Care Home: Roxburgh House

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What the care home does well The home offers a nutritionally balanced diet, with a choice of meals and diets to meet peoples health needs. An activities co-ordinator works Monday to Friday and provides a range of activities to stimulate people living in the home. Staff spoken to were enthusiatic about their job and good interaction was noted between staff adn people living in the home. The Service Users Guide is available in alternative formates this promotes the accessiblity of information available to people. There are good systems in place to manage people`s money, so that it is safeguarded. People are supported to keep in touch with family and friends so they maintain relationships that are important to them. What has improved since the last inspection? The home is now notifying us of events that effect the health and well being of people living in the home so that we can monitor the home in between visits. What the care home could do better: The record keeping systems in the home are poor. This means that people`s care plans and risk assessments do not contain all of the information necessary to give staff clear guidance to meet people`s needs. Further work is need to improve the medication systems in the home to ensure people`s health and well being is promoted and protected. The home needs to improve the way in which it manages people who are at risk of pressure area damage. Systems should be in place to ensure all staff have a knowledge and understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards commensurate with their position to ensrue they are aware of how to support people who lack capacity. The home`s own quality assurance systems should be further developed to ensure continous improvement and outcomes for people living at the home. Maintainance issues need to be dealt with in a timely manner so that facilities that are not working do not impact for a long time on the needs of people living in the home. Staffing levels and the deployment of staff must be reviewed so that the needs of people living in the home are met according to their wishes. Storage facilities must be reviewed around the home so that items are not stored in sluice areas potentially exposing people to unnecessary riskof cross infection. Shortfalls in staff training need to be addressed to ensure that staff have the specialist skills to meet the needs of people living in the home. Key inspection report Care homes for older people Name: Address: Roxburgh House Reddall Hill Road Cradley Heath West Midlands B64 5JE     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: Karen Thompson     Date: 0 1 0 3 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Roxburgh House Reddall Hill Road Cradley Heath West Midlands B64 5JE 01384411029 01384565408 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.schealthcare.co.uk Southern Cross Care Homes No 2 Limited Name of registered manager (if applicable) Mrs Nazia Begum Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 47. The registered person may provide the following categories of service only: Care home only 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) 47 Dementia (DE) 47 Date of last inspection Brief description of the care home Roxburgh is a large home providing accommodation for 37 people who require personal care only and 10 people who have dementia. It is owned by Southern Cross Healthcare Limited who own a large number of homes throughout the UK. Situated on the border of Old Hill, it is easily accessible by public transport from Dudley, Care Homes for Older People Page 4 of 30 Over 65 0 47 47 0 Brief description of the care home Halesowen and Birmingham. The local amenities include a library, community centre, post office, shops and public houses. The home has two large lounges situated to the left and right of the main hall with dining areas off one lounge. Lenches unit ( the dementia care unit) has a large lounge/ dining room with incorporating a conservatory. The home has three double bedrooms and forty-one single rooms, three having ensuite facilities. Bedrooms are located on the ground and first floor and there is a lift available for people to access all communal areas of the home. There is a small pleasant garden area accessible from Lenches unit that people living at the home can enjoy on fine sunny days. There is a car park situated to the front of the building that is quite reasonable in size. There are also smoking facilities for residents. Fees range from £335 to £535 depending on the needs of the service user and the room that they occupy. For up to date fee information the public are advised to contact the home. 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 focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs adn focuses on aspects of service provision that need further development. The last key inspection was undertaken on 3 April 2007 and the home was given a 3 star quality rating. This inspection found the home to provide adequate outcomes for people 1 star quality rating demonstrating a decline in the standard of care being provided to people living at the home. We issued one immediate requirement during our visit due to bathing facilities not working, this is done when work is required to be done by provider within a very short space of time to promote the health and well being of people living in the home. The provider has since written to us to confirm this has been done. Care Homes for Older People Page 6 of 30 Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. One inspector and one local area manager undertook the fieldwork visit over one day. The manager of the home was available for the duration of the inspection. The home did not know that we were visiting on that day. At the time of the inspection thirty nine people were lving in the home and information was gathered by speaking to and observing people who lived at the home. Five people were case tracted and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of the inspection five people who live in the home and six members of staff were spoken to in order to gain comments. There is an established staff team with a low staff turnover, so staff were aware of peoples needs. However there were areas that need to be reviewed and developed to ensure people needs are met and these have been identified in the section below (What the service could do better) 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: The record keeping systems in the home are poor. This means that peoples care plans and risk assessments do not contain all of the information necessary to give staff clear guidance to meet peoples needs. Further work is need to improve the medication systems in the home to ensure peoples health and well being is promoted and protected. The home needs to improve the way in which it manages people who are at risk of pressure area damage. Systems should be in place to ensure all staff have a knowledge and understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards commensurate with their position to ensrue they are aware of how to support people who lack capacity. The homes own quality assurance systems should be further developed to ensure continous improvement and outcomes for people living at the home. Maintainance issues need to be dealt with in a timely manner so that facilities that are not working do not impact for a long time on the needs of people living in the home. Staffing levels and the deployment of staff must be reviewed so that the needs of people living in the home are met according to their wishes. Storage facilities must be reviewed around the home so that items are not stored in sluice areas potentially exposing people to unnecessary riskof cross infection. Care Homes for Older People Page 8 of 30 Shortfalls in staff training need to be addressed to ensure that staff have the specialist skills to meet the needs of people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. The home does supply information for people to help them make a choice about living in the home. Peoples needs are assessed prior to admission to the home but these needs are not always being met appropriately. Evidence: The Service Users Guide was on display in the front enterance of the home, the guide stated it had last been reviewed February 2010. On inspection of the document it gave a range of information but the section on customer feedback did not indicate when this was obtained. The guide however also stated that the Service User Guide was available in audio cassette form if required, so that it is accessible to people with sight problems. The home provides care for people who require long term and respite care. People can visit the home before moving in, so they can view the facilities, meet the staff and Care Homes for Older People Page 11 of 30 Evidence: other people who live there in order to sample what it would be like to live there. One person we spoke to stated: I was in hospital and someone from here who has left now, came to ask me questions. I was too poorly to come and look at the home then but my daughter and daughter in law did. Im happy. Would rather be at home, but I am happy here. I could not wish to be looked after any better. Staff undertake a pre-admission assessment for all people before they move into the home to determine if their needs can be met appropriately. On inspection of three peoples records who had moved into the home it was found that staff had competed a pre admission assessment and they had obtained copies of assessment from the social worker. The pre admission assessments for two of these people had not been dated while the one that had did not have the signature of the person completing the document. We visited the Leeches unit which is dedicated to the care of the people with dementia. We observed 14 people sitting having breakfast in this unit and was told by staff that they care for 18 people. Following admission to the home there is a trial period of one month and a review is held at the end of the month with the person, staff and any relevant others. This provides an opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. The home does not provide intermediate care. 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 arrangements for meeting peoples health and personal care needs including medication are not always being adequately, consistently and appropriately met which puts them at potential risk of harm. Evidence: We looked at five peoples care files in detail. We found that one person at the home did not have a care plan. We spoke to staff about this and they told us A member of staff is working on .... permanent care plan at home and is bringing it in, they have been working from the temporary care plan (this is the pre admission care plan) This person had been in the home for several months. We also identified another person who had behaviour that challenged from the safeguarding records but they did not have care plan in the home. We also found that care needs were not being identified in the care planning process. An example of this was a person who had returned from hospital with a urinary catheter but also had no care planning instructions to care for this need. This same person had been experiencing shortness of breath and had been prescribed medication but this again was not acknowledged in the care plan. We found one person was on a pureed diet but care records made no mention of this. By not Care Homes for Older People Page 13 of 30 Evidence: formally identifying needs it cannot be guarenteed that all staff will be aware of what is required to monitor and assess these needs. Care plans looked at contained evidence of risk assessment that had been completed in respect of nutrition, skin etc. One care plan was found to have blank risk assessment in relation to manual handling assessment. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. We also found that people living at the home who had cognitive impairment had not had their capacity to consent formally assessed. We looked at how the home manages pressure area care for people living there. We spoke to staff about how they support people in reducing the risk of pressure damage occuring. We found for those people whose records we looked at did not include equipment to be used or how often pressure reliefing strategies were to be implemented. Staff told us that they stood people up though out the day and this was observed to be occuring. Staff knowledge in relation to prevention was weak. The home carries out skin integrity risk assessments but whilst staff appear to act appropriately when concerns are identified, strategies should be put in place prior to such issues developing. The pressure relieving equipment is supplied by the district nursing service. There was evidence to show the home does call for medical assistance and other specialist advice from healthcare professionals. We also saw written evidence that families are kept informed of changes in condition. On inspection of the medication for the current month it was found that audits were correct for both blistered and boxed medication. We observed good medication practice occuring on the residential unit of the home in relation to the morning medication. We spoke to two members of staff to ascertain their knowledge iabout medication which was found to be good. The medication room was found to be at 24c although the home is recording medication room temperatures daily. We asked staff if the room got hot and they told us sometimes they have to put the portable air cooler on, which was observed in the room. We visited in February 2010 and are concerned that in the summer months this rooms temperature will exceed 25c. The home needs to monitor this closely and take appropriate action if needs be to ensure the stability of medication stored in this room. There were two medication fridges. The one that was in use was not lockable and we were told that the lockable fridge was not working. Handwritten medication charts did not contain the two signatures of the staff checking the medication into the home. We also found one person living in the home Care Homes for Older People Page 14 of 30 Evidence: had had medication prescribed for behaviour management on an as and when basis (PRN) but there was no protocol to advise staff as to when this would be necessary. Staff were recording when they opened medication but it is recommendated that they write this information on the bottle as opposed to the box, in case the box gets discarded. We found prescribed creams stored in one persons room when their care plan clearly stated no medication was to be stored in their bedrooms not even homely remedies. The manager told us that in two weeks time all staff would be having medication refresher training. We observed staff treating people with respect and dignity. We do however have concerns about the practice of getting people up early in the home (discussed in daily life and social activity section of report) and the lack of accessible and functioning bathing and toileting facilities ( discussed in the environment and management and adminstration section of the report). All these practices impact on the respect and dignity of people living in the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals are of a good quality and meet peoples needs. There are some restrictions on peoples choice due to availabiity of staff, environment and staff practice. People have the opportunity to lead an active life and maintain their relationships and friendships. Evidence: Visiting was flexible with the exception that visitors have been asked to try and avoid meal times. People living at the home can maintain contact with friends and family. There was good interaction between staff and visitors making them feel welcome. There is an activities coordinator employed by the home who arranges events and other activities. The home has access to a mini bus but we were told that people had not been out in the mini bus for a number of months. The activities coordinator has a meeting every Monday with people living at the home to see what they would like to do. Each person is encouraged to make their room their own by decorating in with their own personal possessions such as ornaments, photographs and furniture. We observed the majority of people living at the home to be up and dressed on our Care Homes for Older People Page 16 of 30 Evidence: arrival to the home. We were told by staff at 7:40am that there was only six more people left to get up and dressed. From this we concluded that night staff would begin getting people up from 5am onwards. One person living at the home had their preferred time for rising as 8am recorded in the pre-admission assessment but they were found to be up on arrival to the home at 7:15am. Not all care plans we looked at did not documented the preferred time of rising and going to bed. We were told by people living at the home when asked by ourselves whether they like to get up at this time: got to get up early to get them all up and got to get the wheelchair people up. These comments are concernings as it demonstrates an acceptance of people living at the home that they have no choice in when they get up or go to bed. We did have the opportunity to observe meal times during this inspection on both the residential unit and Leeches unit. On arrival to the home in the early morning we did observe that people who were up and sitting in the lounge area had been offered a drink. We also saw jugs of squash being given to people living in the home throughout the morning. The dining areas in both units were pleasant,tables had cloths and floral decorations on them. Only one Person sitting in Leech unit was observed to have their breakfast at the dining table, the others remained sitting in their armchairs. We observed people balancing their cereal bowl on the arm of the armchair or holding the bowl as they did not have access to a small table. We asked staff about this and they told us there were not enough small tables. People living at the home told us: The food is always very nice, food always good and we can choose. We observed the cook asking people what they would like to eat that day. They were offered a choice and this choice mirrored what was written on the menu displayed on the dining room tables. We spoke to the cook who was aware of peoples special dietary needs. Care Homes for Older People Page 17 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. There are systems in place so that people are protected from harm but further work is required. Evidence: A complaints procedure was on display in the reception area and in the service user guide. On discussion with people living in the home they stated: no complaints, if I did I would speak to the girls and no complaints about here, if I did Id speak to the head one or tell my daughter, I would not mind telling them We saw the complaints procedure in some of the bedrooms we visited. There is a complaints book where complaints are recorded and two have been recorded since our last key inspection. One of these had been referred by ourselves after concerns had been raised with us directly. Records indicate that most staff had undertaken training in respect of safeguarding and on discussion with members of staff they had a satisfactory knowledge of the procedure within the home. One member of staff informed us they had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. The training records given to us however did not demonstrate that this had taken place for any staff working at the home. Systems need to be put in place to demonstrate which staff have completed the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff must receive training in this legislation that is commensurate with their position, so Care Homes for Older People Page 18 of 30 Evidence: that they are aware of the procedure for supporting people who lack capacity to make decisions and are kept updated with recent legislation. Care Homes for Older People Page 19 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. Shortfalls in the maintainance of aids and adaptations are impacting on the choice, privacy and dignity of people living in the home. Evidence: The home is a detached two storey building with adequate off road parking to the front of the building for visitors. The home is on a main bus route anc close to local shops and amenties. A partial look around the home was undertaken and it was found that bathing facilities did not meet the standard. The bath was found not to be working on Leeches unit and staff told us that if someone wanted a bath they would be taken to us the residential units bathing facilities. This impacts on a person privacy and dignity by having to access a bath in another part of the home. Leeches unit did however have a working shower unit. We found on the residential unit that the shower units was not working and had a strong musty smell. Staff informed us that they had not used this shower room for some time. We also found that one of the assisted baths in the residential unit had not been working for some time. We left an immediate requirment with the care manager to investigate why these facilities were not working and draw up an action plan to have them back in use. We received following the inspection confirmation from the providers representative that these facilities are now in working order. No bedrooms in the home have ensuite facilities. Some people living on the first Care Homes for Older People Page 20 of 30 Evidence: floor of the home have quite a distance to travel to use the tiolet we did see commodes in bedrooms. The home needs to audit the number of side tables available for use around the home as detailed in the daily life and social activities section of the report. Sluice disinfectors for cleaning commode pots were available on both the ground and first floor. We did however see wheelchairs being stored in one of these sluice areas. We highlighted to the care manager that this was not good infection control prevention and she had these wheelchairs removed. We did observe liquid soap, paper towels and diposal gloves and aprons around the home. Care Homes for Older People Page 21 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. Staff working pattterns are not taking into account the wishes of all people living in the home. Further work is required on staff recruitment to ensure that staff working at the home are supported to meet the needs of people living in the home. Evidence: The numbers and deployment of staff needs to be reviewed. The practice of getting the majority of people up and dressed before 8am by the night staff indicates that there are not sufficient staff allocated to meet their needs of a morning shift. The lack of good care plans and the practice of staff taking care plans home to write is also an indication that staff do not have sufficient time to do this whilst at work. The home does have domestic, laundry and catering staff employed daily as well as an activities coordinator. All staff spoken to were happy with working at the home and liked the people in they cared for. People living at the home also spoke positively about the staff: the carers are lovelyand The staff always help me . Three staff files were looked at in relation to staff recruitment. We found in two of the staff files that the health declaration form had not been completed and were blank. The employer has a duty of care to protect their employees and ultimately the people living in the home. The health declaration form is a vital piece of information to ascertain whether someone requires support to work in the home. Care Homes for Older People Page 22 of 30 Evidence: Following employment new staff undertake the home induction training programme. This training ensure that staff have the appropriate skills and knowledge to care for people living in the home. The percentage of staff who have obtained the National Vocational Qualification (NVQ) level 2 is within the sixty percent range. We were given a training matrix during the inspection. The majority of staff have received training in safeguarding, fire safety and fire drills. There has been a small amount of slippage in manual handling training. The matrix did not record any specialist training that had taken place in the home such as the Mental Capacity Act and dementia, some of the staff spoken to during our visit however did confirm they had attended this. The home has it own in-house trainer who spoke positively about their role. Care Homes for Older People Page 23 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. Systems for managing this home sometimes work and sometimes do not, meaning that the service is not always being run with the best interests of people who use it in mind Evidence: The homes manager has not changed since our last key inspection of April 2007. We have found during this inspection a decline in the standards of service people are receiving. These shortfalls must be addressed by the management team. The homes manager is registered with the Commission and has a recognised management qualification. Issues identified by ourselves should have also been identified by the provider. The provider does send a representative to carry out visits and a report is produced. The report is based on a template produced by the organisation but it did not include checks to bathrooms or toilets or infection control. The bathing facilities have been out of action for a number of years and the manager was able to demonstrate Care Homes for Older People Page 24 of 30 Evidence: repairs/replacement had been requested but they needed to be persistantin their requests as this has ultimately impacted on peoples privacy, dignity and choice. Small amounts of money are held on behalf of people living in the home and they have bank accounts where appropriate. The system in place for the safekeeping of money appears to be robust. There are systems in place for servicing and maintaining equipment to ensure the health and safety of people living and working in the home. A sample of records were inspected and they were found to be satisfactory. The home notifies us of changes in peoples conditions and other adverse events under Regulation 37 of the Care Homes Regulations. Care Homes for Older People Page 25 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 26 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 1 21 23 The upstairs shower and an assisted bath on Lenches unit is not working. To ensure that people living at the home have access to bathing facilities that meet their needs and are within easy of access so they do not impact on their privacy and dignity. 03/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be based 30/05/2010 on a thorough assessment of needs and show how care is to be delivered. Care plans must be accessible to staff working in the home at all times and be a reflection of the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and staff must be aware of these changes. To ensure that people living at the home have all their needs assessed and meet appropriatley. Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 7 15 Care plans and record 30/05/2010 keeping for people who have behaviour that challenges must be based on a thorough assessment of their needs and show how care is to be delivered. Care plans must be accessible and known to staff delivering care. Care plans must be reviewed regularly at the point where a persons needs change and staff must be aware of these changes. To ensure the health and well being of people living in the home is promoted and protected. 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 2 9 9 It is recommended that the date of opening be written on the medication box as well as the box. The home should purchase a pill counter so that when counting pills they are not in danger of loosing tablets or staff are exposed to drug absorption. Handwritten Medication Adminstration Records (MAR) should contain the signature of the two staff checking the medication into the home. It is recommended that all occassional use medicaines have a supporting protocols to adminster them against to ensure they are adminsitered as the doctor intended endorsed by a clinician. 3 9 4 9 Care Homes for Older People Page 28 of 30 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 5 9 Medication room temperatures should be closely monitored to ensure they do not exceed 25c as this compromises the drugs stability. Staff should review with people living at the home their prefered waking and going to bed times and ensure these are meet. This review should be linked to the review of staffing levels and deployment. An audit of small tables should take place in consultation with people living at the home and or their representatives. Following this an action plan should be drawn up to supply these tables to meet individuals needs. This will ensure people have sufficient furniture to allow them chocie and promote dignity and independence. Sluice areas should not be used as general storage areas and alternative areas should be sort for storage. Staffing levels and deployment of staff should be reviewed in the home to ensure that people live in the home receive the care in an appropriate manner to meet their individual needs. Health declarations should be completed by all staff working at the home so that staff are fully supported to meet peoples needs and no one is exposed to unnecessary risk. Shortfalls identified in staff training such as dementia care, Mental Capacity Act awareness, Deprivation of Liberty, tissue viability and manual handling should be addressed through the appropriate learning style so that staff fully understand their roles and responsibilities. This will ensure knowledge and practice mirrors and meets the needs of people living in the home. The Quality Assurance report should be reviewed to ensure that it looks at bathrooms, toilets and infection control matters. This will ensure that provider is fully aware of issues that are affecting the lives of people living in the home. 6 14 7 24 8 9 26 27 10 28 11 30 12 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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