Care Home: Newton House EPH

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What the care home does well When we spoke to people at the home about the care they received by the staff, they made positive comments. People said that staff knew how to meet their needs, the manager would be approached with complaints and they felt respected and safe at the home. What has improved since the last inspection? When we asked the staff about the recent changes, staff told us that there were improvements in the staffing levels, the day to day management of the home and activities. The manager is taking steps to address gaps in the standards of care and cannot be held responsible for the change in rating. What the care home could do better: There is one requirement outstanding from the last key inspection in 2007 and arising from this inspection there is an Immediate Requirement and seven requirements. These requirements are based on procedures, care planning, and medication, alerting agencies and staffing levels. The Immediate Requirement is on medication which is an outstanding requirement from 2007. At present medication systems are poor and must be improved to ensure there are safe systems of medication. Medication administration sheets must be an accurate reflection of medications administered. This means that staff must sign the records immediately after administration and use codes to explain the reasons for not administering the medications. The manager must ensure that medications are clearly labelled with the dosage and the times that they must be administered; this will give staff clear guidelines and provide safe handling of medications. The admission procedure must be reviewed to specify the steps to be taken when assessing the needs of those individuals wishing to live at the home which must include criteria that can and cannot be met by the staff. This will ensure that from the assessments only those people whose needs can be met by the staff are accommodated. Care plans must be more personalised, they must include the way the person wishes to have their care delivered. Having the likes, dislikes and preferred routines will provide a personalised approached to the way staff meet the person`s needs. Risk assessments for activities that involve an element of risk must be developed. The purpose of risk assessments must be to assess the level of risk to the person, consider the most appropriate action for the person so that the action reduces the level of risk can be implemented. Where there are allegations of misconduct by the service provider or anyone working at the home, CQC must be notified through Regulation 27. The report must include an action plan on the way the allegation is to be investigated and any other agency that has been alerted of the allegation. Complaints received at the home must be fully investigated and the levels of satisfaction included, this will then determine that the complaint has concluded. The manager must ensure that the staffing levels reflect the individual`s levels of need and complete a risk assessment to consider the number of staff that must be on duty at all times. Key inspection report Care homes for older people Name: Address: Newton House EPH Earlstone Crescent Newton House EPH Cadbury Heath South Glos BS30 8AA     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: Sandra Jones     Date: 2 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Newton House EPH Earlstone Crescent Newton House EPH Cadbury Heath South Glos BS30 8AA 01454866281 01454866282 lucy.vickery@southglos.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): South Gloucestershire Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 37. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Newton House is a purpose built home that is operated by South Gloucestershire Council and is registered to provide personal care and accommodation for up to 37 Service users aged 65 or over. The home is located in Cadbury Heath on the outskirts of Bristol. There are shops, community facilities and local bus routes nearby. Accommodation is provided on two levels and residents have the choice of stairs or Care Homes for Older People Page 4 of 32 Over 65 37 0 Brief description of the care home passenger lift to the first floor. All rooms are single occupancy. Two rooms are designated for service users to receive respite care. Each room has a wash hand basin. One room has an en-suite bathroom. Communal/shared spaces comprise of three main lounges, a visitors lounge, smoking room, large dining room, activities rooms, visitors lounge, and hairdressing room. The grounds and gardens are well maintained and are fully accessible to service users. All exits have ramps and handrails. Fees range from around 500 pounds per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted unannounced in over two days in June 2010 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from the staff, people living in the home and visitors. Prior to the visit some time was spent examining documentation accumulated since the previous inspection including the Annual Quality Assurance Assessment (AQAA) and this information was used to plan the inspection visit. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There is one requirement outstanding from the last key inspection in 2007 and arising from this inspection there is an Immediate Requirement and seven requirements. These requirements are based on procedures, care planning, and medication, alerting agencies and staffing levels. The Immediate Requirement is on medication which is an outstanding requirement from 2007. At present medication systems are poor and must be improved to ensure there are safe systems of medication. Medication administration sheets must be an accurate reflection of medications administered. This means that staff must sign the records immediately after administration and use codes to explain the reasons for not administering the medications. The manager must ensure that medications are clearly labelled with the dosage and the times that they must be administered; this will give staff clear guidelines and provide safe handling of medications. The admission procedure must be reviewed to specify the steps to be taken when assessing the needs of those individuals wishing to live at the home which must include criteria that can and cannot be met by the staff. This will ensure that from the assessments only those people whose needs can be met by the staff are accommodated. Care plans must be more personalised, they must include the way the person wishes to have their care delivered. Having the likes, dislikes and preferred routines will provide a personalised approached to the way staff meet the persons needs. Risk assessments for activities that involve an element of risk must be developed. The purpose of risk assessments must be to assess the level of risk to the person, consider the most appropriate action for the person so that the action reduces the level of risk can be implemented. Where there are allegations of misconduct by the service provider or anyone working at the home, CQC must be notified through Regulation 27. The report must include an action plan on the way the allegation is to be investigated and any other agency that Care Homes for Older People Page 7 of 32 has been alerted of the allegation. Complaints received at the home must be fully investigated and the levels of satisfaction included, this will then determine that the complaint has concluded. The manager must ensure that the staffing levels reflect the individuals levels of need and complete a risk assessment to consider the number of staff that must be on duty at all times. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is not enough information available to enable people to make an informed choice about moving into the home. Work currently being undertaken around assessment of peoples care needs has the potential to improve the admission procedure and help ensure that peoples needs can be met. Evidence: There is a prepared Statement of Purpose that says the aim of the home is to provide the highest level of care. It was recently updated to show changes in the staffing structure. However, the information included is insufficient and does not currently meet legislation. This means that it would be difficult for people to make decisions about moving into the home. Care Homes for Older People Page 10 of 32 Evidence: The home has the capacity to accommodate 37 people and currently there are two blocked beds, one person on respite care and 34 people accommodated. The manager is assessing the needs of the people accommodated for this reason any new admissions are closely monitored for suitability. An assessment tool, based on a scoring system is used to determine the persons dependency level with personal care, communication, mobility, orientation and mental health needs. People that scored 2051 were assessed as having high levels of need while people with a 51-100 score were medium to low levels of needs. It is evident from the assessment tool that 9 people have very high to high levels of dependency, 6 people fall into the low dependency category and 19 people on medium levels. The manager told us that while the reassessment is taking place and, only people with low levels of need can be accommodated at the home. We were also told that the Local Authority is involved in finding alternative accommodation for five people whose needs cannot be met by the staff. One person that sits in a lounge was consulted about the way people in the lounge spend their time together. This individual said that spending time in the lounge can be difficult when people with high levels of need are shouting. Three staff were consulted about the individuals dependency levels and they said while the situation is improving it can be difficult. We discussed, with the manager, the admission process followed when assessing the needs of people that wish to live at the home. The manager explained that when referrals are made by a social worker, a current needs assessment is provided which is discussed with the team. A days visit is then arranged to assess whether the staff have the skills to meet the needs of the people wishing to live at the home. Further discussions based on the social workers needs assessments and days assessment then take place and once an agreement is reached a months trial period is arranged. There is a South Glos. Admission criteria policy and that lists the needs that must be looked before accommodation can be offered to an individual. However, the criteria is unclear about the range of needs that can or cannot be met at the home. The admission procedure needs to be reviewed to ensure that the process is robust so that only those individuals whose needs can be met are accommodated at the home. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have some involvement into care planning. To provide a more personalised approach people must be at the center of their care and care planning must be essential to the delivery of care. Risk assessments must have more detail about the risk and the way the risk will be lowered to ensure the person can take risks safely. Medication systems are not safe. Evidence: The care planning process was discussed with the manager who said that care plans are developed during the 4 weeks trial period. This information is gathered from the social workers needs assessment and day visit. Care plans are then monitored monthly and reviewed annually with the care manager, the person, their relatives/representative and home staff. We were told that a Person Cantered Plan approach (PCP) will be introduced into the way the staff meet the needs of people at the home, there was one PCP completed. The case records for four people were looked at to determine the approach followed at Care Homes for Older People Page 12 of 32 Evidence: the home. Overall care plans lists the need and where care plans include the way the person says the care is to be delivered a presonalised approach is confirmed. The current care plans need more information to provide a more consistent approach, for example, the way the person likes to be addressed, triggers that would alert staff that intervention is needed, the way the person communicates and makes decisions. Where people have little verbal communication, care plans must show the way people make decisions. Evidence was found in the records to indicate that aids are being used which could be seen as restrictive and these must be supported by a risk assessment. Where there is a potential that restrictive measures are taken multi-agency decisions must be followed to ensure they are in the best interest of the person. This will ensure that a multi-agency decision are reached and confirm that the person has capacity to make decisions about aids to be used. Comments about the care planning process and supporting people to make decisions were sought from staff at the home. We were told that keyworkers were responsible for monitoring and updating care plans. However, staff said that up until recently care plans were out of date when the manager reviewed them. The responsibilities of a keyworker was discussed with the staff and they told us it involved providing personal care to a specific number of people, arranging health care visits, purchasing toiletries and ensuring people have the correct clothing. When we asked staff about the way people are empowered to make choices we were told that people make choices about food, clothing and personal care. It was also stated that profiles are kept about the way people make choices, families also help but this can at times be difficult. We spoke to four people about the way their care needs are met. However, these individuals could not recall if they had a care plan or whether they attended reviews. When asked if staff met their needs we were told they did and were able to name the person that provided their personal care. They also said that staff were respectful, for example, they knocked on doors before entering and closed doors whenever they provided personal care. There are people at the home that use aggression and violence to communicate. Care plans and risk assessments are not clear about the triggers that alert staff that intervention form them is needed and the techniques to diffuse and divert aggressive and violent behaviours. For people with dementia, care plan must say about the way the dementia manifests Care Homes for Older People Page 13 of 32 Evidence: itself and the way staff must meet the needs exhibited. Mobility risk profiles are completed during the individuals admission to the home and included are personal details, the preferred form of address unlike the care plans, weight and built. The forms of mobility impairments that may require assistance from staff is incorporated, for example, the persons ability with standing, the equipment needed to support the person and the number of staff to support the manoeuvre. Risk assessments are in place for activities that may involve an element of risk and are mainly for individuals with a history of falling, transferring from a chair and bathing. The risk assessments are generic and say very little about the level of risk to the person. Risk assessments must assess the level of risk to the person, considers the preventative measures that can be taken to provide to develop an action plan that allows the person to take risks safely. Care plans include the individuals health care needs, the health care professionals that visit people at the home and NHS facility that people access. People at the home are registered with a GP and multidisciplinary reports of visits from health professionals confirm that people see health care specialists. People have annual optician checks, dentist and chiropodist six weekly. The manager told us that a Community Nurse visits the home to check on the individuals well-being, with Community Psychiatrist Nurse (CPN), Speech and Language therapist and Dermatologists. Medication systems were examined to ensure there are safe systems of administration. When the records of administration were checked, a significant number of gaps in the recording were found. The records were then compared with the medication held and it is evident that staff are not recording the reasons for not administering medications and signing the records when the medication was not administered. There are separate records of administration for creams, ointments, inhalers and eye drops and gaps in the recording were also found. Protocols must be devised for when required (PRN) medications including creams, inhalers and eye drops. This will ensure that staff administer PRN medicines when its needed by the person. A number of prescribed medication have as directed on the label and the manager must consult the appropriate health care professional to ensure the correct dosage is administered and at the correct time. Care Homes for Older People Page 14 of 32 Evidence: An Immediate Requirement was issued for the manager to ensure that the administration records accurately reflect medications administered. Staff must have clear guidance on administering PRN and medications must have instructions about the dosage and when medications are to be administered. The manager has acted promptly by introducing measures that will ensure safe systems of medication administration. The pharmacist is supporting the manager to devise medication profiles, individual profiles that say the purpose of the medication and side effects with information leaflets about the medication. A record of medications no longer required is maintained and the signature of the pharmacist indicates receipt of the medication for disposal. The manager told us that there are no homely remedies administered from a stock supply when required by the person. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities take place each day and 1:1 time must be offered to people that prefer not to participate with group activities. People are supported to maintain contact with family and friends. Evidence: The duty manager was consulted about the way activities are arranged at the home. We were told that activities were scheduled twice daily on a running two week rota and a record of activities is maintained. The manager told us that notices about the planned activities to take place are displayed in the corridor adjacent to the lounges. Notices are symbolised with pictures and words to ensure that the people for whom its intended can understand it. While it is evident that small group activities are taking place, the manager must ensure that people who do not participate in group activities have meaningful 1:1. One person consulted about the way they occupy themselves during the day made the following comments I dont have to worry about cooking or doing my laundry. The home is warm and clean. Two people said that it was not their choice to participate in group activities and another said that they do participate in any activities organised. Three staff were asked about the activities that take place and one said that they try Care Homes for Older People Page 16 of 32 Evidence: and follow the rota but its difficult to motivate people, for this reason there is more 1:1s. Another member of staff said that more activities are taking place, although the records do not always demonstrate that they have taken place. The third member of staff said that the provision of activities was poor its mainly because undertaking caring roles and coordinating activities is difficult and not all the people at the home want to do the same thing. The Statement of Purpose says that friends and family will be encouraged to visit and the duty manager told us that there are no restrictions on visiting. Although it is suggested to visitors that they avoid mealtimes. Visitors record the nature and date of their visits which confirms that people are supported to maintain links with family and friends. Meals and Mealtime was not part of this inspection as temporary arrangements were in place while the floor covering in the dining room was being replaced Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints procedure on display in the home. However, the procedure is not always followed. People said they felt safe at the home but the organisation has failed to follow Safeguarding Adults procedures. Evidence: The Complaints procedure is on display in the foyer of the property and the records of complaints were examined to determine the way complaints received are managed. The last 3 complaints were received in December 2009 and were about inappropriate behaviour displayed by people accommodated. While the actions taken were included, the level of satisfaction was not recorded in the log book, making it difficult to establish whether the complaint was concluded. An anonymous complaint was received at CQC about inappropriate placements, staffing levels and the number of injuries sustained by the people at the home. The registered manager was asked to investigate and in the registered managers absence, the team manager conducted the investigations. Additional details are needed to ensure that the complaint was adequately investigated. We asked four people living at the home about making complaints and we were told that the manager would be approached with complaints. We also asked about their feeling of safety and they said that they felt safe at the home. Feedback was sought from staff about the way people are supported to make complaints. Staff said that Care Homes for Older People Page 18 of 32 Evidence: there is a complaints procedure in the foyer and the organisations expectation is that staff pass complaints to the manager. However, one member of staff said that complaints are not always acted upon, promptly. Two staff said that they had attended Safeguarding Adults training while a new member of staff said that this training is yet to be provided. Three staff said that if poor practice is witnessed it would be reported. While the two staff that have done the training said that making sure that people are in a safe environment is a way that individuals are protected from abuse. We made a Safeguarding alert about the inappropriate placements, the medication systems and about the home not notifying the appropriate agencies about financial irregularities. Two staff said that they had attended Safeguarding Adults training while a new member of staff said that this training is yet to be provided. Three staff said that if poor practice is witnessed it would be reported. The two staff that have done the training said that making sure people are in a safe environment is a way of making sure people are protected from abuse. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home live in a comfortable and homely environment Evidence: The Home is purpose built and provides good accommodation for the people living there. The property is arranged over two floors with lifts so that people can move around the home independently, communal space and bedrooms on both floors. Bedrooms are single, lockable and personalised. People have a combination of the homes furniture and personal belongings which reflects their personalities and interests. Toilets and bathrooms have hand and grab rails and manual handling equipment to assist with the mobility of service users. The communal areas are decorated to a good standard and each lounge has a specific purpose for example, quiet area and television lounges. At the time of the inspection the dinning room floor covering was being replaced which indicates that there is a maintenance programme to ensure people live in a homely environment. Care Homes for Older People Page 20 of 32 Evidence: Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home would benefit from sufficient staffing levels so that their needs can be met consistently. Staff attend core training that ensures they can meet the changing needs of people at the home. Evidence: Staffing levels were discussed with the manager and we were told that the individuals levels of dependency are used to calculate the staff numbers. There are 640 hours allocated which incorporates day care hours, with time for activities and night care cover. At the time of the inspection there are six staff rostered in the morning, five in the afternoon, two staff awake at night and ancillary staff for cooking and cleaning the home. The manager and duty managers were supernumerary unless needed by the caring staff to provide hands on care. We were also told by the manager that new rotas will be introduced from Sunday to create longer shifts which ensure that staffing levels can be maintained. The shifts will be 8:00 - 3:00, 2:00 - 10:00 and 3:00 - 10:00. However, the existing rotas were examined and it is evident that staffing levels at times fall to 4 staff; this is mainly from 2:00 till 4:00 p.m. The manager must conduct a risk assessment to ensure that there are sufficient staff to meet the needs of the people at the home. Where there are risks identified, the manager must then call upon additional staff to ensure that people at the home are safe and their needs are met. Care Homes for Older People Page 22 of 32 Evidence: There is 1.5 ft. equivalent post that will be filled by staff that need to be re-deployed within the organisation. While re-deployment takes place, vacant hours are being covered by existing, casual and agency staff. We asked people at the home about the staff and whether there were sufficient staff when they needed them. One person said that there were a lot of casual staff and felt that this could be because so many staff were on annual leave. Another felt that there could be more staff on duty. We then asked the staff about the staffing numbers and they made the following comments they are not the greatest, its getting easier but its still hard, a lot of agency staff were being used because of the individuals levels of dependency. At one stage it was awful, staff were going off sick and they have improved. South Gloucestershire Council are not currently recruiting into their residential care homes, staff that are under the threat of redundancies are given the opportunity for re-deployment into care home. Staff training was discussed with the staff on duty at the time of the inspection. Staff said that there is a lot of training such as Manual Handling, Medication, and Health & Safety which form part of the organisations core training. Dementia training was also provided and staff said the training was good, it has increased their awareness and the way they treat people with dementia. We were also told that NVQ training has been offered recently and staff are now working towards a vocational qualification. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home will benefit from strong leadership, staff must have regular supervision so that their performance can be monitored. Individuals can be reassured that records of cash held in safekeeping is accurate and up to date. Evidence: The current manager has been in post for four weeks and the change in rating has no bearing on the current managers performance. The manager was asked about the systems in place that ensure consistency and we were told there are handovers when shift changes occur, daily reports and staff meetings that keep staff informed. Handover is where daily discussions about the individuals welfare take place, running reports provide a written record about daily occurrences and incidents. Staff meetings are pre-arranged and initially to be held for all staff, with a set agenda focusing on ground rules, medication and people at the home ensure that staff are working together. Two meetings have taken place since March and feedback from staff are that they are good and staff are satisfied and the home is heading in the right direction. Care Homes for Older People Page 24 of 32 Evidence: We then asked the manager about the leadership of the home. The manager told us that working with staff where suggestions are taken seriously and considered is the management style used. Regular staff meetings, maintaining contact with the staff and ongoing monitoring of standards are part of the role which ensures that people have a consistent approach. It was further stated that a task orientated approach, where staff are delegated specific areas of responsibility is another way of working together towards a shared goal. We spoke to staff about the way the manager leads the staff to meet the needs of people at the home. One member of staff said that the manager is doing brilliantly, she is trying hard and the day to day leadership is getting better. Another told us that it is more organised and although suggestions are taken seriously they are not always acted upon. The third member of staff explained that there were problems with the way the home was managed and these were about the staffing levels and the needs of the people at the home. These concerns were taken seriously by the organisation and action was taken to improve outcomes. People were consulted about the staff at the home, they said that that the staff were okay and didnt shout at them and another said that the staff were nice. We spoke to a duty manager about the financial arrangements for people that have money in safekeeping. There are facilities at the home for people to have cash and valuables in safekeeping. We were told that two people have their personal allowance from the Local Authority; the staff receive notification by email of the amounts to be paid which is then withdrawn and given to the person. There are facilities at the home for safekeeping cash and valuables and the duty manager said that generally cash is handed in by relatives for sundries. Records show that one member of staff signs the records whenever money is deposited and two staff sign for withdrawals. We were told by the duty manager that the purpose of having money in safekeeping is for people to have ready cash to purchase toiletries, hairdressing and chiropody. A sample check of cash held in safekeeping was undertaken and records were found to correspond with the cash held and the receipts supported the purchases made on behalf of the person. We understood from the duty manager that these records are checked weekly to ensure safe handling of finances. Supervision was discussed with the manager and staff at the home. We were told that supervision for care assistants occur 4-6 weekly but it was acknowledged that they have not been previously taking place as regularly. Three supervision records were examined and these staff had received 1 supervision session in 2010 and must occur Care Homes for Older People Page 25 of 32 Evidence: more regularly. We spoke to staff about supervision and staff meetings. We were told that staff meetings are regular and there are minutes of the meeting for staff that were not able to attend. We understood from these staff that the manager will then go through the meeting minutes with those individuals that did not attend. In terms of supervision, staff said that it is taking place although its not regular at the moment. The manager was consulted about the way the Registered Individuals (R.I.) makes arrangements to check on the conduct of the home. We were told by the manager that there is a yearly programme of peer visits and a report on the findings is prepared and sent to the home, team manager and service manager. The current manager is going through the induction period and is being supported by peers who act as mentors, two weekly supervision from the team manager with weekly visits from the service manager. South Gloucestershire Council operates a Quality Assurance System through surveys from people at the home, family/representatives and staff. Responses can be anonymous and are sent directly to an independent organisation that analysis the responses and then prepares a report. The report is then sent to the home where an action plan is devised. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 (2) The manager to make sure that administering records are fully completed. (This refers to evidencing that medication has been offered or given to individuals) (Not met). 21/08/2007 Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The manager must make arrangements for the recording, handling, administration of medicines. The manager must ensure that records of administration are an accurate record of medicines administers. Also prescribed medicines must be clearly labeled on the way that the medications are to be administered. 11/06/2010 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 3 4 The manager must include the arrangements for admission to the home which must include the criteria that can and cannot be met at the home. An admission procedure must be devised which clearly describes the steps that will be taken to ensure that only those individuals whose needs can be met are offered accommodation. 11/06/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 3 14 The registered manager must ensure that suitably trained staff undertake assessments of the people wishing to live at the home and only offer accommodations to those individuals whose needs can be met at the home. The manager must only offer accommodation to those individuals whose needs can be met by the staff at the home. 11/06/2010 3 7 13 Risk assessments for activities that involve an element of risk must be devised Risk assessment must assess the level of risk to the person, consider the actions to reduce the level of risk to devise an action plan. 04/12/2010 4 7 12 The manager must take into 04/12/2010 account the individuals wishes and feeling on the way their health and welfare needs are to be met. Care plans must be more personalised, They must include the likes, dislikes and preferred routines. The way people communicate and make decisions must Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action also be incorporated into the care plans. 5 18 37 The registered person must inform the Commission of any allegations of misconduct by any person who works at the home The registered provider must notify the Commission of any allegations by any person working at the home and the action they intend to take. 6 18 22 The manager must ensure 04/07/2010 that complaints received are investigated fully. The manager must ensure that the level of satisfaction is included this will determine that the complaint has concluded. 7 27 18 The manager must ensure that at all times there are sufficient staff on duty to meet the needs of the people accommodated. The manager must ensure that the staffing levels meet the dependency needs of the people accommodated 11/06/2010 04/08/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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