Care Home: Penn House Residential Care Home

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What the care home does well Staff were observed throughout the day treating people with dignity and respect. People who were unable to tell us their views of the home looked clean, comfortable and well-cared for. The home is clean, bedrooms are spacious and people are able to make their bedrooms as homely as possible by bringing in items which are important to them, such as photographs and pictures. What has improved since the last inspection? We saw the new manager has completely reviewed how care plans are structured, so they focus on how care should be given based on the person`s preferences and needs. We also saw that possible risks to the health, safety and welfare of people living at the home are now identified and the home is contacting healthcare professionals, such as GPs promptly when there are concerns about people`s health and well being. The home has introduced good systems to ensure that people receive their medication as it has been prescribed. People are provided with some opportunities to enhance their social well-being. The home now makes its complaints procedure available, which ensures people and their representatives know how to raise concerns and complaints. Monitoring and checking of equipment and the environment has improved, to ensure the home is safe and well-maintained. Staff are checked for their suitability to work with vulnerable adults before they start work at the home and the new manager keeps staffing levels under review to ensure there are sufficient staff to meet the needs and numbers of people living at the home. A new manager has been appointed, who appears enthusiastic to continue to develop and improve the home. What the care home could do better: A lot of effort has taken place to do the things we asked the home to do following our last inspection and we view that the new manager, Ms Maria Langworthy has been fundamental to these improvements. The home now needs to show it can sustain and further develop these improvements for the benefit of the people who live at Penn House. For example a training plan, showing staff training to date shows that for sometime there has not been a high level of importance placed on the training and development of staff. The manager discussed with us training she intends to put in place to ensure staff have all the skills and knowledge to meet people`s needs. At the time of our inspection there was nothing to show that staff had received recent training or updates in fire safety, although we received confirmation soon after our inspection to confirm that fire safety training had subsequently been booked for staff.As the staff group becomes more knowledgeable and confident, further work should be done to develop individual plans and techniques so that people`s independence and well being are promoted as much as possible, including the development of more social opportunities. The outside space remains limited in that the only accessible area is a small patio outside the dining room. The provider now needs to act on plans so that people have improved, accessible outside space. Key inspection report Care homes for older people Name: Address: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ     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: Rosalind Dennis     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ 01902345470 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Shanta Arjan Odedra,Mr Arjan Bhoja Odedra,Mr Vijay Odedra,Daljit Takhar,Jasvinder Takhar care home 24 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 24. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 24 Dementia (DE) 24 Date of last inspection Brief description of the care home Penn House Care Home provides personal care and accommodation for 24 older people with Dementia. The home is an early Victorian two - storey building that has been adapted internally to meet the needs of older people. There is easy access to local amenities, which includes a park, churches, temples, a library and shops. The home is located approximately 1 mile from the city centre and a local bus service stops nearby. The accommodation consists of two lounges and one of these is a large L shaped Care Homes for Older People Page 4 of 31 Over 65 0 24 24 0 2 4 0 9 2 0 0 9 Brief description of the care home lounge, and a dining room. There is one double bedroom and 22 single bedrooms and seven of these have en-suite facilities of toilet and wash hand basin. There are communal bathrooms/showers and toilets on each floor. The home has a passenger lift, in addition to two staircases. There is a small patio, otherwise there is limited outside space for people to access. There is car parking at the front of the premises. People who use the service and their representatives are able to gain information about Penn House from the Statement of Purpose and Service User Guide. The Guide includes information on the fees charged by the home, which are noted as £349 to £420, dependent on the room and care required. The reader is advised to contact the service for up to date information on the fees charged. The last key inspection of Penn House was undertaken on the 24th September 2009. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Older People Page 5 of 31 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 carried out over two days in total. Our pharmacist inspector visited on the 22nd December 2009 and another inspector visited on the 8th January 2010. On both days the home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. The purpose of this inspection was to assess all key standards - that is those areas of service delivery that are considered essential to the running of a care home - and to establish whether the provider has complied with requirements we have previously made. This included looking at whether the provider had complied with two Statutory Requirement Notices relating to Regulations 12 (1) and 13 (2) of the Care Homes Regulations 2001, which required that the provider comply with the notices by a certain date. The Statutory Requirement Notices were served after our pharmacist inspector visited on the 8th October 2009 Care Homes for Older People Page 6 of 31 and identified that people were being placed at risk of not receiving the medication they need. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home and information sent to us from other agencies. We also looked at the written improvement plan from the service which we had asked for after our last key inspection and looked at the homes responses to the Statutory Requirement Notices we had served. We also looked at information in the homes Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think it meets the needs of people living there. The AQAA gave us a reasonable picture of the current situation within the home. We case tracked some of the people we met during the inspection. Case tracking involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Two people were able to tell us about their day to day life at the home and the support they receive from staff. Other people living at the home were not fully able to comment on the care they receive and so we observed the support given by staff and how staff interacted with them. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff and the new manager during the inspection to establish their views of working at the home, the improvements which have taken place and to establish if anything still needs to be improved. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: A lot of effort has taken place to do the things we asked the home to do following our last inspection and we view that the new manager, Ms Maria Langworthy has been fundamental to these improvements. The home now needs to show it can sustain and further develop these improvements for the benefit of the people who live at Penn House. For example a training plan, showing staff training to date shows that for sometime there has not been a high level of importance placed on the training and development of staff. The manager discussed with us training she intends to put in place to ensure staff have all the skills and knowledge to meet peoples needs. At the time of our inspection there was nothing to show that staff had received recent training or updates in fire safety, although we received confirmation soon after our inspection to confirm that fire safety training had subsequently been booked for staff. Care Homes for Older People Page 8 of 31 As the staff group becomes more knowledgeable and confident, further work should be done to develop individual plans and techniques so that peoples independence and well being are promoted as much as possible, including the development of more social opportunities. The outside space remains limited in that the only accessible area is a small patio outside the dining room. The provider now needs to act on plans so that people have improved, accessible outside space. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. We were not able to fully assess this outcome group as there have not been any new admissions to the home. However, systems to help improve peoples experience of moving in have improved. This should reassure people that the home can meet their needs before they are offered a place. Evidence: There have not been any recent admissions to Penn House, so for the purpose of inspecting this outcome group we looked at the processes, which the home intends to use at the time of a persons admission to the home and also discussed these processes with the manager. We observed new documentation, which demonstrates that the service has recognised where weaknesses previously existed with its assessment and admission process and we view that the service has made improvements to these. We saw that the manager is reviewing the care files for all people currently living at Care Homes for Older People Page 11 of 31 Evidence: the home, so that any gaps with how people want and need to have their care needs met are identified. The manager confirmed with us at the time of inspection and in the AQAA that, for any new admission, a full assessment of the persons needs will be undertaken, which will include seeking information from the person, their representatives and others involved in their care prior to making the decision to admit the person. This will help to ensure that people are only admitted to Penn House if the service is confident it can meet their needs. We saw the home has improved its Service User Guide so that along with information about the service, it now includes a copy of the complaints procedure and makes people aware of the range of fees charged by the home. Care Homes for Older People Page 12 of 31 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. People now have their personal and healthcare needs met and they have care plans in place to show how they want their needs met. Evidence: When we last visited the home we were concerned that people were being placed at risk of not receiving the care they need. Our pharmacist inspector visited on the 8th October 2009 and identified that people were being placed at risk of not receiving the medication they need, which led to the serving of two Statutory Requirement Notices relating to Regulations 12 and 13 (2) of the Care Homes Regulations 2001, requiring that the provider comply with the notices by a certain date. This inspection finds improvement in how the home is planning and providing the care people need and with the administration of medicines. Most people were unable to give us their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation to show how peoples needs are met and speaking with staff. People looked clean and staff were quick to support people if they needed additional assistance. A person cared for in bed looked comfortable. Care Homes for Older People Page 13 of 31 Evidence: We looked at three peoples care records and saw the manager has recently completely reviewed how care plans are structured, so they focus on how care should be given based on the persons preferences and needs. We saw that possible risks to their health, safety and welfare have been identified and the management of reducing the risks documented, such as in the use of bed rails. We spoke with staff who could describe the care people need and they told us how they look at peoples care plans so they know the care that is needed. We saw that care staff are now keeping detailed written records to show the care which has been given to people at different times of the day and during the night, which helps to ensure information in care records is current and up to date. We saw from looking at care records that the home is contacting healthcare professionals, such as GPs promptly when there are concerns about peoples health and well being. The manager also showed how she has written to peoples GPs to request reviews of their health needs. The manager spoke of how people and their representatives will be involved in reviews of care and saw that the manager has been involving in seeking information from peoples representatives to assist with updating care records. Much of the improvement we saw has been as a result of the managers input. We were informed that the manager has provided guidance to staff on the care planning process and a member of staff commented to us that they are now able to recognise what needs to be included when planning and reviewing peoples care. Ongoing training and development of staff skills should ensure staff have the knowledge to be able to sustain improvements with how people have their care planned and risks identified and managed. The pharmacist inspector visited the home on the 22nd December 2009 to assess what progress the home had made in meeting the two Statutory Requirement Notices served on the 6th November 2009. We found that there had been improvements in the management of medicines within the home and concluded that the home had met both Statutory Requirement Notices. It was recognised that the manager and the care staff had worked very hard to achieve this. We found on the whole that the receipt, administration and disposal of medicines were being recorded so that it could be seen that people were receiving their medication as prescribed. The home was regularly auditing medication and had introduced a running balance sheet for those medicines that were not packed into the Monitored Dosage System to ensure that these medicines were being administered as prescribed by the doctor. We did not find any medicines out of stock during the inspection and we found that the running balance sheets were a useful tool to highlighting any potential short Care Homes for Older People Page 14 of 31 Evidence: falls. We found that the home was recording the amount administered for those medicines that had been prescribed with a variable dose. We found that the home still needs to ensure that all medicines, which are unable to be placed into a disposal envelope after people refuse them and have to be disposed of in other ways, are accounted for in the records. We saw that the written information about medicines in care plans had improved and it could be seen more clearly why medicines had been prescribed, altered and discontinued. We found that the medicines of one person using the service had to be crushed and saw that the home had obtained in writing what was required from the persons doctor and had checked with a pharmacist that what was being asked of them was safe for the person concerned. We found that people living in the home had been reviewed by their doctor and as a consequence their medication regimes had been rationalised. We found the home had introduced further training for the staff on the safe handling of medicines and staff appeared to be more competent in administering medicines to the people who used the service. We saw that the security and storage conditions of medicines had improved. Medicated creams and ointments were now securely stored in the mobile drug trolley and not left in peoples rooms. We found that overall the fridge being used to store medicines, which require cold storage conditions, was being maintained within the required temperature range. Towards the end of the inspection on the 22nd December 2009 the proprietor, Mr J Takhar informed us that in order to further improve the management of medicines in the home he intended to appoint an experienced deputy manager to support the manager in ensuring that the management of medicines within the home remained a high priority. He also informed us that he was arranging for the manager to attend an advanced course in the safe handling of medicines. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities to enhance their well-being, although further effort is still needed to ensure these fully meet the needs and capabilities of people living at Penn House. People are offered a choice of meals to meet their dietary needs and preferences. Evidence: The manager told us the home has a programme of activities and we saw a copy of the programme in the main lounge, showing activities including dominoes, hand massage, singing and I spy. We saw photographs of people involved in Christmas and New Year parties, which they appeared to be enjoying. During the inspection we saw one person completing a crossword, others were seated in the main lounge where a television was on and staff were seen sitting down and speaking with people. We were informed that staff record in a book, the activities people are offered and have taken part in. However this book was not available on the day of inspection, which makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. Two care staff we spoke with described how they talk with people about their lives before their illness and about current events and news. We found that one staff member has some good ideas for developing the provision of activities for people with Care Homes for Older People Page 16 of 31 Evidence: dementia related illnesses. Another staff member spoke of how they are finding the training they are doing about dementia care is helping them think about what could be put in place to enhance peoples well being. The AQAA describes how the home encourages diversity, equality and dignity and we saw in care records that information has been sought about peoples cultural, religious and spiritual needs. The AQAA also describes how the home is planning to add more entertainment and encourage more people to join activities. We discussed with the manager how more could be done in meeting the needs of people with dementia, as there is little within the home to stimulate and promote positive responses from people. We heard staff offering people choices of what they would like to eat and drink and saw that staff encouraged and supported people to eat independently. When a person said they were hungry late afternoon we saw they were provided with a snack and drink. Menus are now located in one of the lounge/dining rooms. We saw that some people had given negative feedback about the meals and choices and we were informed by the manager that it is intended that menus will be reviewed to ensure meals are based on what people want to eat. We did not meet with any visitors during the inspection but heard many people phoning up and the manager providing them with a detailed update on their relatives condition. Care Homes for Older People Page 17 of 31 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. The home has a complaints procedure which ensures people and their representatives know how to raise concerns and complaints. Staff know how to safeguard adults from harm and abuse Evidence: The complaints procedure is displayed on a notice board in the reception and is also available within the service user guide. By the entrance door there is also a folder where people can record concerns, complaints and any comments/suggestions. The complaints procedure provides people with clear information on the process to follow and who to contact if people want to complain. We saw that one complaint has been received by the home recently and the manager described how they are still looking into the complaint before a response is made to the person raising the complaint. We advised that it is good practice to keep a written record of the action taken to any complaint and the response. The manager informed us in the AQAA how the home deals with any concerns straight away and we discussed that it may be beneficial to also record the action taken when people raise minor concerns. We were informed by the manager that all staff have now received training in safeguarding vulnerable adults from abuse. One member of staff could not recall attending training, so the manager was advised to follow that up. Three staff we spoke with could define whistleblowing and they confirmed they wouldnt hesitate to report poor practice or abuse. Care Homes for Older People Page 18 of 31 Evidence: The manager demonstrated a good knowledge of adult protection, the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards and is aware that all staff should have awareness training on the Act, so that they know how to put the Act into every day practice and the procedure to follow should peoples freedom need to be restricted. We were informed training is in the process of being arranged. We saw leaflets in the Reception about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an environment which is clean and safe but needs enhancing so that it may promote positive responses from people with dementia, including the development of outside space. Evidence: We looked at the bedrooms for the people we case tracked and also some other parts of the home. All of the bedrooms we saw were very clean and possessions, photographs and pictures create a homely feel. We saw that the home has made improvements such as fitting headboards to beds and ensuring beds are more stable so they are less likely to slide on the floor. We also looked at written records, which indicate staff are more vigilant in reporting if equipment needs repairing. We saw the home has replaced a sink which was leaking when we saw it at the last inspection. The manager informed us that an audit was recently undertaken of the home by an infection control specialist from the local PCT. The audit identified the home needs to take action to improve infection control practices and the manager confirmed to us the home is in the process of addressing all action points. We saw a bathroom where staff clean commodes, is now kept locked and the manager confirmed in the AQAA that the laundry has been decorated. At the last inspection we had been concerned that staff working alone in the laundry had no means of calling for help. At this inspection the manager showed us that an assessment of the risk of Care Homes for Older People Page 20 of 31 Evidence: working in the laundry has been undertaken and that mobile phones are now available for staff to use. The outside space remains limited in that the only accessible area is a small patio outside the dining room. The provider now needs to act on plans so that people have improved, accessible outside space. The home is waiting for a specific type of lock to be fitted to one of the exit doors and is aware that the suitability of the lock needs to conform to fire safety requirements. Care Homes for Older People Page 21 of 31 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 are supported by staff in sufficient numbers to meet their needs and who have been checked for their suitability to work with vulnerable adults. The manager knows there are gaps in the training programme and has plans to deal with these gaps so that all staff receive the training they need. Evidence: The manager confirmed to us that after the last inspection, when we had some concerns about how the home is staffed, staffing levels were reviewed and increased at night. The manager informed us that since then there has been a reduction in the numbers of people living at home and staffing levels at night have been reviewed in line with this reduction. The manager is aware that staffing levels need to be kept under review, so that there are sufficient, competent staff to meet the needs and dependency of the people living at the home. At the time of our inspection sufficient staff appeared to be on duty to meet the needs of people living at the home and the staff we spoke with viewed that staffing levels are usually sufficient. Staff described how they do additional shifts to cover for absences, rather than use agency staff, so that people are cared for by staff who know them. We looked at the process used by the home to recruit new staff and spoke with the manager, which demonstrates the home has improved its recruitment process so that new staff do not start work until they have been checked for their suitability to work Care Homes for Older People Page 22 of 31 Evidence: with vulnerable adults. We also saw that the manager has taken steps to audit the files of staff who were previously employed without sufficient checks being made and has sought additional information about these people to confirm their suitability to work with vulnerable adults. At our last inspection it was difficult to establish what training had been undertaken by staff because an overall training plan was not available. Since then the manager has attempted to look at the training which staff have completed so that it is possible to identify what further training is needed. The manager has put this information into a training plan which shows that most staff have attended training in moving and handling and safeguarding adults from abuse, but the plan shows that for sometime there has not been a high level of importance placed on the training and development of staff. Some staff have attended training in first aid, safe handling of medication and dementia care. Staff currently studying for a qualification in dementia care told us how they have found it beneficial in their work and observations at this inspection show that staff are putting this training into practice through how they speak and approach people. The manager confirmed in the AQAA that all staff are now working towards a recognised qualification in care (National Vocation Qualification) at level 2 or 3, which should contribute to ensuring the staff team have an effective knowledge of social care. The manager also told us about how she is looking for additional training for staff to attend, such as how to reduce the risk of pressure sores occurring. At the time of inspection there was nothing to demonstrate that staff have received recent training or updates in fire safety. We informed the provider and manager of our findings and received confirmation soon after our inspection to confirm that fire safety training had subsequently been booked for staff. Care Homes for Older People Page 23 of 31 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 manager is developing and improving the home to ensure it is run in the best interests for the people who live there. The home now needs to show it can sustain and further develop these improvements for the benefit of the people who live there. Evidence: Since the last inspection there has been a change in the management arrangements in that a new manager, Ms Maria Langworthy started working at the home in October 2009, following the resignation of the previous manager. We received good feedback from staff working at the home describing the manager as approachable and someone who they can speak with. Staff told us they view there have been big improvements with the how the home operates, which is of benefit to the people who live at the home. Throughout the inspection there was a relaxed, friendly atmosphere and staff appeared to be working as a team. Ms Langworthy gave us an overview of her previous employment and experience and from our observations appears to have the knowledge and skills for the role of manager and to continue to develop and improve the home. Ms Langworthy is aware that an application for consideration for Care Homes for Older People Page 24 of 31 Evidence: registration with us is needed. We looked at how the home has provided people and their representatives with opportunities to comment on different aspects of the home through surveys. We saw that people had given varying feedback, indicating some positive views of the service and some negative, including comments about the need for more activities and improved meals. We also saw that a person had made a comment about staff using inappropriate techniques to move people, and this requires prompt action to ensure staff are aware of their obligations to adhere to safe moving and handling practices. At the time of our inspection we saw staff moving people safely. We discussed with the manager that when all results from surveys are received then they should be collated so that people know what action the home is taking in response to their feedback. The proprietor visited during the inspection and staff confirmed to us that he regularly visits the home. We were shown a copy of a document which the proprietor intends to use on a monthly basis, so as to demonstrate how the quality of the service is monitored and any action taken. The proprietor needs to ensure that this process is robust, so that outcomes for people continue to improve. After our last key inspection we asked for a written improvement plan for the service to tell us how it will comply with requirements from the last inspection. We received the improvement plan when we asked for it and also the AQAA, which gave us a reasonable picture of the current situation within the home and we used this information to supplement the inspection process. We saw from written records that staff are now checking the temperature of hot water, to ensure it is not too hot for people and that checks regarding fire safety are now up to date. As previously noted earlier in the report we identified that staff need training in fire safety to ensure they know the procedures to follow in case of fire. We found improvements with how accidents are recorded and saw that people who are assessed as needing bed rails have a risk assessment in place. The manager described how staff have been informed how bed rails need to be fitted and we advised that is good practice for staff to be given access to written guidance on the safe use of bed rails. The bed rails we saw were fitted correctly. Care Homes for Older People Page 25 of 31 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 3 14 Assessment of peoples care 03/11/2009 needs must be undertaken before they are admitted to the home. This is to ensure people can be confident the home will meet their needs and avoid the home admitting people whose needs cannot be met. 08/01/2010. Unable to assess compliance fully as no new admissions to the home 2 9 13 Statuatory Requirements 17/11/2009 Notice for Regulation 13[2]. 1. Put in place safe and adequate arrangements for the ordering, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. 2. That all medications received into the Home are audited and recorded on the medication administration charts 3. Ensure that medication administration records are accurately maintained including the number of tablets administered when the prescription states that one or two tablets can be given as required. The registered person shall Care Homes for Older People Page 26 of 31 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 make arrangements for the recording handling safekeeping safe administrartion and disposal of medicines received into the care home. 3 9 18 Regulation 18[1] [a] To 17/11/2009 ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. The registered person shall ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 4 9 12 Statutory Requirements 17/11/2009 Notice for Regulation 12[1]. 1. To review and put systems in place at the home to promote and secure the proper provision for the health, welfare, care and treatment of people using the service 2. Make arrangements and put systems in place to ensure that all medicines prescribed to people using the service are available in the home at all times for administration as prescribed by their General Practitioner. 3. Put systems in place to ensure that information about how Care Homes for Older People Page 27 of 31 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 medications and creams are to be administered to people using the service is clearly documented in their care plan. 4. Make arrangements and put systems in place to ensure that all discontinued medications are removed from the medicine trolley immediately and a written record made of the amount of medication disposed of. The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The home should continue to expand on the range of activties, ensuring they are appropriate and meet with individual needs and capabilities. This is to promote wellbeing and ensure that the social needs of people living at the home are met. Staff should be provided with training about the Mental Capacity Act and Deprivation of Liberties. This is so that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. 08/01/2010 Not yet achieved. The internal and external environment should be developed in accordance with good practice guidance for people with dementia. This is to promote positive responses from people and enhance well-being. 08/01/2010-Not yet achieved The Registered person should consider developing how the service is monitored during monthly unannounced visits. This is to show that outcomes for people are monitored more closely so that action can be taken to improve the service. Page 29 of 31 2 18 3 19 4 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 08/01/2010-not yet achieved 5 38 All staff should be made aware of guidance documents on the safe use of bed rails. This is so that all staff are able to recognise the correct fitting of bed rails. 08/01/2010-not yet achieved Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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