Care Home: Lansdowne Road 75-77

What the care home does well The people who live in the home said they liked living there and that they liked the staff. The expert by experience commented very positively on the care offered at the home. Comments included: `I definitely observed service users being treated with the greatest respect.` `From what I observed the carers were doing an excellent job in looking after each person within the restrictions of their capabilities and the home`s facilities.` `I observed excellent caring and extreme kindness from the carers which ensures they will be getting everything they need.` `There were four carers on that shift and all of them were really good at interacting with the service users.` People were able to see medical professionals when necessary ensuring they stayed well. People were able to visit the home before they moved in to see if they liked it. People were happy with the meals served. Staff knew what they liked which meant people got the food they liked. People were able to do the things they liked doing. Some people are able to go out on their own which helps them retain their independence. People were able to keep in touch with people that are important to them. Equipment in the home is well maintained ensuring it works when needed and is safe to use. What has improved since the last inspection? Risk assessments had been improved and were more robust ensuring people were safe. People were being supported appropriately at all meal times ensuring they got the nutrition they needed. There had been further improvements in the environment enhancing the comfort of the people living in the home and the facilities available to them. Staff were having regular meetings so they knew how to support the people living in the home. What the care home could do better: The home should be able to show that peoples` needs have been assessed before they were admitted to the home and how the decision was made that staff could meet their needs. Robust manual handling guidelines must be in place to ensure people are moved safely. Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. CCTV cameras should only be used to enhance the security of the people living in the home. Equipment should be made available so that weights can be checked regularly to ensure people are well and do not have any health needs that are not being met. Activity records should state the activities provided by the home that people enjoy. Chairs should be replaced where necessary so that people are comfortable. Induction training for new staff should be improved to ensure they have all the necessary skills and knowledge to care for the people living in the home. Information must be available to show staff have been checked to ensure they are safe to work with the people living in the home. Fire drills should take place more regularly so that staff know how to keep people safe. The home must have a registered manager so that the people living in the home can be assured the home is being run in their best interests. Key inspection report Care homes for older people Name: Address: Lansdowne Road, 75-77 Lansdowne Road, 75-77 Handsworth Birmingham West Midlands B21 9AU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 1 2 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 35 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 35 Information about the care home Name of care home: Address: Lansdowne Road, 75-77 Lansdowne Road, 75-77 Handsworth Birmingham West Midlands B21 9AU 01215542738 F/P01215542738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Delores Matadeen care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability or Dementia (MD) 14 Date of last inspection Brief description of the care home 75-77 Lansdowne Road is situated in a popular residential area of Birmingham. It benefits from being close to local amenities including public transport, shops, health services and places of worship. The community is a rich mix of cultures, faiths and nationalities. The home was originally two houses. They have been thoughtfully converted into one large home. The home provides a service for older people with an enduring mental illness, nursing is not a service provided at the home. Care Homes for Older People Page 4 of 35 Over 65 0 14 1 3 1 0 2 0 0 8 Brief description of the care home The home has three floors and there are bedrooms and bathrooms on all three levels. There are both single and shared rooms. No bedrooms have en-suite facilities. A passenger lift enables access to all floors. On the ground floor are a communal lounge and a large dining room. At the rear of the property is a garden and paved area. The home has a large kitchen. Main meal meals are prepared at another home in the company and delivered to the home. The home has a laundry and can undertake most routine washing of clothes and bedding of the people living there. The service users guide did not state the scale of current charges for the home. The last inspection report is available in the home for the people living there and visitors who wish to read it. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one and half days by one inspector. The home did not know we were going to visit. An expert by experience came with us on the inspection. Experts by experience are people who are or have used services we are inspecting. This experience makes them experts. Their role is to bring a different and independent view to the inspection process by working alongside inspectors observing and gaining the views of people who use the service. Comments from the expert by experience are included throughout the report. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 35 Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, the acting manager, owner and three staff to get their views on the home. We sent seven Have your Say surveys to people who live in the home and six to staff members. A total of eight were returned, four from people living in and four from staff. These views have been included in the report. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Risk assessments had been improved and were more robust ensuring people were safe. People were being supported appropriately at all meal times ensuring they got the nutrition they needed. There had been further improvements in the environment enhancing the comfort of the people living in the home and the facilities available to them. Staff were having regular meetings so they knew how to support the people living in the home. Care Homes for Older People Page 8 of 35 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need about the home to help them make a choice as to whether or not their needs can be met there. Arrangements are in place to ensure people can be confident their needs their needs can be met at the home but it could not be shown these were consistently implemented. Evidence: There was a statement of purpose and service user guide for the home and both were on display. The documents had recently been updated and included the majority of information people would need to help them decide if the home was suitable for them. It would be useful if the service user guide included the range of fees charged at the home so that people knew what the costs might be. The statement of purpose included some pictures which made the document more interesting and easier to understand. Both documents were available in large print so that they were accessible to people with visual impairments. Care Homes for Older People Page 11 of 35 Evidence: The pre admission procedure was looked at for two of the people living in the home who had been admitted since the last key inspection. The file for one individual included a copy of an assessment undertaken by the staff at the home. The assessment was dated the day the individual had been admitted to the home. We were told by staff that this was a mistake and that the assessment took place during a pre admission visit to the home. The person concerned could not remember if they had visited the home before admission however a relative was spoken with and they confirmed a pre admission visit had taken place. The assessment covered all the areas of the persons life including personal care, communication, mobility and social interests. It did indicate some of the persons abilities and preferences and what the individual would need help with. As long as this information was available for staff before admission it would ensure they were aware of the needs of the person. The file for the other person did not include any evidence of a pre admission assessment however a staff member told us it had been done as she had completed it. The person concerned was not able to confirm this. Staff told us the document may have been removed as it was now some months old. Both files included copies of care plans drawn up by social workers who had been involved in the admission process. However there were no copies of the social work assessments available and when asked the acting manager did not recall ever seeing these. Copies of these should be obtained so that the staff at the home have as much information as possible about the people being admitted to the home so that they can be sure they can meet peoples needs. It was noted that the diagnosis on one of the social workers care plans was dementia. The home is not registered to admit people with dementia and as there was no pre admission documentation available it could not be determined how the decision had been made that the staff at the home could meet this individuals needs. We were told that the proprietor takes responsibility for who is admitted to the home. She was not available at the time of the inspection therefore a letter was sent asking for further information in relation to this individual. The person with dementia had settled well and staff were able to tell us what his needs were and how they were to be met. They also told us they had received some training in caring for people with dementia. The home does not provide intermediate care. Therefore the standard relating to this was not assessed. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of detail in the homes recording systems means that there is a risk that people will not consistently get the care they need in a way they prefer. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. We looked at two peoples care files in detail and partly reviewed another. Care plans did include a brief overview of the person which gave some detail of the individual and why they had been admitted to the home. Some areas of the care plans included some very good detail about peoples needs, their preferences, abilities, likes and dislikes. Areas covered included personal care, communication, mobility, mental health and social needs. The care plans included details of peoples cultural needs in relation to their diets, hair and skin care. Staff were able to tell us about these needs and how they were met by Care Homes for Older People Page 13 of 35 Evidence: applying oils to peoples hair,ensuring they had appropriate foods and so on. One of the care plans could have included more detail of how the person liked their hair. It was styled in a very specific way and one staff member told us she was the one who usually did this and also dyed the persons hair. Other people needed this information in case this staff member was not available to ensure this persons needs were met on an ongoing basis. There were some good details of how staff were to communicate with people particularly when people were unwell due to their mental health. Staff spoken with were able to tell us about this. Which showed people were managed consistently and in their best interests. There were some key worker reports on the files sampled which were a way of establishing how effective the care plans were. We were told these should be completed monthly this was not being done. Those seen had not been done for several months. If these were done any discrepancies in the care plans or changes in needs could be addressed quickly. The care plans in place had been updated quite recently but not all of them reflected the current needs of the people living in the home. For example, one care plan stated the person should have small amounts of food given him at a time as he was a very slow eater. Our observations indicated this was not being done. This person did not seem to be eating particularly slowly and staff told us this was not the case and he did not need to have small amounts. This care plan needed to be updated to reflect the current needs of this person to ensure his needs were met in a way that suited him. At the time of the last inspection an issue was raised about the people living in the home being weighed regularly particularly when they had lost weight and were at risk. Records indicated people were being weighed every two to three months. There were no indications on the records seen that people were losing any significant amounts of weight and the acting manager stated no one was causing any concerns. However the care plans in place stated that people should be weighed monthly. If this was not felt to be necessary they should be amended accordingly or they should be followed to ensure the well being of the people living in the home. As at the last inspection the acting manager stated that some people found it difficult to stand on the scales so they had asked for scales to be provided that people could sit on. At the time of the last inspection the owner of the home had said these were available at another home she owned but were not needed there and would be provided. This had not happened and we were told staff had to ring the other home to have the scales delivered and this was not always carried out. Care Homes for Older People Page 14 of 35 Evidence: We were told one of the people living in the home was physically very frail and that he was hoisted into a wheelchair for all transfers. This was observed to happen throughout the course of the inspection and staff were well aware of how to carry out the transfers. However there was nothing detailed in this persons care plan or manual handling risk assessment about the use of the equipment. This could mean this person may be at risk of being moved inappropriately particularly if newer staff were on duty. The systems in place for completing risk assessments had improved since the last inspection and those seen were quite robust. Risk management plans were in place for such things as falls, fire evacuation, prevention of pressure sores and managing challenging behaviours. Staff spoken with were able to tell us how they managed peoples challenging behaviours and how they reduced the risks of people having falls etc. This showed people were not exposed to unnecessary risks. Records sampled showed that where appropriate health professionals were involved in the care of individuals to meet their health needs. People had regular check ups with the dentist, optician and where needed the chiropodist to keep them well. The expert by experience was concerned that the vast majority of the people living in the homewere not wearing dentures. Records did indicate people had seen the dentist and dentures obtained where necessary. The manager stated that many did not like wearing their dentures. At the front of each persons Medication Administration Record (MAR) there was a photograph of the person so that unfamiliar staff would know who to give the medication to. Copies of prescriptions were kept so that staff could cross reference to these. Records sampled showed that medication had been given as prescribed to ensure that individuals health needs are met. Some relatively minor issues were raised with the acting manager. The guidance for staff in relation to when to administer when required medication needed to be more robust and also needed to be in place for medication with variable doses. This would ensure staff administered when required medication only as necessary ensuring the well being of the people living in the home. It was also noted that staff had signed to say they had administered medication to one individual on 4 occasions this had then been crossed out. The acting manager stated the person was no longer having this medication and there was none available so it could not have been given. The MAR chart needed to indicate this was not being administered and staff should be checking what they are administering before completing the MAR chart to ensure people are receiving the correct medication. We were told only staff that had received the appropriate training administered medication. Care Homes for Older People Page 15 of 35 Evidence: All the people living there were dressed appropriately to their age, gender, cultural background and the weather. Staff were seen to speak to people very respectfully. There was screening in double bedrooms so people could have privacy if they wished. Some people had keys for their bedrooms to enhance their privacy. A visitor to the home told us if he wanted some private time with his relative they went to the individuals bedroom and this was respected by staff and they were not disturbed. The expert by experience stated in relation to dignity and respect, I definitely observed service users being treated with the greatest respect. The elderly gentleman who had to have his clothes changed was spoken to very kindly. Seeing the cat curled up on a service users bed shows real regard for an old mans attachment to his pet. The acknowledgement and accommodation of the different faiths practised within the group of service users. Plus the encouragement showed to the man who played piano so beautifully even though he was so ill. CCTV cameras had been installed in the home since the last inspection. The cameras for this were located in the communal areas of the home which significantly impinged on the privacy and dignity of the people living in the home. The owner of the home was not available at the time and the acting manager could not clarify why these had been installed. A letter was sent to the owner of the home asking why these had been installed as the Care Quality Commission see this as a gross invasion of peoples privacy and rights. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there do things that they enjoy and want to do to help them to lead fulfilling lifestyles. People are offered a healthy and varied diet so they can keep well. Evidence: The AQAA stated the home has a comprehensive activity plan which is discussed in service users meetings, a program of events is displayed on the service users notice board no activity plan was seen and there was no progamme of events on the notice board. Records showed that there had been some discussion in meetings about people going out but there had been no follow up to this. Staff told us there had been no outings this year due to the poor weather. The expert by experience commented: When I asked the service users about outings, two of them told me that they used to have trips out but not lately. I checked with a carer and she said they hadnt done much as the weather had been so bad this year. One of the service users was out for the day, and it was confirmed that he was the only one who went out, the others were not able to manage on their own. Care Homes for Older People Page 17 of 35 Evidence: The information we were given differed slightly from this we were told that three people were able to go out independently. Two people only went to the local shops and one was seen to do this during the day. Another person went further afield and he told us he went out every day but came back for his lunch and he fetched the papers back for the home. Another person told us that she went out to church with friends and records seen supported this. Staff told us people were taken to the park and the local shops but there was no evidence seen to support this and the people living in the home could not confirm this. People who needed support to go out had less choice about what they did and this should be considered so that all the people living there have opportunities to do the things they want to do. Activity were seen over the two days. Staff were facilitating some ball games, an outside agency visited the home and facilitated an exercise session and a church service was held. People seemed to enjoy the activities that were offered. The expert by experience commented: Although there wasnt a lot of comfort in the home, I did observe an enormous amount of care. There were four carers on that shift and all of them were really good at interacting with the service users. Two carers were encouraging the group in the circle to catch balls and to engage in a game. They also had hand fed two of the residents. Many of the service users had physical problems as well as mental health problems and needed help to walk. The service user that could play the piano was encouraged to play by the carers and two other service users joined in with the singing. There was lots of clapping and encouragement to the music, it was lovely to see this. Activity records were being completed by staff on most days but these did not state who had taken part in the activity and mostly stated session went well. The records indicated that activities were quite repetitious. This does not show a variety of activities are offered by the home. Staff told us about other activities, for example, reading the paper to people, having discussions and so on but these were not always recorded. People spoken with told us and the expert by experience they were happy in the home. The expert by experience commented: He said he used to live in the same road as the home and had asked to come here as it was so good. He said he was really happy here and he had a niece and some friends who visit him. He also told me there was transport available for them to be taken to Care Homes for Older People Page 18 of 35 Evidence: the doctors and hospital visits. There was only one female living in the home. The expert by experience asked her if she minded being the only woman her report stated she said it was wonderful and she was very happy there. She told the expert she had regular visitors and that they could join in activities if they wished and that she joined in the church service. This person also told us she was very happy. We were told by staff and a visitor how much this person had improved since being at the home. She used to spend long periods of time in her room at her previous home. Here she had been encouraged to spend time with the other people in the home and was now spending much more time socialising which meant she had a much better quality of life. The expert by experience commented about this: I think this is a wonderful indication of the quality of care at the home, and with so many difficult conditions to deal with; the staff are doing an exceptional job. There did not appear to be any rigid rules or routines in the home. Records showed that people could have a lie in if they wished and stay up late. People were seen to come and go from the home where they were able and spend their time as they wished. The expert by experience commented about choice and control: It is very hard to judge if the service users in Lansdowne Road had the control they are entitled to. The range of difficulties seemed quite severe and their conditions meant that they have huge care needs, and from what I observed the carers were doing an excellent job in looking after each person within the restrictions of their capabilities and the homes facilities. Because of the limitation created by the range of physical and mental issues within this group of service users, I think it is impossible to expect them to have more control over their lifestyle within the home. I observed excellent caring and extreme kindness from the carers which ensures they will be getting everything they need. Records showed and people told us they were able to keep in touch with people that were important to them. We spoke with a visitor to the home and he was very happy with the service being provided and told us he was always made welcome at the home. The main meal of the day was served at lunch time and cooked at another home operated by the owner and transported to the home. Meals were observed to be well presented and of adequate portions. Food records showed that people had quite a Care Homes for Older People Page 19 of 35 Evidence: varied and nutritious diet and that cultural diets were being catered for. Records did not always detail what sweets had been given. This needed to be included so that it could be determined diabetic diets were being catered for and that people received a variety of sweets. The expert by experience commented about meals: I asked to see a menu, and this seemed to cause a bit of a stir. After consulting each other a carer came and told me that they dont have menus as they dont prepare the food in the kitchen at this home. In fact, it is cooked at another home that belongs to the same owner of Lansdowne Rd. I saw a carer in the kitchen preparing vegetables so I asked what she was cooking and she explained that although the meals were all cooked off site, they always made extra vegetables and gravy on site to supplement the meals. I asked how they made sure that service users had a choice of menu, and the carer said that they went around to each service user checking what they wanted and telephoned the choices over. I wasnt convinced by this as I could see that so many residents did not have capacity to be able to choose, or even voice their preferences. People were observed to have a variety of meals, for example, some had boiled potatoes, others roast others rice. Some people had mince others had chicken. Staff were available to give assistance where needed but people were encouraged to eat independently as much as possible. Care plans detailed what peoples likes, dislikes and preferences were in relation to their diets. Staff were aware of these and were able to tell us about them, for example who liked West Indian food and what were there preferred dishes. Records showed that people did get the foods they liked. Staff were seen to ask what drinks people wanted, they knew that one person preferred drinking chocolate. It was pleasing to note that people were offered fresh fruit with their mid morning drinks which they all seemed to enjoy and which helped ensure their nutritional needs were met. Care Homes for Older People Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the people living there can be confident that their complaints will be listened to and acted on. The systems for staff recruitment did not consistently ensure that people were safeguarded from harm. Evidence: The complaints procedure had been updated with our current details and clearly told people how they could make a complaint. The procedure was included in the service user guide which was available in the home. So people had access to the information. Forms for people to raise a complaint, if they wished to put it in writing, were readily available in the home by the signing in book. We received four completed surveys from the people living in the home. They all indicated they knew who to speak to if they were unhappy with something and that the staff listened to them and acted on what they said. However two of the surveys indicated people did not know how to make a formal complaint. It may be useful to speak to people individually about this procedure to ensure it has been reinforced. We spoke to one visitor who told us if his relative was unhappy with anything she would tell him. He said he would tell staff about this and felt sure they would deal with any issues appropriately. The minutes for the meetings held with the people living in the home showed that people were asked to raise any concerns they may have so that staff can look into them. People were very comfortable in the presence of the staff which would give them the confidence to raise any concerns. Care Homes for Older People Page 21 of 35 Evidence: It would be difficult for some of the people living in the home to raise their concerns due to their illnesses. Staff told us they would know if people were unhappy by their facial expressions and their reactions to staff. One staff member told us they had been given some guidance on this in the training they had received for dementia care. This meant staff would be able to react appropriately to address any concerns. The complaints folder at the home was seen. No complaints had been raised with the home and none had been raised with us since the last inspection. An incident had been recorded in the complaints folder which was a safeguarding issue. We had been notified about this and it had been reported to the appropriate people ensuring it was managed in the best interests of the individual concerned. The training matrix indicated staff had received training in safeguarding adults from abuse. Staff spoken with were very clear of what the indicators of abuse may be and what they must do should they suspect or witness any abuse in the home. The training matrix also indicated that the staff team had attended awareness training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. This training should ensure staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. Staff recruitment procedures were not always ensuring the appropriate staff were being employed at the home and that people were being safeguarded. Further details in relation to this are given in the staffing section of this report. Care Homes for Older People Page 22 of 35 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. Improvements are continuing to ensure that people live in a safe, homely, comfortable and clean environment. Evidence: The AQAA stated there had been an ongoing refurbishment plan for the environment since 2007. There had considerable investment in the home to make it more comfortable and enhance the facilities for the people living there. The expert by experience found the home quite basic in terms of the accommodation her report included: On entry, I noticed that the building was quite run down and in need of decoration but it didnt smell bad and was warm and clean in the rooms where the residents were sitting - i.e. the dining room and lounge. The bedrooms are all quite bleak with the minimum of furniture and lino on the floors. The rooms were not very clean. But the carer showing me around explained, that the cleaner hadnt cleaned the rooms yet as she had only just started her shift. Every room was immaculately tidy without clothes strewn around. Some had family photographs on display. Care Homes for Older People Page 23 of 35 Evidence: The bedrooms are on the second and third floors with a lift in good working order to go up and down to the ground floor where the lounge, dining room, kitchen and staff rooms are. The windows to the rooms were new, and where they were open, they had safety locks so that they couldnt open too wide and become a risk. There was a cat on one of the beds and the carer explained that the service user in that room was allowed to keep his cat. One of the bathrooms on the top floor is out of use as it had a broken shower, but the other bathrooms are well fitted. Outside, there is a small garden with a new garden shed which is used as a smoking room. There is a pile of plastic garden chairs in the shed for the service users to sit in, or take into the garden when the weather is good. Improvements that had been made in the home included new boilers being fitted, windows had all been replaced with double glazing, some of the bathrooms and shower rooms had been refurbished to make them more accessible for people with mobility difficulties and to allow room for staff assistance. We checked some of the water temperatures to ensure they were at an acceptable level. The water in one of the ground floor shower rooms was excessively high and people could have been scalded by this. The acting manager locked this room off on the first day of the inspection. We were told on the second day of the inspection that a plumber had been and the fault could not be rectified so the shower had been disconnected until a new one was purchased ensuring people were safe. There had been a considerable amount of redecoration and the areas seen were clean and bright. New chairs had been purchased for the lounge however it was noted that the dining room chairs were looking very worn and the vinyl covering was splitting on several of them. This could lead to food debris and liquids penetrating the chairs which is not conducive to good infection control. Also some of the bedroom chairs were looking very worn and needed replacing. These should be replaced to ensure they are kept to an acceptable standard for the people living in the home. As mentioned earlier in this report CCTV had been installed in the home with cameras in the communal areas which significantly impinged on the privacy and dignity of the people living in the home. These should only be used for security purposes. Bedrooms seen were personalised according to individual tastes and interests. People Care Homes for Older People Page 24 of 35 Evidence: said that they could have their personal possessions in their bedrooms. People were able to have keys for their bedrooms if they wished. We were told at least five people had their own keys so that they could lock their doors if they wanted and have their privacy. The kitchen had been refurbished since the last key inspection. We were told at the last inspection that a dishwasher was to be provided as part of the refurbishment which staff said would improve the hygiene standards. This had not been installed and staff were still having to do all the washing up by hand. Having a dish washer would not only improve the hygiene standards but would also reduce the work load for staff. The home was generally clean and there were no offensive odours making it a nice place to live. A housekeeper is employed who does most of the cleaning. The laundry has been refurbished and industrial washing and drying machines provided. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were being cared for by a stable staff team that could meet their needs. Recruitment procedures were not robust and put people at risk of harm. Evidence: The AQAA indicated there had been little staff turnover at the home and many of the staff told us they had worked at the home for a number of years. This is very good for the continuity of care of the people living in the home. We observed some very positive interactions between the staff and the people living in the home. People spoke highly of the staff team describing them as friendly and helpful. The expert by experience commented: I did observe an enormous amount of care. There were four carers on that shift and all of them were really good at interacting with the service users. The rotas for the home indicated there was a minimum of three staff on duty throughout the day. Observations made indicated this was adequate to meet the needs of the people living in the home. More staff are provided at lunch time so that people have assistance with their meals if needed. Staff spoken with indicated the staffing levels in the home were sufficient. Care Homes for Older People Page 26 of 35 Evidence: Staff were able to tell us what the needs of the people living in the home were and how they liked their care needs met. This ensured people received their care in a way they liked. Staff meetings that involve all staff had been introduced since the last key inspection. This provided an opportunity for staff to keep updated with changes to peoples needs, changes in care practices and to ask questions about these. The AQAA and the training matrix stated that all staff have achieved National Vocational Qualification in Care at level 2. Some senior staff have achieved level 3 or 4. This ensures that staff have the skills and knowledge to meet the needs of the people living there. Staff spoken with were satisfied with their ongoing training and were able to tell us what training updates they had undertaken recently. One person stated: The home has provided support through learning and seminars i.e. we are sent on courses. It gives us an understanding on the role we are allocated to and helps us boost our confidence in performing our duties well. The training matrix indicated staff had undertaken training in topics such as, manual handling, food hygiene, first aid, dementia care, safeguarding, health and safety and infection control. This ensured staff had received training in how to meet the needs of the people living there and how to ensure their safety and well being. When staff had first started working at the home they had completed an induction but the records seen for this indicated it was just one day and comprised of a very brief tick list. Staff starting work at the home should undertake induction in line with the specifications laid down by Skills for Care to ensure they know how to support the people living in the home. On the first day of the inspection we asked to see the recruitment records for two staff that had been employed at the home since the last key inspection. After a telephone conversation with the owner of the home, who unavailable at the time, we were informed these would be available on the second day of the inspection. We were given some records on the second day but these were incomplete in particular for one staff member. All that we were given for this person was a folder with an application form and a copy of a passport. There was no evidence that any references had been obtained or that a Protection of Vulnerable Adults or a Criminal Records Bureau check had been undertaken. These checks need to be completed to ensure staff are safe to work with the people living in the home. Care Homes for Older People Page 27 of 35 Evidence: Also during the second day of the inspection we were given an e-mail that had been sent by the owner of the home. This stated that the staff member concerned was employed as office staff. However this person was quite clearly on the staff rotas for Lansdowne Road as care one shift a week. The manager confirmed that she had worked these shifts. We have written to the owner of the home asking for evidence that this staff member has been checked appropriately to ensure she is safe to work with the people living in the home. The acting manager was advised to take this person off the rota until it was clarified that all the appropriate checks had been undertaken. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of people as people are not always protected from harm. Evidence: There has not been a registered manager at the home for several years. The owner has been overseeing the home and senior staff have been managing the home on a day to day basis. One of the senior staff is the acting manager and told us she is planning to apply to be registered with us. However we were told this at the last inspection. It is important that the individual applies to be registered to ensure that the home is managed in a way that benefits the people living there and that regular management support is available for staff. We will be formally writing to the owner of the home about her plans for the management of the home. The main issue raised at this inspection was the poor recruitment procedures which do not always safeguard the people living in the home. Care Homes for Older People Page 29 of 35 Evidence: The AQAA stated managers and senior staff are familiar with our quality assurance system. Internal auditing and self-evaluation methods used to provide evidence of achievement and areas which require improvement. Records showed that there were some internal audits undertaken in the home to ensure that home was safe and met the needs of the people living there. The home also send out satisfaction surveys to interested parties as part of their quality assurance system. The responses on the most recent of these were sampled and found to be very positive about the service. When asked the acting manager was unsure if the home has a development plan as a result of internal audits and the findings of the surveys. A development plan is needed to ensure the home is continually improved for the benefit of the people living there. Records showed that there meetings held with the people living in the home. Topics discussed included trips out, meals, peoples opinions of the care they receiving. people were asked for any concerns however it was difficult to know if issues were followed as the meeting minutes did not give any feed back at the next meeting. For example,someone asked for television in the lounge to be moved. The acting manager said this was not done due to the layout of the lounge and strength of the walls however there was nothing in the records to show the person had been told this. The home was managing some money on behalf of some of the people living there. The records for this were sampled and showed that people were safeguarded by the procedure. All income and expenditure was detailed with receipts obtained for all expenditure. All the balances checked agreed with the records being kept. Some of the people living in the home continued to manage their own finances helping them maintain their independence. Health and safety were generally well managed in the home. The home was generally well maintained and staff had received training in safe working practices. The only issue raised in the environment was the water temperature at one of the showers. This was addressed very quickly. The AQAA told us that the equipment in the home is regularly serviced. Some of the records for this were sampled and agreed with the AQAA. The in house checks on the fire system were sampled and were mostly up to date. However it was noted that the last recorded fire drill was in June 2008. These should take place every six months to ensure staff are familiar of what to do in the event of a fire and are able to keep the people living in the home safe. Care Homes for Older People Page 30 of 35 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 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Manual handling risk assessments must clearly detail any manual handling needs of the people living in the home and any equipment to be used. This will ensure people are not at risk of injury due to inappropriate handling. 30/11/2009 2 9 13 Medication records must 30/11/2009 accurately reflect when people are to have their medication administered and when it has been administered. This will show people are receiving their medicines as prescribed. 3 10 12 CCTV cameras must only be in place for security reasons and not in communal areas. 31/12/2009 Care Homes for Older People Page 32 of 35 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 This will ensure they do not impinge on the privacy and dignity of the people living in the home. 4 18 19 Robust staff recruitment procedures must be in place and followed at all times. This will ensure people are protected from harm. 5 20 13 Any worn chairs in the home 31/12/2009 should be replaced. This will ensure furniture is kept to an acceptable standard and that people are comfortable. 6 31 9 An application for the registration of a manager must be forwarded to the Commission. This will assure the people living in the home that someone has responsibility for the day to day management of the home. 7 38 23 Fire drills must be undertaken twice yearly. This will ensure staff can keep the people living in the home safe. 30/11/2009 31/12/2009 31/10/2009 Care Homes for Older People Page 33 of 35 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 Copies of the assessments undertaken by the social workers should be obtained so the home have as much information as possible to help them when meeting the needs of people being admitted. Evidence should be available that peoples needs have been assessed prior to admission to the home and how the decision has been made that staff can meet the identified needs. Care plans should be regualrly reviewed so that they reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Appropriate equipment should be made available so that people can be weighed as necessary so that weight loss can be monitored as this can indicate an underlying health concern. Activity records should state the activities that are provided by the home so it is clear that a range of activities that people enjoy are provided. Consideration should be given to ensuring that people who cannot go out on their own have opportunities to do the things they enjoy. Records of food served to the people living in the home should include enough detail so that they show people have a varied and nutritious diet and any special diets are being catered for. People should be made aware of how to make a formal complaint. This will ensure they have this information if they need to use it. To further enhance the hygiene standards in the home a dish washer should be installed. New staff should have induction training in line with the specifications paid down by Skills for Care to ensure they have all the required skills and knowledge to care for the people living in the home. Records of meetings should show peoples views have been acted on. 2 3 3 7 4 8 5 12 6 12 7 15 8 16 9 10 26 30 11 33 Care Homes for Older People Page 34 of 35 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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