Care Home: Hornchurch Nursing Centre

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What the care home does well The service has a comprehensive activities programme, to ensure they can meet all the needs of residents. There is a good selection of meals provided at the home and relatives made very positive comments about the menu at the home. Pre-admission assessments are completed before prospective residents move into the home, ensuring that the service will meet their needs and to ensure that they receive a personalised service. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Care planning is very comprehensive. All residents could also be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The management of the home operate a open door culture welcoming complaints and feedback. The health and safety of staff and residents is promoted by the home`s policies and procedures. The service has robust recruitment procedures ensuring the safety of residents. What has improved since the last inspection? Three requirements were made at the last inspection in relation to medication practises, health and safety checks and for the service to provide height adjustable beds to all residents. Two of the requirements have been met at this inspection and the one relation to medication practises has been partly met. What the care home could do better: Four requirements have been made at this inspection in relation the registered manager reviewing staff training in medication practises; the service to provide person centred care and one to one support to residents who require support with eating at meal times; to urgently review the current state of the environment; and review staffing levels at the home. Failure to act on requirements that relate to the care provided for the people living in the home impacts on the welfare and safety of service users and may lead to the Commission taking enforcement action against the registered person. Key inspection report Care homes for older people Name: Address: Hornchurch Nursing Centre 2a Suttons Lane Hornchurch Essex RM12 6RJ     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: Harbinder Ghir     Date: 0 3 0 8 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 31 Information about the care home Name of care home: Address: Hornchurch Nursing Centre 2a Suttons Lane Hornchurch Essex RM12 6RJ 01708454422 01708445456 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupacarehomes.co.uk BUPA Care Homes (ANS) Ltd care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 55 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: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability Code PD Date of last inspection Brief description of the care home Hornchurch nursing home is a purpose built fifty-five bed home, which is owned and operated by BUPA. The home caters for three categories of service user: up to 16 people over the age of 65 with a diagnosis of dementia, up to 34 people over the age of 65 who have age related physical illnesses/ disabilities and up to 5 people between the ages of 18-65 who have physical disabilities / complex needs. The home is Care Homes for Older People Page 4 of 31 Over 65 0 55 0 55 0 55 Brief description of the care home managed and staffed by registered nurses, care assistants and support staff. The home offers administrative, catering and laundry facilities on the ground floor and care accommodation on the further three floors. Each floor operates as a separate unit with staff allocated to each floor with bedrooms, a lounge, dining room, small kitchen area and bathrooms and toilets situated on each floor. The Home itself is situated within two minutes walk of the railway station and is easily accessed by car from the A13, A127 and M25. Hornchurch shopping centre is approximately twenty minutes walk or a short bus ride away. The current weekly cost of a placement is £800 for self-funding residents and fees can vary between £590 - £750 for local authority and primary care trust funded residents. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the Monday 3rd August between 10.00 am and 5.00 pm and feedback was provided to the registered manager of the home. During the inspection the inspector was able to talk to the residents residing at the home, staff and relatives who were visiting during the inspection. Thier feedback has been included in the report. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. The inspector would like to thank everyone involved in the inspection process. The Care Quality Commission received a completed Annual Quality Assurance Care Homes for Older People Page 6 of 31 Assessment prior to the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 3, 4, 5, 6. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. People who use the service know that the home they enter will meet their needs. The service does not provide intermediate care. Evidence: The service has a comprehensive pre-admission policy and procedure in place and admissions would not be made to the home until a full needs assessment has been Care Homes for Older People Page 10 of 31 Evidence: undertaken by the management of the home. Pre-admission assessments were closely examined and assessments comprehensively covered the personal, health care and social care needs of residents. It was evident from speaking to residents during the inspection and examining the assessments that significant time and effort is spent planning to make admissions to the home personal and well managed. Residents and their families are treated as individuals and with dignity and respect for the lifechanging decisions they need to make. There is a high value within the home on responding to individual needs for information, reassurance and support. The homes Annual Quality Assurance Assessment further informs us that they have regular mystery shoppers visiting the home to ensure they are providing adequate information to enquirers. Evidence was also seen on residents files, that the service obtains care management assessments from the placing authorities and information on the homes assessments and care plans was consistent with the information provided by the funding authorities. It was evident that new prospective residents would be able to visit the home as many times as they like before making a decision whether they would like to move in or not. Relatives and family would also be invited to visit the home. A relative spoken to as part of the inspection whos loved one had recently moved in informed My mum has settled in. We had a look at the home before she moved in, the home was recommended to us by a friend. We have found that the care staff are friendly and everybody I have spoken to has been friendly and helpful. Overall we have found the home to be ok. Further positive comments about the service were received from relatives who were spoken to as part of the inspection. The care has been excellent. They have entertainment here, and my husband has put on weight since moving in. In the mornings, they take him to do some painting and they have a church service here once a month. He also does the exercise sessions. They celebrate everything here, birthdays to Christmas. The carers are also alright informed a relative. The carers look after my wife. We are quite happy with the home said another relative. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 7, 8, 9, 10, 11. Residents health and personal care needs are set out in individual care plans. Care plans are detailed, to ensure the needs of residents can be met effectively. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the recording of medication administration, which may result in unsafe practises. All residents can be assured that, at the time of their death, staff would treat them and their family with care, sensitivity and respect. Evidence: Five care plans were closely examined and samples were taken from each of the three units. The home uses their own computerised system, Quest, on which their care plans are produced and updated on. A hard copy of the care plan is also kept on each unit for each resident. Care plans were very comprehensive and they included a photo Care Homes for Older People Page 12 of 31 Evidence: card of the resident, details of their next of kin and emergency contacts. Information covered the comfort and safety of residents, their communication needs, their nutritional needs, personal care, mobility and their hobbies and leisure. Care plans were very comprehensive and gave attention to particular attention to how each individual resident would like their needs met. For example for one individual their care plan stated Y is usually watching television at night and asks at different times to have it switched off. Y sleeps with three pillows and a quilt and likes the curtains closed. The times residents like to get up and go to bed were also identified in their care plans and their communication needs and how staff must meet these. A map of life, which included a life history of the individual was also completed which was particularly important in planning dementia care for residents with a diagnosis of the condition. The documentation/ health records relating to pressure care areas; management of diabetes, falls, turn charts and fluid charts were examined. The records for these were found to be detailed and were adequately maintained and updated throughout the day. Residents who were bed bound were turned regularly. There was evidence that care plans were being reviewed regularly or as when required and risk assessments were updated accordingly. Evidence was seen of reviews taking place with care managers also involving the resident and their representatives. Risk assessments are routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and are reviewed on a regular basis. Monthly weight checks were in place where necessary and fluid intake charts were also in place where there were concerns regarding nutritional intake. Records indicated other health professionals such as the tissue viability nurses, optical, dental and chiropody services saw residents. Every visit made by a health professional to each resident was recorded in their care plan. Daily case recording notes were examined which are linked to the care plan and focus on the specific needs of residents rather than recording information in a general manner. Each resident has a personalised case recording sheet which may focus on their challenging behaviour, their diet or the risks they are posed to, which provided specific information about each resident which is used to monitor their care needs or their behaviour on a on-going basis. The service is in the process of implementing the Liverpool Care Pathway and the Gold Standard Framework End Of Life Scheme. The schemes focus on agreed practises to support people when they are terminally ill or who are at the end of their life. The main premise of this is to involve the resident and establish their needs and wishes Care Homes for Older People Page 13 of 31 Evidence: and to ensure these are met by the service. All care plans examined included residents wishes in the event of their death. There are policies and procedures for the handling and recording of medicines. Policies and protocols were seen in relation to covert medication administration, medication administration errors and the protocol to follow, medication leaving the home and guidelines for staff to follow when handling Cytoxic medications. Medication is stored in a locked medication room on each unit. Medication Administration Records were examined on each unit and staff were also observed administering medication at lunch time. The medication files included the identification signatures of staff with permission to administer medication. Each residents medication file included a photo card, and if they had any allergies. However the following issues were highlighted and discussed with the registered manager of the home. The controlled drugs register on the 03/08/09 only had one signature and therefore does not demonstrate that there was a witness to the administration of that controlled drug. The monitoring of temperature controlled drugs was not completed consistently on all three units. Medication administration records (MAR Chart) were not completed in full. A number of entries were missing on the records throughout the charts on all three units. The above issues were discussed with the registered manager who admitted the gaps in their medication practises. A requirement will be made in relation to these findings. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 12, 13, 14, 15. There is a varied programme of activities available at the home. There is a wide choice of meals in the home, to ensure they meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. Evidence: The home employs a full time activities co-ordnitor who is responsible for organising indoor activities and entertainment within the home. The activities co-ordinator has also completed a Bupa/Napa training programme which focuses on providing activities for the elderly frail and those with a diagnosis of dementia. On the day of the inspection residents were seen to be participating in a quiz during the morning of the inspection. Posters of forthcoming entertainment were also seen around the home and relatives were heard talking to the manager about the recent garden party that had taken place within the grounds of the home and informed the manager about how Care Homes for Older People Page 15 of 31 Evidence: much they had enjoyed it. Activities and social events are discussed with residents and relatives at regular meetings and views are further seeked through quality assurance surveys. There was also sufficient information on the organised activities displayed around the home, such as an Indian head massage, movement and exercise sessions and quizzes. The service also has a very appealing sensory garden, which residents go out into a daily basis and where they can have their tea. A garden party was recently organised for residents and relatives. A relative spoken to during the inspection informed Mum has settled in well and the staff are fine here. Mum is kept clean and the food is ever so good here. I cant fault the activities. I know the residents go on a few pub lunches here. The garden party was very good. We are very satisfied with the care here. There is a four weekly menu and a nite bite menu available from 6.30pm and 6.30am offering a variety of hot and cold snack throughout the night. The menu included a variety of fresh fruits and vegetables and a choice of two meals at lunch time and snacks throughout the day. On speaking to the chef, she was able to demonstrate her knowledge of those residents requiring special diets, for example diabetic and pureed diets. Residents and relatives spoken to spoke very highly of the meals provided at the home. The inspector joined residents for lunch on the Dorchester unit. Lunch was observed being served which looked and smelt appetising. There were condiments placed on each table and attention was given to dressing the tables with table clothes and table decorations. Residents were offered a choice of drinks. Members of staff were observed to be feeding some residents. However, it was very alarming to observe two residents being fed by one carer who was rushing both residents to eat. One resident was being spoon fed at such a fast pace that they began to cough. At this point the carer had stopped feeding the resident and the feeding was taken over by a nurse, who also hurriedly fed the resident. There was no verbal conversation with residents to explain what the carers were doing or that they were going to support the resident to have lunch. This is very poor practise, which is not person centred. The inspector then joined residents on the dementia unit and two residents were being supported to eat by two carers. However, one carer was called away, which left one carer to support two residents to eat.Therefore one to one care is not being provided at lunch times, which does not ensure all residents receive a person centred service. A relative spoken to further informed of her concerns at the way carers support her mother to eat. I have seen carers shovelling food into my mothers mouth. Not all the carers are the same and some carers are not that good. Therefore one to one care is not being provided at lunch times, which does not ensure all residents receive a person centred service. A require will be made in relation to these findings. Care Homes for Older People Page 16 of 31 Evidence: Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 16, 18. People who use the service can be assured their views are listened to and acted on. All complaints are recorded, including concerns to ensure any dissatisfaction is acted upon regardless of source. All staff have received up to date training in safeguarding adults, which ensures the protection of residents. Evidence: The ethos of the home is that it welcomes complaints and suggestions about the service, uses them positively and learns from them. The complaints procedure is clear and easy to follow and was displayed in the home. Timescales within which a complaint would be investigated were stated on the complaints procedure. A complaints logbook is kept by the home, which was viewed. Complaints logged had been investigated robustly and actioned accordingly. All complaints received by the home are logged on a centralised computer system which is also monitored by the regional management team of Bupa. The home also holds regular residents and relatives meetings and records seen demonstrated that all concerns raised by residents were listened to. Care Homes for Older People Page 18 of 31 Evidence: All staff attend POVA training and safeguarding adult protection is comprehensively covered in the induction and training programme. The service has comprehensive safeguarding adults procedures and protocols in place. The service has obtained safeguarding adult protection procedures devised by The London Borough of Havering. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 19, 20, 21, 22, 23, 24, 25, 26. Residents do not live in a comfortable environment and the decor of the homes does not enhance residents comfort. Evidence: Hornchurch Nursing Home has three floors; each has a lounge, dining room and kitchen area and adequate numbers of bathrooms and toilets. During a tour of the building it was identified that the environment of the home does not meet the specialist needs of people with dementia. There is some historical pictures of The London Borough Havering on the dementia unit but there is no interactive art displayed on the walls. There was some signage and decor however, this was not adequate to the needs of residents living with dementia and this needs to be developed further. Toilets had some signage and the doors had been painted a different colour. However, this had not been continued through to en suite facilities to aid identification. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The home is registered to Care Homes for Older People Page 20 of 31 Evidence: accommodate people with dementia. Therefore the general environment on the dementia unit must reflect good practise guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of this unit to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. More pictures and items of interest must be provided in the corridors, lounges and dining rooms. These can be used as points of discussion/ interaction with residents living with dementia. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above, if implemented, can help to support people living with dementia, and help to maximise independence and minimise confusion. The main kitchen is situated on the ground floor, which was inspected. The kitchen was clean and was equipped with suitable cooking appliances and kitchen equipment. There was a wide range of fruit and vegetables and meats with food being correctly labelled with date of opening. Fridge, freezer and food temperatures were taken consistently. The general decor around the home requires an urgent decoration programme. Carpets throughout the home need replacing, as they were badly stained in some parts or were very worn out due to wear and tear. Some residents rooms also smelt of urine. We were informed by the registered manager that they have carpets in these rooms washed on a daily basis, but unfortunately they are unable to get rid of the smell. The decor of the home is very dated and furnishings, such as curtains in residents bedrooms and in communal areas need replacing, as they contribute to the dark and dull environment throughout the home. The communal bathrooms throughout the home need urgent attention and need to be decorated. There were tiles falling off the walls and paint was also flaking off. The decoration reflects the convenience of the provider rather than the people using the service. We were informed that the home does not have a re-decoration programme in place and they are not a home that is priority. The Care Quality Commission is very concerned at the current state of environment at the home and the above concerns have been passed to the Care Qualitys National Providers Relationship Team who hold regular business meetings with the larger scale and or more prominent corporate providers of independent health and social care such as BUPA, as an issue of concern. The Care Quality Commission would like see an investment programme which is part Care Homes for Older People Page 21 of 31 Evidence: of the homes business plan to include an urgent re-decoration programme. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing At this inspection we looked standards 27, 28, 29, 30. Recruitment practises are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. There is good skill mix of staff to meet the needs of residents, however, staffing levels at peak times need to be reviewed, to ensure all residents needs are met. Staff are trained and competent to meet the needs of residents but this still could be improved further. Evidence: The company has recruitment policies and procedures in place. Staff files were inspected at random and found to be in good order with a checklist system in place. Interview records are held and gaps in employment discussed. These were available for inspection. All the required documentation was seen to be in place along with Criminal Record Bureau /POVA checks. Care Homes for Older People Page 23 of 31 Evidence: The home is on three floors and 1 nurses and 3 care staff are provided during the day on each floor and 2 nurses and 4 care staff during the night. In addition to this the deputy manager and manager are also on duty. The home uses its internal bank staff when required. As already discussed under the outcome of daily life and social activities, staffing levels were not sufficient in meeting the needs of residents at busy peak meal times. One relative said I feel Bupa dont give the home enough staff. There should be more staff as carers are always rushing around. A requirement will be made to ensure that service reviews its staffing levels, to ensure the needs of residents are met. The home has a staff-training programme in place and a training matrix, which provides records evidencing that training provided to all staff at the home. Records show that there is a good level of compliance with statutory training, with staff being provided with training in manual handling, health and safety, COSHH, first aid and fire safety. It is disappointing to note that in -depth dementia training has not been provided to staff. Gaps have also been highlighted in the provision of person centred care which were evident through some staff practises observed at lunch time. Serious short falls in medication recording were identified at the home inspection. The registered manager is aware of this informed of the new medication administration training programme for all staff to attend in the coming months. A news brief to the home regarding the training was also seen. However, it is recommended that all staff under go further training in person centred care and dementia training, to ensure residents receive an individualised service, tailored to meet their needs. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 31, 33, 35, 36, 38. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. The systems for service user consultation ensure the home is run in the best interests of residents. Residents finances are safeguarded by the home. The welfare of staff and residents is promoted by the homes policies and procedures. Staff are supervised at least six times year to ensure they are equipped with the skills and knowledge to meet the needs of people who use the service. Care Homes for Older People Page 25 of 31 Evidence: The registered manager is a qualified nurse and has the qualities and experience necessary to manage the home. The manager is commended for her organisational skills as all documentation required for inspection purposes was easily accessible. The manger also demonstrates through her formal qualifications, robust operational systems and her professional experience and ability that she is knowledgeable and highly competent in a range of areas, which included good practise areas, understanding current legislation, and the importance and purpose of having effective quality assurance systems in place. Quality assurance systems have been developed and surveys for people who use the service have been devised. The results of surveys are analysed and incorporated into a report format and subsequently the manager implements an action plan, to action any dissatisfactions with the service. Residents records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. The latest supervision records were viewed for all staff. A supervision programme is in place and staff files evidenced that staff members are supervised formally on a regular basis (at least six times a year). This ensures that staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. The home works to clear health and safety policy. Health and Safety records were inspected. All documentation was in order and appropriately completed. Certificates viewed included certificates verifying up to date portable appliance testing, electrical installation, gas safety, employers liability insurance and records of fire drills and fire alarm testing and water temperature testing. Regulation 26 visit reports were examined during the inspection. These reports were completed monthly and were very comprehensive and also included action points where any areas for improvement had been identified and were reviewed to check for compliance. The accident and incident records were closely examined which evidenced that all accidents and incidents were comprehensively recorded and further follow up checks were also completed by the manager of the home to ensure residents did not have any further health associated risks posed to them. A completed Annual Quality Assurance Assessment was received before the inspection Care Homes for Older People Page 26 of 31 Evidence: and was supported by a wide range of evidence. It informed of the changes the service has made and where they still need to make improvements. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 13 The Registered Persons 30/09/2009 must ensure that medication administration practises are reviewed throughout the home and monitor and reviews staffs understanding of the homes medication practises and protocols to ensure the safety of all residents. . 2 15 12 The Registered Persons must review its lunch time feeding support and staff practises, to ensure that care staff provide a person centred support and assistance which is not hurried and sensitive and meets the individual needs of the person. . 30/09/2009 3 19 12 The Registered Persons must urgently review the state of the current 30/09/2009 Care Homes for Older People Page 29 of 31 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 environment and implement an investment programme which is part of the homes business plan to include an urgent re-decoration programme. . 4 27 18 The Registered Persons must review staffing levels throughout the home, particularly at busy peak times, to ensure that staffing levels are sufficient to meet the needs of all residents. . 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 30/09/2009 1 28 It is recommended that all staff under go further training in person centred care and dementia training, to ensure residents receive an individualised service, tailored to meet their needs. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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