Care Home: Granville House

What the care home does well People told us "we like being here, the staff are good to us" "The food is good. There is a good choice" and "I like living here I can go out when I want to, I go to the shops on my own which I like doing" Everyone is assessed by the home prior to admission ensuring that their needs are known and can be met. Care plans give detailed information about peoples individual needs. Visitors are encouraged at all times. Throughout the day of this inspection the home was very `busy`. Visitors - relatives and external professionals arriving throughout the day provided opportunities for people to engage with a range of visitors, there was much for people to see and do. There are alternative quiet areas if people prefer this. We observed positive engagement and support between staff and people living in the home. What has improved since the last inspection? The necessary improvements to the home have continued since the last inspection. Virtually all areas of the home have been completely refurbished. This includes the 3 main lounge areas, dining area, laundry, bathroom and toilet areas and a proportion of the bedrooms. These areas have all been redecorated, some with new furniture, light fittings and soft furnishings and flooring. This was necessary work to improve presentation in all areas and replace worn, dated and defective furniture. This progress is planned and recorded in the annual development plans of the home in the past year. The providers tell us the cost of refurbushing in the past year is £15K. The cleanliness and hygiene standards have been improved, housekeeping staff had not previously been replaced putting pressure upon care staff to fill the gaps. A new housekeeper is working positively in the home to improve and maintain standards. Regular deep cleaning duties are allocated to ensure continued higher standards. Odours arising from continence issues and resultant marks and odours on carpets have been eliminated by means of replacement carpets and ongoing deep cleaning. No malodours were evident in the home on this inspection - this includes bedrooms. The previous atmosphere of staff unrest has been resolved. Some staff have left, new staff without historical attitudes show enthusiasm and a clear wish to provide a more positive environment for people living here. Staff we talked to acknowledge the previous tensions and unrest but say that they now work well together and there is a mutual wish to provide the most positive atmosphere for people in the home. One said "we all really work well together now and I enjoy coming to work". An Activities Co-ordinator has been appointed who is new but very enthusiastic, she will lead on activities but it is a joint process with other staff in the home. Infection control has improved with major changes to the laundry environment and the necessary ongoing cleaning routines to maintain standards. An audit of the laundry and kitchen are now an integral part of ongoing monitoring. Staff appointed with only POVA (Protection of Vulnerable Adults) checks are supervised, pending receipt of the CRB (Criminal Records Bureau) checks. This ensures greater safety for people in the home. Some improvements in medication include recording the amount of medication in stock at the start of the medication cycle. This will enable an accurate audit of medication at any point. All handwritten entries on Medication Administration Records are now witnessed by a second member of staff, this reduces the risk of errors in transcribing and is good practice. What the care home could do better: The Statement of Purpose/Service Users Guide is presently being reviewed and updated. This will ensure people have the necessary current information about the home prior to making a decision about admission. People must be weighed regularly and any changes checked and monitored closely. Where there concerns about weight loss referrals should be made to the GP for external assessment and advice. Monthly reviews of care plans must record all changes in peoples health and care needs. Often `no change` is recorded but records indicate otherwise. Falls risk assessments must include a history of falls and included whenever this is available. In relation to a person sometimes found on the floor, this must be further investigated and the risk assessment updated. Gaps around the edge of the vinyl flooring in the laundry must be sealed. It is important that there is impermeable floorcoving in this high-risk area for infection. Arrangements to access and regularly remove the clinical waste from the bathroom area should be put into place. In shared bedrooms where items present potential cross infection risks, they should be clearly identified for each person. There should be no shared use of individual items. Key inspection report Care homes for older people Name: Address: Granville House 40 Woodgreen Road Wednesbury West Midlands WS10 9QS     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: Peter Dawson     Date: 1 8 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Granville House 40 Woodgreen Road Wednesbury West Midlands WS10 9QS 01215022654 F/P01215022654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Amarjit Kaur Sandhu,Mr Avtar Singh Sandhu Name of registered manager (if applicable) Wendy Francis Type of registration: Number of places registered: care home 21 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: 21 The registered person may provide the following category of service only: Care Home Only (Code PC); 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) 21 Dementia - over 65 years of age - (DE(E)) 21 Date of last inspection Brief description of the care home The home is an adapted and extended traditional detached property that is sited within a short distance of Wednesbury Town centre with access to good transport links and the M6 motorway. Accommodation in the home includes three lounges, a conservatory, dining area with toilets and bathrooms on each floor. Communal areas are divided into Care Homes for Older People Page 4 of 29 Over 65 21 21 0 0 1 7 0 9 2 0 0 9 Brief description of the care home separate units with a number of key padded doors around the home to assist with security. There are fourteen single and three shared rooms, these on three floors, with only the first floor accessible via shaft lift. There is parking to the front and rear of the home and a patio and small garden area to the side and rear. There are a number of aids available including adapted baths, raised toilet seats and call system. The home is run by a manager who oversees staff including seniors and carers. The home provides a service to older people with dementia. Whilst nursing may be provided by primary health care staff on occasions (such as district nurses) the home does not itself offer any nursing care. The current range of fees is not included in the service user guide and readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out by one inspector on one day from 08:30 - 19:00. The home did not know the day we were visiting. Our last key inspection of this service was on 17th September 2009 when we made five requirements and six recommendations. A random inspection a month earlier had identified some areas of serious concern about the poor environment and standards of cleanliness in the home. We made immediate requirements to address this. In September we had concerns about the management of staff and the considerable staff unrest - issues that needed to be swiftly addressed. The focus of this key inspection therefore, was to ensure continued improvements planned for the environment and to look at the issues surrounding staff unrest. The service completed and Annual Quality Assurance Assessment (AQAA) - a legally Care Homes for Older People Page 6 of 29 required self-assessment by the service, outlining the standards of care being provided. This focuses upon what the service does, how they evidence this and any areas in need of improvement. This document was returned to us but was a replica of the AQAA provided to us for the sister home nearby that had been inspected one week previously. We therefore do not accept that this is an accurate picture of the care being provided at Granville House and for the purposes of this report have to disregard the AQAA. It is important that an AQAA is individualised to give a current and accurate statement about the service. This was not the case. There were 20 people living in the home at the time of this inspection. We saw most of them and spoke with about half of them. We spoke with two visiting relatives and also visiting District Nurse and Community Psychiatric Nurse. We were able to speak with staff on duty on the day of the inspection and we interviewed three staff members who had attended an arranged staff meeting. Conversations with staff were individual and most were in private. The purpose was to ascertain whether the unresolved issues amongst the staff group identified in the last inspection report had been resolved. We inspected the communal areas of the home, and the kitchen, laundry and bathroom/toilet areas. We saw a sample of bedrooms. We looked at care plans, risk assessments, complaints and safeguarding records, medication records, staff records, health and safety audits and other documents relating to the inspection process. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The necessary improvements to the home have continued since the last inspection. Virtually all areas of the home have been completely refurbished. This includes the 3 main lounge areas, dining area, laundry, bathroom and toilet areas and a proportion of the bedrooms. These areas have all been redecorated, some with new furniture, light fittings and soft furnishings and flooring. This was necessary work to improve presentation in all areas and replace worn, dated and defective furniture. This progress is planned and recorded in the annual development plans of the home in the past year. The providers tell us the cost of refurbushing in the past year is £15K. The cleanliness and hygiene standards have been improved, housekeeping staff had not previously been replaced putting pressure upon care staff to fill the gaps. A new housekeeper is working positively in the home to improve and maintain standards. Regular deep cleaning duties are allocated to ensure continued higher standards. Odours arising from continence issues and resultant marks and odours on carpets have been eliminated by means of replacement carpets and ongoing deep cleaning. No malodours were evident in the home on this inspection - this includes bedrooms. The previous atmosphere of staff unrest has been resolved. Some staff have left, new staff without historical attitudes show enthusiasm and a clear wish to provide a more positive environment for people living here. Staff we talked to acknowledge the previous tensions and unrest but say that they now work well together and there is a mutual wish to provide the most positive atmosphere for people in the home. One said we all really work well together now and I enjoy coming to work. An Activities Co-ordinator has been appointed who is new but very enthusiastic, she will lead on activities but it is a joint process with other staff in the home. Care Homes for Older People Page 8 of 29 Infection control has improved with major changes to the laundry environment and the necessary ongoing cleaning routines to maintain standards. An audit of the laundry and kitchen are now an integral part of ongoing monitoring. Staff appointed with only POVA (Protection of Vulnerable Adults) checks are supervised, pending receipt of the CRB (Criminal Records Bureau) checks. This ensures greater safety for people in the home. Some improvements in medication include recording the amount of medication in stock at the start of the medication cycle. This will enable an accurate audit of medication at any point. All handwritten entries on Medication Administration Records are now witnessed by a second member of staff, this reduces the risk of errors in transcribing and is good practice. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current and pertinent information about the home would ensure people are able to make an informed choice about the homes suitability for them. People funding their own care need a signed contract to protect their rights. Evidence: The Statement of Purpose/Service Users Guides are in the process of being updated. Previous information was dated and inadequate. It is important that the service state and provide details of the range of needs for people with dementia that can be met by the home. This is important in people making a decision about suitability of the home for those with specialist dementia care needs. We were told that people are always invited to visit the home prior to making a decision to move in although this often falls to the relatives to visit rather than the person considering admission who may find a visit to a new setting unsettling for them. For those able to do so they are encouraged to spend time in the home before Care Homes for Older People Page 11 of 29 Evidence: making a decision about suitability for them. We looked at a sample of pre-admission assessments carried out by the home prior to admission. We found the assessment tool used covered all aspects of health, personal and social care adequate to make a judgment about suitability of the placement. We saw a good pre-assessment relating to a person recently admitted, the information clearly outlining the care needs of that person and providing the basis for the subsequent initial care plan. Assessments had been obtained from the social worker with details of a multi agency assessment. We looked at contracts and found that a person funding their own care did not have a contract directly with the home. This person had changed from funded to self-funding some months ago but the contact had not been signed and concluded. This must be done to ensure the rights of the person are known and protected. This home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be sure that their healthcare needs will be met and there are good systems in place to manage their medication. Evidence: An individual care plan is established for each person based upon the pre-admission assessments and multi-agency assessments. These provide the basis for care plans that are further developed and reviewed. We sampled 4 care plans and found that assessments were in place for general physical health, nutrition, waterlow assessment and risk of falls, with moving and handling assessments also. We saw assessments relating to continence and Mental Capacity. These were generally good although we found some shortfalls. The homes policy is to weigh each person every 2 weeks. We found that a person admitted in April had been weighed upon admission and twice since. There was no weight recorded from May 2010 and there were 2 weight loss figures of 1.7kg and 2.1kg. These were clearly not correct. It is important to weigh people regularly and to Care Homes for Older People Page 13 of 29 Evidence: closely monitor any weight loss. We found that a falls risk assessment did not include the fact that the person had fallen 3 times in hospital and once at home in the week prior to admission. This persons daily notes showed that she was found on the floor in her bedroom and although not witnessed was presumed to have sat on the floor. We later spoke with her daughter who said she had not done this prior to admission. The falls risk assessment and moving and handling risk assessment for this person must be reviewed in the light of the additional information. We saw that care plans were reviewed monthly, but in relation to the person mentioned above 2 monthly reviews had been recorded no changes although there had been admissions to hospital and changes to medication and behaviours. We saw some good information in care plans including social histories and clear records of peoples individual personal and health care needs. We spoke with the visiting District Nurse who comes daily to administer insulin. She told us that staff were helpful and cooperative and readily ask advice and follow instructions where necessary. No one in the home has pressure damage at this time, only dressings and the usual blood samples are monitored. We also spoke with a visiting Community Psychiatric Nurse (CPN) who had not visited the home previously but had been called appropriately to discuss the care and management of a new resident. We saw the recording of visits by the primary care team including GP, District Nurse, CPN, chiropodists, dentists, opticians and hospital outpatient appointments with Consultants. We looked at the medication system in use in the home. At the time of the last key inspection we made a requirement to record variable dose medication and 2 recommendations to record medication being brought forward each month on the MAR sheet and that all handwritten entries on MAR (Medication Administration Record) sheets should be signed by 2 members of staff to ensure accuracy. We found that the requirement and recommendations had been actioned. In relation to variable dose medication we found that analgesics had been prescribed with variable dose but only 1 tablet provided in the blister packs. If more than one tablet was needed this had to be taken from the next months blister pack. This is unsatisfactory and should be taken up with the pharmacist, although the home are changing to a new medication supplier at the end of this medication cycle, whose system operates differently and will reduce confusion. Care Homes for Older People Page 14 of 29 Evidence: Whilst all medication brought forward from the previous cycle is now entered on MAR sheets we found that returns to the pharmacy were not dated. This did not allow a full audit of the system. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In house activities for people have been improved, providing a wider range of individual activities and improving quality of life. Evidence: People told us in our last inspection that they were unhappy about the range of activity and occupation the home offered to them. They asked for more activity in the home to relieve boredom but particularly for those unable to access external visits. Staff felt they had little time to engage with people in activities. We discussed this with the Managers and made a requirement that the home should review the staffing levels so that people have the opporunity to take part in activity. On this visit we found that this had been done. A new Activities Coordinator has been appointed and been in the home for only a few weeks, but she has already made an impact upon the activities provided, particularly inside the home. She has established a record for each person identifying activity needs and recording when they take place. Some people have been a little reluctant to engage in new activities but patience is productive and people are engaging more in Care Homes for Older People Page 16 of 29 Evidence: social and occupational activities in the home. We feel this is a good start and if continued will have a positive impact upon peoples lives. Regular weekly trips to the pub for lunch and also to bingo continue but are supplemented by the changes mentioned. People told us that they enjoy the new games and activities and clearly benefit from the social engagement they offer. Several people go out with relatives and this in encouraged. On the day of inspection a person was making her regular weekly trip to West Bromwich on the call and ride bus. She does this several times each week and enjoys the independence and enjoyment it provides for her. Whilst the care staffing levels have not changed the domestic hours have. A new housekeeper has been appointed working 20 hours per week plus overtime if needed. This means that care staff are relieved from cleaning duties and have more time to spend with people using the service. We feel that social activities have improved the daily life for people in the home. Some changes are recent and we will closely monitor the progress being made. We looked at food provision in the home and found a varied and interesting menu was in place with choices at mealtimes. Daily choices are listed on the board in the dining area. People told us that they like the food and can always choose something we like. The dining room has been refurbished with new furniture, flooring, table linen and cutlery/crockery since the last inspection. On this visit the new table cloths, napkins, other tableware and furniture presented a more attractive setting for meals. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home responds to peoples concerns and systems are in place to protect them. Evidence: There is an excellent pictorial complaints procedure in place for people using the service. The complaints procedure used by visitors needs reviewing and updating to provide a more concise procedure for them to follow. This is presently being revised. No complaints have been recorded in the homes complaints log since the last inspection. Since the last inspection 3 referrals have been made to the Safeguarding team, there have been 2 investigations. These relate to the vulnerability of a person and suspected emotional abuse by a relative. All referrals were approriate and Safeguarding procedures followed. Prior to the last inspection we had been made aware of several concerns about the service and we made referrals directly to the Safeguarding team. There have been improvements in this area since that time. Staff understand the whistle blowing policy and how to protect vulnerable people. Care Homes for Older People Page 18 of 29 Evidence: Further training in safeguarding vulnerable adults was needed at the time of the last inspection, this was arranged in October 2009, although two staff we interviewed during this inspection told us that they had not undertaken this training. At the last inspection staff had not received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Since that time about half the staff have received this training and more is planned. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the home have provided an improved environment that is pleasant, comfortable and homely. There are improved standards of hygiene too. Evidence: When we visited the home in August 2009 we were very concerned about the poor state of furniture, fittings and equipment. Maintenance was poor and the standards of cleanliness and hygiene also poor. Most areas needed refurbishment upgrading. We made immediate requirements requiring urgent action to address the main areas of concern. When we carried out our Key Inspection of the service a month later we found that the home had made a start in improving the living conditions of the home. On this Key Inspection visit we focused upon the changes made to improve the environment. - We found considerable work had been carried out to improve standards. All the communal areas - the 3 main lounge areas have been upgraded. All have been redecorated, new flooring and soft furnishings and general decor have been vastly improved. The dining room has similarly been completely upgraded with new decoration, new flooring and replacement of the dining room furniture and other equipment. These necessary changes have dramatically improved the presentation and comfort in all areas. Care Homes for Older People Page 20 of 29 Evidence: The laundry area required urgent work to ensure good hygiene and to reduced infection control risks. Plastic wall cladding has been fixed to enable a better cleaning processes. Most equipment (apart from washer/dryer) has been replaced with colour coded cleaning equipment. Improvements were needed to improve the standards of furniture, equipment and furnishing in bedrooms with complete redecoration and replacements. In 2009 six bedrooms were upgraded, this year (2010) work is progressing to upgrade a further 6 bedrooms. We have seen the homes Development Plan for both 2009 and 2010 and the changes described emanate from the stated plans to change the environment. The home are on target to complete total upgrading of communal, bedrooms, bathroom/toilet and other areas of the home in the current year. One of the most significant areas of improvement has been in the standards of cleanliness and hygiene throughout the home. A plan of ongoing deep cleaning is now in place with regular audits established to ensure standards are maintained. There is now a new housekeeper who is aware and responsible for the ongoing maintenance of cleanliness and hygiene in the home. During this inspection we looked at all areas of the home including a sample of bedrooms. In the laundry area we found that the flooring had been replaced but there gaps around a round the perimeter of the room. These must be sealed providing an impermeable finish to ensure good infection control. We also found that access to the clinical waste bin was restricted and the bin not emptied regularly. This needs to be addressed. The sample of bedrooms seen had mostly been upgraded and redecorated. We saw two bedrooms without any personalisation - there were no photographs or personal effects. Efforts should be made to provide some basic personalisation to assist people in orientation and individual awareness, this is particularly important in this home where people have dementia care needs. In a shared bedroom there was one washbasin with a toothbrush in a holder on the sink. It was not possible to ascertain which person this belonged to. Each had separate toiletries near their bed but neither had a tootbrush. This has clear implications for cross-infection. Care Homes for Older People Page 21 of 29 Evidence: The entrance area to the home has been redecorated and new carpet installed. We were surprised upon entering the home to be faced with an area with several freezers located in a glassed area facing the front door entrance. To improve presentation and initial impressions we would suggest these could be screened from direct view. On previous visits there has been a strong smell of urine, particularly in bedrooms. On this visit there were no mal-odours - probably a combination of replacement of carpets and much improved cleaning routines. The environment generally presented well on this visit. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in overall staffing levels, training and general atmosphere in the home mean people receive an improved service. Evidence: In our last inspection report we identified that there was a considerable amount of staff unrest and the home needed to take effective action to resolve this. There were unresolved issues making life uncomfortable for people using the service. We spoke with all staff on duty on the day of this inspection and particularly took the opportunity to speak in private with five members of staff individually, some had arrived for the monthly staff meeting that had to be cancelled due to other pressures of the day. Staff felt previously that there was little time to spend with people in the home and to provide activities due to staffing shortages. This has improved with a houskeeper vacancy filled, meaning staff did not additionally have to cover domestic duties. Catering staff are now constant and an Activities Co-ordinator has recently been appointed to lead on activities. Staff were concerned about the poor environment and standards and they told us with enthusiasm on this visit about the changes that have been made. Care Homes for Older People Page 23 of 29 Evidence: We discussed openly with staff individually the former concerns. They told us that some staff had left the home and that had reduced the levels of tension. New staff have integrated well. Staff told us that we have had a stressful year but we all now pull together They told us We have had outstanding support from the Manager and the provider is very approachable. They also said there has been more training this year and there were regular monthly staff meetings with an open floor for concerns. Staff confirmed regular two monthly supervision is provided with them. A member of night staff arriving for the staff meeting told us we work together more now (day and night) and sit and talk together in staff meetings. Generally staff seemed relaxed and spoke positively about their work and how things have improved. We felt that much progress had been made in the area of staff relationships. The staffing on the day of this unannounced inspection was: Manager, 2 carers, 1 Senior Carer, catering staff, domestic and Activities Co-ordinator. Staffing at weekends reduces when there is not always a manager on duty, or activities or domestic staff. We looked at a sample of staff files. We found that all required references and checks had been obtained prior to employment. On the last visit a requirement was made to ensure new staff who being work with a PoVA (Protection of Vulnerable Adults) check should be adequately supervised by an identified senior worker until such time as a satisfactory Criminal Records Bureau (CRB), police check had been obtained. We found that arrangements made for new workers had been satisfactory with checks in place. This ensured people in the service were protected. We looked at the staff training matrix and found, as stated by staff we talked with, that training has been stepped up in the past year. There were some shortfalls in areas of Dementia Awareness, Health & Safety and continence care. These should be addressed. We saw that some people had attended past training in Communication Skills in Dementia Care - this additional or more specialist dementia training is recommended. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the home mean that the health and safety of people is now protected and they live a more relaxed and comfortable setting. Evidence: The Registered Manager is Wendy Francis who has worked at the home for several years. She has the experience and qualifications to run the home. At the last inspection we identified areas for improvement these included: Resolving the staff unrest and resultant poor atmosphere in the home. The continued programme of improvements and carrying out audits of the environment to monitor and sustain improvements being made. Develop staff understand of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff training was hit and miss and further training needed to ensure staff have the skills to meet peoples needs. In this report we have indicated that progress has been made in many of these areas. Staff have had training in the Mental Capacity Act and we saw mental capacity Care Homes for Older People Page 25 of 29 Evidence: assessments with some care plans. We were told that night staff are now involved in fire drills, this takes place now when all staff attend staff meetings. A quality assurance system is in place to seek peoples views of the home. We identified that where issues were raised, these were addressed. Feedback from relatives are kept and evidence of action was seen. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Complete the review and updating of the Statement of Purpose/Service Users Guide and include details of the services provided to meet the needs of people with dementia care needs. People funding their own care must be provided with a Contract/Terms & Conditions. The falls risk assessment and moving and handling assessment must be reviewed for the person found regularly on the floor. Monthly reviews of care plans must record all changes to care and support made during the month. People must be weighed regularly, weights checked where there are obvious descrepancies and any changes monitored closely and referred to healthcare specialists. 2 3 2 7 4 5 7 8 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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