Care Home: Laurel Bank Nursing Home

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What the care home does well People told us the food is good, they said there is always a choice and alternatives are always available if they don`t like the meals on the menu. The home has been awarded a 4 star (5 is the highest) rating by Environment Health for its standards of food safety and hygiene. People`s need are assessed before they move in and they are given information about the service. This helps people to decide if the home will be the right place for them. People told us the staff on days are friendly and welcoming. What has improved since the last inspection? There were no requirements following the last inspection. Since the last inspection the service has moved to a new purpose built premises. The home is on 3 floors and all the accommodation is in single en-suite rooms. There are lounges and dining rooms on each floor which provides plenty of space for people to get to together. The home has an enclosed garden which means people have a safe outdoor area to use. When we visited it was being developed with raised flower beds to make it easier for people to do some gardening if they want to. What the care home could do better: The home is registered to provide nursing and personal care for up to 63 people; last year they changed their registration to include 20 places for people with dementia. The home is not required to have a separate unit for people with dementia. However, information we have received from a variety of sources indicates that providing dementia care in an integrated setting is having a negative impact on the experiences of people living in the home who do not have dementia. For example, people told us they feel less safe because people with dementia sometimes exhibit aggressive behaviour and because people wander into their bedrooms. They told us they are unable to enjoy all the facilities in the home in the way that they used to, for example, they can`t enjoy watching television in the communal rooms when people are noisy. The information we received also raises concerns about how the needs of people with dementia are being met. People have told us about occasions when they have visited the home and found people with dementia in a distressed state. For example, on one occasion a person was wandering around with their trousers down asking for help and on another occasion a person sitting in the lounge wearing only her underwear. More needs to be done to promote and protect people`s privacy and dignity. The care plans must be improved to provide accurate and up to date information about people`s personal, health and social care needs and the actions that staff should take to meet these needs. This will help to make sure that people`s needs are not overlooked. More needs to be done to develop a person centred approach to social care to make sure that everyone living in the home is given the support they need to make the most of their abilities and follow their personal interests. The numbers of staff on duty and the way staff are deployed must be reviewed to make sure there are enough staff at all times to meet people`s needs. Staff should receive more training and support to make sure they are able to meet people`s needs, particularly the needs of people with dementia. More needs to be done to develop and open and transparent approach to the running of the home. This will help people to feel confident that any concerns or suggestions they have will be taken seriously and acted on. Key inspection report Care homes for older people Name: Address: Laurel Bank Nursing Home Main Street Wilsden Bradford West Yorkshire BD15 0JH     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: Mary Bentley     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Laurel Bank Nursing Home Main Street Wilsden Bradford West Yorkshire BD15 0JH 01535274774 01535274035 laurelbanksnurs@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Victorguard Care plc Name of registered manager (if applicable) Miss Jennifer Teresa Clegg Type of registration: Number of places registered: care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 63 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, maximum number of places 63 Dementia Code DE, maximum number of places: 20 Date of last inspection Brief description of the care home In May 2009 the service moved to a new purpose built premises in the village of Wilsden. It is close to the Post Office, Garden Centre, Pharmacy, village hall and churches. It is on a bus route and there is ample parking for visitors cars. The Care Homes for Older People Page 4 of 32 Over 65 0 63 20 0 Brief description of the care home accommodation is all in single en-suite rooms over 3 floors. There are lounges and dining rooms on each floor. There is an enclosed garden at the side of the home. The home has 2 lifts providing easy access to all areas. In June 2010 the weekly fees ranged from GBP 444.67 to 629.89. Additional services such as hairdressing and chiropody are not included in the fees. For full details of the fees please contact the service. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The last key inspection of this service was carried out on 23 August 2007. We looked at the information we have received or asked for since the last key inspection and/or annual service review. This included The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are Care Homes for Older People Page 6 of 32 called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. What other people have told us about the service. Surveys from people using the service and/or from people with an interest in the service. A site visit carried out by one inspector. The visit was unannounced and we spent approximately 7 hours in the home. During that time we spoke to people about their experience of living at Laurel Bank and spoke to visitors, staff and management. We looked at various records including peoples care records, observed staff as they carried out their duties and looked around the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations but only when it is considered that people using services are not being put at significant risk of harm. In future if a requirement is repeated it is likely enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The home is registered to provide nursing and personal care for up to 63 people; last year they changed their registration to include 20 places for people with dementia. The home is not required to have a separate unit for people with dementia. However, information we have received from a variety of sources indicates that providing dementia care in an integrated setting is having a negative impact on the experiences of people living in the home who do not have dementia. For example, people told us they feel less safe because people with dementia sometimes exhibit aggressive behaviour and because people wander into their bedrooms. They told us they are unable to enjoy all the facilities in the home in the way that they used to, for example, they cant enjoy watching television in the communal rooms when people are noisy. The information we received also raises concerns about how the needs of people with dementia are being met. People have told us about occasions when they have visited the home and found people with dementia in a distressed state. For example, on one occasion a person was wandering around with their trousers down asking for help and on another occasion a person sitting in the lounge wearing only her underwear. More needs to be done to promote and protect peoples privacy and dignity. The care plans must be improved to provide accurate and up to date information about peoples personal, health and social care needs and the actions that staff should take to meet these needs. This will help to make sure that peoples needs are not overlooked. More needs to be done to develop a person centred approach to social care to make sure that everyone living in the home is given the support they need to make the most of their abilities and follow their personal interests. Care Homes for Older People Page 8 of 32 The numbers of staff on duty and the way staff are deployed must be reviewed to make sure there are enough staff at all times to meet peoples needs. Staff should receive more training and support to make sure they are able to meet peoples needs, particularly the needs of people with dementia. More needs to be done to develop and open and transparent approach to the running of the home. This will help people to feel confident that any concerns or suggestions they have will be taken seriously and acted on. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed and they are given information to help them decide if the home will be the right one for them. Evidence: The home told us peoples needs are assessed before they move in. People using the service told us they had visited the home and been given information about the service before making a decision about moving in. Staff told us they are given information about peoples needs before they move in. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans are not always up to date and this means peoples needs could be overlooked. People are not always treated with dignity and respect. Evidence: In their AQAA the home told us the care plans are person centred and reviewed monthly or sooner as needed. During the visit we looked at four peoples care records, two of them in detail. One persons care plan was up to date and had information about their personal, health and social care needs. There was evidence that the person was involved in developing their care plan. The second care plan belonged to a person with dementia. The care plan was not person centred and did not give clear information about the support required. For example, the care plan relating to hygiene said the person needs help to shave every day. There was nothing to say whether the person was able to meet their other personal care needs or what support staff should provide. The assessment showed that the person has hearing and visual needs but there was no care plan to tell staff what support they should provide. In another persons care plan we saw that Care Homes for Older People Page 12 of 32 Evidence: the care plan about eating and drinking had been written in 2004. It was reviewed every month but not changed to take account of changes in the persons condition. The nutritional risk assessment carried out in January 2010 showed the persons weight was 28.7 kg and identified a high risk of malnutrition. The care plan said the person could drink from a feeder cup with a straw. Staff told us this was no longer the case and the person needed their help to have thickened fluids from a spoon. There was nothing in place to monitor the persons dietary intake. In the records of another person identified as being nutritionally at risk there was a chart to record fluid intake but nothing to record dietary intake. Some staff were recording food intake on the fluid charts, others were not. On one occasion we saw that there was a gap of 17 hours between the person having their evening meal and their breakfast the next morning. However, because dietary intake is not being recorded consistently it is not possible to get a clear picture of what the person is eating and when. Some people told us they were happy with the care and support they or their relatives receive. Others raised concerns that there are not enough staff to give people the care and attention they need. People told us that when they ring for help staff come and turn off the buzzer (call bell) and sometimes dont come back for up to an hour. Other people said they cannot reach the call bells in the lounges and are sometimes forgotten by staff. One person who contacted us about the home said on a recent visit they had found one of the people who lives in the home wandering around with his trousers down asking people to help him pull them up but could find no member of staff to help. On another occasion they said a lady was sitting in the lounge wearing only her underwear and again there were no staff to help. Another person said that they have noticed when they visit that the buzzers ring for a long time. People who completed surveys said they did not think enough care was taken with peoples personal belongings. For example, one person said some of their relatives clothes and two pairs of glasses had disappeared despite being named. Another relative said that clothing is often faded and shrunken and clothes are lost, they said their relative had on occasions been wearing other peoples underwear despite the fact that all their own clothing is named. In November last year the home changed their registration to allow them to provide care for people with dementia. The home does not have a separate unit for people. We have received information from a variety of sources which indicates that people who do not have dementia find it distressing living with people who do. For example, they said some people with dementia are noisy and this makes it difficult to enjoy being in the communal rooms watching television or chatting. People told us they are frightened when people wander into their bedrooms. Care Homes for Older People Page 13 of 32 Evidence: During the visit we saw confidential information about peoples dietary needs displayed on a notice board in the dining room. The manager said she would remove it. We looked at the way peoples medicines are managed. In one persons records the medicine chart had a hand written note saying one of the tablets had been stopped but this was not dated. The chart was not signed to say any had been given but a check of the stock balance showed that 18 tablets had been dispensed. The manager said she would investigate this. We looked at how controlled drugs are managed and found they are stored correctly and properly accounted for. The home has a palliative care link nurse, she told us she has started to introduce advance care planning to make sure peoples wishes with regard to end of life care are recorded. This will help to make sure that people get the care they need and want at the end of their lives. Most staff have done training on palliative care. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given the opportunity to take part in a variety of activities however a more person centred approach to social care is needed to make sure everyone living in the home is given the right support to make the most of their abilities and follow their personal interests. Evidence: The home offers people the opportunity to take part in a variety of social activities. These include bingo, quizzes, knitting, reading and visiting entertainers. Following the visit the home sent us a list of recent activities that have taken place; these included a Christmas fayre, a clothes party, a puppet show, line dancers and a visit from the Rotary Club choir. The activities are mainly group activities and there is limited time to spend with people in one to one activities. A number of people who completed surveys commented on this. For example one person said staff spend time with their relative dealing with personal care needs but apart from that very seldom. Another person said staff spend one to one time with people on rare occasions they said most of the time people just sit around with no stimulation. Another person said staff rarely spend one to one time with people because they are too busy. Care Homes for Older People Page 15 of 32 Evidence: It is particularly important for staff to spend one to one time with people who have dementia as they often find it difficult to take part in group activities. During the visit we didnt see any evidence that adaptations have been made to provide an interesting or stimulating environment for people with dementia, for example there was no memorabilia to engage peoples interest. Following the inspection the home told us a display of war time memorabilia had just been removed to make way for a new display. They said they regularly change the displays. A second activities organiser has just been employed to provide more opportunities for people to take part in social events. Feedback from people varied, some people said there was enough to do if they wanted to get involved, others said the activities were not as good as they were in the old home. One person said they used to have outings but have not had any for some time. The information recorded about peoples past lives and social interests varied. There was information in one persons file but in the file of one person with dementia there was no information about their past live or interests. When people have dementia it is particularly important for staff to have information about their past lives, experiences and interests. This helps staff to engage people in conversation and appropriate activities and can help staff to understand peoples behaviour. The home told us they have an open visiting policy which means that people can have visitors at any times that suit them. Visitors confirmed that they are able to visit at any time. The home has a lounge which is designated as an activities area, there were a lot of photographs on display but they were mostly of events that had taken place in previous years, there was nothing recent. During the visit we observed the meal service at lunch time in one of the ground floor dining rooms. People were sitting at the tables for about 10 minutes before the food arrived, people said the food is often late. One person kept wandering away from the table and staff repeatedly told them to sit down until one of the nursing staff came in and said to leave them to wander until the food arrived. There were 20 people in the dining room and 4 staff. One of the staff was told to go for their break in the middle of the lunch service. Staff said they didnt think it was a good idea having their breaks at this time because it disrupted the meal service. This left 3 staff who had to help 3 people to eat as well as serving and helping the other people. One of the care staff who was helping someone to eat had to break off from helping the person 3 times to Care Homes for Older People Page 16 of 32 Evidence: go and do and attend to other people. At one stage another member of staff took over from her and stood while helping the person to eat. Two staff who were sitting next to each other while helping people to eat were having a conversation among themselves. Nursing staff came into the dining room during lunch to give out medicines, one briefly helped out but for the most part they did not get involved in organising or helping with the meal service. Most people said they enjoyed the food, they said they are offered a choice of meals and can have something different if they dont like what is on the menu. During the visit we saw people being asked what they wanted for lunch. The menus are not displayed so people dont know what is available until staff come to ask them. The manager said she had already talked to the chef about displaying the menus. Since the inspection the home have confirmed that the menus are displayed. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure however people using the service do not always feel confident that their concerns will be taken seriously and acted on. There are systems in place to protect people from harm. Evidence: The home has a complaints procedure and the manager told us the policy has just been updated. In their AQAA the home told us they have had 5 complaints in the last 12 months and 4 of them were dealt with within the 28 day timescale. Complaints are recorded. In the past 2 months we have received a number of concerns about the service. The people who contacted us said they wished to remain anonymous because of concerns about how the home would respond to their complaints. They told us that people living in the home have been told by the manager and owners that if they are not happy with the service they should find somewhere else to live. Some people said they found the management team defensive and unwilling to listen to and act on their concerns. The home has policies and procedures in place to protect people from abuse. Staff told us they have attended training on safeguarding (the protection of vulnerable adults) and are aware of how to report any concerns they might have. The training records showed that approximately half of the staff have received safeguarding training and Care Homes for Older People Page 18 of 32 Evidence: others are booked to attend training later this year. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant, comfortable and safe place for people to live. Evidence: The home moved to a new building in May 2009. The new home was purpose built and has 3 floors. All the accommodation is provided in single rooms with en-suite walk in showers. There are wide corridors which make it easier for people to move around. There are lounges and dining rooms on all 3 floors some of which are combined lounge/dining rooms. There are well equipped communal bathrooms and toilets throughout the home, they are spacious with plenty of room to manoeuvre mobility aids such as hoists. Some people told us that they cannot always reach the call bells in the lounges and this means that when they need help the have to wait for staff to come to the lounge. The said this can sometimes take a long time and it is no good shouting because the home is so big staff cant hear them. Staff told us they have all the equipment they need to meet peoples needs. The home has an enclosed garden which is currently being developed with raised flower beds so that people living in the home can do some gardening if they want to. Care Homes for Older People Page 20 of 32 Evidence: We saw that people are encouraged to bring some of their personal belongings to make their bedrooms feel more homely. Most people have their names on their bedroom doors and some people had photographs. The kitchen and laundry are well equipped. The kitchen has been awarded a 4 star rating by environmental health for its standards of food hygiene and safety. The manager told us she had arranged for an external company to carry out an infection control audit recently and the results were good, no improvements were needed following the audit. People told us the home is usually clean. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff to meet peoples needs. More needs to be done to make sure staff have the skills and knowledge they need to meet the needs of people living in the home. Evidence: There were 61 people living in the home when we visited. The manager told us there were 8 care staff and 2 nurses on duty until 2:00pm. In the afternoon there were 7 care staff, one of whom was a senior carer and 1 nurse. The manager told us there are a total of 5 staff on duty overnight, one of whom is a nurse. The manager said this was enough to meet peoples needs. The home employs separate staff for housekeeping, catering and other duties. On the day we visited there were 2 chefs, 2 kitchen assistants, 3 domestic staff, 2 laundry staff, an activities organiser, a receptionist, an administrator and a handyman. The manager is not included in the staff numbers and the owner was also in the building. The manager provided us with copies of the duty rotas for May and they showed that there are usually 12 staff on duty in the morning and 9 in the afternoon/evening. People using the service told us they do not feel there are enough staff to meet peoples needs. They said the staff are very good but are rushed off their feet, they Care Homes for Older People Page 22 of 32 Evidence: said staff do not have time to give people the care and attention they need. People said staff do not answer peoples buzzers promptly. Other people said staff answer the buzzers, switch them off and dont come back for sometimes up to an hour. One person said they felt there were not enough staff around tea time and bed time and another person said there are never enough staff at weekends. Another person said they have noticed when they visit that it can sometimes take a long time for buzzers to be answered and that when they visit their relative is always alone. Staff told us they do not think there are enough of them on duty in the afternoon/evening. They said most people need as much help going to bed as they do getting up and most go to bed before 9:00 pm. During the visit we saw that staff had very little time to spend with people. In the dining room where we observed lunch there were not enough staff to give people the help they needed in an appropriate way, for example one of the staff had to break off from helping someone to eat on 3 occasions to attend to other people. We also saw that the way staff breaks are organised did not take account of peoples needs with some staff going for their break in the middle of lunch service. We asked staff about this and they said they were told they had to take their break at that time. Staff told us they get a lot of training. The training records showed that the majority of staff are up to date with training on safe working practices such as moving and handling, infection control and fire safety. Information provided by the home shows that 62 of staff have attended training on the care of people with dementia. The training plan for 2010 does not show that any further training on dementia care is booked, however since the inspection the home told us that more dementia care training would be booked as it became available. Six staff are booked to attend training on challenging behaviour in June 2010. The home only started to provide care for people with dementia in November 2009 and it is essential that all staff receive training in this area as they are unlikely to have had previous experience of caring for this group of people. The manager told us that all the required checks are completed before new staff start work and staff who completed surveys for us confirmed that this was the case. During the visit we saw that staff do not carry bleeps or any other means of communication. Because it is a big home it can take some time to find the person they are looking for. For example, when we wanted to go into the treatment room it took Care Homes for Older People Page 23 of 32 Evidence: several minutes to find the nurse as staff had to look and ask around in the various units. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have confidence in the management team and do not feel the service is run in the best interests of the people living there. Evidence: The registered manager is a nurse with several years experience. The manager said the owners are actively involved in running of the home. The owners carry out their regulatory responsibility to complete a report on the quality of the service every month. However, part of this requirement is that copies of the monthly reports are kept in the home and available for inspection. These reports were not available when we visited. The home completed an annual quality assurance assessment (AQAA) and sent it to our office in Newcastle on 16 March 2010. Unfortunately the visiting inspector had not received it before the visit and the manager provided us with another copy. The information provided in the AQAA was very basic and did not tell us a lot about the service. In their AQAA the home told us about some of the improvements they plan to Care Homes for Older People Page 25 of 32 Evidence: make in the next 12 months. However, they did not identify any areas where they felt they could do better. In their AQAA the home told us The staff and residents are very important and are encouraged to contribute to any decision making. Resident and staff meetings held regularly. However, since May 2009 when the service moved to new premises there has only been one meeting for people using the service and there have not been any staff meetings. The home told us they send quality assurance questionnaires to people every year. They were last sent in May 2010. Twenty one had been returned when we visited, in nine of the forms we saw that people had identified concerns, these included concerns about staffing levels, the laundry and the temperature of the food. The manager said she had spoken to one person but had not yet taken any other action to address the other concerns. People using the service told us they do not feel the management team welcome feedback and/or suggestions about how to improve the service. For example, one person said The manager is unapproachable if you have a complaint. The owner is also unhelpful. Another person said the manager walks away if they say they have a problem and they have to follow her. The manager told us that there are policies and procedures in place in relation to the Mental Capacity Act and the Deprivation of Liberty legislation. She said all the nursing staff and some senior care staff have attended training on the Mental Capacity Act. However, from discussions with one of the nurses it was clear that they didnt fully appreciate how this applied to every day practices such as decisions about flu vaccinations for people who do not have the capacity to give informed consent. The home holds small amounts of money for people. The money is kept in a safe place and all transactions are recorded. In their AQAA the home told us there are suitable health and safety arrangements in place to make sure the home continues to be a safe place for people to live and work. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Everyone living in the home must have a care plan that sets out in detail how their personal, health and social care needs are to be met. The care plans must be up to date and accurate. To make sure staff have clear information about the care and support people need and to reduce the risk of peoples needs being overlooked. 27/08/2010 2 8 12 More must be done to 30/07/2010 monitor the dietary intake of people who are identified as nutritionally at risk. To make sure people are getting adequate amounts of food and drink. 3 10 12 People must be provided with the care and support they need in a timely manner and information 30/07/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action about peoples needs must be kept confidential. To make sure peoples privacy and dignity is respected. 4 27 18 The numbers and skill mix of 30/07/2010 staff on duty at all times must be reviewed and adjusted to take account of the needs of people using the service and the layout of the home. To make sure people get the care and support they need when they need it. 5 30 18 Staff must receive training which is relevant to the needs of people living in the home, as a minimum this must include training on the care of people with dementia. To make sure staff have the knowledge and skills to understand and meet peoples needs. 6 33 24 An effective system for 27/08/2010 evaluating the quality of the service, which takes account of the views of people using the service, must be established and maintained. So that shortfalls in the 27/08/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action service can be identified and acted on and so that people can contribute to improvement of the service. 7 33 26 Copies of the reports of the 30/07/2010 monthly visits carried out by the provider must be available in the home for inspection. So that there is evidence that that they are carrying out an assessment of the quality of the service and taking action to address shortfalls. 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 9 More care should be taken with the management of changes to peoples medicines to reduce the risk of mistakes. A more person centred approach to social care should be developed to make sure everyone living in the home is given the support they need to make the most of their abilities and follow their personal interests. More attention should be given to the organisation of meal times to make sure there are enough staff available to provide people with the support they need. Signage throughout the home should be improved to help people with dementia find their way around. More attention should be given to making sure people have access to the call bells when they are in the lounge so that they can summon help when they need it. 2 12 3 15 4 5 19 19 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 27 The way staff are deployed in the home should be reviewed and this should include a review of staff break times to make sure the right numbers of staff are available where and when they are needed. Consideration should be given to having some mechanism for contacting staff to make it easier to find staff in the home. The management team should consider how they can develop an more open and transparent approach which encourages people to raise concerns and make suggestions for improvements to the service. 7 27 8 32 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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