Care Home: Meadway Court

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What the care home does well A statement of purpose and a service user guide were available for people who were thinking of living at the home. People said these documents provided them with enough information to make an informed decision about whether they wanted to live there. Each person entering the home was assessed beforehand to make sure their needs could be met. People told us staff worked very hard and that most staff were kind and considerate. Visitors said they were made welcome at the home and were encouraged to visit whenever they wanted. A complaints procedure was displayed around the home. People told us they knew who to complain to and thought staff would try to address any concerns they had. A written record showed that complaints were responded to quickly and investigated thoroughly. When we visited, the home was clean and fresh smelling. Borough Care have a good training programme that ensures staff access to training in a wide range of topics so they have the skills and knowledge to meet peoples` care needs. 63% of care staff had successfully completed National Vocational Qualifications (NVQ). What has improved since the last inspection? At the last inspection we made 3 requirements to improve how medicines were managed within the home. At this inspection we saw that these requirements had been addressed and the procedures for managing medicines were safer. At the last inspection we also made some recommendations and improvements had been made to address most of these. More attention had been paid to peoples` personal hygiene and everyone we saw looked clean, tidy and dressed appropriately. Each person coming to live at the home had been assessed to make sure their food and drink intake was sufficient and they were not underweight. Daily records had improved with entries being made several times a day so we could track what care had been given. What the care home could do better: Although people had care plans and risk assessments, the reviews of these could be more robust to make sure all the information in them is up to date and accurate. Where people are visited by other health care professionals, any advice or instructions should be added to their care plan and all staff should be made aware of any changes. We saw several people who should have been on specific diets that were given the same meal as everyone else and the chef was not aware that they needed specific diets. People in general did not like the food provided at the home. Although this had been raised at a resident meeting and with members of the Board of Borough Care who visited the home in November 2009, people told us they had seen little difference in the quality of food they were offered. In general people were unsure, when they gave feedback about the home, how that was used and whether anyone acted on their views. People told us staff were generally kind but they did have concerns that the home was understaffed at times. Comments included "There are not enough staff. The poorly ones take up their time and there is no time for those that are relatively OK. If you ring the nurse call someone comes eventually - but you have to wait", "there are too many people in wheelchairs for the number of staff", "the home has gone down hill a lot. It is understaffed and they have their hands full", "They say they will do something in a minute and don`t comeback for 40", "the home is so so", and "the home leaves a lot to be desired". Key inspection report Care homes for older people Name: Address: Meadway Court Meadway Bramhall Stockport Cheshire SK7 1JZ     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: Fiona Bryan     Date: 1 3 0 1 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Meadway Court Meadway Bramhall Stockport Cheshire SK7 1JZ 0161-4408150 01614395628 meadwaycourt@boroughcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Borough Care Limited Name of registered manager (if applicable) Miss Tracey Lloyd Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users to include up to 42 OP and up to 5 DE(E). Date of last inspection Brief description of the care home Meadway Court provides permanent residential care for up to 36 older people and offers intermediate care facilities for up to six residents. Intermediate care is for people who have been assessed, by health and social care professionals, as being suitable for a short-term placement of rehabilitative care. The length of stay is time limited between one to six weeks. During their stay residents are seen by Physiotherapists, Occupational therapists, Social Workers and district nurses. Meadway Court also offers day care facilities for up to four service users over seven Care Homes for Older People Page 4 of 30 Over 65 5 42 0 0 2 7 0 1 2 0 0 9 Brief description of the care home days per week. The home is one of 12 care homes owned by Borough Care Limited. The home consists of 40 single bedrooms and one shared bedroom. Bedrooms are situated on the ground and first floor areas of the home, 24 of the rooms have en-suite facilities, which comprises of a wash-hand basin and toilet. There are several communal areas situated throughout the home, including a large conservatory to the rear of the building, which opens onto a large patio area with garden furniture. The gardens are pleasantly landscaped with flowers and shrubs. A lounge is available for residents wishing to smoke. A full passenger lift is in place. The home is situated at the end of a cul-de-sac in the Bramhall area of Stockport. Bramhall village is approximately ten minutes walk away. The village has a wide variety of shops, restaurants, churches and banks. Access to motorway networks, public transport and train station are within a reasonable distance of the home. Fees range from £327 to £436. The service user guide is displayed in the reception area of the home and is given to prospective residents or their relatives when they visit the home. Care Homes for Older People Page 5 of 30 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 key unannounced inspection, which included a visit to the home, took place on Wednesday 13th January 2010. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people living at the home, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to three residents were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and care records was examined, including peoples care files, staff Care Homes for Older People Page 6 of 30 personnel files and duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home asking them what they thought about the services provided at the home. Eight people responded. However, despite there being a significant number of people living at the home who were able to complete the surveys independently, none had been enabled to do so, all being helped by staff. It would have been better if people had been supported to complete the surveys on their own. An expert by experience assisted the inspector for part of the inspection. The phrase expert by experience is used to describe people whose knowledge about social care services comes directly from using social care services. This person talked to people living at the home about their quality of life. She completed a report after the inspection; some of her written comments are included in this report. Before this inspection we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what she felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager did not fully complete the form and therefore did not show that she had a full understanding of what areas of the service needed improving. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Although people had care plans and risk assessments, the reviews of these could be more robust to make sure all the information in them is up to date and accurate. Where people are visited by other health care professionals, any advice or instructions should be added to their care plan and all staff should be made aware of any changes. We saw several people who should have been on specific diets that were given the Care Homes for Older People Page 8 of 30 same meal as everyone else and the chef was not aware that they needed specific diets. People in general did not like the food provided at the home. Although this had been raised at a resident meeting and with members of the Board of Borough Care who visited the home in November 2009, people told us they had seen little difference in the quality of food they were offered. In general people were unsure, when they gave feedback about the home, how that was used and whether anyone acted on their views. People told us staff were generally kind but they did have concerns that the home was understaffed at times. Comments included There are not enough staff. The poorly ones take up their time and there is no time for those that are relatively OK. If you ring the nurse call someone comes eventually - but you have to wait, there are too many people in wheelchairs for the number of staff, the home has gone down hill a lot. It is understaffed and they have their hands full, They say they will do something in a minute and dont comeback for 40, the home is so so, and the home leaves a lot to be desired. 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 30 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 30 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. People are given information, and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: A statement of purpose and service user guide were available, which gave good information about the services provided at the home. Borough Care also has a website that gives information about all the homes within the group. All the people living at the home that returned surveys said they had received all the information they needed to make a decision to move into the home. We looked in detail at the care received by three people living at the home. Each person had been assessed before coming to live at the home. Pre-admission assessments were kept in the managers office and relevant information was transferred to the files that were kept in peoples rooms, for staff to use on a daily basis. Care Homes for Older People Page 11 of 30 Evidence: The home provides six intermediate care beds. People who needed these beds were assessed before admission under the Single Assessment Process and were admitted directly from hospital or home. Physiotherapy, occupational therapy and district nursing input were available for these people. Care Homes for Older People Page 12 of 30 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. Peoples health and personal care needs were generally met despite some shortfalls in how care was recorded. Evidence: We looked at the care three people were receiving in detail. Each person had a care plan written for them and had risk assessments for nutrition, falls, and moving and handling. It was unclear how accurate the nutritional risk assessments were as staff had used the scoring system to indicate that peoples weight was acceptable for their height. This was discussed with the manager as the assessment was based on observation of the person rather than body mass index (BMI) or any other recognised measure. It was reported that care files were audited (reviewed) every month by a care supervisor to ensure they were up to date and accurate. However, we found that the person reviewing the files sometimes highlighted additional information as being required but this was not then addressed so the request for additional information was repeated for several months. Also one file had numerous duplicated care plans with Care Homes for Older People Page 13 of 30 Evidence: the same information, which was confusing for the reader. This gave us concerns that reviews were not very thorough and did not always ensure that care plans and risk assessments were updated to reflect changes to peoples health or personal care needs. Records showed that people had seen GPs, district nurses, podiatrists and opticians. One person had been seen by their GP the day before the inspection but this had not been recorded in their care file. Another person had been seen by the district nurse and advice had been given about providing a high calorie diet and updating their nutritional assessment as they were losing weight. This was not in the persons care plan and the nutritional assessment had not been reviewed although the need for a high calorie diet was on a work allocation sheet. The work allocation sheet was provided on each unit as a quick reference guide for care staff about specific issues and care needs that people needed help with; however the person was not given a high calorie diet at lunchtime and the chef had no knowledge that they needed one. On the work allocation sheet it stated that another person needed a high fibre diet; again the chef was not aware of this and the person was given the same meal as everyone else. All visits by other health care professionals should be recorded and any advice or instructions added to the care plans and followed. Entries in the daily records were made at least once a day and usually several times a day; at the last inspection there had been periods of several days where no entries were made so this had improved. People looked well cared for; clean and dressed appropriately. People we spoke to told us they were usually helped to have a bath once a week. We looked at how medicines were managed in the home. Records showed that medicines were received, stored and administered safely in the main and people told us they usually got their medicines at the times prescribed. One person had been prescribed a gel to apply to their leg and this was kept in their room so care staff could apply it. The record for the gel was also kept in the persons room but this showed that staff had not been applying it three times a day as prescribed. A carer told us that the person had refused to have the gel applied; however, this should still have been recorded. People told us that staff were generally kind and courteous although several people said this did vary. Comments included Some treat you like you dont count at all, others are very kind at times, It varies greatly - some staff are quite insensitive, Shes always very nice She always comes back if I ask for something. and Some Care Homes for Older People Page 14 of 30 Evidence: staff are extremely good. Others just want to watch TV - in a minority of cases. People did say that they thought staff that worked permanently at the home worked very hard and generally treated them well and their comments were mainly directed at agency staff. One person said, carers do work very, very hard and the regular ones treat you with respect. There are agency staff at weekends and they dont know who you are, how to serve a meal and just stand around. The expert by experience observed staff knocking at peoples bedroom doors and waiting for an answer before they entered. Care Homes for Older People Page 15 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The food provided at Meadway Court did not meet peoples expectations in terms of choice and presentation and did not always meet specific dietary requirements. Evidence: One of the care supervisors was responsible for ensuring activities were arranged and carried out. A programme of activities displayed around the home showed that activities such as quizzes, crafts, bingo, card games and movie nights were provided for people to participate in if they wished. One person we spoke to said they thought there were enough activities provided at the home although they would like something more stimulating sometimes. Another person told us they went out regularly with family members and liked to read and write letters, which they were still able to do. Of the 3 people we looked at in detail, 2 had written information in their care files about their families, previous jobs, hobbies and interests - one in particular was very detailed and informative. The third person had no social history provided and very limited information about any interests or pastimes. Individual care files and daily records generally contained little information about how people had spent their day Care Homes for Older People Page 16 of 30 Evidence: and whether they joined in with any of the activities on offer. A separate activities file itemised what social event had taken place each day but because this information was not included in peoples care files it made it difficult for staff to assess whether they were meeting their social care needs in a way that met individual preferences and abilities. A key worker system is in operation within the home although not everyone living there was sure who their key worker was. Development of the key worker system would help staff explore peoples particular interests and how these could be developed. People told the expert by experience they would like to go out of the home more often but found transport too expensive and difficult to arrange in advance. The expert by experience discussed this with the manager and gave some advice about a transport scheme available for people living in residential care homes that would reduce costs. A resident cat and 2 cockatiels lived at the home and the expert by experience noticed people talking to the cat and enjoying his company. The majority of people we spoke to during the inspection did not like the food provided at the home. People complained that the meals were very badly cooked, not suitable for old people, cold, inedible, awful in the main and not so clever. One person said they felt there was little nourishment in the food with not enough greens and soup like water. They said that puddings were often small portions and often ice cream which had little calorific content. We saw people having breakfast in the main dining room. People said they liked the breakfast provided, which included cereal, porridge, toast, tea or coffee and fruit juice. A small choice was offered to people for lunch and tea. People told us staff went round the day before to tell them what the options were and enable them to make a choice. On the day of the inspection lunch was tomato and basil soup and bacon, lettuce and tomato sandwiches or scotch eggs and salad followed by a small cake without custard or cream. The evening meal was beef stew and dumplings or pasta carbonara, followed by pineapple upside down cake. Several people commented that they didnt know what pasta carbonara was. The expert by experience sat with people having lunch and saw that dining tables were set with cloths and white paper napkins but there were no refinements such as flowers or condiments. No bread or croutons were served with the soup and no mayonnaise was offered with the salad. One person asked for a soup spoon and orange juice and was told the soup spoons must be upstairs and theres no juice just Care Homes for Older People Page 17 of 30 Evidence: water. Another person was in pain and uncomfortable when she arrived at the dining table. She asked for a cushion and one was put behind her back but no further efforts were made to ensure her comfort and she ate her soup with great difficulty. This person did not eat her sandwich and it was taken away by a carer but no substitute was offered. The expert by experience felt the presentation of the food and the whole dining experience could be greatly improved as there was no sense of occasion or sense that this was a meal to be enjoyed. Several people complained about the sandwiches saying the bacon was hard and there was quite a lot of food that was wasted. As stated in the previous section, two people needed high calorie diets and one person needed a high fibre diet and they were all given scotch eggs and salad. One of the carers told us that people needing special diets were always given the same choice as everyone else. One of the people that needed a high calorie diet did not have a meal in front of her when the carer was leaving the dining room to return the food trolley to the kitchen and we had to ask what she was going to be given. The meal for this person had not been placed in front of them but at the side of the table and when we brought this to the attention of the carer they went and moved it so the person could start to eat it. Although she did not eat much of the meal and the carer said she preferred sweet food she was not offered a second helping of dessert. We tried a scotch egg, which was home made but lacked seasoning. The chef told us that he had only been able to put sausage meat around half the eggs as there was not enough for them all. The eggs that did not have sausage meat round them had just been coated in a bread crumb mixture and deep fried. At previous inspections we had been told that hot drinks between meals were not always served. At this inspection people said mid morning and mid afternoon tea and coffee was always offered, so this was an improvement. Care Homes for Older People Page 18 of 30 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 using the service were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: The complaints procedure was displayed on notice boards around the home. A record of complaints had been maintained. The record provided information about what action the manager and staff were going to take or had taken in response to each complaint. People that we spoke to could identify someone on the staff team that they felt they could speak to if they had any concerns and most felt these would be addressed. The majority of staff had undertaken training in safeguarding adults and were aware of the procedures to follow. Since the last inspection there have been some safeguarding investigations into incidents that have happened in the home. Three incidents were reported by the manager, which showed that actions were taken appropriately to protect people living at the home. One incident was investigated as a result of a complaint from a relative and this found that staff had neglected to obtain medicines within an appropriate timescale for one of the people living at the home, resulting in them not having their medicines for several days. Following this investigation Borough Care has put into Care Homes for Older People Page 19 of 30 Evidence: place further policies and procedures to ensure staff know how to obtain medicines at weekends and in the evenings. Care Homes for Older People Page 20 of 30 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. People live in suitably adapted, clean, comfortable and pleasant surroundings. Evidence: A tour of the home was conducted. The home was clean, tidy and free from any unpleasant odours. The premises were well maintained, both internally and externally. A number of peoples rooms were seen, which were furnished and equipped to a comfortable standard. The majority had been personalised by the occupants with pictures, ornaments and small items of furniture. The home has several small lounges, including a room designated for people wishing to smoke and a conservatory, which was bright and airy with books and magazines for people wishing to relax and read. Care Homes for Older People Page 21 of 30 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 at Meadway Court receive care and support from a well trained staff team who have gone through a thorough recruitment process to safeguard their interests but staffing levels may affect the ability of care staff to meet peoples care needs fully. Evidence: It was reported that in the mornings there were usually 5 carers on duty to look after up to 42 people, with an additional carer who started work at 7.30am so that if people got up early and wanted breakfast they would be able to have it. This carer served breakfast until 10.30am and then helped with other care duties until 2.30pm. In the afternoons 5 carers were on duty and there was also a care supervisor on duty all day and the manager and/or the deputy manager who worked Mondays to Fridays. The majority of people that we spoke to during our visit said they thought the home was sometimes short staffed. They thought this because they said they sometimes had to wait for help when they needed it. Comments included, Their (Staff) attitude is a bit tomorrow will do - you ask them to do something and they dont follow up, Poorly ones take up their time and there is no time for those that are relatively OK. If you ring the nurse call someone comes eventually - but you have to wait, it (the home) has gone down hill a lot. They are understaffed and they have their hands full. They dont communicate with each other and get organised. They say they will do Care Homes for Older People Page 22 of 30 Evidence: something in a minute and dont comeback for 40. The expert by experience rang the nurse call bell for assistance to leave someones room and had to wait for some time before a member of staff arrived. We looked at two staff personnel files and these showed that all the information and documents required for new employees, to check their suitability to work in a care home, had been obtained before they started working there. Borough Care has a comprehensive training programme and a commitment to ensuring all staff have access to training that is relevant to the jobs they do. The training programme for January 2010 to July 2010 had just been produced and showed that staff had access to training in a variety of topics, such as dementia awareness, pressure area care, audiology, loss, grief and bereavement, first aid, food safety, health and safety, fire safety, safeguarding, medicines management, British Sign Language, and palliative care. In the AQAA the manager reported that 63 of the 20 care staff had successfully completed NVQ training. Care Homes for Older People Page 23 of 30 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. Although quality assurance systems were in place, people living in the home were unsure that their opinions were taken into account. Evidence: Since the last inspection the manager has been registered with us. At the last inspection people told us that they did not see the manager very much around the home and people repeated this during this inspection. Comments included I dont really know what the set up is - who is in authority, I see the manager in the office when I take letters to be posted but she doesnt really chat with me - she doesnt have the time, I dont have much conversation with her and I dont see her much - if she comes and puts her head in she gets out again before I can have a word with her. We spoke to the manager about this and she told us she did regularly go into the dining rooms at mealtimes and had made a point since the last inspection of going round the home more. Care Homes for Older People Page 24 of 30 Evidence: The manager had not chaired the resident/ relative meeting held in December 2009 and we recommended that she attended future meetings with residents to give them the opportunity to meet and talk to her. The minutes of the meeting had not been circulated. People said there had been some suggestions made about the food but they were not sure if anyone had taken any notice. One person said Everyone complained but not much has changed. Following the inspection the minutes of the meeting were sent to the expert by experience. The minutes did not say who had chaired the meeting or who had attended it so people that did not attend the meeting would not know who to ask if they had further questions about what had been agreed. Several suggestions and comments had been made at the meeting but it was unclear at this inspection whether they had been acted on, for example it was agreed that a supper menu would be displayed but we did not see one. Borough Care has quality assurance systems in place that include surveys for people that are new to the home, people on the intermediate care unit that are only staying at the home for a short time and for visiting professionals. Surveys are returned to the company head office. We saw some surveys that were about to be sent to the head office and the responses were generally positive although one commented that the quality of food was poor. A visit to the home by Board members of the company in November 2009 had also highlighted that people living at the home had not been complimentary about the food provided and had recommended that a consumer group was formed to look at the menus and provide feedback to the manager and chef. To date this had not been acted on and we recommended that this should be considered further. Senior managers from Borough Care had visited the home in accordance with Regulation 26 of the Care Homes Regulations 2001 and reports were available of their findings. Some of the issues we found at this inspection had been previously identified during these visits and plans had been outlined for addressing them, for example one regulation 26 report stated that the company would look at recruiting someone specifically to organise and coordinate social activities and events in order to improve the range of opportunities available for people. The manager completes a monthly audit that is sent to the companys head office. The audit covers areas such as medicine management and health and safety records. Procedures for the management and safekeeping of peoples money were satisfactory. Records were available to show that health and safety checks had been carried out in the building and equipment had been regularly serviced. The manager reported that a health and safety meeting was due the following week and that a new health and safety policy had been drafted. Care Homes for Older People Page 25 of 30 Evidence: The AQAA was completed by the manager and did not provide enough information to demonstrate to us that the manager could identify what the home did well, what areas needed further improvement and how future plans could address them. Parts of the AQAA were not completed. Although we received surveys from eight people living at the home, they had all been helped to complete the surveys by a member of staff. This surprised us because during our inspection we saw a lot of people living at the home that would have been able to complete the surveys independently. The surveys did not contain many comments. In order for people to feel comfortable about giving their honest opinion about the home it would be preferable if they could either complete them unaided or with the help of family and friends and not care staff. Care Homes for Older People Page 26 of 30 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 30 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 15 16 People living in the home must be provided with food in adequate quantities that is suitable, wholesome and nutritious and meets any specific dietary requirements. This will ensure that people are given food they enjoy and that is necessary to maintain their health and wellbeing. 01/03/2010 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 7 Reviews of care plans and risk assessments should be thorough and robust to ensure that the information provided is up to date and accurate. Advice and instructions from other health care professionals should be included in peoples care plans. This will ensure that staff have the information they need about how to meet and monitor peoples care needs and will reduce the risk that advice will be forgotten or missed. Page 28 of 30 2 8 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 3 9 Medicines that are in the form of creams and lotions that need to be applied topically must be administered as prescribed and recorded accurately. This will make sure people receive the treatment they require. The key worker system should be developed to enable staff to work with people living in the home on a more individual basis to expand their opportunities for social activities that meet their expectations and abilities. Staffing levels should be reviewed to ensure they reflect the dependency levels of people living at the home and the consequent workload for staff. This will ensure people living at the home are confident staff have enough time to meet their needs. Systems of comunication should be improved so that people living at the home know how their feedback about the running of the home is used to improve the service. 4 12 5 27 6 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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