Care Home: Highfield

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What the care home does well There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Prior to coming to stay at the home pre-admission assessments are completed, so that the home and people who are considering living in the home are confident that their individual needs can be met appropriately. There was range of activities for people to partake in if they wished, so they were adequately stimulated. There was a range of nutritious food that people enjoyed, which met their needs and preferences. The home had also achieved a 5 star food safety and hygiene award. The arrangements for handling people`s personal finances were good ensuring their money was protected. There were adequate numbers of staff on duty at the time of inspection to ensure people`s needs were met. Staff receive a range of training to ensure they have the knowledge and skills to meet peoples needs and the majority of the staff had completed National Vocational Qualification (NVQ) level 2 in care or above. The home had also received the investors in people award. The home was clean and well maintained providing people with a safe place to live. The recruitment of staff was satisfactory ensuring people living in the home were safeguarded when new staff are employed. The home has an external quality assurance systems (ISO 9000) to monitor systems and regular feedback is also obtained from people who live in the home, visitors, staff and professionals to enable continuous improvement What has improved since the last inspection? The bathroom on the first floor had been refurbished providing a very pleasant bathing facility for people. There had been some re-decoration of bedrooms and re-leading of the roof, ensuring a pleasant and safe place to live. What the care home could do better: Action needs to be taken to ensure the medication system is auditable and medication is stored at the correct temperature at all times. Risk assessments for bed rails must be reviewed and action taken to ensure people who require bed rails have the appropriate equipment, so they are safe at all times. Action must be taken to address the outstanding issues in respect of the electrical wiring and a record must be kept in the home.The service user guide should be reviewed and updated to provide relevant information to assist people who are considering moving into the home. Also consideration should be given to providing it in alternative formats to make it accessible o everyone. The complaints procedure should be updated to ensure people are aware of the procedure and who they can contact in the event of any complaints. The manger must ensure all admission documents are completed when people are moving into the home. Risk assessments must be reviewed and updated on a regular basis and action taken to reduce risks to ensure people are safe and their needs met. . Care plans should provide more detailed information about the support people require to meet their needs and monthly evaluations should indicate any changes and care plans updated to reflect them. Staff should be provided with training in respect of the Mental Capacity Act and the Deprivation of Liberty Safeguards commensurate with their position in the home, so they are aware of their responsibility in supporting people who lack capacity. The water from showers should be restricted to 43 degrees to prevent the risk of scalding. Also consideration should be given to providing restrainers on bedrooms windows and staff hand washing facilities in peoples bed rooms to reduce risks to people living in the home. The manger needs to be registered with the Commission to ensure there is a responsible person providing leadership and consistency in the home. The proprietor will need to write a report following monthly visits to the home about the conduct of the home, in order to comply with regulations. The manager should contact West Midlands Fire Service for advice about completion of individual evacuation plans for people, to ensure their safety in the event of a fire. Key inspection report Care homes for older people Name: Address: Highfield Stream Road Kingswinford Dudley West Midlands DY6 9PB     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: Ann Farrell     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Highfield Stream Road Kingswinford Dudley West Midlands DY6 9PB 01384288870 01384270803 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Arthur Proctor,Mrs Mary Proctor care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 13 Date of last inspection Brief description of the care home Highfields Care Home is registered to provide care to thirteen people who require care for reason of old age. The home is situated in a pleasant residential area and is located between Kingswinford and Wordsley. It is a large detached, traditional type of building with a large mature well maintained garden to the rear for use when the weather permits plus a small garden area and car parking space at the front of the building. The home provides a lounge come dining area, conservatory plus nine single and two double bedrooms, one of which has en-suite facilities. It provides assisted Care Homes for Older People Page 4 of 32 Over 65 13 0 Brief description of the care home bathing and showering facilities, a number of assisted and non-assisted toilets, a laundry area and kitchen. Access between floors is enabled by use of a stair lift. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 27th March 2007 when they were given a three star rating. An annual Service Review (ASR) was undertaken in 2008. This is a process where we collect information from various sources and if no changes are identified a report is produced based on the information received without a visit to the home. Care Homes for Older People Page 6 of 32 This inspection found some areas of record keeping that need to be addressed and they can be found in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 1st December 2012. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies plus concerns raised. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. The inspection was undertaken over one day by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection three people who live in the home, three relatives and three staff were spoken with. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Action needs to be taken to ensure the medication system is auditable and medication is stored at the correct temperature at all times. Risk assessments for bed rails must be reviewed and action taken to ensure people who require bed rails have the appropriate equipment, so they are safe at all times. Action must be taken to address the outstanding issues in respect of the electrical wiring and a record must be kept in the home. Care Homes for Older People Page 8 of 32 The service user guide should be reviewed and updated to provide relevant information to assist people who are considering moving into the home. Also consideration should be given to providing it in alternative formats to make it accessible o everyone. The complaints procedure should be updated to ensure people are aware of the procedure and who they can contact in the event of any complaints. The manger must ensure all admission documents are completed when people are moving into the home. Risk assessments must be reviewed and updated on a regular basis and action taken to reduce risks to ensure people are safe and their needs met. . Care plans should provide more detailed information about the support people require to meet their needs and monthly evaluations should indicate any changes and care plans updated to reflect them. Staff should be provided with training in respect of the Mental Capacity Act and the Deprivation of Liberty Safeguards commensurate with their position in the home, so they are aware of their responsibility in supporting people who lack capacity. The water from showers should be restricted to 43 degrees to prevent the risk of scalding. Also consideration should be given to providing restrainers on bedrooms windows and staff hand washing facilities in peoples bed rooms to reduce risks to people living in the home. The manger needs to be registered with the Commission to ensure there is a responsible person providing leadership and consistency in the home. The proprietor will need to write a report following monthly visits to the home about the conduct of the home, in order to comply with regulations. The manager should contact West Midlands Fire Service for advice about completion of individual evacuation plans for people, to ensure their safety in the event of a fire. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about the services and facilities requires updating to ensure it provides relevant information to enable people to make a decision about moving into the home. Pre admission assessments are completed, so people can be assured their needs will be met when they move into the home. Evidence: The home had a brochure which was professionally produced providing basic information about the home. They also had a service user guide, which was given to people when they moved into the home. The service user guide needs updating and consideration should be given to providing it in alternative formats to ensure it is accessible to everyone considering moving into the home. These documents give people information about the services and facilities to enable them to make a decision Care Homes for Older People Page 11 of 32 Evidence: about moving into the home. The home provides care for people who require long term or respite care. People can visit the home before moving in, so they can view the facilities, meet staff and other people who live there, in order to sample what it would be like to live there. The people who were spoken with stated their relatives had visited the home on their behalf. The manager stated she goes out to visit people before they move into the home in order to undertake a pre-admission assessment, so they can determine if peoples needs can be met appropriately and this was confirmed on discussion with relatives. On inspection of the records for two people who had moved into the home recently it was found the documents had been completed. The assessment provided information about peoples basic needs and was of an adequate standard. The manager stated that when visiting people to undertake assessments she takes an album with photographs of the home and letters of appreciation etc, to assist people with making a decision about moving into the home. The manager confirms the outcome of the assessment in writing; so that people can be assured their needs will be met upon moving into the home. Following admission to the home the manager stated a more in depth assessment was undertaken with risk assessments and these had been completed in some instances. There is a trial period of one month. This provides an opportunity to discuss whether the person is happy to continue living in the home and if their care needs are being met or any changes are required. Care Homes for Older People Page 12 of 32 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. Care plans and records require some further detail in order to demonstrate the care people receive. The medication system needs some further development to ensure a robust system that is auditable. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that the home undertakes risk assessments for areas such as manual handling, tissue viability, nutrition and falls. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Background information had been obtained in a document called This is my life to Care Homes for Older People Page 13 of 32 Evidence: supplement assessments and assist staff with developing care plans. Care plans were found to be generally lacking in detail about the support people required to meet their needs. On discussion with staff they were aware of peoples needs. Daily records were satisfactory, but monthly evaluations would benefit with some further detail to demonstrate if the care plan is effective or if changes are required. People living in the home told us they were very satisfied with the care they received and comments included; You could not have better treatment if you were in a posh hotel. I am very fortunate to be here. Its lovely. Some people had been assessed as requiring bed rails for their safety. However, the quality of the risk assessments was not adequate as it did not indicate why they required bed rails; it was not clear when they commenced using them and on inspection it was noted that bed rails on one bed were not high enough to protect the person as pressure relieving equipment was in use. Risk assessments in respect of other areas such as tissue viability and falls had not been consistently completed or updated regularly. The manger will need to ensure this is addressed to ensure risks are reduced and people are safe. If necessary staff should be provided with training in undertaking risk assessments, so they have the knowledge to compete them effectively and put appropriate strategies in place to keep people safe. Personal care records are completed by staff on a daily basis indicating the care provided by staff. However, on inspection it was found that ticks or N/K were used in a number of cases. This is not appropriate and staff need to provide more detail to demonstrate the care provided to people. Everyone living in the home was registered with a local General Practitioner (GP). People have the option of retaining their own GP. on admission to the Home (if the GP is in agreement). People had access to other health and Social Care professionals and records demonstrated visits were undertaken by chiropodist, dentist and optician on a regular basis. There was evidence district nurses visited to provide support with dressing, injections and tissue viability and pressure relieving equipment was in place where one person was identified as being at risk of pressure sores. The homes medication system consisted of a blister and box system with printed Care Homes for Older People Page 14 of 32 Evidence: Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in a locked room. On inspection of the medication for the current month, audits were found to be correct for the medication that was in blisters and boxes for the current month. However, issues were identified where medication was carried over from previous months as records were not clear and it could not be audited. Some medication details had been handwritten by care staff, but the record had not been countersigned by two members of staff and they had not consistently recorded the amount of medication entering the home. Therefore, it could not be audited. The record of controlled medication was good. It was noted that some people were prescribed when required (PRN) medication for agitation and this had been used on occasions. The instructions for the use of it were very vague and the manager will need to ensure a care plan or more detailed instructions are in place for its use, to ensure consistency in practice. Staff recorded the temperature of the fridge, which was used for some medication. It was found the maximum temperature was above the recommended limit and the manager was advised it would need addressed to ensure the medication was stored within safe limits. Staff were observed to assist people in a sensitive manner when undertaking interventions. People were well supported by staff in respect of personal care and choosing clothing appropriate for the time of year which was co-ordinated and reflected their individual culture, gender and personal preferences. The home has a lounge and conservatory, so people have a choice of areas to sit. Some bedroom doors had locks in place and lockable facilities were available in bedrooms to store valuables/medication if required, so enhancing the arrangements for privacy. People can have a telephone installed in their own bedroom and a telephone is available in the hall. It was stated they were considering purchasing a hands free set, so that people could make and receive telephone calls in private. Care Homes for Older People Page 15 of 32 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. Arrangements for visiting the home were flexible, so people were able to maintain important relationships. There was a range of activities to engage people and provide stimulation. The meals were of a good standard and appropriate assistance was provided to ensure peoples dietary needs were met. Evidence: There was no evidence of any rigid rules or routines in the home at the time of inspection. People who live in the home can go outside with friends and family as they choose, depending on their abilities. It was observed that people got up at different times and people confirmed they could do as they wished. People are able to bring personal items of pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. Relatives stated; We can visit at any time Staff are very good. Care Homes for Older People Page 16 of 32 Evidence: We are kept informed of any changes. We cant praise them enough. I dont think I could have found any better for dad. An activities organiser visits the one once a week and provides music, singing etc. There was also a range of other activities if people wished to partake such as films, music, bingo, puzzles, exercises and one to one discussion. Some people go out with staff on shopping trips and there had been a trip to Stourport earlier in the year. The feedback was very positive and people were looking forward to the next trip. Local bell ringers were due to visit the home the next day, a carol service had been arranged and an entertainer was also due to visit the home on 23rd December. The proprietor also has a small dog and he visits the home on a regular basis and people really enjoyed the dog. There is a large well maintained garden with seating and a gazebo that people can use during the summer and a garden fete had been held earlier in the year. The manager also stated some of the people living in the home had been involved with planting earlier in the year. The home provides the opportunity for people to follow their own religion and the vicar from the local church visits regularly ensuring their religious needs are met. The home had a four week rotating menu that provided people with a range of nutritious meals at lunch and evening meal. Breakfast was a choice of cereals, porridge, fruit juice, cooked breakfast etc. according to peoples own choice. The manager stated that if people did not like the meal on the menu alternatives were provided and they would also try to meet any special likes/requests, so that peoples dietary preferences were met. The home had been awarded the 5 star food safety and hygiene award by the local council. There was a record of food taken by people and although alternatives were identified it was no clear who had received them. The manger should provide a clearer record where people take an alternative to the main meal. The dining area was very pleasantly presented with small tables, with table cloth, napkins, condiments and cutlery. Breakfast and lunch were observed and the meals were served from the kitchen by care staff, who provided discreet assistance where appropriate. On discussion with people living in the home they stated the food was Care Homes for Older People Page 17 of 32 Evidence: good. On visitor stated, He enjoys the meals and has enough to eat. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for dealing with concerns and complaints were satisfactory to ensure people were safeguarded. Further staff training is required to ensure staff have the knowledge to support people who lack capacity to make decisions. Evidence: A complaints procedure was available on the notice board and in the service user guide, but this requires updating with the current contact details of the commission. There was a book to record any complaints received and none had been received in the past year. We have received no complaints about the home. On discussion with relatives they stated they had no concerns/complaints and had not had to raise any concerns in the past, but were aware of what to do in the event of a concern/complaint. Records indicated that nearly all staff had received training in respect of safeguarding. There was no evidence of training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards and on discussion with the manager she stated she had received some training in this area. All staff will need training in this area to ensure they are aware of their responsibilities in respect of supporting people who lack capacity to make decisions. The home has a satisfactory recruitment system; ensuring people are safeguarded by Care Homes for Older People Page 19 of 32 Evidence: the employment of new staff. Care Homes for Older People Page 20 of 32 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. People live in a homely, clean and comfortable environment that meets their needs. Evidence: Highfield is a large traditional, detached property with limited parking to the front of the building. There is a large mature well maintained garden to the rear with patio area for use when the weather permits. There is ramped access to the front of the property, which is suitable for people who use wheelchairs. A partial tour of the home was undertaken and it was found to be homely, warm, clean and odour free. There was a routine maintenance plan in place, which was seen at the time of inspection indicating regular maintenance was undertaken, to keep the home in a good state of repair. There is a lounge/dining room plus a conservatory which looks out onto the garden. The area was well maintained and provided a choice of areas for people to sit and receive visitors. The home had communal WCs and bathing facilities on each floor with a flat floor shower on the ground floor. The bathroom on the first floor had recently been upgraded and had an assisted bathing facility, so people had a choice of bathing Care Homes for Older People Page 21 of 32 Evidence: facilities. The hot water is not regulated from the shower units and this should be addressed to reduce the risk of scalding. There were nine single bedrooms and two double bedrooms. One of the bedrooms had en-suite toilet facilities and others were provided with a wash hand basin, but there was no staff hand washing facilities in bedrooms where personal care was undertaken. Consideration should be given to this area to reduce the risk of cross infection. The manager stated they were considering providing en-suite facilities in other bedrooms to enhance facilities for people. A call bell facility was available in each bedroom, so people could call for assistance if required. Some bedrooms had locks on doors to enhance privacy and all had lockable facilities, so people could store medication/ valuables to enhance privacy. However, a number did not have restrainers to windows for security and safety. The manager will need to review this area and take appropriate action based on risk assessments. Bedrooms had been personalised by people with pictures and ornaments etc. reflecting peoples gender, culture and personality. The manager stated some bedrooms had been re-decorated recently and they always consulted people about their choice of wall paper before they moved into the home. The home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, wheelchairs, walking aids, assisted bathing facility and so forth. The main kitchen was clean, well organised and adequately equipped for its purpose. Temperatures of fridges and freezers were recorded on a regular basis to ensure food was stored at the correct temperature. There is a small laundry next to the office. Staff do not approach the laundry through the kitchen. There are hand wash facilities next to the laundry in the staff toilet and procedures were in place to prevent the risk of cross infection. Care Homes for Older People Page 22 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient staff on duty to meet peoples needs. The recruitment of new staff was satisfactory ensuring people were safeguarded. People benefit by being cared for by a skilled and well trained staff group. Evidence: At the time of inspection there were nine people living in the home. The duty rota indicated there were two care staff on during the day and one to two care staff overnight depending on the knowledge and experience of staff, with the manager or deputy on call. This appeared satisfactory to meet the current needs and dependency of people living in the home. Care staff are supported by ancillary staff. The staff files for two newly appointed staff were inspected. The recruitment process was found to be satisfactory and Criminal Record Bureau (CRB) checks were obtained before people commenced work in the home. The manger also invites people who live in the home and their relative to take part in the interview process for new staff, so they have a say in who works in their home. Newly appointed staff undertake induction training and the induction records were seen. This provides staff with the knowledge initially to meet peoples needs. There was a rolling programme of in house staff training, which covered mandatory areas such as manual handling, infection control, fire safety, food hygiene, health and Care Homes for Older People Page 23 of 32 Evidence: safety, medication and safeguarding. They had also achieved the investors in people award. The information provided indicated most staff had completed the mandatory training with the exception of new staff and the manager was organising the training for them. Staff had also undertaken training in respect of dementia awareness. All staff with the exception of one had completed National Vocational Qualification (NVQ) level 2 in care and four had completed NVQ level 3 in care. The new deputy manager was undertaking the registered managers award and the senior carer was undertaking NVQ level 3 in care. Training provides staff with the appropriate skills and knowledge to care for people living in the home. Care Homes for Older People Page 24 of 32 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 home is run in their best interests of people who live there ensuring their health safety and well being. There are systems in place to take into account their wishes and views. Evidence: A new manager has taken up post who has several years experience of working in the care home and has completed the Registered Managers Award. She is in the process of applying to the Commission for registration. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The home does not act as appointee/agent for people in the home, but assists with personal allowances. Individual records were maintained for people where the home held money on their behalf. Receipts were available for all withdrawals and two signatures were obtained for all deposits/withdrawals. Balances of monies checked were found to be correct. This should ensure that peoples monies are held safely. Care Homes for Older People Page 25 of 32 Evidence: Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home, which was completed to a satisfactory standard. The organisation has an external company undertaking quality audits and they have been awarded the ISO 9000 quality assurance award. They send out questionnaires to people who live in the home, relatives, staff and health professionals each year and feedback this year was all positive. Regular staff meetings have occurred and there have been two meetings with relatives over the past year. With employment of the new manager the proprietor will need to write a report on the conduct of the home following a visit each month, which should be retained in the home, to comply with regulations. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was safe and in full working order. These were found to the satisfactory with the exception of the electrical wiring certificate. Some areas had been identified as requiring attention, but there was no record that they had been rectified. Checks had been completed on the fire system regularly ensuring people would be safe in the event of a fire. However, we did not see evidence of individual fire evacuation plans for people living in the home. The manager must ensure these are in place and should seek guidance from West Midlands Fire Service. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 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 13 A review of all risk 01/01/2010 assessments for bed rails should be undertaken to determine if people require bed rails. Where they are deemed necessary action must be taken to ensure the correct equipment is in place. To ensure people are safe. 2 9 13 When PRN medication is used care plans/instructions must clearly outline the indications for its use. To ensure consistency in practice. 01/01/2010 3 9 13 Hand written medication details must be countersigned by two members of staff. To ensure a safe system in the home 01/01/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 Robust systems must be in place for recording the amount of medication received into the home and carried forward from previous months. To enable auditing to take place. 01/01/2010 5 31 7 A manager must be registered with the Commission. To ensure the effective management and leadership of the home. 02/03/2010 6 38 13 The outstanding issues from the electrical wiring certificate must be addressed. To ensure the safety of people in the home. 02/01/2010 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 1 The service user guide should be updated to provide a user friendly document with relevant information to assist people with making a decision about moving into the home. The manager should ensure all assessment documents are completed when people move into the home to ensure a person centred approach to meeting peoples needs. All care plans should be updated and outline in detail the Page 29 of 32 2 3 3 7 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 action required by staff to meet peoples needs to ensure a consistent and person centred approach to meeting peoples needs. 4 7 Risk assessments in respect of nutrition, tissue viability, falls and manual handling should be completed for everyone who moves into the home and they should be reviewed on a regular basis. This will enable staff to identify risks and put appropriate strategies in place to reduce risks. Staff should be provided with training in respect of completing risk assessments where necessary, to ensure they have the appropriate knowledge to undertake assessments. Review the recoding of personal care charts and ensure they are completed appropriately, to demonstrate the care and follow up of people. The record of food should indicate the name of people who have an alternative to the main menu, to ensure a comprehensive record that can be audited. The complaints procedure should be updated to include the current contact details of the Commission. All staff should be provided with training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with their position in the home, so people who lack capacity to make decisions are supported appropriately. Risk assessments should be undertaken in respect of bedrooms windows and restrainers fitted where there is any risk in respect of safety or security. Hot water from shower units should be maintained at 43 degrees to reduce the risk of scalding. Consideration should be given to the provision of staff hand washing facilities in bedrooms where personal care is provided to people, to reduce the risk of cross infection. 5 8 6 8 7 15 8 9 16 18 10 19 11 12 19 26 Care Homes for Older People Page 30 of 32 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 13 33 The proprietor should write a report on the conduct of the home once a month following his visits, in order to comply with regulations. Consideration should be given to developing the accident audit further to provide more detailed information. The West Midlands Fire Service should be consulted about individual Fire evacuation plans for people who live in the home, to ensure they are safe in the event of a fire. 14 15 33 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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