Care Home: Greetwell House Nursing Home

What the care home does well The home provides a comfortable, welcoming and homely atmosphere. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. They told us that they had no complaints and said that they were happy living at the home. One person said, `I am very happy living here, my room is lovely`. A relative told us, `I am more than happy with the way they care for my husband`. Staff have access to a varied training programme and demonstrated a very good knowledge of the people they supported. What has improved since the last inspection? The initial assessment process now refers to people`s capacity to make decision and some staff have received training in this subject so that they are aware of their role protecting peoples rights and choices. The procedure for the recruitment of staff has been improved to make sure that they are suitable to work with vulnerable people. A system to provide staff with regular formal supervision sessions has been introduced to help ensure they are provided with adequate support and guidance. The owner has been undertaking visits to the home and completed reports of his findings on a more regular basis. People commented that they saw him regularly and that he had spoken with some of them. Fire safety checks are now being carried out consistently by the nursing staff and the results recorded. Work has commenced on the environment of the home. The painting of the exterior of the building is underway and several bedrooms have been redecorated. In some rooms new furniture has been purchased and vanity units have been fitted to wash basins. The gardens have been tidied up with new landscaping and planting. People commented very positively about being able to access and sit out on the patio area. The staff training programme has been reviewed and courses have taken place, or been arranged, to make sure that they have the skills and knowledge they need to carry out their job. What the care home could do better: Care records need to identify each person`s needs in better detail and provide comprehensive guidance for staff to make sure they are fully aware of their role in supporting them. They need to be regularly reviewed and updated so that they reflect each persons current needs. They should also be more person centred so that they tell staff about peoples preferences and their involvement in decision making.Risk assessments must be completed more robustly so that any potential risks are identified and management strategies highlighted. This will then provide staff with better information about what minimising actions they need to take. Each person must have a social care plan that tell staff about what the person likes to do and how they need supporting. This will help to ensure that they can continue to follow their interests. Although a system has been introduced for staff to receive regular supervision sessions, this needs to be maintained. They also need to receive an annual appraisal of their performance, which should include a training and development plan that outlines they individual needs. The owner needs to record his monthly visits to the home in more detail so that they fully reflect how the home is operating, as well as any improvements and areas that need attention. All incidents affecting the welfare of people living at the home must be reported to us in a timely manner. This will ensure that we can monitor the home effectively. Other areas that would benefit from some attention include the following. The care planning process should incorporate legislation such as the Mental Capacity Act and Deprivation of Liberties. Senior staff should receive in-depth training in this subject so that they are aware of their role in assessing, recording and protecting peoples rights and choices. The decision making behind the use of restraints such as wheelchair lap belts should be be recorded in more detail. This will help to demonstrate that people`s rights and choices have been respected. Complaints should be comprehensively recorded with the details of the complaint, actions taken and the outcome. This will help to demonstrate that people`s concerns have been addressed appropriately. The planned improvements to the environment should be continued so that all areas of the home are maintained to a high standard. The induction programme for qualified staff should be formalised and recorded in detail so that it clearly shows the depth of the information and support provided to new staff. The owner should continue to look into arranging for people to have their own bank accounts. This will enable them to accrue interest on any savings they have. Equipment such as gas appliances and the emergency call system should be services promptly. This will ensure that the systems are working correctly and thereby protecting the people who live and work at the home. Key inspection report Care homes for older people Name: Address: Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dawn Podmore     Date: 0 7 0 7 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 30 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 30 Information about the care home Name of care home: Address: Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA 01522521830 01522521830 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Sharaf Abd El Monem Salem Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of people who can be accommodated within the home is: 25 The registered person may provide the following category of service only:- Care Home with nursing - Code N To people of the following gender: Either Whose primary needs on admission to the home are within the following categories:- Old age, not falling within any other category - Code OP Physical disability - Code PD - maximum number of places 1 Date of last inspection Brief description of the care home Greetwell House Nursing Home is a privately run, twenty-five bedded, Gothic-style property situated in a quiet residential area in the centre of Lincoln, opposite Lincoln County Hospital. There is a regular bus service into the city and a shopping centre within half a mile. The home is a two-storey, Victorian building, which has been Care Homes for Older People Page 4 of 30 Over 65 25 0 0 1 0 4 0 2 2 0 1 0 Brief description of the care home adapted and extended to provide personal and nursing care for up to twenty-five people of both sexes over the age of 65 years. The home is currently accommodating one resident over the age of 60 years with a physical disability. Residents are accommodated in sixteen single rooms and six shared rooms. Two staircases and a passenger lift give access to the upper floor. Communally, there are three bathrooms, a shower room and three toilets. There is a garden to the side of the property and a limited car parking area to the side and rear of the property, in addition there is on-street parking. At the time of the visit the deputy manager confirmed that weekly charges made by the home for care ranged from £359 - £550 depending on peoples assessed needs. Information about the service, including a copy of the previous inspection report, fees and the homes facilities, is available from the managers office. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was announced shortly before our visit to enable the owner to be present and took any previous information held by C.Q.C about the home into account. Throughout this report the terms we and us refers to the care Quality Commission (CQC). In March 2010 the provider submitted an Annual Quality Assurance Assessment (AQAA) to us. This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. The content of the AQAA has been used as part of this inspection. The main method of inspection used was called case tracking. This involved selecting a proportion of residents and tracking the care they received through the checking of records, discussions with them and some of their relatives, as well as the staff who care for them. We also observed how care was delivered as we took a partial tour of Care Homes for Older People Page 6 of 30 the home, which included looking at some bedrooms, communal areas and bathing and toilet facilities. Documentation was sampled and the care records of the three people being tracked were examined. We spoke with 5 residents, 4 relatives and 6 members of staff. They shared their views about how the home operated on a day to day basis and the care and facilities provided. On the day of the visit 10 people were living at the home. Although the acting manager was not present the deputy manager and the owner participated in the inspection and were both present to receive feedback on the outcome of the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care records need to identify each persons needs in better detail and provide comprehensive guidance for staff to make sure they are fully aware of their role in supporting them. They need to be regularly reviewed and updated so that they reflect each persons current needs. They should also be more person centred so that they tell staff about peoples preferences and their involvement in decision making. Care Homes for Older People Page 8 of 30 Risk assessments must be completed more robustly so that any potential risks are identified and management strategies highlighted. This will then provide staff with better information about what minimising actions they need to take. Each person must have a social care plan that tell staff about what the person likes to do and how they need supporting. This will help to ensure that they can continue to follow their interests. Although a system has been introduced for staff to receive regular supervision sessions, this needs to be maintained. They also need to receive an annual appraisal of their performance, which should include a training and development plan that outlines they individual needs. The owner needs to record his monthly visits to the home in more detail so that they fully reflect how the home is operating, as well as any improvements and areas that need attention. All incidents affecting the welfare of people living at the home must be reported to us in a timely manner. This will ensure that we can monitor the home effectively. Other areas that would benefit from some attention include the following. The care planning process should incorporate legislation such as the Mental Capacity Act and Deprivation of Liberties. Senior staff should receive in-depth training in this subject so that they are aware of their role in assessing, recording and protecting peoples rights and choices. The decision making behind the use of restraints such as wheelchair lap belts should be be recorded in more detail. This will help to demonstrate that peoples rights and choices have been respected. Complaints should be comprehensively recorded with the details of the complaint, actions taken and the outcome. This will help to demonstrate that peoples concerns have been addressed appropriately. The planned improvements to the environment should be continued so that all areas of the home are maintained to a high standard. The induction programme for qualified staff should be formalised and recorded in detail so that it clearly shows the depth of the information and support provided to new staff. The owner should continue to look into arranging for people to have their own bank accounts. This will enable them to accrue interest on any savings they have. Equipment such as gas appliances and the emergency call system should be services promptly. This will ensure that the systems are working correctly and thereby protecting the people who live and work at the home. 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. Care Homes for Older People Page 9 of 30 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 10 of 30 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 11 of 30 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 is a detailed admission process in place which helps to make sure that the home can meet the needs of the people admitted. Evidence: The home provides people with information to help them decide if it is the right place for them to live. The Statement of Purpose and the Service Users Guide, the latter is provided in large print. There have been no recent admissions at the home, but the deputy manager described a satisfactory process that included a detailed assessment of peoples needs that will be used in future. Potential residents are also encouraged to visit the home before making the decision to move in permanently. The manager said that although people come to the home for short stay placements the home does not provide intermediate rehabilitation care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are being met by staff who understand these needs and deliver care in a respectful manner. However shortfalls in care planning records could lead to these needs not being fully met. Evidence: The three care files we sampled contained some information about what care and support people needed. However they did not include peoples assessed need in sufficient detail, this shortfall was identified at the last inspection in February. For example the daily notes for one person highlighted that they had previously had a infection. Appropriate treatment and outside support had been sought but a plan of care had not been devised to inform staff of their role in treating and monitoring this issue. After speaking to staff, the resident and their relative their comments indicated that satisfactory care and support had been provided even though records did not support this. At the last inspection we highlighted that although files contained some informative information about people preferences this had not been used to formulate Care Homes for Older People Page 13 of 30 Evidence: comprehensive care plans which gave staff clear guidance as their role in supporting the person to meet their aims and objectives. We looked at one of the same files during this visit and found that the care plan had not been changed to include additional information regarding helping them to overcome anxiety attacks. Staff demonstrated a good knowledge of how to support the person concerned and his relative said that she was very happy with the care and support he received. We had also previously told the provider that there were no plans in place to tell staff about peoples social needs, this had still not been addressed. We found that some of the information in care plans was out of date. For example one plan said cast in situ but when we asked the deputy manager about this she said that the cast had been removed sometime ago, but agreed that the care plan had not been reviewed and updated. We also found other shortfalls in recording. These included not providing specific details in the care plan about the frequency of taking blood sugar levels for people who were diabetic. Although these had been recording in a septate file the forms still did not contain adequate detail. Peoples weight and nutritional needs were being monitored regularly, but due to information being kept in several different folders this was not easily accessible. The majority of the care plan evaluations did not reflect any changes. The evaluations we saw said, care as plan or care continues as planned, therefore did not give a meaningful evaluations of whether the planned care was effective or if there had been any improvement or deterioration in the persons condition. A daily record of how people were progressing had been maintained in good detail describing how people had spent their day and any changes in their condition. Assessments for potential risk areas, such as manual handling and risk of falls, had been carried out, but they had not been evaluated regularly to monitor for any changes. One plan said that the person was using a lap belt to secure them when sitting in their wheelchair. The deputy said that this had been in use prior to admission. However the decision making behind its use was not recorded and there was no evidence of the resident being asked about its use or a best interest meeting taking place if they were unable to make that decision themselves. Each file sampled contained an assessment of peoples mental capacity, however this information had not been incorporated into care plans to determine if people could, or could not, make decisions themselves. This is new legislation that is aimed at Care Homes for Older People Page 14 of 30 Evidence: protecting peoples rights and choices. The home did not have a copy of the County Council two stage tool used to assess and record the outcome of assessments. The councils monitoring officer had agreed to supply these following their visit in June. Since the last inspection six staff have attended awareness training in this subject, but senior staff had not received in-depth training regarding implementation and recording decision making. The deputy confirmed that at present national and local guidance regarding the Act was not available in the home. Records and peoples comments indicated that residents had good access to outside health professionals such as doctors and other health professionals. Equipment, such as pressure relieving mattresses, were in use. There is a stable staff team working at the home, with some staff working there for many years. They were knowledgeable about the people they supported and how they preferred their care delivering. We observed staff speaking to people with respect and considering their preferences when providing support. People told us that they were happy with the level of care and support provided. One person said we are very happy with the care, we couldnt wish for better. Another person commented, care on the whole is good. The home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Recently the home has changed to a monitored dose system which the deputy said allowed her to audit the medication system and identify any shortfalls easier. She also said that Lloyds pharmacy, who supply the medication, would be undertaking periodic audits of the system and had provided training for staff any who were not familiar with the system. The medication records sampled gave clear instructions regrading what medication was required and the frequency, but two gaps were found in the recording of medication administration. The deputy manager said that she would look into these. This issue was also highlighted at a local authority monitoring visit in June. Care Homes for Older People Page 15 of 30 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. The home provides a varied activities programme which people enjoy, but shortfalls in documentation could lead to peoples social needs not being fully met. People receive a nutritious and varied diet that meets their individual preferences and health requirements. Evidence: The home does not employ a designated person to provide social activities, but the acting manager has devised a programme of stimulation to meet peoples needs, which care staff facilitate. There was an activities programme displayed on the wall and peoples participation had been recorded. Care files did not contain a care plan outlining peoples social needs or how staff should support them to meet these. Other records contain information about peoples likes and dislikes and a separate folder highlighted their interests and recorded what they had taken part in. These records and peoples comments showed that activities provided included: crafts, watching TV, bingo, barbeques, walks and shopping trips. On the day of the inspection some people were watching television, one person was knitting and others were sat outside enjoying the sunshine. Care Homes for Older People Page 16 of 30 Evidence: People told us that they were happy with the activities provided and staff said that they had time to take people out in the afternoons. Some people had helped to plant tomatos in the garden and said that they were looking forward to eating them soon. Meals can be taken in the newly decorated and refurbished dining room or in peoples own rooms. At our last inspection in February people told us that the food was good and offered choice and variety. During this visit they confirmed that this was still the case. At the last visit by the Environmental Health Officer the kitchen was awarded a 4 star rating for the cleanliness and organisation of the kitchen, the highest rating being 5 Star. Care Homes for Older People Page 17 of 30 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. Residents are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, which is displayed in the home and included in the Service User Guide. This is given to people when they come to live at the home. People have not made any complaints directly to us, but the owner told us how one concern raised by several residents had been addressed to the residents satisfaction. However this had not been appropriately recorded. In the main people said that they knew how to make a complaint and would be comfortable highlighting any issues. Residents and relatives told us that they had no complaints. The home has procedures concerning the protection of vulnerable adults. Ten staff had received training in this subject since our last inspection in February. Staff demonstrated a satisfactory knowledge of what to do if they suspected abuse could be occurring. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and homely environment that meets their needs, but there are some areas of the home that still need attention. Evidence: We took a partial tour of the home looking at the bedrooms of the people being case tracked and communal areas. The general atmosphere of the home was welcoming and homely. Bedrooms had been personalised by the resident or their relatives with photographs, mementos and small items of furniture. Several bedrooms have been redecorated since our last visit and some furniture replaced. At the last inspection visit it was highlighted that the exterior of the building was in need of repainting. Since then the lower half of the building has been repainted and plans are in hand to complete the top half. Work had been competed in the gardens with the cutting back of overhanging trees and removal of some scrubs. This included the area at the front of the building which had been re-landscaped and planted. The patio area to the rear of the building is now open with the removal of the trees giving people somewhere light but sheltered to sit. Garden furniture was in use and people said that they really enjoyed going into the garden now. Care Homes for Older People Page 19 of 30 Evidence: People told us that they were happy with their rooms and communal areas. They complimented the home for its homely atmosphere. One person said that they liked the changes being made, another said, my room is lovely. Separate staff are employed to maintain the cleanliness of the home. There were no unpleasant odours detected during the visit and all areas looked clean and tidy. The home employs 2 handymen, on the day of our visit they were repainting the railings in the garden. Care Homes for Older People Page 20 of 30 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. Systems are in place to recruit staff robustly. People receive care from staff who are knowledgeable about the people they support and receive training to meet their needs. Evidence: People raised no concerns about the staff and felt that there were enough staff available to meet their needs. Their comments included, the staff are friendly, you couldnt wish for better and both the carers and nursing staff are good. The staff we spoke with said that they felt that the current staffing levels were satisfactory. Observation showed that staff supported people in a calm and relaxed manner and had time to sit and talk to people. One member of staff told us that since the rota had been reorganised they were much happier with the arrangements. We looked at the file for a nurse who was to be employed shortly to ensure that all the necessary checks were being completed. It contained an application form, 2 written references, proof of identity and their professional qualification details. The deputy explained that they could not commence work until a satisfactory C.R.B (Criminal Record Bureau) certificate and reference from their last employer had been received. At the last inspection it was recommended that a more in-depth induction be Care Homes for Older People Page 21 of 30 Evidence: developed for nursing staff to make sure they had all the information they needed to take charge of the home. Although the deputy said that the acting manager had formulated a new form she could not produce it. The home has a training programme which includes essential subjects. Since the last visit in February 2010 training provided included, manual handling, protection of vulnerable adults from abuse, medications, health and safety and awareness of the Mental Capacity Act and deprivation of Liberties guidance. The company encourage staff to complete an N.V.Q (National Vocational Qualification) in care. Information provided in the A.Q.A.A showed that out of 14 care staff employed 5 had attained an N.V.Q. and 3 others were currently doing the award. Staff said that they received the training they needed and felt well supported. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of consistent management at the home which means that although peoples needs are being met systems are not being maintained robustly enough to ensure full protection. Evidence: The home has not had a registered manager for over a year. A new acting manager Mr Kehinde Popoola was appointed recently, but he has not submitted an application to us to become the registered manager. People told us that the acting manager and deputy were helpful and supportive. They said that the home met their needs well and commented positively about the support they received. However one relative said that they thought that communication sometimes failed because of the shift pattern of the nurses, but went on to say that they did a good job. Staff spoke positively about working at the home. One said that they felt that Care Homes for Older People Page 23 of 30 Evidence: residents felt comfortable telling them about anything they were not happy with and that they thought that the improvements to the environment were fantastic. Another said ,that the constant changes due to management changes had been hard but they felt that a lot were for the better. Staff said that they felt that they were well supported by the management team and there was some evidence of supervision sessions taking place and staff meetings had been held. However the deputy said that staff appraisals still needed to be completed. The home has a quality assurance system so that they can gain the views of the people who use the service. The deputy manager said that there had been a poor response to recent surveys, but more were to be used. People told us that meetings had taken place more regularly over the last few months. The home owner, or his representative, is required to visit the home monthly and complete a report detailing their findings at the home and how any concerns or issues are to be addressed. Since our visit in February 2010 three reports have been completed. People told us that generally they saw the owner a lot more and had had the opportunity to speak to him. The need to provide more detailed information in the reports, including peoples views and areas that needed addressing was discussed with Dr Salem. We should be informed about anything that affects the health and well being of the people who live at the home so that we can monitor incidents. However we found two entries in the care plans that indicated that the person had sustained an injury and been admitted to the accident and emergency department for treatment or tests. We have no record of these incidents on file and the deputy could not demonstrate that the required forms had been submitted to us. At the time of our last inspection there was a system in place for residents monies to be held in safe keeping by the home. This includes keeping a running total of all transactions and obtaining receipts and two signatures. Some monies had been deposited into a joint bank account as the owner said that he was unable to arrange for individual bank accounts so that residents can accrue interest on their savings. The deputy manager confirmed that these arrangements had not changed. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis to make sure that it is in good working order. Care Homes for Older People Page 24 of 30 Evidence: Information provided in the AQAA showed that a health and Safety audit had been arranged by the owner, but the action points were still to be evaluated. Regular checks on equipment, such as hoists, had taking place, but the servicing of the gas system and emergency call bells was outstanding from April 2010. Arrangements were being made for these to take place as soon as possible and the deputy said that she would confirm this once a date had been agreed. We looked at the fire safety folder and found that things like weekly fire alarm and emergency lighting testing had been carried out on a regular basis. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans must be in sufficient detail to enable care staff to provide comprehensive care. They must include all individual care needs, choices and preferences. 13/09/2010 This will help to make sure that staff have access to all the information and guidance they need and can therefore meet peoples needs This requirement is outstanding from the last inspection as issues identified had not been addressed 2 36 18 There must be a system in place for staff to receive regular supervision and appraisal. This will help to ensure that staff are adequately supported in carrying out their job. The requirement had not been fully met, but improvement was noted 30/09/2010 Care Homes for Older People Page 26 of 30 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 7 13 Risk assessments must be 23/08/2010 undertaken to identify any potential risks and strategies formulated to minimise identified risks. These must then be regularly reviewed and amended to reflect any changes. This will help to ensure that people are kept as safe as possible. 2 12 15 Each person must have plan that identifies their social and leisure needs. This will help to provide staff with comprehensive guidance about how to support people appropriately 17/09/2010 3 37 37 The Commission must be 23/07/2010 informed in a timely manner about any incidents affecting the health and wellbeing of people living at the home. This will ensure the Care Homes for Older People Page 27 of 30 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 Commission can monitor incident at the home and how they have been addressed. 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 7 The content of the Mental Capacity Act should be fully incorporated into the care planning process. This will help to ensure that peoples rights and choices are protected. 2 7 It is strongly recommended that the decision making behind the use of restraints such as wheelchair lap belts be recorded. This will help to demonstrate that peoples rights and choices have been respected. 3 4 16 19 All complaints should be fully recorded with the details of the complaint, any actions taken and the outcome. The redecoration and planned improvements to the environment should be continued. This will ensure that people live in a satisfactory maintained environment 5 30 There should be a structured induction programme in place for nursing staff that records the depth of the information, and any additional support, they have received. This will help to demonstrate that new nursing staff have received all the information they need to take charge of the home and have been assessed as competent to do so. 6 37 The content of the providers monthly report should contain more detailed information about what people think of the home and the progress in addressing any outstanding issues. Page 28 of 30 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 This will help to demonstrate that appropriate action is being taken to monitor how the home is operating and any actions taken to address shortfalls. Care Homes for Older People Page 29 of 30 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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