Care Home: Oldfield Bank

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What the care home does well The home recognises the importance of the standard of residents environment and in providing a comfortable, well maintained and clean place to live.The lounges and dining room were all clean,well maintained and decorated.The garden and external grounds provide a colourful and peaceful area for residents to relax. Residents spoken to were complimentary about the quality, choice and amount of food offered. They were encouraged to talk to the cook about their own personal dietary needs and to provide feedback and suggestions. One resident said,"meal times are very important and so the food needs to be good". Staff spoken to had a very good understanding of the residents they worked with. They were aware of the issues and problems they had but focused on the positives they found in residents and concentrated on residents abilities. Residents and visitors spoken with were complementary about the care and support they receive and the skills and personalities of staff. During this visit there was a relaxed and informal atmosphere,and residents appeared settled in their environment. People who were spoken to spoke highly of the staff team, and the way in which they supported them. Staff were observed as they engaged in meaningful conversations with residents, and where appropriate, they offered support and reassurance in a sensitive and caring way. What has improved since the last inspection? Since the last inspection the medication procedures have incorporated improvements to best practice. To safeguard the home and to ensure residents receive controlled drugs as prescribed the home has arranged for a second staff member to sign the medication administration records to confirm and verify administration. An up to date list of staff signatures of staff trained in medication administration is now maintained. The refrigerator, which stores medication has a lock fitted to ensure that the medication is kept securely. To ensure medication that has a limited shelf life is disposed of at the correct time, the date of opening this kind of medication is now indicated on the actual medication.Prescribed creams have been removed from bathrooms and stored dressings and nursing equipment used by district nurses have been put away safely. More attention has been paid to providing activities. A new staff member has been recruited to lead the activities and to provide some administrative support at the home.To demonstrate the organised activities and to record who has taken part a record is made of the activities organised and the name of the resident attending. Care plans are being rewritten to provide more comprehensive information. We were told that the home has enlisted the help of a "facilitator" to give guidance in this development.Four new staff are scheduled to obtain NVQ 3 qualifications in August 2009 and are to then undertake NVQ 4 in care.We were informed in the AQAA that"with the recruitment of more English speaking staff communications within the home have got better,resulting in improved team spirit". What the care home could do better: To provide some degree of protection to residents and staff and to ensure staff know what to do in an emergency situation,All staff must receive routine fire drill training practice training at intervals of not more than six months. The service user guide needs to be further amended to ensure the information provided in the document is accurate and up to date. The owner /manager needs to refer back all medication, which is indicated on the medication records"use as directed"to the residents doctor for clear instruction on how often this medication is administered. This needs to be printed on the medication administration records routinely. Provide staff with guidance, direction and support in how to complete the daily and night reports to demonstrate the care or support provided to residents. Include in the care plan residents individual night time care needs so it is clear what or when staff are supporting residents during the night.Make sure that staff when providing support during the night demonstrate in the records that they have given such care. Discontinue the practice of using correction fluid on records which are maintained for the purpose of regulation ensuring records are maintained in a permanent format and all entries can be seen. Continue with the development of the care plan and include what residents needs, wishes and preferences are in the care plan.Arrange for residents or their family or representatives to view care plans and to agree and sign them. Maintain a record of food served to residents in such detail that anyone examining the record could judge whether the individual diet is sufficient. The owner/manager needs to attend training specific for managers in relation to adult protection procedures and protocol to make sure if there is an allegation of abuse made the procedures are known and are followed to promote the safety of residents. Adult protection (POVA) training must also be arranged for all staff to ensure they have a clear understanding of what to do should an allegation of abuse be made and to recognise the signs and symptoms of abuse. To promote the respect of residents and there independence the owners and manager need to provide plugs to sinks in the wash hand basins in bedrooms, toilets and in sinks and baths in bathrooms. If it is identified that it would be a risk to a particularresident to have a plug in the sink or bath then this should be noted in there care files and a risk assessment undertaken of the steps in place to minimise that risk as opposed to taking away plugs. Toiletries should be personal to the resident and should be in residents bedrooms being taken to the bathroom when they need them. To promote the safety of residents and to ensure that residents are able to call for assistance and this is heard by staff.Provide a call bell system that is audible to staff as opposed to relying on cooking staff or staff in the dining room to alert them to the fact that residents need support or assistance. There needs to be a better system of identifying who is on cleaning and cooking duty and who is on caring duty on the staff duty roster so that the provision of care to the residents is not diluted. To ensure the owner manager is up to date with legislation,training and qualifications they need to research further training available and ensure attendance to updates to her training. This will enable the owner manager in addition to updating on her knowledge to assess the competence of staff and ensure they are doing what they should be doing to keep themselves and residents safe. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oldfield Bank 5 Highgate Road Altrincham Cheshire WA14 4QZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 3 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 36 Information about the care home Name of care home: Address: Oldfield Bank 5 Highgate Road Altrincham Cheshire WA14 4QZ 01619280658 01619290734 oldfieldbankrch1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Anne Leavy,Mr Lawrence Leavy care home 28 Number of places (if applicable): Under 65 Over 65 28 0 old age, not falling within any other category physical disability Additional conditions: 0 28 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 28 Date of last inspection Brief description of the care home Oldfield Bank provides accommodation and personal care for up to twenty-eight residents within the category of old age. Residents may also have a physical disability. Mr Lawrence and Mrs Anne Leavy own Oldfield Bank, with Mrs Leavy being the registered manager. The home is a large detached property, which has been extended and is set in pleasant grounds. The enclosed gardens are well maintained and residents can sit or stroll in Care Homes for Older People Page 4 of 36 Brief description of the care home the grounds. Car parking spaces are provided at the front of the building. The home has 26 single bedrooms, six of which are en-suite and 1 double room which is also en-suite. Upper floors are accessed by a passenger lift and stairways. The home is situated within a residential area of Altrincham and is a short distance from shops, transport links and the motorway network. At the time of this inspection it was reported that the homes charges for care and accommodation ranged from 500 to 550 pounds per week. The home has a service users guide and statement of purpose both of which are available to prospective residents upon request. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the owner,manager, staff and residents were not told that we would be visiting, and took place on 30th July 2009 commencing at 9:20am. We spent nine hours at the home. The owner/manager was available on the visit and provided us with a lot of information and records and support during the visit in addition to the support from staff and residents. The inspection of Oldfield Bank included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was held in July 2007. Care Homes for Older People Page 6 of 36 We looked at the Annual Service Review (ASR) that was carried out on 25th June 2008. An ASR is a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. At that time we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit the owners or manager was asked to fill in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do. We considered the responses and information the administrative officer from Oldfield Bank provided and have referred to this in the report. Oldfield Bank was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at Oldfield Bank the views expressed in returned comment cards and those given directly to the inspector are included in this report.We also send a comment cards to residnets to pass on to their relative, friends or advocates to obtain their views, opinions and feelings about the home. We got our information at the visit by observing care practices, talking with people staying at Oldfield Bank talking with the owner and owner/manager, some visitors and staff.A tour of Oldfield Bank was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Oldfield Bank was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents was looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people consulted during the visit was residents. This term is, therefore, used throughout the report when referring to people living at Oldfield Bank. A brief explanation of the inspection process was provided to the owner/manager at the beginning of the visit and time was spent at the end of the visit again with the owner/manager to provide verbal feedback. We have received no complaints about this service and have been made aware of one safeguarding matter which is being investigated by the police and fire service. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 8 of 36 What the care home does well: What has improved since the last inspection? Since the last inspection the medication procedures have incorporated improvements to best practice. To safeguard the home and to ensure residents receive controlled drugs as prescribed the home has arranged for a second staff member to sign the medication administration records to confirm and verify administration. An up to date list of staff signatures of staff trained in medication administration is now maintained. The refrigerator, which stores medication has a lock fitted to ensure that the medication is kept securely. To ensure medication that has a limited shelf life is disposed of at the correct time, the date of opening this kind of medication is now indicated on the actual medication.Prescribed creams have been removed from bathrooms and stored dressings and nursing equipment used by district nurses have been put away safely. More attention has been paid to providing activities. A new staff member has been recruited to lead the activities and to provide some administrative support at the home.To demonstrate the organised activities and to record who has taken part a record is made of the activities organised and the name of the resident attending. Care plans are being rewritten to provide more comprehensive information. We were told that the home has enlisted the help of a facilitator to give guidance in this development. Care Homes for Older People Page 9 of 36 Four new staff are scheduled to obtain NVQ 3 qualifications in August 2009 and are to then undertake NVQ 4 in care.We were informed in the AQAA thatwith the recruitment of more English speaking staff communications within the home have got better,resulting in improved team spirit. What they could do better: To provide some degree of protection to residents and staff and to ensure staff know what to do in an emergency situation,All staff must receive routine fire drill training practice training at intervals of not more than six months. The service user guide needs to be further amended to ensure the information provided in the document is accurate and up to date. The owner /manager needs to refer back all medication, which is indicated on the medication recordsuse as directedto the residents doctor for clear instruction on how often this medication is administered. This needs to be printed on the medication administration records routinely. Provide staff with guidance, direction and support in how to complete the daily and night reports to demonstrate the care or support provided to residents. Include in the care plan residents individual night time care needs so it is clear what or when staff are supporting residents during the night.Make sure that staff when providing support during the night demonstrate in the records that they have given such care. Discontinue the practice of using correction fluid on records which are maintained for the purpose of regulation ensuring records are maintained in a permanent format and all entries can be seen. Continue with the development of the care plan and include what residents needs, wishes and preferences are in the care plan.Arrange for residents or their family or representatives to view care plans and to agree and sign them. Maintain a record of food served to residents in such detail that anyone examining the record could judge whether the individual diet is sufficient. The owner/manager needs to attend training specific for managers in relation to adult protection procedures and protocol to make sure if there is an allegation of abuse made the procedures are known and are followed to promote the safety of residents. Adult protection (POVA) training must also be arranged for all staff to ensure they have a clear understanding of what to do should an allegation of abuse be made and to recognise the signs and symptoms of abuse. To promote the respect of residents and there independence the owners and manager need to provide plugs to sinks in the wash hand basins in bedrooms, toilets and in sinks and baths in bathrooms. If it is identified that it would be a risk to a particular Care Homes for Older People Page 10 of 36 resident to have a plug in the sink or bath then this should be noted in there care files and a risk assessment undertaken of the steps in place to minimise that risk as opposed to taking away plugs. Toiletries should be personal to the resident and should be in residents bedrooms being taken to the bathroom when they need them. To promote the safety of residents and to ensure that residents are able to call for assistance and this is heard by staff.Provide a call bell system that is audible to staff as opposed to relying on cooking staff or staff in the dining room to alert them to the fact that residents need support or assistance. There needs to be a better system of identifying who is on cleaning and cooking duty and who is on caring duty on the staff duty roster so that the provision of care to the residents is not diluted. To ensure the owner manager is up to date with legislation,training and qualifications they need to research further training available and ensure attendance to updates to her training. This will enable the owner manager in addition to updating on her knowledge to assess the competence of staff and ensure they are doing what they should be doing to keep themselves and residents safe. 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 set out 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 11 of 36 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 12 of 36 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. Prospective residents receive information about the home and have their needs assessed;this enables them to make an informed decision about moving into Oldfield Bank. Evidence: The statement of purpose and service user guide,which are documents that let residents know about the home and the services provided,have been reviewed and updated. The service user guide does have some statements in which are no longer applicable and need to be amended so residents have up to date and accurate information about the home and the services provided. We were told that where possible a visit would be made to prospective residents in their own home or placement to complete the homes own pre assessment procedure.Meeting with residents before they make any decisions about moving in,and Care Homes for Older People Page 13 of 36 Evidence: introducing themselves and assessing the residents needs is best practice and beneficial to the residents and the manager.The manager said it was her intention to carry out these assessments for future prospective residents. When prospective residents are referred through the local authority a copy of the local authoritys assessment and care plan is obtained by the owner. We asked staff if they are given information about the needs of the people they support or care for. All staff who responded said,always. We asked residents if they were provided with enough information before moving in.Residents spoken with told us they were. For those residents whose family members act on their behalf, we were told that they received enough information to enable them to inform the resident about the home. Care Homes for Older People Page 14 of 36 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. Residents health and personal care needs were being met by staff that respected their privacy and dignity. Evidence: A resident told us, I am quite happy and the home provides all I need. The resident added, For my own thought I am happy and contented and should I have any complaints the staff would listen and help if needed. Another resident saidtop rate no complaints.A further resident said, satisfied with the care. A resident said, a wonderful caring home. In response to the question do the staff listen to you and act on what you say one resident said yes and added, but then any action is taken in what is regarded as in my best interest. A resident said that staff dont always listen and act on what they say as they are sometimes too busy. A resident wrote to us to say, the home cares for all of us very well from the time Care Homes for Older People Page 15 of 36 Evidence: they help us get up and dressed until they help us to bed at night. They anticipate our needs before we ask. They are all very kind and so nice to our visitors to. Visitors made welcome and offered tea or coffee.One resident said they felt, safe comfortable and warm. A resident said, My main concern prior to taking up residential care was to be satisfied about the standard of care. I am fully satisfied about the standard of care and am very impressed with the efficiency and kindness of the staff in the execution of their duties.The resident added, I am very pleased to say that I cannot think of anything that would significantly improve on the standard of care or otherwise and I am perfectly happy about the environment and the atmosphere prevalent to Oldfield Bank. A relative told us, In the case of illness, the care and attention particularly during the night was excellent (my cared for relative|) was never left on his own at all when feeling unwell. Very reassuring. A relative in response to the question what could the home do better said, Listening to a problem comes easily but acting on that problem does not always follow on. The care plan should sets out in a clear and detailed way what a person needs and what they would like to achieve. It should give lots of information about the things that are important to that person and describes how the home is going to support them. This would mean that the staff are clear about how they should be working with people but it also gives the person greater control over their life at the home and not have things just done for them. We looked at the care files for three residents.All residents were receiving hourly checks throughout the night. It was not clear what or how staff were assisting residents during the night. There was no detail in the care plan of residents night time care needs. We could not see the time residents were checked or what needs were being checked. We saw that a resident had a fall during the night but couldnt see if or when this resident had received support from staff. We were told that staff had checked this resident not long before she had the fall but this wasnt written down anywhere. In one of the residents care files we looked it said,that,with prompting (the resident)will eat and drink very well.And that staff were to monitor(the residents)weight and report any changes to (the residents) GP(doctor). The resident was weighed monthly which identified that they had put on eight pounds in a month and over a period of four months over a stone. When we looked at the record of Care Homes for Older People Page 16 of 36 Evidence: contact with the residents doctor there was no entry to say that contact had been made. We were told that the resident was putting on weight and this was good. The care plan didnt identify this. A care plan is a record which should clearly identify residents individual care needs and detail the support to be provided by staff. Care plans should be written with the involvement of the resident and agreed and signed by the resident if they are able and or there representative. In the care files we looked at residents or their representatives or familys hadnt signed to confirm their agreement. We were told by the owner that some have signed and the rest will be attended to. We looked at the reports completed by staff during the day to detail the care and support provided. Some of the entries did not tell us what support or care was provided or were very general. Comments such as,all needs attended needs been attended to all care given were some of the entries made by staff. These comments do not show the care and support or assistance given to residents. There was evidence that residents attended health care appointments or were seen by the optician or audiology for example.Records in files demonstrated that residents were supported to keep appointments with health care professionals including hospital visits.The owner said they work hard at the home to ensure that they work well in partnership with all health care professionals. Risk assessments were in place in the files we looked at. There were risk assessments in the care files about things like falls, pressure areas and nutrition. In addition there were risk assessments which were not completed. When we asked about these we were told by the owner that the risk assessment was there just in case the risk was identified. Risk assessments should be in place for risks that are identified as opposed to identifying any and all risks when residents arent at risk for example of salmonella from eating soft boiled eggs unless they eat them.These documents are good to have and can be used if or when a particular risk is identified. But by putting them in all residents care files without filling them in looks as if a risk has been identified and staff have decided not to record in the paperwork. A member of staff told us that they thought theysupported residents with health problems and disabilities well. And that staff are good at, taking good care of the residents. The medication administration records are printed by the pharmacist detailing the prescribed medication and when and how the medication should be given. The pharmacist provides these monthly. Care Homes for Older People Page 17 of 36 Evidence: Some instructions on the medication administration records detailed medication to be administered as directed. This is not sufficient and needs to be referred back to the residents doctor for clear instruction how often this medication should be given. This will safeguard residents and makes sure they receive medication as prescribed by the doctor. Best practice is to indicate in the medication records the usual initials of staff who administer medication. These were in place but were not the initials staff used when signing to administer medication. One of the reasons for having specimen initials is that if a check needs to be made of medication administration it is clear who has given it to residents.The specimen signatures need to be how staff sign when they are administering medication. Some medication has limited shelf life and the date the medication is opened needs to be written on it to make sure it is safe. This type of medication had the date they were opened, so it could be confirmed if the medicine was still in date.This promotes the health of residents. Medication was seen to be stored safely and a lockable fridge is now in place which is used to store medication that needs to be refrigerated.Staff who have the responsibility to give out medication have all received medication training.This provides a safeguard to residents that staff know what they should do when giving out medication. Care Homes for Older People Page 18 of 36 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. Residents were provided with a range of activities to meet their social needs. Contact with family and friends could be maintained and the home provided a well balanced and nutritious diet. Evidence: Menus were planned over a 4 week menu cycle. These were planned to ensure that alternative choice are available. Meals served appeared to be appetising, nutritious and of adequate portion size. One resident told us the food was very good.Another resident said, the dining room is very inviting. All the tables are properly laid. Any unused cutlery is taken to be washed so we know all is clean for the next meal. Lovely birthday cake with candles for every birthday. They try to find alternative food when someone doesnt like certain things. The home continues to offer residents a choice of meals that were balanced and a menu based on residents preferences.Alternative choices was offered to residents who may not like the main meal.The majority of meals were taken in the dining room. Some residents said they didnt have anything to eat or drink after tea time and didnt Care Homes for Older People Page 19 of 36 Evidence: have supper. Residents said if they go to their bedroom after their evening meal they wouldnt get a drink or any supper. The owner said this wasnt the case and residents could have a drink and something to eat at whatever the time of day or night. The owner said she was aware that staff took drinks round but would double check her understanding that all residents,unless they are asleep or ask not to be disturbed get a supper time drink and are offered something to eat. There were no records of what residents had for supper or if they had supper. The cook told us that residents usually had toast or biscuits or that type of thing for supper.One resident told us that they asked for a drink when they were thirsty and this was always supplied. A complete record is not maintained of the food served to residents,so a judgment cannot be made as to what individual residents eat each day.This record may also be used to support the care plan and the progress of residents,as it could be used to take into account if,for example, someone was loosing or gaining weight. We have made a recommendation regarding this. The cook keeps a record of residents likes,preferences and dislikes so that residents only have what they like to eat or in a way which they like there food cooked. Residents said they really liked the home cooking and particularly liked the soups and home made sweets. A resident said that they thought the home could improve by providing some activities and I often felt lonely.A member of staff said that the home could do better with, more activities for the residnets that are able. The owner told us that they had an activities coordinator and we looked at a record of activities that have taken place over recent weeks. On the day of the visit there was a constant flow of visitors to the home and all were seen to be made welcome. Care Homes for Older People Page 20 of 36 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. Policies and procedures are in place,which help to ensure that residents are protected from harm or injury.Training in adult protection would provide staff with the knowledge to protect residents from abuse and harm. Residents know who to contact if they want to make a complaint. Evidence: There was a complaints policy and procedure in place.Residents,relatives and staff were clear that they knew who to approach should they have any concerns or complaints about the service.A resident told us, I have no complaints. Information in the AQAA told us, A copy of our complaints procedure is handed to all residents/relatives on admission to the home and is displayed in the entrance hall. Any complaint is acted upon immediately. The complaints book record,we were told,was one of the records that had been taken from the building as part of an investigation. We could not therefore look at this record. The owner manager said that they receive comments about the service but have not had any complaints as such. The home had a policy and procedure relating to the Protection of Vulnerable Adults(POVA) which was linked directly with the local authoritys guidelines.Safeguarding of vulnerable adults training has not been arranged for all Care Homes for Older People Page 21 of 36 Evidence: staff at Oldfield Bank, which means that staff may not be able to recognise abusive situations or know how to respond to these. We were told in the AQAA thatwe have adopted Trafford Safeguarding of adults policy and procedures and all care staff have received a copy and have signed to acknowledge they have read and understood the content. We were told on our last visit in 2007 that the home were waiting for places to be allocated to them for this training. This does need to be followed through by the owner. We have again repeated this recommendation.Training in adult protection (POVA) is needed and should be arranged to ensure that all staff have a clear understanding of what to do should an allegation be made.In a letter we received from the administrative manager it stated, I am trying to arrange formal training for POVA but as yet, I have not been able to speak to anyone at Trafford. It is our intention to book all carers on a course. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided an environment that was well maintained,clean,and comfortable. Evidence: The information in the AQAA completed by the administrative manager before our visit told us, the home is clean, pleasant and hygienic. Residents are encouraged to furnish their rooms to suit themselves. Communal areas both inside and outside in the extensive gardens, are pleasant and accessible to all residents. We had a look around the home in some residents bedrooms, in some of the bathrooms and toilets and in the lounge and dining room The house provided comfortable surroundings for residents. A resident told us, The lounge is large and open plan but its arranged that chairs are in small groups making it very informal. We all have comfortable armchairs. Residents and staff confirmed this as the usual appearance of the home.Comment cards from residents confirmed their satisfaction with the home in terms of cleanliness and comfort.All residents who completed a comment card said the home was always fresh and clean. The staff told us that several bedrooms have been decorated and had new carpets Care Homes for Older People Page 23 of 36 Evidence: fitted. We were told in the AQAA, some of the communal areas on the ground floor are in need of redecorating, however we now have planning permission to extend into neighbouring premises and this redecoration is scheduled as part of this extension programme. Bedrooms seen were appropriate to meet the needs of individuals and aids and adaptations had been provided.Bedrooms were personalised with items brought from residents homes. Bedrooms were clean and residents told us they had everything they needed in their bedrooms. The number of the bedroom and the name of the resident were on the bedroom door, which helps residents identify their rooms and also in an emergency can be located easily. We noted that some of the sinks in bedrooms, in bathrooms and toilets didnt have a plug, in addition at least two baths were without plugs. This practice of removing plugs is institutional and means that residents cannot independently use the sinks as they should be to have a wash. If it is identified that it would be a risk to a particular resident to have a plug in the sink then this should be noted as opposed to taking away plugs. We did report on our last inspection in 2007, It was observed that a number of the sinks within bathrooms and toilets didnt have a plug, so residents wouldnt have been able to wash in the sink. This needs to be remedied. A recommendation was made to address these shortfalls which has not been actioned. To promote the respect of residents and to encourage independence the owner does need to sort this out. We also saw that toiletries were within the bathrooms. Toiletries should be personal to the resident and should be in residents bedrooms being taken to the bathroom when they need them. Since the last visit the recommendation to remove prescribed creams from the bathrooms has been addressed.We were told that theseare kept in a locked cupboard. And that district nurses now have their own dedicated room in which to store dressings, equipment and a sharps bin. This room is kept locked when not in use. The call bell system was being upgraded when we went on our visit. We noted that the call bell sounder is within the kitchen on the lower ground floor. Staff are reliant on cooking staff alerting them to the sounder going of. Which in turn takes time. The cook will then need to go and find a staff member to let them know someone is calling for support or assistance which delays staff responses. We did try the call bell,but as the workmen were in the home at the time it wasnt obvious to staff initially that we were in fact testing the system. However when we tried the system again from another bedroom a staff member did come up to investigate. Staff were aware that the resident from that bedroom was downstairs. Care Homes for Older People Page 24 of 36 Evidence: We reported when we last visited Oldfield Bank that some of the bathrooms and toilets did not have a call bell in place. This has been the case since registration. We were told on that visit that for one of the bathrooms residents did not use this alone. The call bell system may also be used by staff if they want to get some help say if a resident has fallen or is taken poorly and they cant manage on their own or if they need to get staff to get help.It is important that the call bell system is available in all rooms and is audible in the building so staff can hear immediately when residents call for assistance.The call system with an accessible alarm facility should be provided in every room. The home was clean and tidy with no unpleasant odours detectable throughout the premises.Procedures and measures were in place to monitor and maintain infection control and laundry was dealt with appropriately. All staff and residents had access to hand washing facilities and products. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care and support from staff who have the skills to support them correctly. Evidence: Several staff had worked for a few years in the home, with the continuity of care benefiting the people living there. Some new staff have been appointed to care positions since we last visited. We looked at three of these staff files.There were no references on the files we looked at. The owner told us that an organisation collates references and such like for oversea employees before staff started work at the care home. We were also told, references are routinely taken up when employing staff.The owner also told us,with regard to criminal record bureau information, this is not kept in the staff file. A record of the serial number is made on a master list which is stored in a locked drawer and the certificate is then distroyed in accordance with Data protection procedure The administrative manager who we were told attends to the paperwork for the recruitment and selection of staff was on holiday on our visit and the owner told us that he would arrange for this information to be forwarded to us. Employee references and the number and date of the criminal record bureau checks were forwarded onto to us as requested. Care Homes for Older People Page 26 of 36 Evidence: The home completed its own induction, which appeared to be of a good standard. We were told it was to Skills for Care specification,which supports continuing professional development;including helping prepare workers for entry onto the appropriate Health and Social Care National Vocational Qualification(NVQ). We looked at the staff duty roster and it detailed the names of staff on duty but didnt include their role. Some staff were doing different roles,for example,one member of staff was the cook and the carer whilst on particular shifts.The staff duty roster we looked at had correction fluid on it.We have spoken in a previous section about the use of correction fluid on records and to discontinue using this. This applies to all records kept for the purpose of regulation. Training has been provided to staff that should support them to provide care and support in line with best practice and up to date routines and regulations. A record is maintained of all the training, which makes it easier to arrange for staff to receive updates when they are due and make sure everyone has had the necessary training to do their job well. We were told that the two staff who needed updates to their moving and handling training was in hand. We received a letter from the administrative manager which said,a refresher course for moving and handling has been booked for 26th August. The AQAA indicated that 3 staff had obtained NVQ training. On our visit the training sheet we looked at indicated that five staff had obtained NVQ 2 and four staff had obtained NVQ 3. We asked for clarity on this and we were told that some new staff had recently obtained these and this now made nine staff in total with NVQ qualifications. The national minimum standards indicate that at least 50 of care staff should be trained to NVQ 2. The home now exceeds this standard as they employ 14 care staff. A relative told us thatmost staff very caring professional and dedicated. Another relative said they could improve the service by having more staff during day and particularly at night. Sometimes morning and night bells not responded to promptly. A member of staff said, they provide us proper training and seminars that are helpful in our work. The staff member added, As far as I am concerned I cant see anything lacking or anything negative about our care home. I am very blessed with my work right now. The proprietors are very nice, they are so down to earth and they are not just talking care of the residents, they also care about the staff. A member of staff said, the management is taking care of us to, providing us with Care Homes for Older People Page 27 of 36 Evidence: training and seminars that are helpful in our work. A relative said, without exception the carers at Oldfield Bank are very caring, patient and friendly individuals. They work hard and my (cared for relative|) is very fond of them. The relative added,On occasions there are obviously staffing issues when the staff present are clearly under a lot of pressure taking care of elderly, demanding and often frail residents. A resident said,I am abundantly impressed by the due diligence of all the staff at Oldfield Bank. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems ensure the efficient running of the home and the ongoing improvement of the service. Evidence: The owner is the registered manager and has been such for a number of years. Until recently the owner was supported by a deputy manager and we were told that they did the job together both having differing responsibilities. The deputy has left her employment at Oldfield Bank and on our visit a replacement hadnt been appointed. Senior staff were being given some additional responsibilities and the owner was giving some thought about about the future management arrangements at the home. The owner manager doesnt have any formal management qualifications but has a wealth of experience albeit in some areas limited due to the previous management arrangements. Advice was given on this visit to check out qualifications and training to ensure that she keeps up to date with changes in legislation and best practice and is Care Homes for Older People Page 29 of 36 Evidence: able to direct and support staff when they have undertaken training she is aware of the right way to do things. A quality assurance system is in place that seeks and acts upon the opinions of residents in terms of their day to day experiences and improvements that could be made. The owner has compiled a summary report of the findings to accompany the statement of purpose to evidence this consultation process.Residents confirmed that the home values their views on the quality of care they receive. A member of staff told us, the care home is being run by the management smoothly.Another staff member said, personally as an employee in this home I would give a positive commentary with how they manage the home, how they care to the staff and what exemplary service being given to the residents. All of us work hand in hand as a team and I didnt feel being left out even if the staff came from different countries and different races. No finances were managed on behalf of residents other than small amounts of cash that may be given for safekeeping.Where this is the case, records and receipts were maintained and kept. All incidents affecting the health and wellbeing of residents should be routinely reported to the Commission. This is being undertaken as required by the regulations. To ensure the Commission is aware of these events the owner arranges for this information to be sent to us routinely. As part of an investigation by the police and fire service some records we were told had been taken from the building until the investigation was complete.We looked at the fire records which were available on the day of our visit. Not all staff were recorded as having taken part in fire drill practice training. It is essential that staff know what to do in an emergency situation. Failure to be aware of these procedures could compromise the health and safety of staff and residents. Staff that had received fire training on 16th June 2009 have signed next to their printed name to confirm they have undertaken this training. We had made a recommendation for staff to sign next to their printed name on our last inspection as this is best practice.On our visit there were six people who we couldnt confirm had received fire drill training practice. This included the owner and an agency worker. The administrative officer was on holiday on the visit and the owner said she would Care Homes for Older People Page 30 of 36 Evidence: ask him to ring the Commission on his return to let us know the dates staff which we couldnt confirm as having received fire drill practice training had received them. The administrative manager sent to us a list of staff who received fire drill training on 4th August 2009 which was on his return to work after our visit. There still continued to be two staff and an agency worker who were not recorded as having had the fire drill training. We were told in the letter sent to us that formal fire training takes place every six months but all new staff have informal training within the first few days of commencing work. Other fire drills to take place over the next few days to ensure all staff attend fire drill. On our visit when we looked at the fire safety records we only saw checks to the emergency lighting for June 2009 and not for May 2009 and July 2009 or any records to detail that checks had been routinely made to the means of escape. The owner manager said this information would be provided to us on the administrative officers return from holiday on 3rd August 2009. We were sent a record that checks to the emergency lighting had been undertaken on 29th June and 15th July 2009 and also weekly checks recorded as undertaken to the means of escape from 8th June 2009 until 28th July 2009. Records must be kept up to date of when tests and drills have been completed and this information should be readily available. Care Homes for Older People Page 31 of 36 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 32 of 36 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 19 23 Provide a call bell system that is accessible in all rooms and that is audible to staff as opposed to relying on cooking staff or staff in the dining room to alert them to the fact that residents need support or assistance. To promote the safety of residents and to ensure that residents are able to call for assistance and this is heard by staff. 31/08/2009 2 31 17 Records maintained for the purpose of regulations must at all times be available for inspection. To comply with regulations 11/09/2009 3 38 23 All staff must receive routine 11/09/2009 fire drill training practice training at intervals of not more than six months. To provide some degree of protection to residents and Care Homes for Older People Page 33 of 36 staff and to ensure staff know what to do in an emergency situation. 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 1 The service user guide needs to be further amended to ensure the information provided in the document is accurate and up to date. Provide staff with guidance, direction and support in how to complete the daily and night reports to demonstrate the care or support provided to residents. Include in the care plan residents individual night time care needs so it is clear what or when staff are supporting residents during the night.Make sure that staff when providing support during the night demonstrate in the records that they have given such care. Discontinue the practice of using correction fluid on records which are maintained for the purpose of regulation ensuring records are maintained in a permanent format and all entries can be seen. Continue with the development of the care plan and include what residents needs, wishes and preferences are in the care plan. Arrange for residents or their family or representatives to view care plans and to agree and sign them. 2 7 3 9 Refer back all medication, which is indicated on the medication recordsuse as directedto the residents doctor for clear instruction on how often this medication is administered. This needs to be printed on the medication administration records routinely. Review the activities provided to residents and involve them and their relatives in looking more at the activities provided and how often to see what residents want to do and provide these opportunities. Maintain a record of food served to residents in such detail that anyone examining the record could judge whether the individual diet is sufficient. 4 12 5 15 Care Homes for Older People Page 34 of 36 Ensure that residents are provided with a supper time snack and drink and there next meal is provided within 12 hours of this meal. 6 16 Comments, concerns and compliants do need to be recorded to demonstrate that management take seriously the comments they receive from residents, their friends, visitors or staff and can demonstrate what they have done to remedy the comments received. The manager needs to attend training specific for managers in relation to adult protection procedures and protocol to make sure if there is an allegation of abuse made the procedures are known and are followed to promote the safety of residents. Adult protection (POVA) training should be arranged for all staff to ensure they have a clear understanding of what to do should an allegation of abuse be made and to recognise the signs and symptoms of abuse. 8 19 To promote the respect of residents and there independence provide plugs to sinks in the wash hand basins in bedrooms, toilets and in sinks and baths in bathrooms. If it is identified that it would be a risk to a particular resident to have a plug in the sink or bath then this should be noted in there care files and a risk assessment undertaken of the steps in place to minimise that risk as opposed to taking away plugs. Remove residents toiletries from the bathrooms.Toiletries should be personal to the resident and should be in residents bedrooms being taken to the bathroom when they need them. 9 31 To ensure the owner manager is up to date with legislation,training and qualifications they need to research further training available and ensure attendance to updates to her training. This will enable the owner manager in addition to updating on knowledge to assess the competence of staff and ensure they are doing what they should be doing to keep themselves and residents safe. 7 18 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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