Care Home: St Clements Nursing Home

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What the care home does well People have the majority of the information that they need to enable them to decide if they want to live at the home. A GP visits the home on a weekly basis to assess peoples health needs and to prescribe any necessary treatments. This promotes people`s health and wellbeing. The home has an open visiting policy which means that people can see their visitors as they choose and maintain relationships that are important to them. People are encouraged to personalise their rooms with items that are familiar to them so that they live in an environment, which they prefer. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. This promotes people`s privacy and dignity when personal care is required. Some staff have been employed by the home for a long time. This ensures that people know the staff who will be helping them in meeting their needs. Most of the care staff had achieved a National Vocational Qualification in Care. This means that people are supported by staff who have the right qualifications to meet their needs. The recruitment procedure helps to ensure that people are safeguarded from harm. People told us: `I like it here, there`s lots of people to talk to, staff help me, I`m lucky, they always look after you`. `Food is good, you can choose, I always eat all my meals`. `There`s enough staff, they answer quickly when I use the buzzer` . What has improved since the last inspection? One person who lives at the home told us `management and staff are doing all they can to improve the home, I have seen some very good improvements`. The development of activities has been continued so that people can lead an interesting and stimulating lifestyle, which meets their individual needs. A monthly newsletter has been implemented to tell people and their relatives about what is happening in the home. People are assisted to eat their meals in a way that meets their needs to help people enjoy their meals. More redecoration has been done to help make the home more comfortable and homely for people to live in.When people are assisted to move this is done in a safe manner so that people are not put at risk of injury. A fire risk assessment has been completed to help determine if the current fire precautions in the home are safe. What the care home could do better: The home needs to continue in developing the assessment process to ensure that individuals know their needs can be met at the home before they move there. Care plans need to be further improved to ensure that staff have good information on meeting people`s needs. The home needs to improve the pressure care that people receive to make sure good pressure care is consistent and people can be confident their skin care needs will be met. Minor improvement is needed to the medication administration system so that people can be confident medication is always administered in line with good practice guidelines. Food records should show that people are getting the nutrition they need so ensuring their well being. Staff should have training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This will ensure they are aware of how this legislation may affect the people living there. Continue with redecoration plans for communal areas to make sure the home is well maintained and a nice place for people to live. The systems in place regarding fire safety need to be improved. So people can be confident the home`s fire precautions are satisfactory. Standards of record keeping in the home need to be improved to show that people`s rights,choices, health and safety and general well being is being promoted. Key inspection report Care homes for older people Name: Address: St Clements Nursing Home 8 Stanley Road Nechells Birmingham West Midlands B7 5QS     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: Kerry Coulter     Date: 0 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: St Clements Nursing Home 8 Stanley Road Nechells Birmingham West Midlands B7 5QS 01213273136 01213281461 stclements@bmlhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Noblefield Limited Name of registered manager (if applicable) Mrs Allison Grace Davies Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 37 Old age, not falling within any other category (OP) 37 Date of last inspection Brief description of the care home St Clements is a purpose built three-storey home situated in a residential area of Birmingham. The home provides nursing care and accommodation for up to 37 older people, some have dementia and some have general nursing needs. Care Homes for Older People Page 4 of 31 Over 65 0 37 37 0 Brief description of the care home There are twenty-five single bedrooms and six double rooms, one of which is located on the lower ground floor. All have en-suite facilities consisting of a toilet and wash hand basin but these are not large enough for people with restricted mobility to access safely. Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floors. There are six covered parking spaces on the lower ground floor to the front of the property and unrestricted parking on the adjoining roads. There is a small garden with steep elevations that is accessed from the ground floor. Communal facilities consist of a large lounge on both the ground and first floor. There is also a dining room situated on the ground floor that is adjacent to the kitchen, from where all the meals are provided. The people living there can have their meals on either of the upper floors or in their own room. A laundry facility is situated on the lower ground floor, where washing of peoples personal clothing is undertaken. There are assisted bathing facilities on each floor. The home has pressure relieving equipment and a range of moving equipment to assist those persons who have restricted mobility. The statement of purpose stated that the fees are £368. It stated that the fee structure is a guide only and all room prices quoted are negotiable. Fees do not include hairdressing, dry cleaning, toiletries, chiropody, phone calls, medical supplies, physiotherapy, individual newspapers and aromatherapy. Copies of our reports our available in the home for people to read. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the visit taking place, we looked at all of the information we had received, or asked for. We received an Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. It also gives us some numerical information about staff and people living at the home. The fieldwork visit took place over one day and was undertaken by two inspectors. The home did not have prior knowledge of our visit. Our last visit to the home was in October 2009 when we undertook a random inspection. Care Homes for Older People Page 6 of 31 At this visit information was gathered from speaking to and observing people who lived at the home. Four people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, 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. During our visit we also undertook a Short Observational Framework for Inspection (SOFI). This is where we sit and observe peoples experiences in the home looking at their wellbeing, activity and interactions. It is difficult to get peoples views about the home due to differing levels of dementia and peoples communication needs. However some people spoken with were able to give their views of the home. Prior to our visit we sent surveys to ten people who live at the home, three surveys were returned. Ten surveys were sent to staff and five were returned to us. Ten surveys were sent to the home to distribute to relatives, none of these were returned. However we did speak with some relatives who were at the home when we visited. We also spoke with four health care professionals to seek their views about the care provided at the home. During the visit we spoke with the manager and staff. Staff files, training records and health and safety files were also looked at. We also looked at parts of the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? One person who lives at the home told us management and staff are doing all they can to improve the home, I have seen some very good improvements. The development of activities has been continued so that people can lead an interesting and stimulating lifestyle, which meets their individual needs. A monthly newsletter has been implemented to tell people and their relatives about what is happening in the home. People are assisted to eat their meals in a way that meets their needs to help people enjoy their meals. More redecoration has been done to help make the home more comfortable and homely for people to live in. Care Homes for Older People Page 8 of 31 When people are assisted to move this is done in a safe manner so that people are not put at risk of injury. A fire risk assessment has been completed to help determine if the current fire precautions in the home are safe. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need about the home but may not always be confident that their needs will be met there. Evidence: The certificate of registration was clearly displayed in the reception area and a copy of the previous inspection report is available so that people have access to this information if they want to read it. The home has a service users guide that has recently been updated. This ensured that it included up to date information so that people thinking of moving to the home would have the information they need to make a choice as to whether or not to live there. A copy of the guide was available in the entrance area of the home and people also had their own copy in their bedrooms. The manager told us the guide could be made Care Homes for Older People Page 11 of 31 Evidence: available in alternative formats on request, for example in large print. The homes Annual Quality Assurance Assessment (AQAA) stated that people thinking of moving there are given an information pack that includes the service user guide, sample menus and activity plan. One person spoken with told us they had received enough information about the home. In the survey returned to us the person told us they had been given enough information about the home. We looked at the admission procedure followed for one person who had moved into the home since we last visited. This person had moved to the home following a hospital admission and so they did not have the opportunity to visit the home prior to moving there. The AQAA told us that people are invited to visit the home and have a meal there before moving in. We saw that an assessment of the persons needs had been completed prior to them moving in. This was generally basic in content and could have been more detailed. Some sections of the assessment had not been completed and it did not include the views of the person or their relatives. Assessment procedures should be improved so that the home has detailed information about peoples needs before they move there. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not always met, which could affect their health and well being. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to meet their needs. We looked at three peoples care plans in detail and a care file was partly reviewed. Care plans were variable in quality, some were quite specific about the support people needed whilst others lacked detail. There was some information in care plans about peoples personal preferences. However care plans did not always show how people had been involved in their care plan, sometimes peoples views or agreements with their plan were not recorded. We found that referrals to other health professionals are usually made as needed and people have regular dental and optician check ups. One person has had some falls and Care Homes for Older People Page 13 of 31 Evidence: we saw they had been referred to the falls prevention team. As identified further in this report, we were aware of a recent safeguarding referral that was made regarding the pressure care one person had received. The outcome of the referral was that the home had not managed this persons pressure care satisfactorily. During our visit we saw that for people case tracked assessment had been completed of their pressure care needs and where appropriate care plans completed. However some areas of recording needed improvement. Information about when a persons dressing had been changed had not always been recorded on the appropriate chart but had often been recorded on the persons daily notes instead. Where people needed to be re-positioned in bed there were sometimes gaps on their records. This made it difficult to track that people were having the care they needed. Staff spoken with were aware of peoples pressure care needs. They told us that sometimes staff do forget to complete the records. We spoke with one healthcare professional. They told us pressure care practice is not poor overall and that recently the home had healed a complex pressure sore. However they told us there can be pockets of poor practice due to inconsistency, poor communication and documentation. Discussion with the manager shows the home is aware that improvements are needed. The manager said that additional pressure care training has therefore been arranged for staff. One health care professional told us generally the care is okay, care plans generally good but need to improve their day to day record keeping. They also told us that usually peoples skin is well looked after and the home does not have a high incidence of people having pressure sores. We saw that the home complete risk assessments for people so that consideration is given to supporting them to take responsible risks. This includes assessment of the use of bed rails. We saw that moving and handling assessments identified the specific support and equipment required for each person. In addition the majority of staff had undertaken recent training in this area. This should mean that people are supported to transfer in a safe manner. Where people were in bed we saw that call bells were placed within their reach so they could call staff for assistance if needed. We saw that people were clean, hair was neatly styled, and people were wearing clothing appropriate to their age, gender, culture and the time of year. Care plans usually recorded if people preferred a bath or shower and how often. However recording of when people had a shower did not always match their preference. People told us I like it here, theres lots of people to Care Homes for Older People Page 14 of 31 Evidence: talk to, staff help me, Im lucky, they always look after you. I have a shower every week, Im happy with that. I think the home provides a very good standard of care. Another person told us they could have a shower when they wanted one. We saw staff knocking on toilet doors before entering to ensure peoples privacy and dignity. We overheard one person talking to staff whilst they were assisting them to the toilet, they said I know I am a nuisance, staff responded by assuring them they were not. We did however see some examples that did not promote peoples dignity and privacy. One person was administered their eye drops while they were at the breakfast table. The same staff told another person in the lounge in front of other people that their medication was for their bowels. The manager assured us this would be addressed with staff. We looked at the homes systems for administration of medication. Qualified nurses administer the medication to people. At the front of each persons Medication Administration Record (MAR) there is usually a photograph of the individual so that unfamiliar staff would know who to give the medication to. Medication records sampled and tracking of medication in stock appeared to show that people had been given most of their medication as prescribed. However we saw that improvements were needed to the recording of creams and ointments. The system in use by staff did not accurately show that creams and ointments are administered. Discussion with the manager indicates the home had already identified that the system needed to be improved and plans were in place to do this. One person had recently been prescribed medication to have as required. Guidance on when they should have this medication needs to be written to make sure they get their medication when they need it. Controlled drugs were stored appropriately and records sampled were accurate. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home experience a meaningful lifestyle and are generally offered a choice of meals to meet their dietary and cultural needs or preferences. Evidence: The home has two care activities co-ordinators who take a lead role in organising activities for people. The Annual Quality Assurance Assessment stated the activities co ordinators post is a job share, this allows for more fresh ideas to be put forward. Since the homes last key inspection the levels and choice of activities to people has improved. Records, discussions and observation shows that activities on offer include board games, potting plants, visiting entertainers, trips out, art, parties, hand massages and a history tree project. There were lots of photographs around the home of people participating in activities and artwork they had completed. Photographs included a trip to the Botanical Gardens and the Birmingham German Christmas Market. Staff are trying to be more creative in the activities available. This has included completing a history tree project that has included talking to people about where they were born. An Asian themed food afternoon was also arranged where people had the Care Homes for Older People Page 16 of 31 Evidence: chance to taste new foods. The home has obtained several DVDs that are suited to the age of people and cover different interests, for example traction engines and the history of the 1940s. However staff need to more alert as to how often people watch the DVDs as watching the same ones could be repetitive for people. When we visited one DVD was played several times before staff changed it in the afternoon. During our visit people participated in colouring, reading newspapers and playing games. Staff brought in a box of games, they asked people what they wanted to do. People were having a look in the box, talking to staff about things in there, laughing. Special occasions are celebrated in the home, for example Valentines day and peoples birthdays. One person helped staff to do a display for a Valentines party. One person had a recent birthday and staff had put up a birthday banner for the celebrations. We found that the records of activities undertaken by people could be improved, there were some gaps in the records and they did not always show if people had enjoyed the activity. Improved record keeping will help staff track the activities people have enjoyed and aid the future planning of activities offered to them. Sampled records show that some people have regular contact and visits from their family and friends. One relative spoken with told us that they were always made to feel welcome when they visited. The manager has held some meetings with relatives to seek their views and another meeting was scheduled. Since the last key inspection a monthly newsletter has been implemented to tell people and their relatives about what is happening in the home. One newsletter told people about planned entertainment and said that peoples relatives were welcome to attend. In the majority of interactions staff were seen to offer people choices. For example what they wanted to eat, drink and what activities they wanted to do. In the afternoon people were asked what they wanted to watch on television. People said they can make choices about what they do and what they eat and drink. A rotating four week menu was in place so that this offered variety. Alternative choices were available on the menu and meals were varied with culturally appropriate options available. At breakfast time we saw that people were given the support they needed. Staff brought up a tray of toast and people were asked if they wanted some and how many slices. We saw that it was already buttered but that nothing else was offered to put on it. Currently the main meal of the day is served at lunchtime but there are proposals in place to move this to the evening. Records and discussion with the manager shows that people are being consulted about the proposals before any firm decision is made. Care Homes for Older People Page 17 of 31 Evidence: People told us: Meals are nice. Meals are not too bad, there are two to three choices Food is good, you can choose, I always eat all my meals. Food records sampled stated how much the person had eaten but often did not state what type of food people had eaten. This makes it more difficult to assess whether or not an individual who may be at risk of malnutrition is receiving a nutritious diet. It is recommended that where people are at risk clearer records of what people have eaten are kept to ensure that the person is getting the nutrition they need. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: A copy of the homes complaints procedure is available in the entrance hall of the home. People also have a copy in their service user guide available in their bedroom. The person who returned a survey to us said they were aware of the complaints procedure. Two people spoken with during our visit said if they were not happy about something they would speak to the manager. One relative told us they felt able to raise any concerns with the manager but that they were generally happy with the home. We have not received any complaints about this home since their last key inspection. The homes complaints records detailed that they had received two complaints. The complaint log detailed the nature of the complaints and what action had been taken to try and resolve the issues raised. One of the complaints was still open when we visited as this was being looked at by the local authority under safeguarding procedures. This was in relation to standards of personal care and recording. There has been one other safeguarding investigation since the last inspection as detailed earlier in this report, this related to pressure care. Training records showed that forty of the homes forty two staff have received training Care Homes for Older People Page 19 of 31 Evidence: in safeguarding adults from abuse. The homes annual quality assurance assessment told us that more safeguarding training was being planned. Recently a safeguarding audit has been carried out by the local Primary Care Trust safeguarding team. The manager told us that as a result of this they would be helping the home to identify further suitable training for staff. Information was available in the home about the Mental Capacity Act and the Deprivation of Liberty Safeguards legislation. However some staff spoken with were not familiar with this legislation. The homes annual quality assurance assessment said that training in this is to be arranged for staff. This is important so that staff are aware of how this legislation may affect the people living there. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a comfortable environment in which to live that generally meets their needs. Evidence: Access to the home is gained by the lower ground floor, stairs and a passenger lift give access to the ground and first floors. There is a lounge and dining room situated on the ground floor and a combined lounge/dining room on the first floor. Since our last visit improvements have continued to be made to the decoration and furnishings of the home to make it more comfortable for people to live in. The carpet in the ground floor hallway was heavily stained, however records showed that new floor covering was on order. The appearance of hallways in the home had improved. These had been made more interesting to people with various areas having a theme, for example trains, the beach, gardening and the local area. The themes included objects of interest, photographs and in the beach area soft relaxing music. Lounges are now more homely in appearance with the addition of some pieces of furniture that are of a style suited to the age of the people living there. The desks where nurses did their paperwork and filing cabinets where records were stored have now been moved elsewhere. The decor in the lounges is still quite tired in appearance Care Homes for Older People Page 21 of 31 Evidence: and one of the lounge carpets was a little stained. We were told by the manager that it is planned to redecorate the lounges. The annual quality assurance assessment stated that the home intends to Continue with the ongoing redecoration programme giving residents more say in the colours of their bedroom and living rooms, lounges and dining areas. We saw that the main dining room has recently been redecorated. This area now looks a nicer place to have a meal in and new pictures on the walls and new tablecloths add to the improved appearance. We looked at some peoples bedrooms and these were found to be personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them. Some people have difficulty in remembering where their room is. To help people remember, the home uses pictures on bedroom doors of things that interest them. One person told us they were happy with their bedroom but it would be nice if they could have a lock on the door so they could lock it when they wanted to. The home has a choice of bathrooms and shower rooms. Showers are level access and the bath has a fitted hoist so that they can be used by people who have mobility difficulties. Although bathrooms and shower rooms are functional they need some improvement. Grouting to the tiles in some areas was discoloured and so were some areas of the floors. One bathroom does not look nice in appearance due to the toilet and wash hand basin being a different colour to the bath. The majority of areas in the home were seen to be clean with no unpleasant odours, although one hallway did have an odour of urine. There were some infection control procedures that needed to be improved. In one bathroom we saw an open basket with dirty washing in it. The light pull cord in one shower room was quite grimy in appearance. The manager told us that home does not currently complete formal infection control audits but that they have obtained a format and intend to introduce this. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who know them well and who receive some training to ensure that they have the knowledge to meet individual needs. The recruitment procedures help to safeguard people from harm. Evidence: There are usually six care staff and two trained nurses on duty in the mornings and a minimum of five care staff and one nurse in the afternoons. At night there are three care staff and one nurse. In addition to nursing and care staff the home also employs domestic, maintenance, administration and kitchen staff so that care staff are able to concentrate on providing care to the people living there. The home maintains a stable staff group and this means staff usually know people well. The manager said that they only use agency where they are unable to cover staff sickness by using bank staff or staff working extra hours. There were no agency staff on duty during our visit. One staff told us the home does not use much agency staff which is good for the residents. Staff told us that there were always or usually enough staff on duty to meet peoples needs. People told us theres enough staff, they answer quickly when I use the buzzer and staff are pretty good. Two relatives told us the home usually has enough staff. One health care professional told us there are usually enough staff, I see staff answering buzzers quickly. Care Homes for Older People Page 23 of 31 Evidence: We saw some good interactions with the staff and people who live at the home. During the SOFI observation levels of interaction from staff were good. 84 of the interactions were positive, 13 were neutral and 3 were negative. We spoke with the manager about the negative interactions and we were told this would be addressed with staff. We looked at three staff files and these were found to have all the required checks prior to employment beginning, to ensure that people were safeguarded from harm. The Annual Quality Assurance Assessment recorded that eighteen of the twenty two care staff had achieved a National Vocational Qualification in care. This should help to ensure that they have the skills and qualifications to meet the needs of the people living there. Surveys received from staff indicated they were happy with the training on offer. We looked at staff training records and this showed staff have most of the training they need. The training matrix showed that the majority of staff had received training in fire safety, infection control, food hygiene, abuse, health and safety, dementia, first aid and moving and handling. Only some of the care staff have received pressure care training but we were told more training has been arranged. Discussions with the manager also indicate that in the next twelve months the home intends to provide further training in dementia care. Records and discussion with staff show that additional clinical training is on offer to nursing staff. Training has been undertaken or scheduled that includes medication, blood glucose monitoring, diabetes and stoma care. A variety of staff meetings take place, this includes the full staff team, heads of departments or nursing and senior staff. This means that staff have the opportunity to be involved in the running of the home. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that the health, safety and well being of the people living there is promoted and protected, so ensuring their well being. Evidence: The home has a registered manager who is a Registered Nurse who has experience in management and care of older people. The manager is currently undertaking a qualification in management. It is clear that a number of improvements have been made since the manager has been in post. The home needs to continue to sustain these and work on other areas that still need improving. The manager told us that on some days she thinks the home is moving forward and then on other days she does not think they are progressing as much as she would like. The manager told us she is committed to making it a good home. One person who lives at the home told us this place is pretty well run. Another said management and staff are doing all they can to improve the home, I have seen some very good improvements. Care Homes for Older People Page 25 of 31 Evidence: Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This told us what the home think they do well and how they want to improve. It also gave us some numerical information about the staff and people who live there. There was evidence of regular visits being carried out to the home by the operations manager. The reports were noted to be comprehensive and included discussions with people who live in the home and staff. The home sends out annual quality assurance questionnaires to peoples relatives. The manager had completed a short report of the outcomes of the most recent surveys and along with the action being taken to address any issues raised. Since the homes last inspection the manager has introduced combined relative and residents meetings. One meeting has so far taken place and another meeting was scheduled to take place. Minutes of the meeting held show people were informed about plans to improve the home and relatives had the opportunity to contribute towards ideas for community outings. We have previously recommended that the home needs to consider how it can seek the views of health professionals external to the home. The manager said this was still to be done. The home has the facility to look after small amounts of money for people. The financial records of one person were sampled. Money in their wallets matched the record. Receipts showed that the person had not bought items that the home should pay for. During our visit we saw staff helping people to transfer, for example from their wheelchair to a chair. This was seen to be done in a safe manner. Staff training records show that staff receive training in manual handling and usually have refresher training on an annual basis. This means that staff know how to assist people safely. Some people have rails on their bed to help prevent falls. Bed rails seen appeared to be safe and had covers fitted to help prevent injury. The manager told us the home is trying to reduce the use of bed rails. Some new beds have been ordered that can be set at a low height and means that rails should not be needed. We sampled a number of the homes records regarding health and safety. Water Care Homes for Older People Page 26 of 31 Evidence: temperatures are checked monthly to make sure that the water is at a safe temperature for people to use. At the last key inspection we saw that the home had a fire risk assessment in place but this was overdue for review. A new assessment has now been completed by an external company. A number of improvements were recommended, some of which have already been actioned. The home had an action plan about what needed to be done but it was not clear from this when all the recommendations would be completed. We have asked the home to send us further information about this. We have also told the West Midlands Fire Service about the outcome of the risk assessment. Certificates show that an engineer regularly services the fire alarms and emergency lights. The lights had been checked a few months previously and it had been identified that four needed to be repaired. We were told this had not yet been done. Records show that usually the fire alarms are tested weekly but the record did not show this had been done in the three weeks prior to our visit. We were told be the maintenance staff that the alarms had been tested but that the record had been forgotten to be completed. The alarms were tested during our visit and were in working order. We saw that gas appliances, electrical installations and manual handling equipment had been tested by engineers to ensure that they were safe to use. Care Homes for Older People Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Improve the arrangements for pressure care provided to people. To make sure all people get the pressure care they need to stay well. 12/06/2010 2 38 13 The systems in place 07/06/2010 regarding fire safety need to be improved. So people can be confident the homes fire precautions are satisfactory. 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 3 Pre admission assessments should be completed in enough detail and include the persons views so that people know their needs can be met prior to moving in. Care plans need to be improved so that they consistently give staff all the information they need about the support people needs. Plans also need to evidence that people have been consulted about their care and involved in the care Page 29 of 31 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations plan where possible. This will help people to get the care they need in the manner they prefer. 3 8 Where people are prescribed medication on an as required basis there should be written guidance available as to when it should be administered. This will help to make sure people get the medication they need to stay well. Review the systems in place for the recording of the administration of creams and ointments. To help make sure people are having the medication they need to stay well. Improve record keeping to help staff track the activities people have enjoyed and aid the future planning of activities offered to them. Where people are at risk of malnutrition clearer records of what people have eaten should be kept to ensure that the person is getting the nutrition they need. Staff should have training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This will ensure they are aware of how this legislation may affect the people living there. Continue with redecoration plans for communal areas to make sure the home is well maintained and a nice place for people to live. Consult with people about the provision of locks to their bedroom doors. Where people indicate they would like this facility then suitable locks should be installed that can be accessed in an emergency. Introduce a system to audit the homes infection control procedures on a regular basis. To help make sure procedures are satisfactory and the home is a clean and safe place to live. Improve training arrangements to make sure appropriate training is provided for each member of staff to ensure they have the skills and knowledge appropriate to their role and they can meet the needs of the people living there. Standards of record keeping in the home need to be improved to show that peoples rights,choices, health and safety and general well being is being promoted. 4 8 5 12 6 15 7 18 8 19 9 24 10 26 11 30 12 37 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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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