Care Home: Grassmere Residential Care Home

What the care home does well We received some very positive comments about the care offered at the home including: `Takes good care of my X she is well looked after and fed and cared for.` `Attends to the needs of all the residents they keep in touch if my X is poorly.` `The home is clean, residents eat well, staff are friendly and approachable.` People were provided with information about the home and were able to visit before moving in to see if they liked the home. People living in the home had access to a range of health and social care professionals ensuring any health care needs were met. The relationships between the staff and the people living in the home were good ensuring people were comfortable in their presence. People can have visitors when they want so they can continue to maintain relationships that are important to them. The meals at the home were varied and nutritious and people were satisfied with the standard of catering. Systems were in place to ensure peoples` views were listened to and acted on. The home was well managed and run in the best interests of the people living there. What has improved since the last inspection? Care plans had been reviewed and included more personalised information to help ensure people receive person centred care. Systems were in place to ensure peoples` weight was being monitored to ensure their well being. Records showed people were receiving a varied and nutritious diet. Records showed systems were in place to listen to the views of the people living in the home and their representatives and that these were acted on. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. The privacy of the people living in the home had been improved with more bedroom doors having locks fitted. The environment had been improved to make it more homely and comfortable and easier for people to find their way around. What the care home could do better: Staff must support people to ensure that the risks of them getting sore skin are reduced. People must receive their medication as prescribed to ensure their well being. Care plans should reflect all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Staff should have all the information they need to ensure people are kept safe. Staff should show respect to the people living in the home at all times. All the people living there should be given the opportunity to take part in a variety of activities that they enjoy. Key inspection report Care homes for older people Name: Address: Grassmere Residential Care Home 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2LJ     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: Brenda ONeill     Date: 1 3 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Grassmere Residential Care Home 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2LJ 01213273140 01213273949 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Care Limited Name of registered manager (if applicable) Mrs Tania Yvonne Mason Type of registration: Number of places registered: care home 26 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 to be accommodated is: 26. The registered person may provide the following category of service only: Care Home only - (PC). To service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Older People (OP) 26. Dementia (DE) 21. Date of last inspection Brief description of the care home Grassmere Residential Care Home is situated on Washwood Heath Road, close to shops, pubs, churches and Ward End Park. It is well served by public transport. The Home provides residential care for up to 26 older people and this may include Care Homes for Older People Page 4 of 31 Over 65 0 26 21 0 1 7 0 6 2 0 0 9 Brief description of the care home people in need of care for reasons of dementia. All rooms are for single occupancy and seventeen of these have en suite facilities. There are three linked sitting areas for the people living in the home, together with a dining room on the ground floor of the home. Also located on the ground floor are the main kitchen, a small office and staff facilities. The laundry for the home is situated away from the main building at the end of the garden. The home has two passenger lifts for access to the upstairs and a newer annexe. There are some assisted toilet and bathing facilities in the home and emergency call facilities are available. At the rear of the home is a small garden for the people living in the home to use. There are also some car parking facilities available. The fees at the home were detailed in the service user guide and ranged from three hundred and sixty one pounds to four hundred and twenty five pounds per week at the time of the inspection. 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: This inspection was carried out by one inspectors over one and a half days. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we had received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Care Homes for Older People Page 6 of 31 Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing three people who live in the home for up to 2 hours and recording their experiences at regular intervals. We sent ten Have your Say surveys to the people who live in the home and ten to staff. Six completed surveys were returned to us, three from the people who live in the home and three from staff. These views have been included in this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Care plans had been reviewed and included more personalised information to help ensure people receive person centred care. Systems were in place to ensure peoples weight was being monitored to ensure their well being. Records showed people were receiving a varied and nutritious diet. Records showed systems were in place to listen to the views of the people living in the home and their representatives and that these were acted on. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. The privacy of the people living in the home had been improved with more bedroom doors having locks fitted. The environment had been improved to make it more homely and comfortable and easier for people to find their way around. Care Homes for Older People Page 8 of 31 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 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. There was adequate information available for people wanting to move into the home to help them decide if the home was suitable for them. Arrangements were in place so that people can be confident that their needs will be met upon admission to the home. Evidence: The service user guide for the home had been updated in July 2009 and included the the information people would need to help them decide if the home was suitable for them. The document was available in large print to make it easier for people with impaired vision to read. The surveys returned to us before the inspection indicated that people had received enough information to help them decide if the home was suitable for them. All the people living in the home received a copy of the service user guide and a copy was also on display in the home. People could refer to these if they wanted to check on any information about the home. The pre admission assessment procedure was looked at for two of the people admitted Care Homes for Older People Page 11 of 31 Evidence: to the home since the last inspection. Both individuals files showed that the senior staff at the home assessed the needs of the people wanting to move into the home to ensure their needs could be met. The assessments covered areas such as physical needs, communication, medical history and any current health issues, preferred activities, if people were able to state their preferences and so on. One of the assessments showed it was carried out before the person was admitted the other was not dated. The manager confirmed this had been done prior to admission and the person had visited the home. It was recommended that the venue of the assessments was detailed to show people could visit the home if they wished. The staff confirmed people did visit the home before they were admitted, if this was what they wanted, to see if they liked the home. One of the files sampled showed that the family of the person concerned had visited the home on their behalf to assess the facilities available. There were copies of the care plans drawn up by the social workers that had been involved in the admission process for the individuals concerned. These had not been received by the home until either the day of admission or after and there were no copies of the assessments undertaken by the social workers. It was recommended these documents were obtained prior to admission so that staff have all the information available about peoples needs so that can assure they are met in the way people want. Files showed that people had contracts and third party placement agreements in place. These ensured people knew the terms and conditions of living in the home, what the fees were and who was going to be paying them. The home does not offer intermediate care. 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. The lack of detail in some of the homes recording systems means that there is a risk that people will not consistently get the care they need in a way they prefer. Evidence: We tracked the care for two of the people living in the home and briefly looked at the care for another person. This involved observing their care, sampling their care plans, risk assessments and daily records, speaking to them and the staff supporting them where possible. The care plan files included some good information about peoples likes, dislikes and preferences. There were also some details about the extent to which people were able to self care. This helped staff ensure people maintained their independence and received their care in the way they preferred. The care plans covered areas such as personal care, oral care, mobility, communication, activities, social interaction and so on. Some areas of the care plans were quite detailed and told staff what areas of peoples lives their dementia affected, Care Homes for Older People Page 13 of 31 Evidence: for example, their understanding when staff were communicating with them and how they needed to ensure they gave people time to understand and that people may repeatedly question them. This ensured staff knew how to communicate with people without causing them any distress. Staff were seen to interact well with people during the inspection. Some areas of the care plans could have included more detail. For example, hair care was not mentioned and one person was shaved but there was no indication of whether the person preferred an electric razor or a wet shave. Some areas of the plans needed to be updated, for example, one care plan stated the person wore a hearing aid. The person was refusing to wear this. Staff were able to tell us the needs of the people living in the home. They knew the individual did not wear their hearing aid and that the individual preferred a wet shave. This ensured people were cared for as they wanted. However all the current information needed to be in the care plans for any new staff starting in the home. This will ensure people needs are consistently met. Some very positive comments were received about the care offered at the home including: Takes good care of my X she is well looked after and fed and cared for. Attends to the needs of all the residents they keep in touch if my X is poorly. The home is clean, residents eat well, staff are friendly and approachable. Files sampled included risk assessments for such things as pressure care, nutrition, falls and some behaviors that staff may find difficult to manage. Additional care plans had been put in place for the risks that had been identified. These told staff how the risks were to be managed. Some of these were seen to need more detail to ensure staff had all the information they needed to ensure people were safe. For example, one person had recently shown some behaviours that staff could find difficult to manage. The care plan for this detailed it may be due to an infection but it did not actually detail what the behaviour may be or what staff should do to manage this safely. Staffs descriptions about how they were managing this were consistent. This ensured the individual and the staff were safe. The manager updated the management plan at the time to include all the necessary information. People had care plans in place for pressure care these generally detailed what staff should be observing for to ensure peoples skin remained intact. There were systems in place to ensure peoples skin was checked to identify any soreness. Skin check Care Homes for Older People Page 14 of 31 Evidence: charts were being completed by staff usually at the time people were showered or bathed. It was noted that for one person this was not being done. This could leave this person at risk of not having any sore skin identified. One person had turn charts in place for when they were in bed to help relieve the pressure on their skin. These had not been completed for 4 nights. A staff member who had been on duty one of these nights stated the individual had been turned but recordings had not been undertaken. This person was being visited by the district nurse on a regular basis due to some sore skin. Any lapses in turning this person at night could have been very detrimental to their well being. Information received after the inspection indicated that the district nurses were satisfied with the systems in place to prevent this person getting sore skin and the issues raised were due to recording issues. These had been addressed by the manager. One persons mobility care plan and manual handling risk assessment needed more detail. Staff told us this person was often not able to transfer and they were using the hoist to ensure she was safe. The care plan and risk assessment stated she could weight bare with 2 staff but would then need a wheelchair to transfer her. There was no mention of the hoist. Again as soon as this was mentioned to the manager the appropriate detail was added. Records showed that the systems in place for ensuring any significant weight loss to people living in the home was followed up had improved. The records for one person showed they had lost weight. The G.P. had been contacted and a referral made to the dietician who had visited and given the home some guidance which was being followed. This ensured the well being of this individual. There were systems in the home to ensure peoples general well being and that their health care needs were met. There was ample evidence on the records that people had access to health care professionals as necessary such as GPs, chiropodists, opticians, dentists and so on. One person had been having some dental problems and this had been followed up with ongoing treatment, other people were seeing the district nurse on an ongoing basis and where necessary people were referred to other specialists such as dieticians. The home had recently changed the pharmacist they were using to dispense the medication for the people living in the home. Medication was being administered via a 28 day monitored dosage system for most of the medicines. Some boxed medicines were also still used. Care Homes for Older People Page 15 of 31 Evidence: A random audit of the medicines was undertaken. Records showed that all medication was acknowledged on the MARs (medication administration record)when they went into the home and staff were signing the charts when they administered the medication. The balances of any medication carried forward from one cycle to the next were being entered on the MARs to give a complete audit trail. The numbers of tablets left for three lots of medication that had been carried forward did not tally with what had been administered. There was one too many tablets in each box. This could mean the wrong balances were carried forward or that the person had not had one of each. For another person the balance of tablets left in the box indicated there were three too many in relation to what had been received and what had been administered. This medication should have been administered twice daily the excess tablets indicated this person had not had their correct dose on three occasions. Information received after the inspection indicated that this was due to staff making the incorrect entries on the MAR charts. Systems were being put in place to address this. Other tablet totals that were checked were correct showing people had received their medication as prescribed. One persons MARs indicated they had refused their medication on quite a few occasions. There were no records to indicate this had been followed up and staff told us the G.P. had not been notified. It was important the G.P. was notiifed if people refuse their medication on an ongoing basis as this could be detrimental to their health. The G.P. had been notified on the second day of the inspection. People were dressed in individual styles that reflected their age, gender, background and the weather. The people living in the home were generally treated with respect and their rights to privacy upheld. Staff were very polite, addressed people by the name of their choice and interacted well with them. Staff did need to be mindful about their terms of address when speaking to people and ensure these were age appropriate. This will ensure people are shown respect at all times. Staff were seen to offer people support with personal care sensitively. All bedrooms had had appropriate locks fitted so that people could lock their rooms for privacy if they wanted. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It could not be shown that the activities in the home met the needs of the people living there. The people living in the home received a wholesome and varied diet that met any special dietary requirements. Evidence: The home had a relaxed atmosphere throughout the course of the inspection and no rigid rules or routines were seen. People were observed wandering around freely, watching television, going outside, sitting chatting and taking part in activities. All the people living in the home that were seen seemed very content. As at the last inspection the daily records did not give a general overview of how the people living in the home were spending their time. Many entries stated things such as been fine and remains the same. This does not reflect what people are doing to pass their time or that they are leading fulfilling lives. There were social care plans on the files sampled. Some of these were more detailed than others. Some were quite specific, for example, one detailed the type of music the person liked to listen to and the equipment they had to use to listen to it. The care plan did not detail if the person could use the equipment themselves. Staff told us Care Homes for Older People Page 17 of 31 Evidence: they helped with the equipment and the person loved listening to their music. No records were seen that showed they had been enabled to do this. As many of the people living in the home have some short term memory they will not remember what they have been doing. Records are required to show people are being enabled to pursue the hobbies they enjoy. The activity records in the home showed that there are some activities facilitated by staff such as ball games, exercise, music and dance and reminiscence. However for one person the records only showed no activities in April they stated sleeping and 2 activities in May. This does not reflect a fulfilling life. There had been some visiting entertainers to the home. The completed surveys received by us indicated that people thought activities could be better and people could be taken out more. These included: Some day time activities would be good. Recently had a letter to state a list of entertainment to be started soon. The only thing they could do better I think is to do more activities with the residents. Make residents more social i.e. taking on trips, taking to cinema or shops. The manager and staff were doing some fund raising to enable them to take people out during the summer months. Records sampled showed that people were supported to maintain contact with family and friends so they can maintain relationships that are important to them. Staff were observed making visitors welcome during the day. One visitor spoken with expressed how satisfied she was with the service offered at the home to her relative. During the inspection we observed three people living in the home for a period of nearly 2 hours making recordings at five minute intervals to assess the state of being, level of interactions and engagement for them. The overall findings were that staff interactions were positive for 63 percent of the time and neutral for 33 percent of the time. There was very little negative interaction. Two of the people being observed were in a positive state of being for the majority of the time, one was very passive throughout and the other person was sleeping for most of the time. During the period of observation staff facilitated an activity with the people in the area and they seemed to enjoy this. It was noted that one person in the area, who was not Care Homes for Older People Page 18 of 31 Evidence: being continuously observed, was very quiet and staff interacted very little with this person. Staff need to be mindful that quieter people are not over looked. Staff should also be aware of how distracting it can be for people when there is a lot of background noise. During the observation the television was on and two different types of music could be heard being played in other areas of the home. The people living in the home were encouraged to exercise some choice and control over their lives. For example, what time to go to bed and get up, what to eat, how they spent their time and so on. People were seen to be asked what they would like to eat from the menu and people were seen to have a lie in when they wanted. The people living in the home were encouraged to personalise their bedrooms and personal possessions were observed in all the bedrooms seen. There were rotating menus in place at the home. At the time of the inspection the menus on the dining room tables did not correspond with what was on the menu board in the hall of the home. This could be very confusing for people as they would not know which one was correct. The manager told us this was because staff had forgotten to change the ones in the dining room. Part of our observations were in the dining room. People were seen to have different choices from the menu and a variety of drinks were available. Staff knew what people liked and disliked and this ensured people got the food they liked. Staff were available to give assistance to those people that needed help however this was not always done in a timely manner. One person did not seem to know what to do with their lunch and at one point had their hands in it. Staff did go to them eventually but the food cold have been cold by this time. This would not have been very enjoyable for the person concerned. On the whole the people in the dining room seemed to enjoy their food very much. Two people were observed to be assisted to eat their lunch by staff in the lounge. One person was seen to have a soft diet as in her nutritional plan. One staff member explained to the individual it was lunch time and what was for lunch and asked would they like to try some. The other staff member moved the persons chair without saying anything to them, did not tell them what was for lunch and did not speak to them until saying is it nice. Staff should be reminded that meal times are very important to people and should be seen as a social time. It is good manners to tell people what they have for lunch and ask if they would like to try it. People may have changed their minds and not want what they ordered. Care Homes for Older People Page 19 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. Systems were in place to ensure people were listened to and safeguarded from harm. Evidence: The complaints procedure included the information that people would need so they know how to make a complaint if they are unhappy with the service being provided. People received a copy of this in the service user guide and a copy was on display in the home. The procedure was available in large print and the manager was in the process of compiling one in a picture format to make it more accessible to all the people living in the home. The complaint log at the home detailed one complaint this had been investigated and addressed appropriately and had led to the laundry system in the home being improved. The manager was also recording any minor concerns that were raised in the home and how these had been addressed. For example, one person requesting to be bathed more frequently and a relative raising with the manager someone wearing soiled clothing after a meal. This showed that the people living in the home and their representatives were listened to and their views acted on. Very good relationships between the staff and the people living in the home were evident. The people living in the home were very comfortable in the presence of the staff. This would give people the confidence to raise any issues. Care Homes for Older People Page 20 of 31 Evidence: The training matrix indicated that approximately half the staff team had received training in the protection of vulnerable adults. We were told that more training was planned for July. Staff spoken with were able to tell us what they had to be aware of in relation to abuse. They were very aware that any suspicion or event of abuse must be reported to managers. The manager was well aware of her responsibilities in relation to reporting any issues to the safeguarding team. She told us about one very recent issue where a family member had raised some concerns and she had referred the issues to the safeguarding team. We had been informed of one safeguarding issue relating to the home. This had been resolved and the systems in the home improved to ensure this did not happen again. The arrangements in place should ensure that the people living in the home are protected from harm. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There had been some further improvements to the environment which was comfortable, well maintained and safe. Evidence: We looked at the communal areas in the home, sampled some bedrooms and some of the toilet and bathing facilities. We found the home was well maintained, comfortable and safe and met the needs of the people there at the time. There had been some further improvements to the decor in the home and some new furnishings had been purchased. The communal areas were generally well decorated with adequate furnishings. There had been some additional pictures and ornaments added to the lounge areas making them more homely and interesting for the people living there. It was noted that some of the arms of the armchairs were quite dirty and there were some stains on the carpet in one of the lounge areas. These should be addressed to ensure the home is kept to an acceptable standard for the people living there. The former sensory room had been changed into a staff room. The sensory equipment had been installed in one of the lounge areas so that it could be used on a more regular basis and more people would benefit from it. Care Homes for Older People Page 22 of 31 Evidence: People also had access to some outdoor space with seating for their use in fine weather. Work was underway to try and enhance the garden area so that more of it could be used by the people living in the home. There was a range of bathing, showering and toilet facilities in the home. Some of these were equipped and large enough so that staff could assist people if needed. Some of the facilities were quite basic but all were functioning. A floor level shower has been installed since the last inspection. This means people with any mobility difficulties now have the choice of either a bath or a shower. The shower room was very plain with just the shower and seat, no curtains, towel rails, shelves and so on to make it more homely and domestic in appearance to make people more comfortable. The manager was aware of this and was to address it. Bedrooms varied in size, were quite comfortable and personal possessions were evident in them. Some people had a double bed as this was what they wanted. We were told that ten of the bedrooms had had new flooring. One we saw had all new furnishings and had been redecorated. Another room we saw was in need of decoration. The redecoration of the bedrooms was ongoing. The majority of the bedrooms have en-suite facilities. The home had some aids and adaptations to help people with any mobility difficulties including, hand and grab rails, assisted bathing facilities and free standing hoist. There was an emergency call system in place to enable people to call for assistance when they needed it. The signage around the home had been improved to help people with dementia find their way around independently. The home was clean and generally odour free making a pleasant environment for the people living there. People told us the care home is clean and home is clean and warm. Care Homes for Older People Page 23 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. People were being cared for by a generally well trained staff team that was able to meet their needs. Evidence: Staff turnover at the home remains relatively low which is good for the continuity of care of the people living in the home. The relationships between the people living in the home and the staff group were good. Staff were described to us as friendly and approachable and staff very friendly. Rotas at the home showed that there were four care staff on duty in the mornings, three on the afternoon and evenings and two at night. The home also employed cooks, domestic assistants and maintenance workers. The staffing levels were appropriate for the needs of the people living in the home and staff were seen to be available to the people living in the home. Staff spoken with told us they thought staffing levels were adequate and there were enough staff on duty to meet the needs of the people living in the home. Staff spoken with had a good knowledge of the needs of the people living in the home and how they liked to be cared for. This ensured people received their care the way they preferred. Care Homes for Older People Page 24 of 31 Evidence: The manager told us she had not appointed any new staff since the last inspection. It is known that the company has robust recruitment procedures which should ensure people are safe and only the appropriate people work with them. The training matrix for the home showed staff had undertaken a lot of training including fire safety, food hygiene, infection control, moving and handling and protection of vulnerable adults. Staff confirmed this training had taken place and that for some topics they had dates for future training. Very few staff had had challenging behaviour training and it was clear that some of the people living in the home had some behaviours that could be difficult to manage. This training was recommended for all staff to ensure they could manage any difficult behaviours safely. Not all training was detailed on the training matrix, for example, some staff had undertaken dementia care training and this was not documented. It was also noted that one staff member was not on the training matrix this person had worked at the home for some time. This indicates the matrix is not a true reflection of the staff training in the home. Over fifty percent of the staff at the home had NVQ ( National Vocational Qualification) level 2 or 3. The training staff receive should ensure they have the skills and knowledge they need to care for people safely and meet their needs. Staff were satisfied that they had enough training opportunities to ensure they had the necessary skills and knowledge to care for the people living in the home. Care Homes for Older People Page 25 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. The manager ensured the home was run in a competent manner and in the best interests of the people living there. Evidence: The manager in post at the home was in the process of applying to be registered with us. At the last inspection she had just begun to manage Grassmere. She was an experienced manager who was registered for another of the companys homes. She demonstrated throughout the inspection that she had a good knowledge of the needs of the people living in the home. There had been some improvements made since the last inspection. These included, care plans had been reviewed and did include more information, better systems in place to ensure any weight loss of the people living in the home was monitored, further staff training and some improvements in the environment. The main issues raised at this inspection were the systems in place to ensure people do not get sore skin and some issues with medication. The manager was very receptive to all our Care Homes for Older People Page 26 of 31 Evidence: comments and committed to improving the service further. She was very quick to act on any issues raised. Staff spoken with were very positive about the management of the home. They told us the manager was very approachable and if they raised any issues they were confident she would follow them up. The home had a quality monitoring system in place to ensure the service was improved. This included in house audits on the systems in place, regular meetings with the people living in the home to get their views on the service, staff meetings and satisfaction surveys being sent out to all interested parties. The minutes for the meetings with the people living in the home were sampled. Topics discussed included menus, activities, entertainment and the environment. As the most recent satisfaction surveys were returned the manager was addressing any issues raised on them. The manager had drawn up a development plan for the home based on the findings from audits, meetings, surveys and so on. The development plan detailed the improvements that were planned for the activity programme, the environment, staff training and so on. This showed how the service was to be improved for the benefit of the people living in the home. There was a system in place for managing money on behalf of the people living in the home. The records for this were sampled and found to be appropriate. There were receipts available for all expenditure made on behalf of the people living in the home and two staff were signing the records. All balances checked were correct this means peoples money was being held safely. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices and refresher training was ongoing. There were records of a variety of health and safety checks including fire alarms, emergency lighting, fire extinguishers and water temperatures. Fire drills were held regularly and the manager was ensuring all staff were included over a period of time. This ensured they knew how to keep people safe in the event of a fire. Evidence was available that equipment being used in the home had been serviced to ensure it was safe. We were being notified of accidents and incidents in the home which showed they were being managed in the best interests of the people living in the home. Care Homes for Older People Page 27 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 There must be robust systems in place to prevent people getting sore skin. This will ensure the well being of the people living in the home. 25/06/2010 2 9 13 There must be robust systems in place for managing medication. This will ensure people received their medication as prescribed. 25/06/2010 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 To ensure staff have all the information they need to meet peoples needs in the way they want copies of the assessments and care plans from social workers should be obtained before people are admitted to the home. Records should show if people have had the opportunity to visit the home before admission to see if they like the home and that it is suitable for them. Page 29 of 31 2 5 Care Homes for Older People 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 3 4 7 8 Care plans should include all the needs of te people living in the home to ensure they recieve person centred care. Risk management plans should be updated as peoples needs change and include all relevant details. This will ensure people are fully safeguarded. Staff should ensure they speak to the people living in the home in a respectful manner at all times. There should be evidence that the social needs of the people living in the home are being met. This will ensure people are leading fulfilling lives. Practice at meal times should be improved to ensure people get their meals in good time, peoples dignity is observed and that meal times are seen as important social occasions. All furnishings and fittings should be cleaned as necessary to keep them to an acceptable standard for the people living in the home. The training matrix should be a true refection of the staff training to show they have all the necessary skills and knowledge to care for the people living in the home. Staff should have training for difficult to manage behaviours to ensure they can care for people safely. 5 6 10 12 7 15 8 20 9 30 10 30 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. © 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. 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. 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