assessed by a specialist falls co-coordinator and by the optician. On the day of the visit the optician visited this person. Since their admission into Glenmoor House the person had sustained injuries from two falls, in discussion with the staff they confirmed that this person was still awaiting an assessment visit from the falls coordinator. Most people on the ground floor unit were being nursed in bed, there was evidence of people being assessed for any risks of developing pressure sores. Records showed that appropriate action was taken to reduce the risk, such as people being assisted to change position regularly, specialist pressure relieving equipment being in place to reduce the risk of developing pressure sores and the involvement of a specialist tissue viability nurse (TVN). We looked at how medication was being managed and within one care plan viewed records were available of a medication error which had occurred. Records showed that staff assigned with the responsibility of administering medication had had taken appropriate steps to ensure the health and well being of the person. This involved contacting the persons general practitioner and specialist nurse immediately upon discovering the error. There was records of instructions given from the general practitioner and specialist nurse, and records of close observations of the person carried out over a period of time to observe for any ill effects due to the medication error. We carried out a sample check on the general medication administration records and records of controlled medications to see that people were being given their medications as prescribed, this involved looking at records and stocks of Controlled Drugs (CD) in use. We found that for one CD drug in use there a was discrepancy around recording, which had not been identified in a recent internal medication audit Care Homes for Older People Page 14 of 31 Evidence: carried out at the home. This indicated that the medication audits may not be sufficiently robust in detecting problems within the medication administration records. We looked at the care of a person receiving end of life care, the care plan had instruction that the person should not be transported to hospital and a do not resuscitate (DNR) instruction was included within the care plan. The DNR stated that the decision not to resuscitate had been discussed with the patient and their relatives. The form had been signed by the next of kin and the their GP but no signature had been obtained from the person themselves. There was no evidence within the care plan to demonstrate that a mental capacity assessment had been carried out to determine whether the person had the capacity to consent or not. We would expect that this is seen as an important part of an end of life plan Generally throughout the home there was a calm atmosphere, people looked clean and comfortable and staff appeared to have a caring approach toward the people in their care, we spoke with people visiting the home who expressed satisfaction with the care provided. Care Homes for Older People Page 15 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. Opportunities are available for people to engage in group and one to one activities. Lack of discreet support for people at mealtimes could result in people not receiving meals in a dignified manner. Evidence: On the day of the visit time was spent with people residing on the dementia care unit, a group of local children visited Glenmoor House to sing Christmas Carols, people were observed to enjoy this entertainment. After this had finished staff were observed to spend time with people in the communal lounge, light music was being played and people were observed to enjoy this time with the staff. We observed people to move freely around the dementia care unit , staff stopped to speak with people whilst carrying on with their duties. Glenmoor House employs an activity person this person was busy socialising with people within their bedrooms during the morning, in discussion with the activity person they said that they try to get around to see people in their bedrooms who are unable to be involved in social activities as much as possible. In the afternoon a group of people were observed joining in a quiz run by the activity person, the quiz involved Care Homes for Older People Page 16 of 31 Evidence: naming things such as, peoples names, plants, songs etc. beginning with a letter from the alphabet. The people taking part appeared to enjoy this activity. Within the care plans viewed we saw that some information had been sought on peoples life history, such as past occupations, hobbies, interests, names of family, friends and pets. The activity person informed us that she is involved in seeking this important information. Records were available to evidence when people had taken part in activities. We looked at the care plan for a person assessed as nutritionally at risk, this person had communication difficulties which made it difficult for them to tell us directly what support they required to take their meals and drinks. We looked within this persons eating and drinking care plan which contained basic information, such as needs help with feeding, needs a soft diet, uses a feeder beaker. We observed at lunchtime that the person was given a specialist spoon, we could find no reference within their care plan that specialist cutlery was required. In discussion with the staff they explained that the special cutlery had only recently been obtained by the home. It was also noted that when the person was attempting to feed and take drinks by themselves, they did this more effectively by using their left hand, we asked staff whether the person was left or right handed, they were unable to confirm this. Over the lunchtime we observed the person receiving their meal. It was noted that over a period of approximately fifteen minutes where there was no interaction with staff at all. The person sat with their eyes closed at the dining table. Staff in all instances but one, stood up alongside the person spoon feeding them. There was very little in the way of eye contact or verbal communication between the staff and the person the method in which this person received their meal appeared functional. The Annual Quality Assurance Assessment submitted by Glenmoor House states that choice of menu can be selected on the evening prior, with assistance from carers and that choice is made available at the table. and individual requests are honoured wherever possible. This was seen to take place with some people within the dining room. The social aspects of eating and drinking, along with the way in which staff assist people at mealtimes, are crucial in ensuring people receive a wholesome, appealing and nutritious diet. Any assistance in eating and drinking is done discreetly, sensitively and individually. Care Homes for Older People Page 17 of 31 Evidence: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are listened to and acted upon this ensures people are safe. Evidence: The Complaints Procedure and copies the homes Statement of Purpose and Service User Guide (which also contain information on how to complain were on display within the front entrance of the home. Since the last key inspection the Care Quality Commission had been informed of four concerns/complaints that had been investigated by Glenmoor House and the Local Safeguarding Authority. The nature of the concerns/complaints had been in relation to concerns about staffing, communication, health and personal care, and moving and handling. We looked at records of complaints held at the home, the records included the nature of the complaint, investigation and outcome. The information supplied within the Annual quality assurance assessment (AQAA) identifies that Glenmoor House has an open and inclusive atmosphere and encourages a feeling of community. We have service user meetings, relatives meetings, care reviews, and carry out an annual Quality Assurance Survey. We operate an open door policy so that the service users and their relatives may speak to us with any concerns or questions they have. We have an effective complaints procedure that service users have a copy of and is displayed in the home. A suggestion box is Care Homes for Older People Page 19 of 31 Evidence: provided and we encourage staff to listen to our service users. Records of staff training evidenced that staff are given training in safeguarding of adults, which includes recognising what constitutes abuse, and the procedures for reporting any suspected or actual abuse. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of attention to temperature control and infection control could result in peoples care being compromised. Evidence: We conducted a limited tour of the building and sample checked bedrooms and communal areas throughout the home. Bedrooms were seen to contain small items of furniture and objects to personalise the rooms. As well as public areas, some bedrooms have been redecorated and re floored. Generally the heating throughout the home was adequate apart from the ground floor unit where it was noted that there was a distinct drop in temperature. Several windows and doors were open in this area in an effort to allow fresh air to circulate. This resulted in a draught along the corridors. One person who was in bed complained of feeling cold, the care plan for this person had information that they do feel the cold and for the room temperature to be between 20 - 25 degrees. There was no thermometer in the room to test the temperature, but we asked for some windows to be closed. We brought this to the attention of a member of staff who got a scarf and put it around the person neck. The person said they liked to wear their scarf. We noticed that the duvet on the persons bed was quite thin, this too was brought to the Care Homes for Older People Page 21 of 31 Evidence: attention of staff who made arrangements to get additional bedding. We noticed within one persons room mouth swabs had been left uncovered on a bedside table, we mentioned this to staff who made arrangements to have them placed in a covered container. We looked at records in relation to the maintenance of moving and handling equipment and suction machines. We found that some of the hoist certificates were marked not found or condemned, the Manager was unable to confirm what had happened to these hoists. Each hoist has a serial number but there was no records to match the pieces of equipment against. We advised that records need be kept of checks to suction machines to ensure they are kept in working order. The Annual Quality Assurance Assessment (AQAA) submitted by the provider identifies that planned work is to take place in the gardens, and improvements in standards of cleanliness and the management of odour within the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective staff recruitment procedures ensure that people using the service are safe and supported. Evidence: We looked at staff recruitment and selection files which contained the essential documentation to evidence that staff pre-recruitment checks are carried out to ensure that people employed at Glenmoor House are suitable to work with older people this information demonstrated that staff recruitment is effectively managed. Records of training courses attended was available to demonstrate that staff are provided with induction training to ensure that they are aware of their roles and responsibilities this includes being accustomed with the companies own policies and procedures, fire safety awareness, food hygiene, infection control, moving and handling, health and safety and the safeguarding of adults protocols and procedures. Certificates were available to demonstrate that staff had attended training such as, dementia care, pressure area care, managing challenging behaviour, nutrition awareness. This ensures that people using the service are safe and cared for appropriately to their needs. We were informed by the manager that there had been an increase in the daily Care Homes for Older People Page 23 of 31 Evidence: allocated staff hours. As identified in the Health and Personal care section of this report staff had told us that the majority of people on the nursing floor unit require two staff to assist them with washing and dressing. We observed care staff recording on a daily allocation sheet when they had washed and dressed someone. The final entry for the day was made at 3-15pm and staff confirmed verbally that this was the time that the last person on the nursing floor was washed and dressed. We noted that in between washing and dressing people, staff were responding to requests for assistance, ensuring people had meals and drinks and re-positioning people at risk of pressure ulcers. Records were available of staff receiving one to one supervision with their line manager, record were available on future learning and development needs. Training had been planned to take place on the Mental Capacity Act, Deprivation of Liberty and Venepuncture training that had been postponed, no new dates had been set for these training courses to take place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views are listened to and taken into account in the management of the service, though more effective oversight and management of systems and procedures will reduce the risk of their care being compromised. Evidence: The current manager has been in post at Glenmoor House since April 2009 and registered with the Care Quality Commission in December 2009. Mr Barlow is a registered nurse and has demonstrated through his application for registration that he has the relevant skills and experience to manage a Nursing Home. As identified in the environment section of this report some vital records in relation to the certification of hoist were marked either not found or condemned. The Manager was unable to confirm at the time of inspection what had happened to these hoists. We were unable to locate the hoist equipment that had been Each hoist has a serial number but there was no records to match the pieces of equipment against these. There was insufficient documentation to evidence that other equipment such as Care Homes for Older People Page 25 of 31 Evidence: suction machines were being checked and maintained. Southern Cross have a comprehensive quality assurance system in place that involves seeking feedback from people using the service and their representatives on the quality of service provided. The Annual Quality assurance Assessment (AQAA)was submitted to CQC within the timescale set and gave examples on how Glenmoor House view the service they provide. We were told that as a result of responses to surveys sent out in July /August 2009 that the staffing levels had been increased. We looked at records held at the home of Regulation 26 visits, these visits are intended to be unannounced visits by a representative of the company. Within some of the reports viewed the information was very brief, with no issues identified. Others were more detailed, addressing areas such as complaints, food hygiene standards, redecoration, improvements and refurbishments, staff training and care planning. Cash held on behalf of people using the service is well managed, records of transactions deposits and withdrawals were supported with receipts and balances checked on a regular basis. 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 12 Do not resusitate directives must evidence that the person has the capacity to make this decision, where the person lacks capacity this must be evidenced. This will ensure that peoples wishes are followed, and best interest decisions are reached using a safeguarding framework. 01/03/2010 2 15 12 Assistance given to help people with eating and drinking, must be carried out discreetly, and sensitively. This will ensure that people are supported to eat and drink in a dignified manner. The temperature control throughout the home must ensure that all people are comfortable. This will ensure that all 01/03/2010 3 25 23 01/03/2010 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 people using the service are provided with an environment suitable to their needs. 4 30 18 Nursing staff must receive training appropriate to the work they are to perform, this includes training on Venepuncture. This will ensure that clinical needs are met at all times. 5 30 12 Training on the Mental 28/05/2010 Capacity Act and Deprivation of Liberty must take place without delay. This will ensure that people are enabled to make their own decisions for as long as they are capable of doing so, and best interests decisions are made using a safeguarding framework. The registered manager must ensure that records required by regulation are available for inspection, this includes records of maintenance to moving and handling and medical equipment. This will ensure that equipment is safe for use. 01/03/2010 28/05/2010 6 37 13 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 7 38 13 The registered manager must ensure that cross infection policies and procedures are followed. This will ensure that cross infection is effectively managed. 01/03/2010 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 3 More information on peoples backgrounds, family and social networks, interests, hobbies, religious and cultural beliefs should be included in pre admission assessments. Having such information at the onset of admission would assist in supporting peoples emotional needs, especially those living with dementia and communication difficulties, this enables people to maintain their sense of self identity. 2 8 People assessed at risk of poor nutritional intake should have their weight gains and losses closely monitored and recorded. This will ensure that appropriate action is taken to ensure nutritional needs are met. 3 9 The system to audit medications should be sufficiently robust to identify errors and shortfalls. This would ensure that medications are managed well. 4 27 Staffing levels at peak times of the day, should be in sufficient numbers to ensure that personal care is delivered in a timely manner. 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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