Care Home: Robert Harvey House

What the care home does well People have the majority of the information that they need to enable them to decide if they want to live at the home. People told us that they were happy with how the home support them to meet their personal hygiene needs. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet their health needs. People benefit from being cared for by a staff team that are supported in their job roles. People can be confident that they can choose how they spend their time. The home is sensitive to people`s cultural and religious needs so that they are supported to live their lives pursuing what is important to them. People are supported to keep in touch with their families and friends so that they can maintain relationships that are important to them. People are confident that actions will be taken to address any concerns that they may raise. People told us: "The carers and nursing staff do an excellent job" "I would recommend it to anyone having to place their elderly relatives into care" "The home looks after everybodys individual needs. They treat people with respect and offer them choices" "I am never lonely here. It is so true" "Nursing staff are willing to listen to any relatives worries on behalf of patients and take necessary action" "The manager listens and communicates with service users at all times" What has improved since the last inspection? People are involved in writing their care plan so that care can be provided in the way they prefer. People are encouraged to lead fulfilling lives that meet their needs, interests and expectations. People are offered a variety of healthy meals that meet any special dietary requirements. People have opportunities to be involved in the running of the home. A mobile sensory unit has been purchased so that all people living at the home have the opportunity to use this. People can be confident that there is an effective laundry system in place for their personal clothing and bed linen. People told us: "I have been involved in writing my care plan every time. From the day I came until now". "I like to go to the music and movement on a Friday and I go to my local church. I get the ring and ride". "The new chef has been down to speak to me so he gets to know my preferences". "The food is really well presented and the pureed food is like a picture". "I go to the relatives meetings and if we make any suggestions things are sorted out". What the care home could do better: Prior to coming to stay there people cannot be confident that the home will be suitable to meet their needs. People cannot be confident that they consistently receive care and support at the times that they require. Space is limited in the six bedded `ward` area and this does not promote the comfort and dignity of the frail and vulnerable people in this area. People cannot be confident that they receive their medication as prescribed at all times, which may compromise their health People are not always provided with a clean and hygienic living environment. Communal space is limited and this may compromise the privacy and comfort of people living at the home. Staff must receive all the training they need to meet people`s individual and collective needs. People cannot be confident that their health, safety and welfare are maintained whilst living at the home. Shortfalls within the service provided should be identified and rectified for the benefit of the people living there. People told us: "The lounge is often very busy with visitors this makes it difficult to be close to your loved one and for visitors to chat". Key inspection report Care homes for older people Name: Address: Robert Harvey House Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD     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: Amanda Lyndon     Date: 2 5 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 33 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 33 Information about the care home Name of care home: Address: Robert Harvey House Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD 01215548964 01215543351 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bcop.org.uk Broadening Choices for Older People care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 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: Dementia (DE) 42 Old age, not falling within any other category (OP) 42 Date of last inspection Brief description of the care home Robert Harvey House provides care and accommodation for up to forty two older people. This includes people requiring general nursing care and people who have additional dementia care needs. The home is located in a residential area of Handsworth Wood. It is close to public transport links and ample off road parking is provided at the front of the home. There Care Homes for Older People Page 4 of 33 Over 65 0 42 42 0 Brief description of the care home is a secure garden that is suitable for all people to use. Smoking is not permitted within the building. The home is purpose built. Accommodation is provided over two floors and upper floors are accessed via a passenger lift or stairs. Thirty two bedrooms offer single accommodation, there are two double rooms and a six bedded ward area for people with higher dependency needs. All rooms have en suite bathroom facilities including a walk in shower facility. In addition communal assisted baths and showers are available for all people to use. There is a communal dining and lounge area and smaller seating areas throughout the home. There is a hair salon and kitchen and laundry facilities are based on site. Corridors are spacious and allow people to move around freely with any mobility aids required. The home employs an activity worker. This means that there are opportunities for people to take part in activities both within and outside of the home. In the reception area there is information that may be of interest. This includes our last inspection report, the statement of purpose and service user guide. Details of the fees charged to stay at the home are identified on the application form. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing and newspapers. Care Homes for Older People Page 5 of 33 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 focus of our inspections 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, minimum standards of practice and focuses on areas that need further development. The inspection was carried out over one day by two inspectors. The home did not know we were going to visit. There were thirty seven people living at the home and one person was in hospital. Prior to the visit taking place, we looked at all of the information we had received, or asked for. This included any notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We had not received any complaints about the service provided at the home. The Annual Quality Assurance Assessment (AQAA) was not due for return until after our visit. We sent out random surveys to eight people who live at the home, eight relatives and Care Homes for Older People Page 6 of 33 eight staff members, in order to obtain their views about the service provided. These were not due to be returned until after our visit. However at the time of writing this report three surveys had been returned completed by people living at the home. Seven surveys had been completed by relatives and seven surveys had been completed by staff working at the home. Their comments are included in this report. Four people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to six staff members about the care and support they provided to these people. We sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean and comfortable for them. We gave all people living at the home the opportunity to be involved in the inspection. We spoke with six of these people. We also spoke with three relatives and one health professional that were visiting the home. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? People are involved in writing their care plan so that care can be provided in the way they prefer. People are encouraged to lead fulfilling lives that meet their needs, interests and expectations. People are offered a variety of healthy meals that meet any special dietary requirements. Care Homes for Older People Page 8 of 33 People have opportunities to be involved in the running of the home. A mobile sensory unit has been purchased so that all people living at the home have the opportunity to use this. People can be confident that there is an effective laundry system in place for their personal clothing and bed linen. People told us: I have been involved in writing my care plan every time. From the day I came until now. I like to go to the music and movement on a Friday and I go to my local church. I get the ring and ride. The new chef has been down to speak to me so he gets to know my preferences. The food is really well presented and the pureed food is like a picture. I go to the relatives meetings and if we make any suggestions things are sorted out. What they could do better: Prior to coming to stay there people cannot be confident that the home will be suitable to meet their needs. People cannot be confident that they consistently receive care and support at the times that they require. Space is limited in the six bedded ward area and this does not promote the comfort and dignity of the frail and vulnerable people in this area. People cannot be confident that they receive their medication as prescribed at all times, which may compromise their health People are not always provided with a clean and hygienic living environment. Communal space is limited and this may compromise the privacy and comfort of people living at the home. Staff must receive all the training they need to meet peoples individual and collective needs. People cannot be confident that their health, safety and welfare are maintained whilst living at the home. Shortfalls within the service provided should be identified and rectified for the benefit of the people living there. People told us: Care Homes for Older People Page 9 of 33 The lounge is often very busy with visitors this makes it difficult to be close to your loved one and for visitors to chat. 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 10 of 33 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 11 of 33 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. Systems are in place so that people can make informed decisions about whether to live at the home or not. Prior to admission people cannot always be confident that their care and support needs will be met at the home. Evidence: A statement of purpose and service user guide had been produced and we saw that these were available in the home. These included information about the majority of services and facilities provided there. Information about the procedures in place for people that come to stay at the home in an emergency were not included. This will prevent people from having this information when deciding whether to live there or not. This should also ensure that the home responds appropriately to emergency procedures. We saw that both documents had been produced in a large print format and could be produced in other languages and formats on request. This means that the information will be available in a way that more people will find it easier to understand. In addition the organisation has produced a web site with information Care Homes for Older People Page 12 of 33 Evidence: about the home. We saw that assessments of peoples needs are undertaken prior to coming to stay there. However not all of these had been completed in full. This may prevent staff from making an accurate assessment of whether a persons individual care needs could be met at the home. One person said Before I came to live at the home a nurse came to see if they could look after me here. We spoke to people about the pre admission process. They told us that they had the opportunity to view the home prior to coming to live there. This is in order to sample what life would be like to live there. Intermediate care is not provided at the home. Care Homes for Older People Page 13 of 33 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. Systems in place ensure that the health and personal care needs of the majority of people living at the home are met. Evidence: People told us The carers and nursing staff do an excellent job in providing the care and needs of the residents. I would recommend it to anyone having to place their elderly relatives into care, and The home looks after everybodys individual needs. They treat people with respect and offers them choices. We saw that assessments of peoples individual physical, emotional, and social care needs are undertaken on admission to the home. The majority of these were completed in good detail, however we found shortfalls in a couple of these. This means that a full assessment of a persons needs had not been undertaken and may result in these needs not being met at the home. Since our last key visit it was apparent that improvements had been made regarding care planning documentation available at the home. These are individual plans written Care Homes for Older People Page 14 of 33 Evidence: with the involvement of people and their representatives about what people can do for themselves, and in what areas they require support. One person met during the visit said I have been involved in writing my care plan every time. From the day I came until now. This should mean that people receive care and support in the way they prefer. We found that the vast majority of care plans were personalised, included peoples preferences regarding their daily lives, and identified what the person could and couldnt do for themselves. The majority also gave instructions for staff about the support to be provided. However we found that care plans did not always include specific instructions for staff to follow. For example, we saw that one care plan did not identify the instructions for staff should a person with diabetes require emergency treatment. Another care plan did not identify the ways in which staff could support a person who may exhibit behaviour that could be challenging to others. This may prevent people from receiving the care and support they require. We found that care plans did not always provide specific information about how to position people whilst in bed. There were inconsistencies between the instructions provided in the care plan and the information recorded on the monitoring charts held in peoples bedrooms. Charts showing how often people are turned and what position they were in to relief pressure areas were not completed in some cases. This means that it was not always possible to determine whether people received care and support at the times they required. This is despite staff telling us that this information should be recorded and identifying that this had already been raised as a concern during recent staff meetings. We were told that arrangements were in place in which senior staff were responsible for overseeing that care charts were completed on a day to day basis, however it was evident that this system was ineffective. We saw that the home complete risk assessments for people so that consideration is given to supporting them to take responsible risks and promote their independence. We saw that moving and handling assessments identified the specific support and equipment required for each person. In addition the majority of staff had undertaken recent training in this area. This should mean that people are supported to transfer in a safe manner. We saw that people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture and the time of year. People told us that they were happy with the level of personal care provided by the home. One relative met during the visit said Physical care is good. They care about peoples appearance and take time to make sure their hair is neat and they are wearing their jewellery such as necklace and earrings. One person said I have a bed bath every day. I have never been creamed so much in my life. I have beautiful skin. Care Homes for Older People Page 15 of 33 Evidence: People told us that care reviews are undertaken so that they have the opportunity to discuss their care in order to ensure that their needs were being met. However we saw that these were not always undertaken regularly. We saw that people can retain their own doctor on admission to the home, if the doctor is in agreement. In addition we saw that advice can be sought as needed from a range of other health and social care professionals. We spoke with a health professional who was visiting the home. She said Yes the nurses are fine and helpful. Information received from a relative who completed a survey said The medical care is first class. We looked at the system in place for the management of medication and found that there was a robust system in place for the management of repeat medication for people who lived at the home on a permanent basis. However we found that one person who had recently come to live at the home following an emergency admission had only had their pain relieving gel applied twice in the last seven days. As a result of this the staff told us that the person has stated that they are experiencing pain. We saw that the homes staff had attempted to order this medication however alternative ways to manage the persons pain had not been sought in the interim. Systems must be put in place to ensure that all prescribed items are available in the home. We saw that staff had not always recorded the times that they had administered a pain relieving gel to another person. This will prevent the effectiveness of the treatment from being monitored. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social stimulation meet the needs and expectations of people living at the home. Evidence: From speaking with people living at the home, staff, our observations during the visit and sampling of records, we identified that there is a range of activities provided for people to participate in, if they choose to do so. This included bingo, a dance competition, arts and crafts and entertainers. Forthcoming activities and entertainments were on display in the home, so that people were aware that they had been arranged. People told us that they had been involved in planning these and it was evident that arrangements were in place for people who were unable to join in with group activities. One person who spends her time in bed who we met during the visit said The activity lady has tried to find all sorts of things for me. If any refusal it has come from me. I am never lonely here. It is so true. One relative who we met with during the visit said The activity coordinator tries to do activities, it can be difficult to find things to engage people. Came in a few days ago and they were making pastry this was really good. Care Homes for Older People Page 17 of 33 Evidence: People told us that since our last visit there had been more opportunities to take part in activities outside of the home. This included a trip to a local theatre and a local restaurant. One person met during the visit said I like to go to the music and movement on a Friday and I go to my local church. I get the ring and ride. We saw that a copy of the homes newsletter was on display. This was produced in large print so that it was accessible to more people. It included information of interest to people living at the home, for example the success of recent events and the homes 21st birthday celebrations. People told us that the home is sensitive to their religious and cultural needs. Religious worship services are regularly held at the home. In addition staff can help make arrangements for people to worship at a local place of their own choice if preferred. This means that people have the opportunity to worship and practice their own faith and pursue what is important to them. One person met during the visit said My friends from church visit me here. We keep in touch. People are encouraged to maintain contact with their family and other people important to them. People told us that there is an open visiting policy and that they can meet with their visitors in private if they wish. However information received in a survey completed by a relative said The lounge is often very busy with visitors, this makes it difficult to be close to your loved one and for visitors to chat. It is often too much upset for a very frail person to be moved into a wheelchair to go to their room. We found that this was also the case during our visit and that plans are in place to address this within the renovation plans for the home. From discussions with people living at the home and from our observations, we saw that people have a choice of how they spend their time, where they are served their meals, and the time that they are served their breakfast. One staff member said We give people the option of if they want to get up later. We go back in to them. Since our last visit a new head chef had been employed at the home. It was evident that he had involved people living at the home and their families in preparing new menus. Menus identified a variety of nutritious meals and special diets are prepared for reasons of health, culture, and religion. A choice of meals is always available, and in addition people have the option of choosing snacks at other times. We saw that staff speak to people about what is on the menu so that they can choose which they would like to eat. People told us The new chef has been down to speak to me so he gets to know my preferences. It was nice today as we had fresh poached pear instead of tinned, and The home has now had a change in kitchen staff and the chef is Care Homes for Older People Page 18 of 33 Evidence: aware that some of our service users would like Caribbean meals. He has addressed this. We observed the lunch time meal and saw that seating was arranged to promote social interactions, adapted crockery and cutlery was being used and cold drinks were served. We saw that food was well presented and that staff and relatives were assisting people with their meals in a sensitive manner. We saw that staff reacted appropriately when a person became confrontational towards another person during the meal. This was in order to promote a sociable event for all people using the dining room. People met with during the visit said The food is really well presented and the pureed food is like a picture. We met the head chef at the last relatives meeting, and Lunch was very nice. Care Homes for Older People Page 19 of 33 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. Arrangements ensure that the views of people living at the home are listened to and they are safeguarded from harm. Evidence: Since our last visit we have not received any complaints about the service provided at the home. Information on the AQAA identified that the home had received one complaint in the last twelve months and that this had been upheld and was resolved. This was regarding the poor practice of one staff member. Details about this were included in the complaints register held at the home. We saw that the home had investigated this in an appropriate and timely manner. An easy to read complaints procedure was on display in the home and was included in the statement of purpose and service user guide. In addition we were told that plans are in place for a suggestions box to be made for the reception area of the home. This should mean that people know how to put their views forward. People told us If I have any problems I talk to the key nurse or the manager, and Nursing staff are willing to listen to any relatives worries on behalf of patients and take necessary action. Since our last visit we have been aware of one safeguarding incident between two Care Homes for Older People Page 20 of 33 Evidence: people living at the home. Appropriate actions were taken by the home as a result of this in order to reduce the risk of an incident of a similar nature from happening again. Information on the staff training matrix identified that during January and February 2010 all staff will have received refresher training about safeguarding adults. This should mean that staff are aware of how to protect people living at the home. This should ensure peoples safety. From discussions with staff during our visit it was evident that they had an understanding of safeguarding procedures. One staff member said I would raise any concerns with the lead nurse or would contact the POVA team direct. I would have no problem taking concerns forward if I felt they were not being dealt with. I am an advocate for the people that live here. During the visit we observed an incident of unacceptable practice from a care worker towards a person living at the home. This compromised the respect and dignity of the person living at the home. We reported this to the registered manager in order for actions to be taken. Shortly after our visit the home told us that they had taken appropriate actions to address this for the benefit of the people living at the home. This means that they are aware of how to implement their policies in this area. Care Homes for Older People Page 21 of 33 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. Limited communal space does not ensure the comfort and privacy of people living at the home. People living in the ward area are provided with an unhygienic living environment which may compromise their health, safety and welfare. Evidence: The home is purpose built and has been open for twenty one years. The organisation had identified a need for major renovation work at the home and plans are in place for this to commence later this year. The proposed plans should ensure that there is enough communal space for all people living at the home and all bedrooms will offer single occupancy with en suite facilities. There will also be a separate unit for nine people with dementia care needs. Building plans were on display and from discussions with people living at the home and their relatives it was evident that the organisation was keeping them up to date about the timing of the building work. We looked at the bedrooms of people case tracked and saw that they had personalised their bedrooms to reflect their age, gender, interests and culture. People met during the visit stated that they were very happy with their rooms. Call bells were provided in all bedrooms so that they can get assistance from staff when they require. One person met with during the visit said My call bell is here right where I can reach it. As previously discussed communal space was limited and will be addressed during the Care Homes for Older People Page 22 of 33 Evidence: renovation work at the home. However, we found that the smaller seating areas throughout the home were not in use during our visit and as a result of this the communal lounge was full of people and their visitors. There is equipment available to assist staff to deliver personal care to people living at the home in a safe manner. Since our last visit a mobile sensory unit has been purchased so that all people living at the home have the opportunity to use this. Information received in surveys completed by relatives told us More care could be taken when placing garments in drawers and wardrobes, and After washing clothing it is often some time before garments are returned to their owner. During the visit we found that actions had already been taken to address these issues for the benefit of the people living at the home. There is a six bedded ward area for the more dependent and frail people living at the home. Space is limited in this area and this may not promote the comfort privacy and dignity of the people living there. A nurse call facility is not provided in this area however we were told that the ladies living in this area would not have the ability to use this facility. During our visit we identified poor infection control measures in this area of the home. Some areas were dirty and the arrangements in place for storing personal toiletries and washing equipment for people living in this area were unacceptable. This places people living at the home at risk of harm from cross infection. Care Homes for Older People Page 23 of 33 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. Systems are in place ensuring that people are supported by the right number of staff however people cannot always be confident that there are suitably qualified to provide a good standard of care. Evidence: In addition to care staff, administration, cleaning, maintenance, laundry and catering staff are employed. This means that people living at the home receive some support in these areas. Positive comments were made about the staff team. One person met during the visit said They keep their staff very well here. Some have been here for twenty years. They are friends. The nurses are very knowledgeable. Sometimes I explain to the care staff what is to be done for me but it is not their fault, and Staff are okay I can talk to them They are friendly. People living at the home and the staff team told us that there were enough staff on duty to meet peoples needs. People said The staffing levels are fine now. It is hard when viruses go around but they get agency staff if they can to cover. All staff got in during the recent bad weather, and Always staff around sometimes they may be busy helping someone and you may have to wait a little time but you know they are busy and that they will come. We were told that since our last visit people living at the home have been involved in Care Homes for Older People Page 24 of 33 Evidence: interviewing prospective staff members. This means that they have a say in who supports them at the home. We looked at two staff files and these included the majority of information required. We saw that two references had been obtained prior to people starting work at the home however this was not always from the most senior person from their previous employment. This was discussed with the registered manager who gave an explanation for this however details of this had not been recorded. We were told that criminal record checks were obtained prior to a person starting work at the home. However as these had been stored at the organisations head office we were unable to evidence this. We saw that prospective workers sign a health declaration disclaimer however the document used for this does not identify that a health assessment has been undertaken. This means that prospective workers may fail to disclose conditions that may affect their ability to do the job. We spoke with staff who had recently come to work at the home. They told us that they were supported within their new roles. One new staff member said I talk to any of the nurses. I have one to one meetings with my mentor and I get on with everybody. We saw that new workers undertake induction training. One staff member who had recently come to work at the home said They taught me everything I needed to know such as how to use a hoist and adult protection training. I have got food hygiene training next month. I have had so many training I am allright at the moment. This should ensure that new workers have the skills and knowledge in preparation for providing care and support to people living at the home. The staff training plan identified that there is a rolling programme of training in mandatory areas planned throughout 2010. However it was of concern that the staff training matrix identified that a large number of staff had not received training in a number of mandatory areas since working at the home or within the last three years. This included training about health and safety and food hygiene. This may prevent staff from providing care and support in a safe and competent manner. We saw that the majority of staff had undertaken recent training about fire safety, manual handling and dementia care. In addition information in the AQAA dated February 2010 identified that 73 of staff had achieved a nationally recognised qualification in care (NVQ level 2 or 3 in care). We sampled the minutes of recent staff meetings. We saw that staff had the opportunity to put forward their suggestions about the service provided. One care worker said There is a staff meeting tomorrow. I went to the one last month. They keep us up to date about the building work and recap on residents meetings. Care Homes for Older People Page 25 of 33 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. Systems must be further developed and arrangements must be in place so that people living at the home can be confident that their health, safety and welfare are maintained whilst living at the home. Evidence: The registered manager has been in post since 2008 and has worked within a managerial role at the home since 2005. She has relevant and appropriate qualifications including the Registered Managers Award. She has recently completed the NVQ level 4 in social care and health. Positive comments were received about her management style including The manager listens and communicates with service users at all times. She also gets involved in activities and meal times, and The manager is very approachable can talk to her if I need to. We needed some new bingo cards and I suggested that they were laminated she went out of her way to get a laminating machine so this could be done. The registered manager is supported by a clinical manager who takes the lead on all Care Homes for Older People Page 26 of 33 Evidence: nursing aspects of the home. It was evident that there were clear lines of accountability between the management team, for the benefit of the people living there. Shortly following the visit the registered manager completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This included comprehensive details about the home, staff, and people who live there. It also included information about what the service hoped to achieve for the benefit of the people living there. We found that the information included within this was consistent with the findings of our visit. This means that it gave us a reliable picture of the service provided at the home. There are some systems in place to capture the view of people living at the home and those people important to them. We saw that senior external managers undertake regular quality monitoring visits at the home. However we were not able to evidence that they speak directly with people living at the home during these visits. We saw that menu satisfaction questionnaires had recently been sent out to people living at the home in order to seek their views about the meals provided there. A report based on the findings of these was yet to be written. However the feedback was still being collated and we could evidence that a number of actions had already been taken in response to suggestions made via the surveys. Group meetings involving people living at the home and their relatives are held regularly. This means that people have the opportunity to put forward suggestions about the service provided on a regular basis. People told us I go to the relatives meetings and if we make any suggestions things are sorted out. They are starting a new laundry regime today, and I cant get to the residents meetings and I have no relatives to go so the staff always come and ask me if I have anything that I want to bring up at the meeting. I get a copy of the minutes. Money is not held at the home for safekeeping on behalf of people living there. Hairdressing and chiropody services are charged to the individual people after they have received the service. In addition to our concern about a number of staff not receiving training in health and safety matters, during our visit we identified a number of risks areas within the living environment for people at the home. We saw that the laundry door is kept open throughout the day and a risk assessment had not been written about this. This is despite being told that at least one person wanders throughout the home and would be at risk of harm if entering this area unsupervised. We saw that products considered Care Homes for Older People Page 27 of 33 Evidence: to be harmful to people if not used as they are meant to be had been left out in a number of areas of the home. Prescription items had been left out in the treatment room and there was no lock to this room. Prescription creams had been left out on peoples lockers in the ward area of the home. We were told that arrangements were in place for the senior staff and management team to regularly inspect the premises to ensure that it was a safe place for people to live. Therefore it was evident that the system in place for this was ineffective. We saw that actions had been taken to address the issues raised before the end of our visit. However arrangements must be in place to ensure that the measures are sustained. As previously identified in this report we found that improvements are required regarding the day to day monitoring of care being provided to people living at the home. A system is in place so that the senior staff should be checking that care records are being completed correctly, however it was evident that this was ineffective at times. From our observations and discussions with the senior staff team it was evident that this system required review in order to ensure that people always received the care and support required. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Comprehensive assessments 31/03/2010 of peoples care and support needs must be completed prior to coming to stay at the home. This is in order to determine the suitability of the home to meet peoples individual needs. Each person must have a care plan identifying specific instructions for staff. This is so care is provided in the way they require and prefer. 30/04/2010 2 7 15 3 7 12 Comprehensive assessments 31/03/2010 of peoples care and support needs must be completed on admission to the home. This is in order to ensure that peoples needs are met whilst living at there. Care Homes for Older People Page 30 of 33 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 4 8 12 Care records must be up to date and reflect the actual care provided. This is to ensure that people are receiving care and support at the times that they require. 31/03/2010 5 9 13 Systems must be in place so 31/03/2010 that medication is available in the home. This is to ensure that people receive their medication as prescribed. 6 26 13 Arrangements must be made so that People are provided with a clean and hygienic place to live. 31/03/2010 7 30 18 Arrangements must be made so that Staff have the necessary skills and knowledge to provide care and support in a safe and competent manner. 31/05/2010 8 33 24 Systems must be in place so 15/04/2010 that shortfalls regarding the care provided at the home are identified. This is so that actions can be taken to address the shortfalls, and improve the Care Homes for Older People Page 31 of 33 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 service provided to people living there. 9 38 12 Arrangements must be in 31/03/2010 place so that all areas of the home that people living there have access to are deemed to be safe. This is to maintain the health and safety of people living there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide should identify all services provided at the home so that people have this information when choosing a care home. Arrangements should be in place so that people and those important to them have regular opportunities to discuss the care being provided to them. Systems should be in place so that it is possible to assess the effectiveness of all medicines prescribed. Recording systems should be improved so that it is possible to determine whether all prospective workers are suitable to work at the home. Arrangements should be made so that people living at the home have opportunities to take part in quality monitoring visits undertaken by external senior managers. This is so they can put forward their suggestions about the service provided. 2 8 3 4 9 29 5 32 Care Homes for Older People Page 32 of 33 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. 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