Care Home: Lyndon Hall Nursing Home

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What the care home does well There are good systems in place to ensure peoples personal money held by the home for safekeeping are protected. Visiting to the home is open and people living within the home can maintain relationships that are important to them. The home was clean, comfortable and individual rooms were personalised. There is a choice of communal areas. What has improved since the last inspection? Care plan documentation has improved so that staff have the information to meet, monitor and evaluate needs of people living in the home. This has been further helped by improvements in how records are organised allowing for easy of information retrievial. The availability of working bathing facilities has been reviewed thus ensuring people living at the home have these needs meet as and when required. Provision of food outside main kitchen times has improved ensuring that staff have the ability to provide snacks, drinks and supplements to meet peoples nutritional needs . Medication administration has improved ensuring people recieved their prescribed medicines as ordered by their clinician. The number of complaints the home has received since the last key inspection of June 2009 have decreased. This may however be linked to the decline in number of people living at the home and the significant management input from the organisation to improve the quality of care provided to people living at the home. What the care home could do better: Activities must be taylored to the needs of people living at the home. The training needs of staff must be reviewed to ensure they have the right skills and competencies to meet the needs of people living in the home. Training is needed in areas such as safeguarding, Mental Capacity Act 2005, nutrition, infection control, food hygiene and fire safety. The staffing levels need to be reviewed to ensure that staff are deployed appropriately to meet the needs of people living in the home at all times. The home needs to look at how it can sustain improvements and continue to improve and meet the needs of people living in the home. Menus need to be reviewed with people living in the home to ensure they meet the tastes and preferences of people living in the home. Key inspection report Care homes for older people Name: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP     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: Karen Thompson     Date: 0 9 0 3 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 28 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 28 Information about the care home Name of care home: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP 01215005777 01215005551 lyndonhall@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 80 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: 80 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 40, Old age, not falling within any other category (OP) 40 Date of last inspection Brief description of the care home Lyndon Hall Nursing Home is a purpose built three-storey building. The Home is set in attractive grounds surrounded by mature trees. There is car parking facilities available. Entrance to the home is through a secure door that leads into a small reception area. Accommodation is provided on the ground and first floor with a staff room and meeting Care Homes for Older People Page 4 of 28 Over 65 0 40 40 0 1 4 1 0 2 0 0 9 Brief description of the care home room on the second floor. The home is divided into four 20 bedded units, namely Poppy, Rose, Sunflower and Bluebell. Poppy unit and Sunflower are registered for the care of persons with Dementia and are situated on the first floor. Rose and Bluebell are situated on the ground floor and are registered to accommodate people who are elderly and frail. Each unit has a large lounge and separate dining room for communal use. There is also a quiet lounge situated on Bluebell. There are seventy-eight bedrooms in total, sixty-six single rooms with en-suite facilities and two double bedrooms both also having en-suite facilities available on Sunflower and Rose units, and ten single rooms without en-suite facilities, five on Poppy and five on Bluebell. Assisted baths are available on each unit. A shaft lift is available to provide access to all floors. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection; the home did not know we were coming. It was carried out by two inspectors who wer there for one day. The focus of the inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. The process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a questionaire that was completed by the acting manager and it gave us information about the home, staff people who live there, any developements since the last inspection and their plans for the future. We were supported thoughout the inspection process by the management team at the Care Homes for Older People Page 6 of 28 home. At present the manager is not registered with the Commission and an application needs to be submitted so that we can assess their fitness to run a care home. We carried the majority of our inspection activity on Bluebell and Rose unit which are situated on the ground floor. Information was gathered by speaking to and observing people who lived at the home. Four people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and training records were also examined. We also looked at records pretaining to the maintenance and health and safety aspects of running of the home. Prior to this key inspection we carried out a random inspection in October 2009 to check compliance with requirements made at following June 2009 key inspection and to look at concerns raised about meeting the nutritional needs of people living in the home. Findings of this visit are available on our intranet. Since August 2009 the home has had its contract suspended by the placing authorities. This means that there have been no new admissions to this home from this period onwards. The placing authorities as of May 2010 have not lifted the suspension of the contract due to ongoing concerns. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Activities must be taylored to the needs of people living at the home. The training needs of staff must be reviewed to ensure they have the right skills and competencies to meet the needs of people living in the home. Training is needed in areas such as safeguarding, Mental Capacity Act 2005, nutrition, infection control, food hygiene and fire safety. The staffing levels need to be reviewed to ensure that staff are deployed appropriately to meet the needs of people living in the home at all times. The home needs to look at how it can sustain improvements and continue to improve and meet the needs of people living in the home. Menus need to be reviewed with people living in the home to ensure they meet the tastes and preferences of people living in the home. Care Homes for Older People Page 8 of 28 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The previous judgement for choice of home was good and this will remain until we are able to reassess. Evidence: The homes contract with the placing authorities has been suspended since August 2009 and therefore there have been no new admissions to the home during this period. We therefore did not look at the admission process on this occassion for people recently admitted to the home. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 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. People health needs are being met in a consistent manner but this will need to be sustained. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individual needs. It outlines what they can do independently, the activities people require assistance with and the action staff need to provide in order to support them. We looked at four peoples care files in detail and others were sampled for information. There was evidence that risk assessments have been completed in key areas for example manual handling, tissue viability, nutrition and falls along with dependency ratio assessment. Risk assessments are completed in order to identify areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningfull life; that risks are reduced and peoples well-being promoted. Care Homes for Older People Page 12 of 28 Evidence: Care staff spoken to demonstrated that they were aware of the recorded needs of people living in the home. Everyone living in the home is registered with a local General Practitioner (G.P). they have the option of retaining their own G.P on admission to the home ( if the G.P was in agreement). People had access to other health and social care professionals as required including social workers and opticians. We did however find that people have not received regular chiropodist care for a considerable period of time. We were advised that a new chiropodist would be visiting the home in the near future. This will ensure peoples health care needs are being met. The needs of people with dementia and or challenging behaviour were being met on Bluebell and Rose unit. There were good plans in place for management of behaviour that challenges. We have however had concerns raised by other agencies about the homes ability to meet needs of people with challenging behaviour and these are being looked at by these agencies. Records demonstrated that nutritional needs were being planned for, monitored and the appropriate action was being taken. Staff were able to tell us about the specific nutritional needs of people in their care. Records were being kept in relation to monitoring food and fluid intake and these were found to be of a good standard. Records demonstrated and staff confirmed that people were receiving a bath on a regular basis. This is an improvement in meeting the needs of people since our June 2009 key inspection and will be linked to the number of working bathing facilities in the home. The homes medication system consisted of pre-packed pharmacy boxed medication and a boxed system with Printed Medication Adminstration Record (MAR) sheets supplied by dispensing pharmacist on a monthly basis. Records demonstrated the temperature in the treatment rooms and medication fridges were within the acceptable range. This makes sure that all medication is stored within the recommended ranges. The homes has copies of the orginal prescriptions (FP10s) for repeat medication so they were able to check prescribed medication againtst the MAR chart when it entered the home. We visited medication room on both Rose and Bluebell unit. We are aware that the PCT pharmacist has visited the home to carry out medication audits. We found medication management to meet the standard on the unit we visited. We discussed with the acting care manager concerns around administration of covert medication. We were advised by the acting care manager that Care Homes for Older People Page 13 of 28 Evidence: no one was having their medication administered covertly however they were in the process of discussing with external professionals whether this may be in the interest of someone living in the home. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home are flexible, so people are able to maintain important relationships. The is a choice of healthy meals and systems in place to provide food out of normal kitchen hours. Evidence: People are able to bring in personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere and reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. Visitors were observed around the home during our inspection. We observed carers interacting with people living at the home. Carers were able to tell us about peoples preferred activities and past social history, thus demonstrating an understanding of the social needs of people they care for. Care plans for people living at the home did not always include a plan of social activities. We were told that the televisions in the home have been replaced with larger screen televisions. Thus ensuring that people living at the home have a television that can meet their needs. Care Homes for Older People Page 15 of 28 Evidence: There is a rotating four week menu. The menu demonstrated a variety of nutritious meals and people living in the home confirmed that they are offered a choice each day however this has not been reviewed since June 2009. We previously made a recommendation that the menus be reviewed with people living in the home and this will remain. However there are a number of people living at the home with cognitive impairment and systems need to be developed to ensure facilities are available for them to take active part in choosing their meal. Following our previous key inspection of June 2009 concerns were identified in relation to meeting nutritional needs of people living in the home and this formed part of our random inspection of October 2010. Since this inspection staff spoken to at this visit were able to demonstrate an awareness of the facilites and food available to meet people nutritional needs outside of the main kitchen hours. They were also able to tell us the specific nutritional needs of people living in the home. This enhanced awareness should lead to better nutritional outcomes for people living at the home. We visited a dining room on each floor of the home and they were decorated to a satisfactory standard. The dining tables at lunchtime were observed to have a table cloth and floral decoration. The meals were nicely presented. We sampled the main meal on offer to people living at the home and this was found to be appropriately cooked and tasty. Care Homes for Older People Page 16 of 28 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. People who use the service are able to express their concerns. Staff have a good knowledge of safeguarding and how to protect and promote the rights of people living in the home. There are however a number of outstanding safeguarding concerns which means the homes contract remains suspended with placing authorities at present. Evidence: The home has a complaints policy that is available to all people. A copy of the complaints policy is in the service user guide and in each persons bedroom. The manager told us that she is always there to talk through any concerns that people have and will always act upon them. We looked at the way in which the home manages and investigates complaints. Since our last key inspection in July 2009 the home has received six complaints and these have been investigated by the home. People we spoke to during this inspection told us this is a really good home, my husband is content here, nothing is too much trouble for staff. I havent made a complaint because there is nothing to complain about. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had Care Homes for Older People Page 17 of 28 Evidence: witnessed an act of abuse. The manager of the home understands what is expected of her in relation to reporting of incidents and allegations to the safeguarding team. We also talked to staff about their knowledge of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. We did this because we wanted to know if staff were aware of what the implications for practice this legislation has. Staff need to be able to understand what a deprivation of liberty is so that they can take action to prevent it from happening or to take steps to protect the people in their care. Staff told us actually we are doing that training today, another person said its about making sure people arent kept from doing things they want to We looked at recruitment practises and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Independent Safeguarding Authority (ISA) and a Criminal Records Bureau disclosure (CRB). Care Homes for Older People Page 18 of 28 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. Some improvements are needed to ensure that the service is suitable to meet the needs of all people living in the home. Evidence: The home is a detached three storey building with parking for visitors. The car park for visitors still has a number of potholes so care was required when driving there. The paint is peeling from parts of the exterior and it is in need of some work to enhance the appearance and protect the building. Entry to the home is gained through two doors. We looked around the building mainly concentrating on the two ground floor units, Rose and Bluebell. The home was found to be clean, hygienic and free from offensive odours. There are extensive grounds that people living at the home and their visitors can use. There is also an enclosed garden area which has seating. We observed a number of radiator covers not attached to walls whilst walking around the home. We received a complaint in January 2010 in relation to the heating not working in the building. The complaint was forwarded to the providers representative. This has resulted in the home renewing both pipe work and radiators throughout the home and the work was evident to be ongoing during this inspection visit. The bedrooms were spacious, light, comfortable and had been personalised with the Care Homes for Older People Page 19 of 28 Evidence: individuals own photos and ornaments to reflect their personal taste, gender and culture. All the bedrooms had a call bell, so people could call for assistance if required. En-suite facilities consisted of wash hand basins and toliets in each bedroom. Assisted bathing facilities were located within easy reach of bedrooms. The assisted bathing facilites were not working but we were told that a quote had been obtained from head office as a prelude to replacing them. There was a separate laundry located in the basement, which was appropriately equipped. We visited the laundry and no staff were present at the time of our visit to this area. All washing machines and tumble dryers were observed to be working. Care Homes for Older People Page 20 of 28 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. People living in the home are not always supported as they should be due to staff not being trained in sufficient numbers to meet their needs. Evidence: The home has a skill mix of both trained nurses and care workers on duty to meet peoples needs. In addition to the care staff there are housekeeping, kitchen, laundry and maintenance workers all working hard to keep the home running smoothly. At present the home appears to have sufficient staff on duty to help meet peoples needs. The home is aware of the need to review staffing levels as peoples needs change. This is an improvement since our visit in October 2009 . We identified then, that staffing levels were not always consistent in meeting peoples needs. This no longer appears to be the case, however we do note that the suspension of placements from the local authority remains in place and numbers of people living in the home have dropped since then. The home supports all care staff through training in National Vocational Qualifications. Staff we spoke to confirmed that they had completed both their level 2 and 3 NVQ training in Health and Social Care. This means that staff should have the knowledge and understanding to be able to meet the peoples needs who live in the home. In addition to this training the home has also trained members of staff to be trained trainers in moving and handling, tissue viability and continence care. Care Homes for Older People Page 21 of 28 Evidence: We spent time talking to the nursing staff during this inspection, it was evident they had not received updates in specialised areas of care such as, catheter care, PEG feeding and pressure sore management for some time. The home should consider providing this type of training for its nurses to ensure their skills are being kept up to date. The training matrix the home has provided us with shows that there are gaps in staff attendance, however this has been addressed by the home who have identified those staff in need of updates and have arranged this. The home has told us in the AQAA about staff training they want, To continue with the plan to achieve 100 compliance in all subjects and develop new areas as identified following the annual appraisals We looked at the recruitment processes in the home. We saw the staff files of four people. All of them contained the required information and security checks such as previously mentioned ISAs and CRBs. This means the home has systems in place to prevent unsuitable people from working with vulnerable adults. All new staff spend a week being trained before starting work, so that they are equipped to care for people. When they do start they are supported by senior care staff. Staff are supported to undertake further training. Staff we spoke to said the training here did drop off a bit but the new manager is making sure that we are getting some now, it is better now we have the new manager, actually Im going to training today to learn about the Mental Capacity Act. Care Homes for Older People Page 22 of 28 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. Whilst there have been improvements in the management of the home further work is required to ensure this is maintained and sustained. Evidence: The home still does not have a manager that is registered with us. This will need to happen in order for the home to avoid any further enforcement action. The current manager has told us she is due to apply within the next two weeks once her position is made permanent. We have identified within the complaints and protection section of this report that staff were not aware of the Mental Capacity Act and the Deprivation of Liberty safeguards or their responsibilities under this legislation. We advise that all staff have training in this legislation so that they are aware of their responsibilities under the legislation. The manager has told us the organisation has already recognised this as an area for improvement and they will be providing training for their staff in the near future. Care Homes for Older People Page 23 of 28 Evidence: The Home Manager completed the homes AQAA which was returned to us when we asked for it. The AQAA gave us adequate information about the service and developments that have been made although more information could have been included on current developments. The home has an identified quality plan. The information from the most recent Southern Cross key outcome inspection tool showed the home is performing well but there were some improvements to be made particularly in the provision of activities. People are surveyed about their experiences and quality of service they receive and relatives, and professionals were also included. This gives people the opportunity to raise any concerns or compliments they have about the service they receive. Staff are also kept up to date by staff meetings although these have not been happening on a regular basis for some time. This was highlighted in the homes own quality report and the manager told us this is being addressed. There has not been a relative or residents meeting in the home since December 2009. Secure facilities are available for the safe keeping of peoples personal money and valuables. Records are available for all transactions which detail the reason for the withdrawal and receipts are available as proofs of purchases. All money is kept within a bank system and we were able to see that interest is added monthly to any balances. The home has computerised records of all training statistics which show that some staff have received all statutory training and when needed training is booked to address any gaps. The home also has trained trainers to deliver training which we have already commented on this in the staffing section of the report. We spoke to staff who told us the training had dropped off, its much better now though. The AQAA confirms that maintenance contracts for the building are up to date and we also found that the home is in a good state of repair and equipment is in working order. All of the staff we spoke to confirmed that they had had fire training, and a recent fire drill. We did look at the provision of hoists and slings in the home for the safe moving and handling of people. Care Homes for Older People Page 24 of 28 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 28 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 31 20 The Acting Care Manager 28/05/2010 should submit an application for registration with the Commission. The Commission needs to be assured that the manager is fit to run a care home. 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 2 9 12 Staff should sign for the administration of creams on the MAR sheet rather than tick the entry. Activites should be reviewed and based on individual needs. Following this review an action plan should be drawn up and findings implemented. (Recommendation made at June 2009 key inspection. ) The home should consider introducing pictorial menus so that people with cognitive impairment have an opportunity to make an informed meal choice. Menus should be reviewed with people living at the home. (Recommendation made at June 2009 key inspection) It is recommended that the home obtain a copy of the Page 26 of 28 3 15 4 5 15 18 Care Homes for Older People 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 Department of Health Guidance Mental Capacity Act 2005 core training set published July 2007 and staff are aware of their role and responsibility and peoples rights are protected. (recommendation made at June 2009 key inspection) 6 18 The home should ensure that staff are trained on a regular basis in safeguarding procedures to ensure that all peoples are protected. (Recommendation made at June 2009 key inspection ) The refurisbishment and replacement programme should have timescales for completion to ensure things do not slip. ( Recommendation made at June 2009 key inspection) Staffing levels should be reviewed in the home so that people living in the home recieve care in an appropriate manner. (Recommendation made at June 2009 key inspection) Shortfalls identified in training needs such as fire, food hygiene, safeguarding, infection control, mental capacity, nutrition and specialist topics must be addressed in the appropriate style so that this training embeds. This will ensure that knowledge and practice mirror and meets the needs of people living in the home. (Recommendation made at June 2009 key inspection) The organisation draws up a plan for sustainability of improvements made and this is reviewed on a regular basis. 7 19 8 27 9 30 10 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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