Care Home: Lickey Hills Nursing Home (2 Units)

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What the care home does well Assessments are carried out by the home manager before people move in, so that people can be confident that the home are able to meet their needs. Each person has a care plan which is based on their individual care needs. Overall, the care plans are well written and contain good information to ensure that staff know what to do for each person and each person receives a consistent standard of care. The home are able to meet people`s health and personal care needs. There is a range of social opportunities for people living at the home. A variety of choice of meals are available, providing a well balanced and nutritious diet. People can be confident that any concerns will be listened to and acted upon. The home provides a safe environment for people to live in. Infection control is generally very well managed. Staff are caring and provide people with care that meets their individual needs with dignity and respect. Staff receive training to give them the skills and knowledge they need to work in the home. The home is managed well, and people can be confident that is is run in their best interests. What has improved since the last inspection? No requirements have been made following this inspection, although there is information in the report of areas which still need more work to improve the standard provided by the service. What the care home could do better: There were no outstanding requirements following the random inspection in March 2010 and no requirements made at this inspection. Key inspection report Care homes for older people Name: Address: Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Bromige     Date: 2 2 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 27 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 27 Information about the care home Name of care home: Address: Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER 01214455532 01214477835 lickey.hills@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 97 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. The maximum number of service users who can be accommodated is: 97 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: Physical disability - over 65 years of age (PD(E)) 47 Old age, not falling within any other category (OP) 97 Dementia (DE) 47 Date of last inspection 0 4 0 3 2 0 1 0 47 0 0 Over 65 0 97 47 Care Homes for Older People Page 4 of 27 Brief description of the care home Lickey Hills Nursing Home is situated in a picturesque area of Barnt Green close to the Lickey Hills visitor s centre. It comprises of two units, one catering for the elderly physically frail Cofton Unit and the other for people who have care needs arising from dementia related illnesses Rednal Unit. Both units offer facilities for male & female residents who require nursing care. Both units are on two floors and all rooms, single and shared have en-suite facilities. This report reflects inspections of both of the units in the home as it is registered as one service.Up-to-date information relating to the fees charged for this service is available on request from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection to review the quality of service. One inspector spent one day at the home talking to people who use the service and the staff, and looking at the records which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included spending time 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. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The area manager told us they completed the AQAA and returned it to us in January 2010, but the document was not Care Homes for Older People Page 6 of 27 available in the service file. We received completed survey forms from people who use the service and staff working at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. In March 2010 we carried out a random inspection of the service to see if the home had complied with the three Statutory Requirement Notices served on the 9th November 2009 following the random inspection in October 2009. We also checked to see if the home had complied with the additional requirement made following the key inspection on 1st December 2009. The outcome of the inspection showed the service had complied with the Statutory Requirement Notices and the seven outstanding requirements thus ensuring good outcomes of care for the people who use the service. Due to the poor outcomes of care for the people who use the service following the inspection in October 2009, the Provider made a voluntary agreement with us and Worcestershire County Council not to admit any further people to the home until the standards of care had been improved. In March 2010, following the random inspection, it was agreed that the service could start to admit people to the home. They have been admitted people to the dementia care unit, but chose to continue not to admit people to Cofton unit. There are no current restrictions on admissions to the home. We have received one complaint about the service relating to poor care since the last key inspection in December 2009. This was referred to the Provider to investigate and this was resolved to the satisfaction of the complainant. The complaint was upheld and an apology was sent to the family by the Provider. There have been 12 safeguarding referrals since the last key inspection to Worcestershire County Council, who are the lead agency in co-ordinating safeguarding investigations. These referrals have all been made by the service. We have received the outcome of ten ongoing investigations, some were referred prior to the last key inspection. Eight allegations of neglect were proven, one allegation of physical abuse was inconclusive, and one was not proven. The service are now recognising what are safeguarding concerns and are referring them promptly and according to local procedures for safeguarding adults. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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 before they move into the home to enable the home to find out all about them, and the support they will need. The service does not provide intermediate care Evidence: We looked at the pre-admission assessment for a person who had recently started using the service. We saw the assessment had been carried out by the manager (designate) six days before the person moved into the home. The assessment was comprehensive. Information from Social Services about this persons care needs had not been received before this person was admitted. The home need to ensure they receive this information before the person is admitted to ensure they are able to give the care expected by the funding authority. The previous two key inspection reports have judged this outcome group as good. Care Homes for Older People Page 10 of 27 Evidence: The service does not offer dedicated intermediate care facilities. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the care records have improved and provide a good standard of information for staff to ensure they have sufficient knowledge to meet the healthcare needs of the people who use the service. The homes management of medication has improved ensuring peoples health and well being are safeguarded. Peoples privacy and dignity is maintained at all times. Evidence: We looked at the care of two people who use the service. We saw they had care plans that had been written and reviewed in consultation with the persons family. Overall, the care plans were very informative and they were much more person centred. We spoke to staff about the care these people needed and we found these staff had a good understanding of their individual care needs. We spoke to and observed the care of the people whose care we tracked and we saw they were receiving the care they needed. For example, people were using the specialist pressure relieving equipment that was designated in the care plan to prevent them from getting or developing any further pressure sores. We saw the air mattress in use was on the correct setting. We saw people were being assisted to eat and drink and at coffee time that staff were Care Homes for Older People Page 12 of 27 Evidence: offering people snacks of bite size pieces of pizza and cake. The catering staff make high protein smoothies twice a day for people who are at risk of, or are losing weight. We saw pressure ulcer care plans and wound assessments were in place and the nurses were changing the dressing at the frequency stated in the care plan. We saw the wound was re-assessed each time it was redressed. We saw acute care plans were written when someone developed an acute problem such as an infection. These care plans were discontinued once the problem was resolved. There were some areas in the care records that needed improvement. For example, if incontinence pads are used the type and size need to be written in the care plan to ensure staff know what to use for this person. One dressing for a pressure ulcer had been changed but the care plan had not been updated. We looked at the food charts for one person and saw on two recent days they records were poorly completed. We looked at the pressure sore prevention charts for the same person and saw that the records did not consistently show the person was always being move at the stated frequency in the care plan. One person was not being weighed weekly as they were losing weight as stated in the care plan. We received eight completed surveys from people who use the service. Five people told us they always receive the support and care they need. We asked them what the service does well and we received the following comments: -Everything really. Look after me. Give us support. Look after me. Help me when I need it. Staff ask if I need any help every day. Informs at all times of any changes etc. Keeps us informed. We also asked them what the service could do better and we received the following comments: - Give me more baths. Provide a room to take clients to for a private visit. Take a little more care when dressing X. Make sure X always has some socks on. One freezing cold day X had not been dressed with any socks and yet there were two pairs in his drawer. Just a bit more though and effort would be appreciated. Provide area to take X to sit and be away from other residents. We received surveys from seven staff and five told us they were always given up to date information about the needs of the people they support or care for. Comments written by staff told us; we look after residents well. I can say that the home is improving a lot, baths are regularly given, residents who are losing weight are now on a fortified diet, Fortisip given regularly as prescribed by GP (now prescribing). Number of staff working on the floor is enough now, I can say that we are getting there (good improvement). Cares for the needs of the residents. We looked at the management of medication for these two people. We looked at the medication administration record (MAR) charts and overall found that they were well Care Homes for Older People Page 13 of 27 Evidence: documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts and we saw clear directions recorded for the application of any external preparations such as creams or ointments. This ensured that staff knew when to give medicines. We saw the temperature of the rooms and refrigerators where medication is stored were recorded daily and these were within the range recommended by the manufacturer to ensure the medication is not harmed through too high or too low temperatures. We carried out seven audits of medication and found six were correct. One was incorrect, which showed the person had not received the medication as prescribed by the GP. We saw two insulin pens in use in both units and the were being correctly stored at room temperature when in use. Neither of the pens were labelled with the persons name and dated of opening. This need to be addressed. We saw in one unit they were storing internal and external medication on the same shelf. We saw staff have used zinc and castor oil for one person out of the homely remedies stock and had returned the used pot of cream to the homely remedies stock. We advised this cream must not be used for another person due to cross infection risk. We saw one person had bee prescribed medication to be given as required but there was no information in the care plan about this medication stating why and when it should be given. We saw peoples privacy and dignity was being respected at all times. Staff told us they close the door when getting people up, and close the curtains. People being hoisted and wearing skirts we use a blanket to preserve their dignity. Care Homes for Older People Page 14 of 27 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. Further improvement is needed for the provision of social care to ensure people are stimulated and supported to continue and enjoy their hobbies and interests whilst living at the home. People are able to keep in touch with family, friends and representatives and the home supports them to continue these relationships. People are offered a variety of healthy meals and snacks at a time and place to suit them. Evidence: The manager (designate) told us they have one activity coordinator in post at the moment as one person is away on maternity leave. The temporary post was filled but this did not work out. Currently, designated staff are supporting the activity person, but on the day of the inspection the second activity person was off sick. We saw the sensory trolley in use on Rednal unit in the morning and music playing for people to listen to. We saw less interaction between people and staff than during out last visit in March 2010, but this was due to the lack of presence of an activity person and the majority of care staff were engaged in giving personal care to people and the two trained nurses were administering medication. We saw the activity person going around the people on Cofton unit asking them if they would like to join in with the picnic in the garden in the afternoon. We saw pictures of a recent fun day that was held at the home, this was well attended by people who use the service. We saw a Care Homes for Older People Page 15 of 27 Evidence: copy of the activity programme for this week. This shows the following activities are planned: every morning between 9-10.30 it is the sensory trolley or keeping in touch. 11-12.30, puzzles & quizzes, nail & hand care, church service, gardening club, orientation & memory lane. 2-3.30, painting in the garden, picnic in the garden, bingo, outing to visitors centre, play your cards right and 3.45-4.30, one to one time with people and a picnic in the garden on the Tuesday. There were no activities planned for the weekend. We spoke to staff on both units and they told us they have activities every day during the week but none at weekends. We saw the board behind the desk on Rednal unit stated it was Saturday 19th June 2010. This had not been changed for three days and would be very confusing for the people on this unit. We saw social care plans in the care records and a life history for one person. One person did not have one yet as the staff were waiting for this information from the family of one person who uses the service. People who use the service were asked by us in surveys if the home arrange activities that they can take part in if you want? One person said always, one usually, three sometimes and two said dont know. One comment said they would like to go out more - take us to shops in the Town. The manager (designate) was aware that improvement is needed in this area. We saw from the minutes of a recent meeting that activities were discussed. The minutes showed people had suggested there needs to be more activity people, and carers needs to interact with residents more. We looked at the provision of nutrition for the people whose care we tracked. We found there had been considerable improvement in this area. People at risk of losing weight were receiving snacks and high protein drinks in between meals. We looked at the menus provided over a four week period and these showed a choice of a good balanced diet is provided by the home. The chef told us they are now making all their own soups provided and the manager (designate) told us they are offering alternative trial starters to soup at the evening meal such as prawn cocktail, pate and oatcakes, egg mayonnaise, sardines on toast, cheese and biscuits, mini ploughmans. Once they have established what the people enjoy most they intend to add this to the menus. People told us in surveys they always or usually liked the meals at the home. Staff told us in surveys the meals have improved. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concern with their care, they or people close to them know how to complain. These concerns are looked into and action taken to put things right. People who use the service are safeguarded from abuse. Evidence: We looked at the homes complaints records and saw seven complaints had been recorded since December 2009. The outcome for all of the complaints was available and five had been substantiated. We saw correspondence that had been sent to the people who had complained advising them of the action being taken and the outcome of any investigation. This is in line with the homes procedures and the standard expected by the commission. We have received one complaint about the service relating to poor care since the last key inspection in December 2009. This was referred to the Provider to investigate and this was resolved to the satisfaction of the complainant. The complaint was upheld and an apology was sent to the family by the Provider. Five people who use the service told us in their completed survey that they knew how to make a complaint. There have been 12 safeguarding referrals since the last key inspection to Worcestershire County Council, who are the lead agency in co-ordinating safeguarding Care Homes for Older People Page 17 of 27 Evidence: investigations. These referrals have all been made by the service. We have received the outcome of ten ongoing investigations, some were referred prior to the last key inspection. Eight allegations of neglect were proven, one allegation of physical abuse was inconclusive, and one was not proven. The service are now recognising what are safeguarding concerns and are referring them promptly and according to local procedures for safeguarding adults. Staff spoken with were aware of the homes complaints procedures. They had received training about safeguarding people and were clear of the action they would take if they suspected any abuse taking place in the home. A recently recruited member of staff told us they had received training about the Mental Capacity Act(MCA) and Deprivation of Liberty safeguards (DoLs). The manager (designate) told us this is now including in the safeguarding training for all staff. Staff told us in surveys the home had requested references and CRB checks before they started working at the home. We looked at a recruitment file and saw all the relevant checks had been done to ensure only suitable people are employed at the home to ensure the protection of the people who use the service. Care Homes for Older People Page 18 of 27 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. The home is in need of refurbishment to make it a more pleasant and a safer environment for the staff and people who use the service. Evidence: People who use the service and staff told us in surveys that the home need to provide a room to take clients to for a private visit. Provide an area to take people to sit and be away from other residents. People would like a nicer garden to look at. The home is in need of renovation to promote a good environment. Urgent refurbishment needed. Lickey Hills has the potential to be a good home as it has many resources and is in a lovely location. It just needs some investment in its people and building for a start, followed by closer monitoring of the care it provides. Previous reports by the commission have highlighted that the home is in need of refurbishment. The Provider has taken these comments on board and they have agreed to invest £1.3 million in refurbishing the home. The manager (designate) has already been consulting people who use the service, their relatives and staff about the planned refurbishment which is due to commence in July 2010. All bedrooms in the home will be refurbished and a sample bedroom will be available for people to look at so they can see the proposed standard of the refurbished rooms. People will be able to choose their own decor and furnishings from a the range on offer. The refurbishment will include the building of a new laundry on site and a quiet room where people can Care Homes for Older People Page 19 of 27 Evidence: go with their visitors. At the time of the inspection there was a very strong odour of stale urine in Rednal unit. We acknowledge the domestic staff have recently cleaned the carpets but it is likely they will not be able to eradicate this bad odour until the carpet is removed and replaced as part of the refurbishment. We looked at the maintenance checks for the bed rails and the fire equipment. These had been recorded as taking place at the required frequency to ensure the ongoing safety of the people who use the service and its staff. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff provided to meet the needs of the people who use the service. Staff are receiving training to ensure they have up to date skills and competencies to enable them to carry out their role and continue to meet the needs of the people who use the service. Thorough recruitment procedures are in place to ensure the safety of the people who use the service. Evidence: On the day of the inspection there were 40 people on Rednal unit with two trained nurses and nine care staff. Later in the morning an agency carer joined the team to make ten care staff as they were one short at the beginning of the day. At night the rotas show one trained nurse and four care staff for this unit. On Cofton unit there were 32 people with two trained nurses and eight care staff. At night the rota shows one trained and four care staff, this includes the use of agency staff. There is considerable less usage of agency staff in the home since the last inspection in March 2010. This is much improved as it ensure more consistency of care for the people who use the service. The manager (designate) told us they are still recruiting further staff for the home. Care Homes for Older People Page 21 of 27 Evidence: Staffing levels have been reduced recently due to the reduced numbers of people using the service. The home started to re-admit people to Rednal unit in March 2010 in agreement with us and Worcestershire County Council. The Provider made a decision to continue not to admit to Cofton unit. The home will continue to have less people in the home to enable them to carry out the planned refurbishment. There are currently no voluntary restrictions on admitting people to the home by us or Worcestershire County Council. Surveys from people who use the service told us the staff are superb, helpful, kind and caring. Always make you feel welcome. The staff are very friendly. Surveys completed by staff when we asked them what the home does well told us, the home is hiring more staff now, also hiring a new unit manager on both sides. The managers are very supportive now. Communication, training and human support. The home tries to get/hire enough carers to work in order to meet the needs of the residents. Well knowledge staff. Domestic staff work hard and show commitment to their duties. The laundry runs well considering its limitations. They put in place training regularly. We spoke to staff on Rednal unit, they told us, staffing levels have been reduced recently. It is do able. Today six of us have not had a break yet (11:30am) and they came on at 08.00am. We asked them is people were getting the care they need and they told us, yes, they are getting the care they need. They told us there are not enough staff during the daytime. People are getting their regular baths. We may not be able to get people to the toilet as quickly as needed. We spoke to staff on Cofton unit who told us the staffing levels are fine. Staff told us in surveys the home had requested references and CRB checks before they started working at the home. We looked at a recruitment file and saw all the relevant checks had been done to ensure only suitable people are employed at the home to ensure the protection of the people who use the service. We saw new staff had received induction training. We looked at the training matrix for the home and saw the majority of staff were up to date with their mandatory training such as, fire, safeguarding people etc. The area manager told us 61 of staff have currently attained NVQ 2 or above. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is well managed to ensure it is run safely and in the best interests of the people who use the service. Evidence: The home has been without a registered manager for 17 months. A manager (designate) was appointed in August 2009, but she left the home in January 2010. In the absence of a registered manager the area manager has been spending all of her designated time at the home to support the management of the service. Other regional support staff has been provided by the Provider and this continues to date. In March 2010, Maureen Ferrari, a manager from one of their other homes was seconded to manager the home on an interim basis. She has now been appointed as the manager(designate) for this service and intends to submit an application to us for registration without delay. Maureen is a registered mental health nurse and has had many years experience in mental health nursing in the NHS and private sector. She has held her Registered Managers Award for the last three years. Care Homes for Older People Page 23 of 27 Evidence: Since the last inspection in March 2010 there has been a continuity of leadership in the home, and this has had a positive impact on the outcomes of care for the people who use the service. The manager (designate) holds daily meetings each morning with the Heads of Departments to ensure she is fully aware of any concerns they may have about people who use the service or about the service provision. We could see from recent minutes of meetings with people who use the service, their relatives and staff that the manager (designate) is consulting people about the standards in the home and keeping them fully informed of the changes planned. We looked at the outcome of a recent audit about pressure sores in the home and this showed there were less people with pressure sores than there were when the audit was undertaken in March 2010. Staff told us in surveys, the managers are very supportive now. Lickey Hills has the potential to be a good home as it has many resources and is in a lovely location. It just needs some investment in its people and building for a start, followed by closer monitoring of the care it provides. We looked at the management of peoples monies held by the home. There have been changes made to this since the last key inspection. We saw that peoples money is managed safely and in line with regulation. People are now receiving monthly statements so they are aware of their individual balance in the account. This is good practice. We are now receiving notifications of any significant events that the home are required to advise us about through regulation without delay. This is a considerable improvement made by the service. We looked at the maintenance checks for the bed rails and the fire equipment. These had been recorded as taking place at the required frequency to ensure the ongoing safety of the people who use the service and its staff. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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