Care Home: Pine Meadows Care Centre

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What the care home does well People told us that`The meals are very good` `The staff do a good job under difficult circumstances. By and large they couldn`t do better`. `I have a room on the residential unit, it is comfortable and I am satisfied with the accommodation`. Staff told us that they try and find out as much as they can about a person prior to them moving into the home. This tells the staff all about the person and the support they need. People (whenever possible) and/or their representative are involved in the planning of their care. This ensures that staff have details of the personal preferences of each individual. What has improved since the last inspection? The AQAA that was completed by the manager tells us of the improvements that have been made within the last twelve months. `The Company has produced the Service User Guide in CD format and has a variety of differing language versions available on request` `Care Profiles have been developed to reflect a more organised way of planning care`. What the care home could do better: The information documents about the service should include the correct contact details of the commission, so that people are able to contact us if they wish to do so. Information on the level of weekly fees should be in the Service user guide. This will provide essential information for people wishing to move into the home. The care plans should be in sufficient detail to provide staff with the information needed to enable them to support people to meet their health and social needs. Staffing levels must be determined according to the assessed needs of the people living at the home. This will ensure that the health, personal and social care needs of people are fully met. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. All areas of the home should be clean, well decorated and comfortable. Equipment in use should be in good working order and fit for the purpose. Key inspection report Care homes for older people Name: Address: Pine Meadows Care Centre Park Road Leek Staffordshire ST13 8XP     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: Joy Hoelzel     Date: 0 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Pine Meadows Care Centre Park Road Leek Staffordshire ST13 8XP 01538392520 01538392530 pine.meadows@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons 2000 Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 70 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 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 70 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 70 Dementia (DE) 20 Physical disability (PD) 50 Date of last inspection Brief description of the care home Pine Meadows Care Centre is a purpose built establishment and provides accommodation, nursing and personal care for up to seventy people. The establishment is set in landscaped gardens and is close to Leek town centre and local amenities. Care Homes for Older People Page 4 of 30 Over 65 0 70 0 20 0 50 Brief description of the care home The establishment is divided into three units; Acorn, Fir Cones and Chestnuts. Fir Cones Unit is a separate 20 bedded Dementia Care Unit, and is located on the first floor of the establishment. The Acorns unit provides personal care to older and younger people with physical disabilities, and the Chestnut unit provides personal care and nursing care to people with physical disabilities. There is ample dining and sitting accommodation provided on all three units. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents are readily available from the home. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for this service was completed 10th October 2007, with an annual service review 2nd September 2008. The home did not know that we would be visiting on this occasion to conduct a full inspection of the service. We were accompanied on this inspection by an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Their comments are included in this report. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of six people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and Care Homes for Older People Page 6 of 30 staffing records. Discussions were held with people living, visiting and working at the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document and returned it to us in August 2009. Comments from the AQAA are included within this inspection report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the service user guide which offers more detailed information that a person may want when moving into the home. Some of the information in the documents were dated 2007 and 2008 so it was not possible to determine when the complete documents were last reviewed. Parts of the documents refer to the previous regulatory body and will need amending to ensure that the most current information is available. To comply with the regulations and to give people full information and details of the service, the service user guide should include the levels of weekly fees payable. The case file of the person who recently moved into the home was looked at to see if Care Homes for Older People Page 11 of 30 Evidence: information had been sought regarding this persons needs prior to moving in. The care home manager had visited this person in the previous health care setting and completed a full assessment of the persons needs prior to offering a placement. Information had also been obtained from the local county council social services department and the hospital. The home had also completed a brief assessment of this person on the same day as they arrived at the home. The care manager told us that risk assessments are completed within twenty four hours of arriving at the home, with the care plan being formulated within five days. This gathering of information ensures that the staff have a record of a persons care needs and that the care can be provided effectively. The home also provides a respite care short stay service. One person currently on a two week stay told us that they were satisfied with the service. They said the staff were very good, they had a comfortable room and that the food provided was satisfactory. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plan includes basic information necessary to deliver the persons care, there are some gaps in important information and does not consistently reflect the care being delivered. Evidence: We looked at the care records and assessment documents of a selection of people on all of the three units. We saw that the plans had been completed and reviewed with the person (whenever possible) and/or their representative or advocate. A new way of documenting a persons care needs had recently been completed in one of the units with the staff telling us that they think this is a much improved way of recording information but that they are still getting used to it. Care staff told us that they do not often refer to the plans when providing the care or have any responsibility of updating the information. The AQAA completed by the manager explains the recent improvements made - Care Profiles indexes have been put into place; these help our staff, relatives and external agencies to better understand the layout of the care profile and where to find things Care Homes for Older People Page 13 of 30 Evidence: quickly and easily. The layout of the Care profile has been changed to reflect a better way of planning care. Staff have been trained in Person Centred Care and care profiles now reflect this The plans we looked at gave us an overall picture of the care needs of people and where a potential risk to the person is identified a plan of care has been completed. One person requires regular interventions from the staff for a specific condition. Records were seen for the monitoring of this and included the frequency of the interventions and any changes that are noted. The plan documented the visits and guidance made from other health care professionals. However, we found that there were some omissions of information when we were observing practice and talking to people. For example one plan indicated that a person did not have problems with communicating or making their needs known. This person told us the opposite and said it takes me so long to get my words out, that sometimes they are unable to have the care provided that they need at the time when they wish to receive the care. We spoke with another person who has sight impairment, we looked at their care plan to see if there were any specific details relating to this and how staff could assist them with daily living. We could find no reference to this specific difficulty. The people living in one unit all had an assessment and plan of care for assisting with personal hygiene, the plans had recently been reviewed by senior staff. We observed that some people looked a little unkempt in their appearance and are reliant on staff to assist them with personal hygiene and grooming. It is acknowledged that some difficulties may arise from time to time during the course of the day; nevertheless staff should be in sufficient numbers to ensure that standards are maintained and people are clean and well groomed at all times. We observed staff to be extremely busy with little time to pay attention to detail. They told us that they were particularly rushed and that they did not have enough time to fully complete an intervention before they are required to begin another. The expert by experience observed and commented - Some of the residents on one unit in particular appeared rather disheveled and unkempt in appearance. One person was wandering about seemingly very distressed. She was quite shabbily dressed. On asking about her condition I was told that nothing more can be done for this person. We saw that when a health care problem had been identified people were referred to and seen by healthcare professionals, for example the tissue viability nurse, the Care Homes for Older People Page 14 of 30 Evidence: speech and language therapist and the general practitioner. We looked at the systems for administering medication to people and found that the areas for storing medication were safe and secure. Staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. We discussed the administration of creams and lotions and it was evident that the nurses are relying on care staff to administer these but that the nurses are signing the MAR. We spoke to the manager and suggested that a separate record for care staff to sign could be used in conjunction with the MAR. Care staff would need training in the safe administration of creams and lotions to ensure they have sufficient knowledge and are competent to do so. We saw that not all prescribed as required medications have a protocol or information for staff as to when these medications can be given, when they can be repeated and for how long they can be given. In one care plan we looked at, there was an instruction for staff to ensure that a particular prescribed medication is reviewed by the general practitioner every three months. We could find no record of a medication review and staff were unable to tell us if this instruction had been carried out. We saw that on occasions peoples dignity was being compromised by being somewhat disheveled and unkempt in their appearance. These people are fully reliant on staff to help them with maintaining acceptable standards of dress and grooming. We saw that people were helped to private areas of the unit for assistance with personal care, washing and using the toilet. Again we saw that staff were very rushed in helping with these care needs and did not pay sufficient attention to detail. For example one persons appearance would have benefited from a change of clothes after their clothing had become soiled. We saw this person in the same clothing for the whole time we were at the home. The expert by experience made an observationStaff were seen to be treating residents with patience and care. The young carer in particular displayed a very caring and pleasant attitude towards people on the dementia care unit. The care records recorded the name that people preferred to be called and throughout the day we heard staff addressing people in the way they prefer. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service cannot be assured that the care home will support them to follow personal interests and activities. Evidence: The AQAA tells us that - There is a variety of activities provided, the programme having been developed following discussion with the residents. The service user guide informs people that - Regular outings and entertainments are arranged. We observed very little structured activity happening in the home, although a short religious service took place in a downstairs lounge during the morning of this inspection. We asked if the people from the other units were offered the opportunity to participate but were told that they could if they asked to do so. We saw no information in the units of this service taking place. The manager later told us that the information is included in the monthly activities calendar. Some people were able to entertain themselves with watching the television, listening to music or receiving visitors. Other people were wandering around their unit area, Care Homes for Older People Page 16 of 30 Evidence: some were sleeping and disengaging and others just sitting watching other people. People told us - I wouldnt mind if I could do something, I would just love a trip to the shops. I am always sitting here bored. I have never been on any trips out. I go out on a Saturday up town for a meal with my family. People working at the home told us - There are not enough activities going on for residents. There is no stimulation for them. The expert by experience spent time at the home observing and talking with people about the activities that are arranged. I saw no activities taking place in the home during the time of my visit. I saw the activity schedule, which included items such as cards, ladder game, dominoes, crafts, skittles etc. but learned that this is a guideline only and that sometimes only one hour of these activities would take place on a given day. I saw the hobbies room upstairs which contained a variety of games and resource materials. The activity coordinator reported that a system of responding to individual preference in the area of activity is being adopted, but I wonder if there is enough time under the current hours available for this to happen as there are so many residents with differing needs in the home. There are no trips out currently on offer, although I was informed that the home has access to a minibus shared out between three homes. However only around 8 residents can be fitted into the bus and no trips have yet taken place because of an issue over whether a qualified member of staff needed to accompany residents on a trip. Given that there could be 70 people in the home; this does not currently meet many peoples needs within the home. There was little evidence of people being taken out of the home, except by individual relatives. The Statement of purpose and service user guide offer details of the visiting arrangements and maintaining contact with family and friends. We spoke with visitors to the home they confirmed that they are satisfied with the visiting arrangements and were generally content with the care provided. The main front door is kept locked during the evening and night, but the door is not locked during the day. People are requested to sign the visitors book on entry to the home. A number key pad is sited on the doors to the dementia care unit, thereby restricting access to and from the unit. Some bedroom doors are locked during the day, staff told us this is to stop other people going into the rooms and removing the items belonging to the inhabitant. Staff hold a pass key to the bedroom doors. People generally stay within their own units and do not go into other areas. The meals are prepared by the catering staff and served in the dining areas of the Care Homes for Older People Page 17 of 30 Evidence: units. There was a marked difference in the appearance of the dining areas in each of the three units. One of the dining areas was very well prepared prior to the meal with the tables being set with linen, cutlery, drinks and condiments, making it a congenial setting in which to dine. Other areas were either very sparsely prepared or not prepared at all. It would appear that either mealtimes are not viewed as an opportunity for socialising or that there are insufficient numbers of staff to make the necessary preparations. People told us - I enjoy the meals here - yes they are very good. The meals arent bad. Food is not bad but the alternative is always Broccoli Bake. Staff told us that drinks and snacks are available at all times and that they can get supplies from the main kitchen out of normal working hours. The expert by experience was invited to have lunch in one of the units and commented The mealtime procedure was a bit chaotic. The food was tasty and well cooked, although the presentation poor. Staff were helping residents who needed it to eat their meal and allowed them time to finish their meals if they wanted to. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Evidence: The complaints procedure is clearly displayed at the entrance to the home and is included in the service information documents. Our contact details in the service information documents are incorrect and should be amended so that people are able to contact us should they wish to do so. The manager offered an assurance that this would be done immediately. The AQAA tells us - All complaints are taken seriously with the culture being that complaints/comments are viewed as a way to improve. Investigations are timely and thorough. The manager maintains a log and audit of complaints or concerns that are raised directly with them. The log contains details of the concerns, the action that has been taken and any correspondence relating to the concern. Several people stated that they would report any mishap to the manager or any other member of staff. They said they would be confident that appropriate action would be taken. One person said they would inform their family who would sort it out for them on their behalf. Care Homes for Older People Page 19 of 30 Evidence: One referral has been made to the local authority when a serious allegation was made. A decision was made for the home to deal with the issue and a satisfactory conclusion was reached. The manager and the deputy manager have both attended workshops and training in the Mental Capacity Act and Deprivation of Liberty safeguards. They are currently working with other grades of staff to cascade the information. We looked at systems for safekeeping of peoples money and found they were in good order. The home has good records of all transactions and obtains receipts and two signatures. This will reduce the risk of errors occurring with peoples money and offer an assurance that their money is being kept safely and securely. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have an on-going maintenance programme. A number of the fixtures and fittings need replacing and some of the decor requires upgrading. Evidence: Pine Meadows Care Centre is a purpose built property in a quiet residential area, close to shops and local amenities. It is a two storey building providing accommodation for up to seventy people. It is divided into three units each with kitchen, dining area, lounge, toilets, bathrooms and bedrooms. The redecoration and replacement of the fittings and fixtures occurs as the need arises. The manager explained that a monthly budget is allocated for expenditure; they explained that household items (crockery, bed linen etc.) have recently been ordered which had used the entire amount for this month. The AQAA tells us - The home is kept clean and tidy and the house keeper directs her team to ensure all areas of the home are well maintained. We have an annual programme of refurbishment supported by an appropriate capex budget. It goes on to identify- Some residents rooms need to be more personalised. We looked at a number of the bedrooms and saw that some contain personal possessions of the inhabitant and some are very sparsely furnished with very little belonging directly to the person. Care Homes for Older People Page 21 of 30 Evidence: The expert by experience had a look around the home and made this observationThere was a marked contrast between the environment on the dementia unit and that of the residential unit. The decor and furnishings were inferior in the dementia unit to those in the residential unit, shabbier and much more basic. There was a detectable odour in areas of the upper unit in particular. The residential unit appeared well furnished and decorated. People in this unit told us they were fully satisfied with the accommodation. Other areas of the home are in need of attention both in decor and replacement of the furniture and fittings. For example carpets are stained and worn, some of the recliner chairs are broken, the wall paper in some areas is peeling off the wall and some of the beds frames are rusty. We saw that some bed linen in use was thin and almost transparent. Not all of the extractor fans in the en suite rooms appeared to be in working order. Some people in the dementia care unit require a commode for night-time use. The unit does not have a sluice facility for the safe disposal of bodily waste. Staff explained that the contents of the commode are disposed of in the toilet, the pot is then swilled out in the wash hand basin and the pot is then taken to another unit to be washed. This practice is not conducive to maintaining the privacy and dignity of people, is a potential hazard for staff and maybe ineffective in managing the control of infections. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service cannot be assured that their care needs will be met in a timely way. Evidence: A visitor told us - The staff do a good job under difficult circumstances. By and large they couldnt do better Throughout the day we observed staff working positively with people, they appeared patient, caring and committed to their work. They were all very busy attending to the care needs of people but we heard the call bell remain activated for considerable periods of time. We saw that one person waited for twenty minutes for staff to arrive to attend to them. People we spoke with commented about the delay in getting attention from the staff - It takes staff ages to answer the buzzer when you ring. It took staff 2 hours to come to me the other day when I buzzed and I needed something. I dont bother ringing between 8am and 10am as there is no service here at that time. I usually have to shout out if I want anything the staff come to me then. I am sick of having accidents from having to wait to be taken to the toilet. We looked at the staffing rotas and saw that the staffing levels are maintained with different numbers of staff during the day and night. The manager explained that recruitment for staff is ongoing and the use of agency staff to fill the shortfalls of the Care Homes for Older People Page 23 of 30 Evidence: permanent staff is minimal. The AQAA documents that the service plans for - More Senior Care Staff to be employed to assist the nurses in managing their units. From our observation during the day and what people told us we consider that the staffing levels are insufficient to meet the needs of people residing in the home. Basic care needs are not being met within acceptable time limits. The AQAA informs us that of the forty nine permanent care workers, twenty have received accreditation of National Vocational Qualification in care level 2 or above. Care staff trained to NVQ 2 is currently 45 . We currently have a further four staff completing NVQ 2 training. We sampled the files of five staff holding various positions within the home. The files were well presented and contained the information required to safeguard the people living at Pine Meadows Care Centre. A training matrix is used as a quick reference guide as to the training that a member of staff has completed. Staff told us that they had received training in dementia care mapping, but had been unable to put this training into practice. There was no evidence on the training matrix or in the staff files to support this. Other staff confirmed they had received training in the mandatory subjects, moving and handling, fire safety etc. and they feel well supported with the training needs. A new member of staff confirmed they are currently working through an induction programme. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that the manager has the necessary experience to run the home. There are one or two areas that require attention to ensure effective outcomes are achieved for people using the service. Evidence: Mrs Barbara Jackson is the registered care manager for the service and has been in this position since January 2000. Mrs Jackson is supported by a deputy manager and there are support networks in place with the providers of the service. People told us that the manager is supportive and helpful. I see the manager around the home. She is very popular. She comes around to see me and is just like a mother to me. The AQAA was completed by the manager and returned to us, it tells us what has been done at the home over the last twelve months and the plans it has for the next twelve months. Some of the information provided in the AQAA did not accurately Care Homes for Older People Page 25 of 30 Evidence: correspond with the findings of this inspection. The areas being in relation to social activities, care provision and person centred care, the environment and mealtimes. The manager explained the quality assurance systems in place and stated there are numerous weekly, monthly and annual audits completed and analysed. Customer satisfaction surveys are sent out annually with the comments both negative and positive analysed. A report is then produced and sent to relatives and residents and discussed at the staff meetings. A senior member of the company continues with the monthly formal visits as part of the monitoring of the service, reports are produced of the visits and available for inspection. We looked at systems for safekeeping of peoples money and found they were in good order. The home has good records of all transactions and obtains receipts and two signatures. This will reduce the risk of errors occurring and give the added peace of mind to the people living in the home. We saw the records, documents and certificates for the weekly, monthly and annual health and safety checks are being maintained. All records requested were readily available for inspection. We saw one or two areas of concern where there is a potential risk to people. For example, we saw two staff assisting a person to stand from an easy chair using the underarm method and pulling the person to their feet. This underarm technique has been condemned as a dangerous method for a period of years. Staff told us that they had received recent training in moving and handling, and if this is the case they are either not receiving the correct training or not putting the training into practice. We saw a wheelchair being used without footrests. We spoke to staff about the risks to the person and to themselves of using unsafe equipment. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Correct contact details of the commission are needed in the information documents to ensure that people are able to contact us should they wish to do so. To comply with the regulations and to give people full information and details of the service, the service user guide should include the levels of weekly fees payable. The care plans should contain the full details of a persons assessed care needs to ensure that the care needs are fully met A review is needed for the application and administration of creams and lotions. This will ensure that people receive the preparations in the way they are prescribed. Medication reviews should be completed in accordance with instructions. This will ensure that people are not at risk of receiving medication that are no longer required. Where required people should be helped and assisted with maintaining their dignity by maintaining acceptable standards of personal hygiene. More attention should be given to increasing the variety, Page 28 of 30 2 1 3 8 4 9 5 9 6 10 7 12 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 frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. 8 9 10 14 15 19 People should be assisted to make choices and have control of how they wish to spend their day. The meals provided to people should be appetising varied and served in pleasant surroundings. All areas of the home must be well maintained, well decorated and furnished. This will ensure equality for all people living at the home. Sluicing disinfectors should be supplied and fitted in all areas where there is a need to effectively dispose of bodily waste. This will ensure that peoples privacy and dignity is not compromised,staff are not at risk of cross contamination and that effective infection control is achieved. Staffing levels should be determined according to the assessed needs of the people living at the home. This will ensure that the health, personal and social care needs of people are fully met. The home should achieve a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times. Wheelchairs should not be used without footrests. This will ensure that people are not put at risk of harm. Staff should be instructed on the most appropriate and safe transferring techniques. This will ensure that people are not put at risk of harm. 11 26 12 27 13 28 14 15 38 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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