Care Home: Hollybush House Nursing Home

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. Information was readily available in a variety of formats, so that it was accessible to people visiting, providing them with information about the services and facilities to assist them with making a decision about moving it. Suitable arrangements were in place to ensure peoples health needs were met. Two activities co-ordinators are employed Monday to Friday to support people with social activities ensuring they receive adequate stimulation. Systems are in place for dealing with any complaints or concerns and people feel they are listened to. There were adequate numbers of staff on duty at the time of inspection to ensure people`s needs were met. A separate staff team were working on the long term and intermediate care unit, so providing greater consistency of care. Staff have received a range of mandatory training to ensure they have the skills to meet peoples needs. 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 are safeguarded when new staff are employed. The organisation have a suitable quality assurance system to assist them in monitoring aspects of the service and care, so that continuous improvement can be achieved. What has improved since the last inspection? A new manager with considerable experience has been employed to lead the staff team and this will provide stability and consistency in the home. The frequency of staff meetings and staff supervision has improved, which aids communication and provides support for staff. Staffing arrangements have improved with the employment of two nurses on shift during the day (one on each unit). The frequency of activities has improved, so people are receiving more stimulation to enhance their well being. The home have purchased some new commodes, mattresses and specialised chairs to meet people`s individual needs. The garden area was improved, seating was provided and new fencing to part of the area, so enhancing the facilities for people living in the home. A buffet is held once a month with relatives, which is followed by a meeting three monthly. This provides support for relatives and enables the exchange of ideas. What the care home could do better: The manager stated they were planning to refurbish the bathrooms and bedrooms next year. They also have plans to replace some of the chairs, replace fencing and make the paving slabs even in the garden area. She would also like to develop the activities kitchen into a multi purpose room, so enhancing the environment for people. The manager stated work is being undertaken by the organisation to develop a new computerised system for care planning based on assessments and they were looking at short term care plans for the intermediate care unit, to make information easier to access. A review of all risk assessments for bed rails must be undertaken. Where it is deemed necessary for people to have bed rails suitable equipment must be used to ensure their safety. The medication systems need to be improved to ensure people receive the medication prescribed for them. Systems for monitoring of fluid intake and output should be more robust and consideration should be given to the use of communication aids to ensure peoples needs are met effectively. The manger should review the communication systems in the home to ensure the effective flow of information between staff and they are aware of people`s needs. Staff should be provided with training in respect of the Mental Capacity Act, Deprivation of Liberty safeguards and Dementia, commensurate with their position in the home, so they can effectively support people. Staff hand washing facilities should be provided in bedrooms where personal care is provided. A risk assessment should be completed and implemented in respect of the laundry and kitchen also to reduce the risk of cross infection. Consideration should be given to the use of surveys for additional stakeholders, as part of the quality assurance process to ensure continuous development. The records in respect of hairdressing should include the date and signature of the hairdresser on every occasion, to ensure robust procedures when dealing with peoples money. The gas equipment should be serviced as recommended, to ensure continued safety in the home. The manager is also advised to contact West Midlands Fire Service for advice about evacuation plans for individual people living in the home. Key inspection report Care homes for older people Name: Address: Hollybush House Nursing Home Corbett Hospital Vicarage Road Stourbridge West Midlands DY8 4AP     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: 2 8 1 0 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: Hollybush House Nursing Home Corbett Hospital Vicarage Road Stourbridge West Midlands DY8 4AP 01384442782 01384444734 Hollybush-House@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw healthcare Ltd Name of registered manager (if applicable) Mrs Rebecca Jane Richards Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Age: Dementia (DE) age 50 and above. The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24 Date of last inspection Brief description of the care home Hollybush House is a purpose built, single storey nursing home situated on the site of Corbett hospital, which provides care for people with dementia. There is adequate parking to the side of the building. The building is owned by the Primary Care Trust and leased to Shaw Homes. The home Care Homes for Older People Page 4 of 32 Over 65 0 24 Brief description of the care home is divided into two units; one for people who require long term care and one for people who require intermediate care. Each unit has lounge and dining area and in addition there is an activities room and activities kitchen. The home has a secure garden with patio area and seating for use when the weather permits. The home was designed for people with disabilities in mind, and includes wheelchair access, handrails, assisted baths and other adaptations. 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 16th October 2006 when they were given a three star rating. An annual Service Review (ASR) was undertaken in 2007 and 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 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 21st October 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 two days by one inspector. The Manager was available for the second day 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 two people who live in the home, two relatives and five staff were spoken with. In addition, surveys were sent to relatives, staff and visiting professionals in order to gain feedback about the home and feedback was positive. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A new manager with considerable experience has been employed to lead the staff team and this will provide stability and consistency in the home. The frequency of staff meetings and staff supervision has improved, which aids communication and provides support for staff. Staffing arrangements have improved with the employment of two nurses on shift during the day (one on each unit). The frequency of activities has improved, so people are receiving more stimulation to enhance their well being. The home have purchased some new commodes, mattresses and specialised chairs to Care Homes for Older People Page 8 of 32 meet peoples individual needs. The garden area was improved, seating was provided and new fencing to part of the area, so enhancing the facilities for people living in the home. A buffet is held once a month with relatives, which is followed by a meeting three monthly. This provides support for relatives and enables the exchange of ideas. What they could do better: The manager stated they were planning to refurbish the bathrooms and bedrooms next year. They also have plans to replace some of the chairs, replace fencing and make the paving slabs even in the garden area. She would also like to develop the activities kitchen into a multi purpose room, so enhancing the environment for people. The manager stated work is being undertaken by the organisation to develop a new computerised system for care planning based on assessments and they were looking at short term care plans for the intermediate care unit, to make information easier to access. A review of all risk assessments for bed rails must be undertaken. Where it is deemed necessary for people to have bed rails suitable equipment must be used to ensure their safety. The medication systems need to be improved to ensure people receive the medication prescribed for them. Systems for monitoring of fluid intake and output should be more robust and consideration should be given to the use of communication aids to ensure peoples needs are met effectively. The manger should review the communication systems in the home to ensure the effective flow of information between staff and they are aware of peoples needs. Staff should be provided with training in respect of the Mental Capacity Act, Deprivation of Liberty safeguards and Dementia, commensurate with their position in the home, so they can effectively support people. Staff hand washing facilities should be provided in bedrooms where personal care is provided. A risk assessment should be completed and implemented in respect of the laundry and kitchen also to reduce the risk of cross infection. Consideration should be given to the use of surveys for additional stakeholders, as part of the quality assurance process to ensure continuous development. The records in respect of hairdressing should include the date and signature of the hairdresser on every occasion, to ensure robust procedures when dealing with peoples money. The gas equipment should be serviced as recommended, to ensure continued safety in the home. The manager is also advised to contact West Midlands Fire Service for advice about evacuation plans for individual people living in the home. Care Homes for Older People Page 9 of 32 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 10 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 11 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. Information is available for people moving into the home to assist them in making a decision about moving into the home. The assessment completed by staff prior to admission for long term care was good and provided staff with the information required to determine if they could meet peoples needs. The assessment for people requiring intermediate care requires further development. Evidence: The home had a service user guide available on entering the home. The service user guide was also available in alternative formats such as large print, braille, audio cassette and symbols. It stated it could also be translated into other languages if required. These documents provide people with information about the services and facilities to assist them in making a decision about moving into the home. Care Homes for Older People Page 12 of 32 Evidence: The home provides nursing care for people with dementia who require long term, respite care or intermediate care. It was stated the manager or deputy manager visits people who require long term care before they move into the home in order to undertake an assessment to determine if they are able to meet the persons needs. For people requiring intermediate care an assessment is completed by a nurse from the Primary Care Trust (PCT). One file was looked at for a person who had recently moved into the home for long term care and respite care. The assessment for the person moving into the home for Long term care was of a good standard. However, the assessment for the person requiring intermediate care lacked detail. If assessments lack detail it results in poorly developed care plans and therefore, cannot guarantee that peoples needs will be met effectively. The manager stated they do not routinely send out letters to people following assessment to confirm their needs can be met by the home, but stated they would commence the process. This gives people the confidence their needs will be met when they move into the home. There is a separate unit with separate staff within the home for people who require intermediate care. This facility provides care and rehabilitation for people who are discharged from hospital for a period of eight weeks. A occupational therapist assistant is available in the home three days per week and a physiotherapist visits regularly. The manager stated they are currently recruiting for a qualified occupational therapist to work on the unit. This provides people with support and rehabilitation with the view to returning home and if that is not possible they may need long term care in an alternative home. Care Homes for Older People Page 13 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 further work in order to demonstrate care/interventions and enable follow up. The medication system needs further development to ensure people receive the medication prescribed for them. 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. Four peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of 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. Everyone living in the home suffers with dementia, has high needs and many are Care Homes for Older People Page 14 of 32 Evidence: unable to communicate their needs verbally. The care plans and risk assessments on the Hollybush unit for people requiring long term care were variable and some gave much more detail than others. Background information had been obtained to assist staff with developing care plans. However, some comments were rather vague especially in relation to communication and observation of behaviour e.g. watch body language and facial expressions and react accordingly or beware of non verbal body language. Therefore, they did not give staff the specific information they required to meet peoples needs. Daily records and evaluations seen were generally of a good standard, but reviews held with family were variable with some providing good information and others were rather brief. The intermediate care unit had a pack of documents to be used for people admitted with a number of pre printed care plans. It was found a number of the documents had not been fully completed, pre printed care plans had not been personalised and when information was added it was limited. A member of staff on the intermediate care unit stated they were sometimes working blindly for the first few days if they did not receive a good assessment and family may not be available to assist with drawing up care plans. Staff record incidents of challenging behaviour on ABC chart that are used to help identify any triggers to the behaviour, the type of behaviour and follow up. Although the charts were used there was little detailed information to indicate triggers, in some cases they did not indicate when medication had been used for the behaviour and daily records did not include the detail of some incidents. Therefore, it was difficult for us to follow up some of these areas. In another case one person had previously had problems in respect of nutrition and weight loss. Although it had now stabilised the records did not clearly demonstrate the actions taken at various times and the changes in treatment. Also the person had been seen by the speech and language specialist and it was recommended that they be weighed every 2 weeks, but there was no record of weight since 16th September which was satisfactory at that time. Some people had been assessed as requiring bed rails for their safety. However, one risk assessment stated they were not a risk of falling out of bed. Also the bed rails in use were not sufficiently high enough to protect the person due to the use of pressure relieving equipment. The person was in hospital at the time of visiting and the manager was advised the use of bed rails should be reassessed and if there was a Care Homes for Older People Page 15 of 32 Evidence: need for them appropriate equipment should be obtained to ensure the person was effectively protected. Other bed rails seen were of a satisfactory height. One person was experiencing communication difficulties and there was no evidence of any communication tools to aid the process. This was discussed with the manager and she stated she would address it. Fluid intake and output was being recorded for one person on the intermediate care unit on a daily basis. It was noted that the fluid intake on some days was poor and there was no record of fluid output. There was no evidence of any effective systems for monitoring of fluid balance. The deputy manager stated they had spoken to staff about the issue recently. More robust systems will need to be put in place for monitoring of fluid balance and where it is not sufficient appropriate action taken. There was evidence of pressure relieving equipment and regular pressure relief where a person had been identified at risk of developing a pressure sore. Feedback from relatives was positive and included comments such as; The care is really good - way up high. They are all treated with respect and as individuals. 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 consultants, social workers, chiropodist, and speech and language therapist. Feedback from visiting professionals was generally good and one stated they were introduced to the person, they had a two way conversation with staff and staff knew the person. Another informed us peoples social and health needs are usually monitored, reviewed and met by the service. Also staff usually had the right skills to support people, but better communication was required. The manager will need to follow up this area. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in a locked room in locked cupboards with the exception of destroyed medication and this will need to be addressed. On inspection of the medication for the current month, audits were found to be correct for the medication that was in blisters. However, a number of the Care Homes for Older People Page 16 of 32 Evidence: medications audited in boxes were not correct and this was mainly for the intermediate care unit. There was no record to indicate medication had been checked with the GP for one person who had been admitted to the intermediate care unit for respite care from home. Also medication for one person had almost run out on the first evening of inspection. On returning the next day a further supply of medication had not been received and the person had missed three doses of medication. Therefore, it could not be guaranteed that everyone received the medication they were prescribed. Homely remedies were in use and it had been agreed by GPs. On inspection it was found the medication and records did not correspond. The care plans for the use of when required (PRN) medication did not give clear information about the times/circumstances such medication should be used and this area will need to be developed further. Staff recorded the temperature of the fridge and medication room regularly to ensure they were within safe limits and this was satisfactory ensuring medication was stored appropriately. 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 reflected their individual culture, gender and personal preferences. The home is divided into two units and there is two lounges/dining rooms. 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. Care Homes for Older People Page 17 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 satisfactory 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 some people received their breakfast in bed. 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. Care Homes for Older People Page 18 of 32 Evidence: Staff are very good; we are made to feel welcome. We are kept informed of any changes. Two activities co-ordinators work in the home between Monday and Friday and a monthly plan of activities is drawn up by them. The plan demonstrated a range of activities that included art, baking, films, music, reality orientation, bingo, pub quizzes, discussion, pampering and sensory sessions. There is a separate activities room and kitchen to be used for activities. Birthdays and special days are celebrated just as Easter, New Year, Christmas, Bon Fire night, Valentines Day. In addition, they had celebrated a Black country night, Ascot and were in the process of making decorations to celebrate Halloween. Staff stated they have a barbecue each June to celebrate the opening of the home. Records were maintained for each person about the activities they were involved in and their responses to them enabling the activity co-ordinators to identify individuals suitability for different activities such as reminiscence therapy, relaxation, music etc. Feedback from relatives indicated there had been an improvement in the activities as there was something on each morning and afternoon. The home provides the opportunity for people to follow their own religion and a service is held in the home once a month ensuring their religious needs are met. Meals are prepared and cooked by a hospital contractor and brought into the home on a cook chill basis. There was a three weekly menu that gave a choice of meals at lunch time and evening meal and relatives had been involved in making choices for people living in the home. The home used the service each lunch time and three evening per week. On the remaining evenings people had a choice of sandwiches, salad or cold buffet. There were several visitors in the home at lunch time and they assisted with feeding their relative. Staff gave discreet assistance to people who required assistance to eat their meals. Relatives stated; The food is good; they gave us a menu to decide what she liked. Care Homes for Older People Page 19 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. 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 in reception and in the service user guide. There was a book to record any complaints received and none had been received in the past year. On discussion with relatives they stated they had no concerns 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, but was aware of the need for all staff to undertake the training. This training will ensure staff are aware of their responsibilities in respect of supporting people who lack capacity to make decisions, as all the people living in the home suffer with dementia and lack varying degrees of capacity. The home has a satisfactory recruitment system; ensuring people are safeguarded by 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 clean and comfortable environment that meets their needs. Evidence: Hollybush House is a single story building that is situated in the grounds of Corbett Hospital. It provides care and accommodation for 24 people with dementia. There is a parking area to the front of the building with external security lighting and level access to the building for wheelchair users. Internally the home is divided into two units; one for people requiring long term care and a separate eight bedded unit for people requiring intermediate care. Each unit had a separate garden facility with tables and seating for use when the weather permits. The manager stated new fencing had been provided to the intermediate units garden area, but they were still waiting for new fencing for the remaining area. It was noted some of the paving slabs were uneven and may be a potential trip hazard. A partial tour of the home was undertaken and it was found to be warm, clean, and maintained to a high standard. The atmosphere was calm, relaxed, friendly and there were no unpleasant odours. Each unit had a lounge and dining room which were decorated and furnished to a good Care Homes for Older People Page 21 of 32 Evidence: standard providing pleasant areas for people to sit and take meals. There was also a separate activity room and kitchen. The manager stated she wanted to develop the activity kitchen into a multi purpose room that could be used for activities and socialising with visitors to the home for drinks and snacks etc. Toilets were strategically placed around the home and were provided with liquid soap and paper towels for infection control purposes. There are three bathrooms in total; two on Hollybush have assisted baths and the bathroom on the intermediate care unit has a flat floor shower. The manager is hoping to have the bathrooms completely refurbished next year to provide more appropriate bathing facilities for the people living in the home. All bedrooms were single occupancy and bedroom doors had been painted different colours to assist people to locate their own room. A call bell facility was available in each bedroom, so people could call for assistance if required. Bedroom doors had locks and lockable facilities were available in bedrooms, so people could store medication/ valuables to enhance privacy. New mattresses and commodes had been purchased, but there was no staff hand washing facilities in bedrooms where personal care was undertaken. This needs to be addressed to reduce the risk of cross infection. Bedrooms had been personalised by people with pictures and ornaments etc. but they were in need of redecoration and looked rather institutionalised. The manager stated they were waiting to have some new light fittings and then re-decoration and some re- furbishment of bedrooms would take place. The home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, etc. The main kitchen was clean, well organised and adequately equipped for its purpose. Temperatures of fridges and freezers were being recorded on a regular basis to ensure food was stored at the correct temperature. The laundry was situated next door to the kitchen, which could have consequences in respect of infection control. The manager was advised to ensure appropriate risk assessments were in place to ensure effective infection control within the home. Laundry equipment was adequate to allow sluice and pre-wash cycles. 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 good 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. Staff would benefit from some further specialised training to ensure they are up to date with current practice. Evidence: At the time of inspection there were eleven people on Hollybush unit and seven people on the intermediate care unit. The duty rota indicated there was one nurse on each unit plus two care staff on the intermediate care unit and three care staff on Hollybush. One nurse and three care staff were on duty overnight for the whole home. This appeared satisfactory to meet the current needs and dependency of people living in the home. Ancillary staff such as domestic, laundry, catering, administration, and maintenance staff support care 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. Newly appointed staff undertake induction training and the induction packs 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 Care Homes for Older People Page 23 of 32 Evidence: areas such as manual handling, infection control, fire safety, food hygiene, health and safety, risk assessments and safeguarding. Two staff were in the process of undertaking training in respect of end of life and training was in the process of being provided to all staff in respect of managing challenging behaviour. The information provided indicated fourteen care staff had completed National Vocational Qualification (NVQ) level 2 in care and two had completed NVQ level 3 in care. Training provides staff with the appropriate skills and knowledge to care for people living in the home. There was no evidence of training in respect of dementia, medical conditions and as identified earlier the Mental Capacity Act plus the Deprivation of Liberty Safeguards. These areas will need to be addressed to ensure staff are suitably trained to meet the needs of the client group. 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 managed in the best interests of people living in the home. Evidence: There has been a turnover of managers over the past eighteen months, which has led to an unsettled period. A new manager took up post in April and is waiting for a CRB in order to apply to us for registration. She is a qualified nurse who has completed the Registered Managers Award and has several years experience as a manager in homes for people with dementia. She stated she will be commencing the diploma in dementia care in the near future. Staff stated the managers were approachable and willing to help where ever possible. People/relatives 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 given for all withdrawals and two signatures were obtained for Care Homes for Older People Page 25 of 32 Evidence: all deposits. Balances of monies checked were found to be correct. This should ensure that peoples monies are held safely. However, the records in respect of hairdressing were not consistently signed or dated and this will need to be addressed. Prior to the inspection an Annual Quality Assurance Assessment (AAA) 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 a quality assurance process that consists of a range of audits and surveys are sent to relatives every three months. The manager stated there had also been a staff survey earlier in the year, which had been returned to senior managers and they had the report of the findings. Surveys are not forwarded to any other stakeholders for feedback and consideration should be given to this. Since the manager took up the post there have been regular staff meetings and staff confirmed these were taking place. A buffet is also held for relatives each month and every three months there is a formal meeting. This gives the opportunity for people to meet, discuss things provide support to each other and discuss any issues or concerns with management. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and in full working order. They were generally found to be satisfactory and some were due to be checked again. However, it was noted the gas safety certificate recommended the gas equipment should be serviced. The evacuation plans for people living in the home in the event of fire were very brief. It is recommended that advice be sought from the West Midlands Fire Brigade about the suitability of them. 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 27/11/2009 assessments for bed rails should be undertaken. Where it is deemed necessary for people to have bed rails systems must be in place to ensure the correct equipment is in place. To ensure people are protected 2 9 13 When PRN medication is 27/11/2009 used care plans must clearly outline the indications for its use. To ensure consistency in practice. 3 9 13 Systems must be in place to ensure there are adequate stocks of medication in the home at all times. To ensure people receive the medication prescribed to them. 27/11/2009 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 Effective systems must be in 27/11/2009 place to check medication details for people who are moving into the home. To ensure the correct medication is administered. 5 9 13 All medication must be stored in locked cupboards within locked rooms. To ensure the safe storage of medication. 27/11/2009 6 9 13 Robust systems must be in 27/11/2009 place for the correct administration and recording of medication. To ensure everyone receives the medication prescribed for them. 7 19 13 Action must be taken to ensure the paving slabs are even. To reduce the risk of accidents. 27/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 It is recommended a letter is forwarded to people following assessment advising them of the outcome, so they can be assured their needs can be met upon moving into the home. Care Homes for Older People Page 29 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 2 7 Records of all reviews should provide comprehensive information to demonstrate all aspects of care has taken place and any changes should be reflected in care plans. All care plans should be updated and outline in detail the action required by staff to meet peoples needs to ensure a consistent approach to meeting peoples needs. It is recommended a communication tool be used where people are experiencing difficulty expressing their needs to aid communication. Undertake a review of the communication systems in the home and take action to ensure all staff are fully aware of peoples needs and the support they require, so peoples needs are met effectively. It is recommended that systems for monitoring and follow up in respect of record of fluid balance be reviewed and action taken where people are not receiving a sufficient fluid intake. Records in respect of behaviour that challenges must clearly indicate the detail of behaviour and action taken in daily records in addition to ABC charts. 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 they are aware of their responsibilities in supporting people who lack capacity to make decisions. A redecoration programme should be undertaken for bedrooms and bathrooms, to enhance the environment for people living in the home. Ensure risk assessments are in place for the kitchen and laundry, so the risk of infection is reduced. Provide staff hand washing facilities in bedrooms where personal care is provide to people, to reduce the risk of cross infection. It is recommended all staff receive training in respect of dementia care, to ensure the have the specialist knowledge to meet peoples needs. 3 7 4 8 5 8 6 8 7 8 8 18 9 19 10 11 26 26 12 28 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 Consideration should be given to obtaining feedback form other stakeholder as part of the quality assurance system. Ensure the record of money withdrawn for hairdressing clearly indicates the date and signature of the hairdresser. Advice should be sought from the West Midlands Fire Brigade about evacuation plans for people living in the home, to ensure people are safe in the event of a fire. It is recommended the gas equipment be serviced to ensure the continued operation and safety of equipment in the home. 14 15 35 38 16 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. 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