Care Home: St Agnes

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What the care home does well The needs of people moving into the home are assessed where they are staying directly before moving into the home to determine if the home would be suitable for them. People can visit the home to see if they would like to live there and they are informed in writing if the home feels that their needs can be met. There is written information available to people thinking about moving into the home that tells them what they can expect to find at the home. People living in the home have a contract that tells them what the terms and conditions of living in the home are. The people living in the home have good access to health professionals and receive support in accessing them. The people living in the home receive their medicines as prescribed. There are good relationships between the staff and the people living in the home and they are treated with respect by the staff. The food provided in the home is varied and nutritious and choices are provided so that the people living in the home can choose what they eat. What has improved since the last inspection? The home has been decorated and continues to be refurbished and updated providing a comfortable environment for people to live in. A system has been put in place to manage items placed in safekeeping to ensure that the people living in the home are safe from financial abuse. Staff have had fire training every six months as required at the last inspection. This ensures that the staff would know what to do in the event of an emergency. Equipment in the home has been serviced and maintained so that it is safe for use. What the care home could do better: The registered person should develop the care plans further to ensure that there is sufficient detail for all staff to know how to assist the people living in the home. Care plans should include details of how cultural and social needs will be met. The registered person should ensure that people have access to zimmer frames and can make decisions for themselves at all times. If there are reasons preventing this the rationale and timescales for any interventions must be clearly recorded. This will ensure that their movements are not restricted without good reason. The registered person must ensure that the emergency call system is accessible to the people living in the home at all times so that they can summon assistance easily.The registered person must ensure that all recruitment checks are in place before people start their employment in the home. Induction training should be in line with the competencies identified by Skills for Care. This will ensure that the people living in the home are cared for by people who are suitable to work with vulnerable people and have the necessary skills and knowledge. Key inspection report Care homes for older people Name: Address: St Agnes 31/33 Silverbirch Road Erdington Birmingham West Midlands B24 0AR     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: Kulwant Ghuman     Date: 2 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: St Agnes 31/33 Silverbirch Road Erdington Birmingham West Midlands B24 0AR 01213504212 01213504212 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Residential Care Limited Name of registered manager (if applicable) Ms Lesley Mulhall Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 25 Date of last inspection Brief description of the care home St. Agnes was originally two large three storey, Victorian style houses. These have been converted and extended to provide a care home for a maximum of 25 older people. The home is situated in a residential area between the Wylde Green and Erdington shopping areas in a road directly off the Sutton Road. Both the shopping areas and the centre of Birmingham are accessible by public transport. Care Homes for Older People Page 4 of 32 Over 65 25 0 Brief description of the care home The bedrooms are spread over the three floors of the building and are a mix of singles and doubles, some with en suite facilities. The home has a lift to the upper floors however access to some of the bedrooms on each floor requires people living in the home to negotiate some steps. On the ground floor are three lounges, a dining room with the main kitchen leading off, a small laundry and an office. Assisted bathing or showering facilities are available on the ground and first floors and there are ample toilets throughout the home. There is level access into the home and off road parking for a few cars at the front of the home. There is a very large, well-maintained and pleasant garden to the rear. Fees were not included in the service user guide and the reader should refer to the home for current charges. The people living in the home will be need to pay additional costs for things such as newspapers. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection to this home was carried out on 25th June 2008. This inspection was carried out over one day during June 2009 and the home did not know that we were going to visit. The focus of 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, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). Care Homes for Older People Page 6 of 32 This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We took 5 Have your Say surveys with us for the people who use the service, 5 for staff and 5 for relatives. We received five completed surveys from staff and three from relatives. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The registered person should develop the care plans further to ensure that there is sufficient detail for all staff to know how to assist the people living in the home. Care plans should include details of how cultural and social needs will be met. The registered person should ensure that people have access to zimmer frames and can make decisions for themselves at all times. If there are reasons preventing this the rationale and timescales for any interventions must be clearly recorded. This will ensure that their movements are not restricted without good reason. The registered person must ensure that the emergency call system is accessible to the people living in the home at all times so that they can summon assistance easily. Care Homes for Older People Page 8 of 32 The registered person must ensure that all recruitment checks are in place before people start their employment in the home. Induction training should be in line with the competencies identified by Skills for Care. This will ensure that the people living in the home are cared for by people who are suitable to work with vulnerable people and have the necessary skills and knowledge. 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 32 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 32 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 homes admission process ensured that the individuals needs could be met there but they did not always have all the information to make a fully informed decision. People moving into the home received information so that they knew what they could expect from the home. Evidence: There was a service user guide available in the home that would provide anyone thinking of moving into the home with details about what the service provided. The document was quite comprehensive but did not include information about the range of fees charged at the home. It did however, state that the fees were charged as per guidelines set by Birmingham Social Services for each type of accommodation available ie single, shared or en suite rooms. People may not have access to this information and it would be better if the lowest and highest fees were identified. There was a contract on the file of a person who had recently moved into the home Care Homes for Older People Page 11 of 32 Evidence: and this did include the required information. It was evident from the documentation seen that an assessment was carried out of anyone thinking of moving into the home in the place where they were living. They were then able to visit the home and decide if it was to their liking. Individuals were informed by the home if they thought that their needs could be met. There was no evidence seen on the file sampled that an assessment or care plan had been received from the placing authority. It was important that this information was available to the home so that they could make a fully informed decision about whether they could meet the individuals needs. There was a review after 28 days to ensure that the home was able to meet the individuals needs and to ensure that the individual was happy about the service they were receiving. Care Homes for Older People Page 12 of 32 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 needs of the people living in the home were being met but the care plans and management of medicines could be improved to ensure that they received their medicines as prescribed. Evidence: We cased tracked the care given to three people and looked at aspects of care for two other individuals. Case tracking means that we observe individuals care, speak to staff, sample records and where possible speak to people involved in their care. It was pleasing to note that the files we looked at included an over view of the individuals background including any employment they had had and details of their family. Each person had a care plan and it was evident that the care plans were regularly reviewed. As part of the care planning process the home carried out an assessment of daily living needs to determine the level of care they needed, then, individual care plans were formulated. The care plans covered areas including personal hygiene, Care Homes for Older People Page 13 of 32 Evidence: nutrition, self image, social and emotional support, finances, health support and communication. The plans included a brief statement of what the individuals needs were and then there were some pointers for staff to follow. For example, for one individual the personal hygiene plan stated that the individual would need prompting from one carer and that the individual would request a shower on a particular day. Instructions to staff included statements about ensuring privacy and dignity at all times, where to find toiletries, to encourage independence, regular showers and hair washing, prompting to wash and change clothes and ensuring nails were cleaned and trimmed. These statements showed that the home was promoting individuals privacy, dignity and independence but did not give staff clear instuctions on how this was to be achieved. Discussions with staff and observations during the day indicated that the individual was mainly self caring. Staff ensured that the individual wore fresh clothing in the morning by bringing laundry down in the evening. The nutritional plan for this individual stated that they they liked most foods but mainly snacks during the day and enjoys Caribbean foods and sweets. Instructions to staff were: observe daily intake of food and fluids, weigh monthly and provide nutritional meals, Caribbean foods and sweets. Evidence gathered from staff indicated that curry and rice and mango were provided during the week. Plans needed to be more detailed about how the cultural diet was to be met, what was to be prepared and how often as the individual clearly also liked English meals. The review in March 2009 stated that the individuals weight was stable but that they refused build up drinks but liked milky coffee with three sugars. This information needed to be put into the care plan. There was no information regarding why or how often build up drinks were being offered. Staff were aware that the individual cut up clothing to sew together however, there was no information about how staff were to manage this. For another individual the nutritional plan drawn up in June 2008 indicated that the individual struggled with plated meals but could manage finger foods and sandwiches. The instructions to staff indicated that lunches were to be pureed, that food intake and weight was to monitored and that the staff should assess improvement. There was no indication of any assessments or how this was being recorded. Observations showed Care Homes for Older People Page 14 of 32 Evidence: that the individual had their lunch pureed and small meals were provided. Staff stated that the individual ate better with a spoon but during lunch they were given a knife and fork. We were told that this was because we were in the home but staff must ensure that the needs of the people living in the home are catered for as needed regardless of who is in the home. There were risk assessments in place that covered moving and handling, falls, nutritional and pressure area care. The weights of the people living in the home were being monitored, however, where there was a significant drop in weights the manager needed to ensure that more regular weighing was undertaken and steps taken to investigate the weight loss and advice sought regarding increasing the calorie intake of the individuals. The home has admitted some individuals who have enduring mental health issues. It would appear that the individuals had settled well in the home and their mental health issues were well managed, however, it was recommended that the manager speaks to the professionals involved in their care to get information about what indicators there would be if their mental health relapsed. The medical needs of the people living in the home were being met by referral to the appropriate professionals. Professional visits sheets were available that recorded the contacts with the different professionals. There was input from GPs, District Nurses, Chirpodists and Continence Advisors. Individuals were seen to receive practical and emotional support when attending appointments at hospitals for their medical needs. We looked at the management of medicines in the home. The medicine trolley was secured to a wall however, the keys to access the medicines had been left on top of the trolley. This would indicate that the management of medicines was not robust at all times. We looked at the administration of the medicines for the people whose care we had looked at. In general the management of medicines was good. There were specimen signatures of the people who were able to give out medicines, there were photographs of the people for whom the medicines were for and the MAR (medicine administration record) charts did not show any gaps. The manager carried out weekly audits on the medicines. During an audit of the medicines we found that not all medicines were being booked in as they were being received in the home. For example, if the pharmacist was unable Care Homes for Older People Page 15 of 32 Evidence: to supply the amount identified on the prescription in one go rather than recording what had actually been received the amount identified on the prescription was recorded. This meant that one medicine could not be fully audited. In another case the MAR chart being used was dated for the previous month. We were assured that the dates were wrong and the individual had been receiving the medicine they were prescribed. There were a number of creams found in bedrooms that had been opened several months previously. We were told that opened creams were kept for a month. These were obviously not being replaced. There were no controlled medicines in the home at the time of this inspection. The privacy and dignity of the people living in the home was being well managed. The care plans, locks on bedroom, toilet and bathroom doors and the provision of privacy curtains ensured this. The three relative surveys told us that they were happy with the care provided in the home. Care Homes for Older People Page 16 of 32 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. The people living in the home were provided with opportunities to undertake activities and outings. Their dietary needs were being met. Evidence: The people living in the home were able to make everyday choices about when to go to bed and when to get up, where to sit and who with. They could choose what to wear, eat and when to bathe. The care plans indicated the hobbies that individuals had however, the care plans did not clearly show how these hobbies were to be planned for and met. There was evidence that individuals did go to the garden centre, shops and church but it was difficult to audit this as being met to the extent and the way that individuals liked. The needs of some of the people living in the home were increasing significantly and we were told that due to the amount of input needed by some of them the organisation of activities had suffered. We saw evidence of a number of activities having taken place during June including skittles, garden centre, shopping and listening to Irish music. There was a weekly Care Homes for Older People Page 17 of 32 Evidence: activities plan in place that included Holy Communion, hair dressing, bingo, music and sing a long. There was evidence that in the sunny weather the people living in the home regularly sat out in the garden. There was regular contact with relatives in the home and visitors appeared to be welcomed and at ease with the staff. Some of the people living in the home went out with their friends and relatives. Activities were discussed with the people living in the home during meetings held to get their views. We were able to take lunch with the people living in the home and we observed that people were given choices, second helpings were offered and assistance given where needed. Special diets were catered for including diabetic, cultural and soft. Where pureed diets were needed the individual components of the meal should be pureed separately so that people can enjoy the individual flavours the meal. The menu showed that there were a variety of meals available every day. In order to show that the food provided is nutritious and varied the food records should also show the types of sandwiches and vegetables served at mealt times. One of the people spoken to told us that they did not know what they were going to eat that day and that they would wait and see what they got but was happy with the food. They told us that fresh fruit was available in the home. One of the surveys completed by a relative told us that the food was good and the staff told us that they thought the food was good. There was a piece of paper on a mirror that stated what the meals for the day were however, it was unlikely that people would see it and be able to read it. Information for the people living in the home should be presented in a format that they could see and read. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were generally protected and they could be assured that their views would be listened to. Evidence: The home has a written policy and procedures for complaints which have been updated. The procedure was on display in the entrance hall of the home. The staff had a good knowledge of what to do in the event of a complaint being made. We have not received any complaints about the home and the service it provides and the manager stated that the home had also received no complaints in the past twelve months. The Care Manager does have a grumbles book for people to write in if they have any matters that they feel do not warrant a formal complaint. There was evidence that some issues had arisen and these had been appropriately dealt with. The adult protection procedures were not looked at during this inspection. The majority of staff have received training in Adult Protection. Staff knowledge about safeguarding issues was good and staff demonstrated a zero tolerance to any form of abuse. The Care Manager has had training in Mental Capacity Act awareness. The home appears to be meeting the rights of people living in the home but will need to review its systems and daily practice of obtaining consent for accommodation, care and Care Homes for Older People Page 19 of 32 Evidence: treatment decisions in line with the Mental Capacity Act Code of Practice. We discussed issues such as an individual who did not want to live in the home in the long term and about placing zimmer frames out of reach of people. There needed to be clear evidence for the reasoning for this and the timescales to which it would apply. The recruitment procedures in the home were not as robust as they could be and this could put the people living in the home at potential risk of harm. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and comfortable environment where they are happy and secure and their privacy is maintained. Evidence: The home is not a purpose built property and as such there a number of different levels in the home. This means that people needed to have a good level of mobility to be able to move around all areas of the home as there are steps in several areas of the home. The AQAA told us that improvements have been made to the home in respect of new boilers, tanks, stained glass in front door, decoration in the home and new flooring in some areas as well as the garden having been worked on. All these actions have improved the environment for the people living there making it more comfortable and homely. There was an extensive garden to the rear of the home that was well maintained and with a small patio area for people to sit out in. Accomodation can be provided for up to 25 people over three floors in the home. There are separate lounges and dining rooms and also one combined lounge diner providing comfortable areas for the people living in the home to sit and take their meals. Care Homes for Older People Page 21 of 32 Evidence: The home was found to be generally clean but there were some bedrooms seen where odour control was an issue that needed to be addressed. In one of these bedrooms the plastic covering on the mattress was torn and urine was seeping into the mattress which needed to be replaced. Additionally, throughout the home there were a number of tablets of soap and nail brushes found in the communal washing facilities which did not promote good infection control practices. There were containers for liquid soap however none of them contained any soap. We were told that the soap was no longer available for these. The registered person needed to address this issue. There were bathing facilities and communal toilets on all floors. On the second floor of the home the shower was not producing any hot water and one of the baths on the first floor did not have a hoist chair on it but the other did enabling people with limited mobility to be able to have a bath. The bath chair was found to be in need of a clean on the underside and the end panel of the bath needed to be secured in place. Some bathing facilities could be made more homely. The bedrooms varied in size and decor. One of the bedrooms seen was quite small and the occupant needed to be hoisted. Staff said that they managed but it was obviously not an ideal situation. Other bedrooms were larger and it was pleasant to see that they had small sitting areas with settees and easy chairs. Some bedrooms had en suite facilities and others did not. Some of the bedrooms had fire exits through them. The home had managed to have them linked into the fire alarm system so that they opened only in the event of an emergency thereby limiting the amount of time their privacy could be compromised. Bedrooms were personalised with peoples belongings. Some bedrooms did not have the wardrobes secured to the walls putting individuals at risk if they pulled them onto themselves. The home did have adaptations in place such as passenger lift, part ramp into the garden, support rails on stairs, adapted bathing faciliites and an emergency call system. The emergency call system was old and did not have sufficient extension leads to enable all the people living in the home to have access to one. The layout of some bedrooms meant that the call points were not accessible. In one bedroom the emergency call pull had been tied out of reach. There was a laundry and kitchen but these were not inspected during this inspection. Care Homes for Older People Page 22 of 32 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. There are staff in appropriate numbers to care for the people living in the home. They receive the necessary training to ensure that they have the appropriate skills and knowledge. The recruitment process does not safeguard the people living in the home. Evidence: There were sufficient numbers of staff on duty at the home to meet peoples daily needs. We looked at the rota and saw that the manager and assistant managers were generally on duty together during the week however there were no managers on duty during the weekend. The registered person should consider spreading these hours across all days of the week so that the management team can ensure that the standards of care are maintained at all times. There are generally three staff on duty during the day and two staff on duty at night. There are staff in the kitchen and laundry but the home employs contract cleaners that come into the home on a regular basis. The assistant managers have delegated duties including health and safety, supervision, staff matters and medication. This helps individuals develop their skills and support the manager. There were individual training records for staff that showed what training they had Care Homes for Older People Page 23 of 32 Evidence: done but there was no overall training matrix so it was difficult to determine if all the staff had had all the required updates for the training. It was recommended that a training matrix was set up to help the manager monitor training needs. From the records seen the staff appeared to have had sufficient training to meet the needs of the people living in the home. Staff will however need to have training in mental health awareness as several people have been admitted with enduring mental health needs. We looked at the files of two staff to assess the recruitment process. The files showed that although all the required checks had been undertaken the individuals had started work before some of the checks had been received. This could put the people living in the home at potential risk of harm as the home cannot be assured that the individuals are suitable to work with vulnerable people. There was no evidence in the files that the individuals had completed induction training based on the competencies set down by Skills for Care. There was evidence that a basic induction into the home and some shadowing was carried by staff before they started to work unsupervised. The staff appeared to have the skills and knowledge to care for the people living in the home. One of the relatives told us that the staff were helfpul and respectful. Care Homes for Older People Page 24 of 32 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. There are systems in place to support the management and running of the home. The manager needed to be more proactive in identifying the areas that needed to be improved and provide leadership to the staff. Evidence: The manager has been in a management position for several years and had experience of running a care home. Since the last inspection she had been registered as the Registered Manager for the home and was currently completing the Registered Managers Award. The manager had delegated some responsibilities to the deputy managers however, she needed to put in place systems to monitor their duties and provide leadership to the staff. The staff surveys identified that the manager was accessible and approachable and that they received the guidance and support that they needed. Some progess has been made towards developing the quality assurance system in Care Homes for Older People Page 25 of 32 Evidence: that a plan of actions that need to be taken have been identified to improve the servcie. Some health and safety audits have been undertaken and surveys have been completed with three people living in the home to gather their views. There was evidence that meetings were being held with the people living in the home to decide on activities and menus. The registered manager needed to progress the quality assurance system to show what has been achieved during the past twelve months and what improvements have been identified for the future. The provider carries out regular visits to the home and reports of these visits are available for inspection although they are not always done monthly. The people who we case tracked either had relatives who managed their monies or they looked after their own monies. The AQAA told us that financial systems had been put in place for items kept in safe keeping. The supervision records that we saw did not indicate that the staff were receiving a minimum of 6 sessions in a year. Record keeping in the home was acceptable but the registered manager needed to ensure that care plans were detailed and person centred, that issues such as infection control practices within the home were monitored and that the medication records were accurate. The people living in the home needed to have access to an emergency call system at all times and the manager needed to ensure that wardrobes in bedrooms were secured to the walls to prevent injury. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 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 8 12 The registered person must ensure that advice about nutrition is sought in a timely manner. This will ensure that food intake can be monitored and supplements provided quickly. 31/07/2009 2 9 13 The registered person must 31/07/2009 ensure that the management of medicines is robust. This will ensure that medicines are managed according to regulations. 3 22 23 The registered person must 31/08/2009 ensure that the people living in the home are able to summon assistance at all times. This will ensure that they get the help they need. Care Homes for Older People Page 28 of 32 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 29 19 The registered person must ensure that the appropriate checks are in place before individuals begin their employment in the home. This will ensure that the individuals are suitable for working with vulnerable adults. 31/07/2009 5 38 13 The registered person needed to ensure that all steps were taken to minimise any risks. This would ensure the safety of staff and people living in the home. 31/07/2009 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 A range of fees should be made available in the service user guide to ensure that individuals to make informed decisions about moving into the home. The registered person should ensure that they are fully aware of the needs of people moving into the home before they move in. The registered person should ensure that care plans contain all the necessary information to inform staff about the needs of the individuals and how to assist them. This will ensure that people receive person centred care. The registered person should ensure that staff are made aware of any behavious that would indicate a relapse of the mental health of people with enduring mental health issues. 2 3 3 7 4 8 Care Homes for Older People Page 29 of 32 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 6 12 15 Care plans should be developed to show how the social interests of the people living in the home would be met. The menu for the day should be in a format and displayed so that people would have easy access to it. This would ensure that people would know what the meals for the day were. Individual components of meals should be pureed separately to enable people to experience the different flavours. Food records should be detailed enough to show that the people living in the home get a varied and nutritional diet and that their specific dietary needs are met. The registered person needs to ensure that there was a clear rationale recorded for any actions that were taken that could impinge on the liberty of the people living in the home. The registered person must ensure that all bathing facilities are maintained in good working order. This will ensure that the people living in the home have access to suitable bathing facilities in sufficient numbers to meet their needs. The registered person should ensure that the odour in the indentified bedrooms is addressed and steps taken to manage incontinence. The registered person should ensure that infection control procedures are adequately monitored. The registered person must ensure that people complete induction training based on Skills for Care competencies. This will ensure that staff have the appropriate up to date skills and knowledge to care for people. The registered person needs to ensure that management strategies were in place to montior delegated responsibilities to ensure that the required tasks were being completed adequately. The quality assurance system needs to be progressed to ensure that the service identified good practices and areas which needed improvement and plans could be made to address these. The registered person should ensure that all staff receive 7 15 8 15 9 18 10 21 11 26 12 13 26 30 14 31 15 33 16 36 Care Homes for Older People Page 30 of 32 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 the required level of supervision. This will ensure that staff use working practices that are based on current good practice. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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