Care Home: St Martins Care Home

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What the care home does well People may visit the care home and spend some time there so that they can get a feel for what it would be live at the care home before they make a decision to move in. Staff are kind and caring and maintained good relationships with people using the service and they maintain people`s privacy and dignity at all times. We can see that people living at the care home are settled and comfortable. People using the service are supported to access specialist services such as the district nurse, doctor and dementia outreach team. People are supported to maintain contacts with those people that are important to them and there are no restrictions on visiting times at the home. A varied and appealing diet is on offer and choices are available at each mealtime, specialist diets such as diabetic diets are catered for. What has improved since the last inspection? Plans of care have improved a little, ensuring that more information is now available in regards to complex needs, working towards ensuring that people`s needs are always met. Risk assessments have improved working towards ensuring that people using the service are safe from identified risks. Additional support and assistance has been obtained from specialists services to ensure that people with dementia are supported appropriately and people using the service are safe. The use of the Mental Capacity Act has begun to develop to ensure that people`s rights and choices are maintained and staff act in peeples best interest. Since the last inspection infection control issues and the cleaning regimes have been improved upon to make sure that people using the service live in a clean, comfortable and safe environment. Staff`s knowledge and understanding in regard to diabetes mellitus has developed and improved due to additional training taking place, ensuring that people using the service are supported appropriately. What the care home could do better: Plans of care and risk assessments need to be further developed to ensure that all the necessary information is available and that these are personalised according to people`s individual needs and choices. The medication administration practices needs to be addressed to ensure that people using the service receive their medication as prescribed at all times.Whilst there are activities on offer within the service, these need to be further developed to ensure that everyone living at the care home have the opportunity to lead a satisfying and fulfilling life. The continued use of the Mental Capacity Act is needed to ensure that everyone living in the care home is protected and enabled to make their own choices and decisions where able and if not their best interests are protected. Record keeping in regard to complaints and safeguarding issues needs to be improved upon, to ensure that these issues are dealt with appropriately, there is an audit trail and people using the service are protected. Staff supervision needs to be developed to ensure that staff are supported to continue to develop their knowledge and skills and best practice is maintained. Staff training in compulsory areas needs further attention to ensure that all staff have undertaken this to make sure that they have the necessary knowledge and skills to support people using the service. To ensure that the service is run in the best interests of people living there, the provider needs to ensure that the management systems and structures are further developed and maintained. Key inspection report Care homes for older people Name: Address: St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR     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: Karmon Hawley     Date: 0 1 0 9 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 34 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 34 Information about the care home Name of care home: Address: St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR 01159297325 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): janet1960@msn.com Mrs Barbara Elsie Nunn Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Dementia - over 65 years of age (DE(E) (21) Old age, not falling within any other categort (OP) (21) Date of last inspection Brief description of the care home St Martins Care Home provides 21 places for older people requiring residential care who also have a diagnosis of dementia. The registered company is Broadoak Group of Care Homes. The Registered Provider is Mrs. B. Nunn. It is situated in a quiet part of Strelley, some three miles north west of the centre of Nottingham. There are bathrooms and toilets to both floors. There is an assisted bath on the ground floor to support people using the service in bathing. Suitable aids and adaptations are obtained through the district nursing service. The home has ample communal space Care Homes for Older People Page 4 of 34 0 0 Over 65 21 21 Brief description of the care home and a pleasant enclosed garden. The current weekly fees range from £336 to £394. These fees do not include hairdressing or chiropody. Relevant information in regard to the fees and the facilities and services are available on the point of enquiry. Care Homes for Older People Page 5 of 34 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 Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We also reviewed all of the information we have received about the home since the last inspection and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at St Martins. Because we are unable to communicate effectively with all of Care Homes for Older People Page 6 of 34 the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service over an hours period and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining room, during the lunchtime period. We spoke with two members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Plans of care and risk assessments need to be further developed to ensure that all the necessary information is available and that these are personalised according to peoples individual needs and choices. The medication administration practices needs to be addressed to ensure that people using the service receive their medication as prescribed at all times. Care Homes for Older People Page 8 of 34 Whilst there are activities on offer within the service, these need to be further developed to ensure that everyone living at the care home have the opportunity to lead a satisfying and fulfilling life. The continued use of the Mental Capacity Act is needed to ensure that everyone living in the care home is protected and enabled to make their own choices and decisions where able and if not their best interests are protected. Record keeping in regard to complaints and safeguarding issues needs to be improved upon, to ensure that these issues are dealt with appropriately, there is an audit trail and people using the service are protected. Staff supervision needs to be developed to ensure that staff are supported to continue to develop their knowledge and skills and best practice is maintained. Staff training in compulsory areas needs further attention to ensure that all staff have undertaken this to make sure that they have the necessary knowledge and skills to support people using the service. To ensure that the service is run in the best interests of people living there, the provider needs to ensure that the management systems and structures are further developed and maintained. 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 34 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 34 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. People using the service are assured that their needs will be assessed and that these will be met before they make a decision to move into the care home. Evidence: People using the service undergo a preadmission assessment before they live at the care home to make sure that staff are able to meet their needs, we can see evidence of these assessments taking place within the plans of care. Staff liaise with relevant specialists such as the physiotherapy department to make sure that people have all the necessary equipment that they will need before they move into the care home. People can come and have a look around the care home to get a feel for what it is like before they make a decision to move in and they are given written information to help them make this decision. Care Homes for Older People Page 11 of 34 Evidence: The service does not offer intermediate care. Care Homes for Older People Page 12 of 34 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. People using the service are supported to meet their needs; however additional personalisation of plans of care will enhance staffs knowledge and thus enhance the support that people receive. Continued development of plans of care and risk assessments will ensure that people are supported appropriately and their individual and complex needs are fully met. People have not always been protected by the medication practices undertaken by some staff and they may not have always received their medication when prescribed due to this, however it is hoped that the additional training that has taken place will address these issues. Evidence: We can see that people have plans of care in place in regard to their needs, and most of them provide good information however some of this is rather lengthy. It is also evident that staff rely overmuch on the computer database for developing plans of care and they are not always personalising the templates as required, to ensure that Care Homes for Older People Page 13 of 34 Evidence: peoples individual needs are fully considered and they are supported appropriately. Since the previous inspection the acting manager has begun to implement the Mental Capacity Act assessment in regards to people being able to make their own choices and decisions. She intends to continue this process for all people using the service to ensure that their interests are protected. However in those that we did see, there was no further consideration given to additional support a person may need following the assessment which shows that they are unable to make their own choices and decisions. There is evidence of peoples dementia care needs being assessed, however this information is not always utilised within the plan of care to show how it may affect them in other areas of their care, for instance personal hygiene, to ensure that staff are aware of peoples specific needs and how their behaviour may affect this process. We can see that staff have been liaising with the dementia outreach team in regard to peoples behaviour and gaining additional support that may be needed to ensure that people are safe and supported appropriately. Although plans of care address abuse in general, they do not address the issue of ensuring that other people that reside in the care home are protected from other people who may have behaviour that challenges. We can see that there has been one episode where this was the case and staff did deal with it effectively; however risk assessments and plans of care had not been completed following this incident so that other staff are informed of the action to take should it happen again. There is good information available in regards to peoples daily activities of living, however again some of these were not fully personalised to reflect individual needs and choices for example the correct use of footwear to reduce the risk of falls. We can see that risk assessments are in place for peoples highlighted needs, however some of these only contain basic information and need to be developed further to ensure that staff have the necessary information to support people so that they are fully protected. A requirement was set at the previous inspection in regard to ensuring that there is sufficient information in regards to peoples complex needs, such as diabetes mellitus. On examining plans of care we can see that these have been further developed and more information is now available. Care Homes for Older People Page 14 of 34 Evidence: We can see that up to date records are in place in regards to events such as hospitalisation and how this has affected the care a person may require, however the plans of care have not then been updated to reflect these changes to ensure continuity of care. On speaking with staff they tell us that they read every detail of plans of care and they are able to relate these to people using the service. They tell us they are also responsible for writing daily records, and if a residents need changes plans of care are updated accordingly. So that peoples health needs are maintained staff regularly liaise with specialist practitioners such as the doctor, district nurse and dementia outreach team. On examining personal care records and the communication book we can see that staff are using these services effectively to ensure that peoples needs are met. We can see that specialist equipment such as beds, mattresses and pressure aids are in place for people who require them to ensure that their health care needs are met. There is evidence to show that these aids have been obtained before a person has moved into the care home if required. Staff have been liaising with the dementia outreach team in regard to peoples dementia and the behaviours that they may present. Additional information and advice has been sought to enable staff to support people using the service more effectively. On speaking with staff, one told us, that some new furniture is needed. There are a number of small fold up tables for staff to put hot drinks on for those residents that are unable to hold a cup for a length of time, these tables are very useful, however there is not enough of them. They stated that they had discussed this with the acting manager, who raised this with the provider, but no additional tables have yet been purchased Due to concerns raised at the previous inspection in regard to staff knowledge in medication, the provider arranged additional training for staff. This covered the area of concern which was staffs limited understanding in regard to diabetes mellitus. We can see that a number of staff have attended this additional training and on speaking with a member of staff they confirmed that they had attended. The staff member was able to discuss what they had learned with us and demonstrated a satisfactory understanding of diabetes mellitus. Care Homes for Older People Page 15 of 34 Evidence: On checking the medication records, we can see that sometimes medication has been administered but not signed for as given, which may result in mistakes being made. This however was before the additional training had been implemented; nevertheless this was discussed with the provider to ensure that this is remedied. We can also see that some people are refusing medication on a regular basis, some of which is to ensure that their dementia is managed and they are comfortable. This and the need for continuity in this type of medication was discussed with a member of staff and the provider. The member of staff stated that in the incident that we had highlighted this was due to additional health issues; however these were still to be followed up. The service has undergone an audit by the PCT and we can see that good practice recommendations have been acted upon. The staff currently do not carry out regular audits of the medication to ensure that issues such as the above are highlighted and remedied. The need for this was discussed with the provider. On observing staff interactions with people using the service we can see that they are respectful and maintain peoples dignity. Staff converse with people and offer them choices as able and assist them as needed in this regard. We can see that plans of care highlight maintaining peoples dignity and provide staff with information as to how this is to be implemented. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities tend to be hit and miss and are not always inclusive, quieter people may not always receive stimulation to improve their quality of life. People using the service receive a wholesome and nutritious diet. Evidence: As the majority of people using the service have dementia care needs we used a specialist observation technique to enable us to get a view of what it is like for people using the service living in the care home, and the quality of life they live and the care that they receive. From these observations we can see that staff maintain professional but kind and caring attitudes with people using the service. There is evidence of some good natured banter taking place which people using the service enjoyed and they appeared relaxed and happy. Although we observed good staff interaction, there are times when people using the service only get attention when they shout out, for instance staff only went to one person when they shouted out, they were not asked to take part in an activity, nor Care Homes for Older People Page 17 of 34 Evidence: was any one to one activity provided for. It stated in this persons plan of care that carers should try and encourage them to interact more with others as this will help them to feel less isolated. This was discussed with a member of staff who informed us that the person did not like to join in group activities, but that staff did try and sit with them and chat when they have time. At approximately 11am we watched an activity taking place in the main lounge. Eight residents and two members of staff were present. The activity was a beanbag floor game activity. Six residents took part, the other two present, who appeared frail, were not asked to join in. Those that took part appeared to enjoy the activity and they brightened up when it took place. Four residents in the adjoining smaller lounge did not take part. They were watching television. Staff told us that they were not able to participate due to their dementia. On discussing activities with one of the members of staff present. She indicated that activities were ad hoc and carried out when staff were free and residents are in the mood. The Poster (Events Diary) on the wall in lounge for activities was dated February 2010 and showed different activities every day, but staff said these are just suggestions and not always adhered to. A member of staff changed the day and date of the board during our visit, so that people could see what date it actually was. We looked at care plans and saw that all residents had identified hobbies, interests, and things they liked to do. However only group activities were taking place and those were not suitable for all the residents in the home. So that people using the service are enabled to maintain relationships with people that are important to them, there are no restrictions on visiting and visitors may be received in private. We saw one relative visit the service during the inspection and they were made welcome by the staff. People using the service are offered a wholesome, well balanced and appealing diet. There are choices at each meal and specialist diets such as diabetic diets are catered for. We observed staff supporting people using the service as needed when eating and drinking and their dignity was maintained at all times. Care Homes for Older People Page 18 of 34 Evidence: Although people using the service are not fully able to converse with us, one person tells us that the food is very nice, and they like they way that they do it. Care Homes for Older People Page 19 of 34 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. People are able to express their concerns; however there is a risk that these will not be formally documented and appropriately acted upon, due to the lack of required documentation in place. People using the service have not been fully protected from abuse due to the recording and documentation practices that have been in place, nevertheless appropriate action to remedy this is now being taken. Evidence: The acting manager stated that no complaints have been received during this inspection year. People using the service and their relatives are supported to express their opinions in regard to the service that they received when they attend the monthly residents meeting. We can see from the meeting minutes that no issues of concern have been brought to the staffs attention and everyone present has stated that they are satisfied with the care received. Although a complaints procedure is available as required there is no log/file in place for recording and monitoring complaints if received so that an audit trail is available to demonstrate that complaints have been acted upon and resolved. Care Homes for Older People Page 20 of 34 Evidence: Necessary policies and procedures are in place in regard to safeguarding vulnerable people, however despite a safeguarding allegation in regards to residents personal allowances and an investigation by the Local Authority there are no records of this available within the care home. The acting manager told us that a safeguarding file is not in place to record these issues and the outcomes. We discussed the findings of the safeguarding investigation with the safeguarding team, who tell us that at the time of their visit no concerns were identified. We therefore informed them of the issues of concern that we identified during our visit and the action that is currently being taken to resolve these. They will therefore follow this up with the provider and acting manager to ensure all issues are resolved. On examining the staff training matrix we can see that staff have undertaken training in this are and on speaking with staff they confirm this. Care Homes for Older People Page 21 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have taken place in regard to infection control issues, to ensure that people using the service live in a clean and safe environment. Evidence: We undertook a tour of the service and looked at the issues of concern that had been raised at the previous inspection to make sure that these had been dealt with. The provider stated that all stained bedroom carpets have now been deep cleaned and during the tour of the care home we can confirm that this has taken place and there are no visible stains. The provider stated that a dedicated carpet (steam) cleaner had been purchased and was available in the home. It was stated that this would be used to clean any specific bodily fluid spills as and when required. It was also stated that each room carpet will be deep cleaned on a regular basis (monthly). This cleaning will be on top of the usual daily cleaning regime. The acting manager has also developed a monitoring/checking process whereby care staff/domestic staff have to record that they have carried out the required cleaning tasks identified for each of the three shifts. Whilst the template has been designed, at the time of the inspection this had not yet been implemented. At the previous inspection we saw that there was cracked and rusted commodes, a Care Homes for Older People Page 22 of 34 Evidence: requirement was set stating that these must be disposed of and replaced as they present an infection control risk. The provider told us that some of these had been replaced and others where applicable had been cleaned. During the visit all commodes that were situated within the bedroom areas were checked and were visibly clean and in good condition. None of the commodes checked were rusty. Staff spoken with during the course of the visit were able to describe how they clean the commodes and what disinfectants they use. A further requirement was set to make sure arrangements are in place to ensure appropriate domestic cover to keep the home hygienic at all times. The provider stated that appropriate domestic cover is now in place to ensure satisfactory cleanliness and that cleaning schedules have been developed to ensure that all staff (domestic and care staff) are aware of their responsibilities in relation to cleaning duties. The proposed monitoring system as stated above has however yet to be implemented. At the time of the inspection we could see that the care home was clean throughout, with the exception of one bath on the first floor. This is in a poor condition, (heavy scaling) however it was indicated by the acting manager that this bath is not in use for people using the service. It was confirmed that flushing takes place on a daily basis to comply with the legionella policy for unused/infrequently used water outlets. We can see that all hand wash basins have adequate liquid soaps and tissues for drying. Personal protective equipment (gloves, plastic aprons) are accessible for staff. It was confirmed by two members of staff that they had received infection control training within the last 12 months (in-house via Nottingham College). Care Homes for Older People Page 23 of 34 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 using the service are supported by sufficient numbers of staff who have been recruited safely; however they have not all completed compulsory training which may affect their knowledge in supporting people with complex needs. Evidence: On examining the staff rota we can see that staff are allocated to attend to peoples needs on a shift basis. During the inspection we saw that staffing levels were in accordance with this and that staff are available to attend to peoples needs as required. Staff worked in a professional manner and were well organised and caring towards people using the service. On discussing staffing levels with a member of staff they tell us that there had been a problem due to staff sickness/holidays, but this has now been resolved and in their view the numbers of staff on duty are satisfactory To ensure that people using the service are protected from unsuitable people supporting them we checked four staff files to ensure that they contained all the necessary documentation required by law. On examining staff files we are able to confirm that the necessary documentation is in place and that staff have undertaken a through recruitment process. Care Homes for Older People Page 24 of 34 Evidence: On examining the staff training matrix we can see that for the majority of staff that there are deficits in health and safety and the mental capacity act, along with other minor deficits in manual handling, first aid and fire. This was discussed with the provider and the area manager who told us that plans are in place to address these deficits and a main training matrix is currently being drawn up at head office and training resources are currently being researched to ensure that the deficits are addressed. When discussing training with a member of staff, they tell us, that they have completed the NVQ level 2 (National Vocational Qualification - a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring for and supporting people.) They also told us that they get plenty of training, all that they need and they have undertaken a range of short courses, including one on dementia. They told us that they are happy to carry out the training as they want to learn as much as they can about care. Care Homes for Older People Page 25 of 34 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. Although management systems are currently being addressed and developed, unless the time dedicated to developing these and ensuring that the acting manager receives supernumerary time is given, this will not be sufficient to ensure that people using the service live in a care home that well run and managed in their best interest. Evidence: We can see on the staff rotas that the acting manager is not getting supernumerary time to carry out and maintain the management duties of the service. This is vital to ensure that the care home runs smoothly and in the best interest of people using the service. The acting manager told us that she tries to get these hours, however it is not always possible. It is evident that supernumerary hours are required to ensure that the standards continue to develop within the service and that these are maintained. The provider is aware that the management of the service requires further input and in view of this a new acting manager has been appointed to support the current acting manager; who is to become the assistant manager. The new acting manager was at Care Homes for Older People Page 26 of 34 Evidence: the service throughout the inspection and is aware of the continued improvements that are required. She has previous experience in managing a care home and also has the qualifications relevant to this job role. Staff spoken with tell us, the acting manager is brilliant, very supportive, however they do not feel that the acting manager has been given adequate time to carry out management responsibilities. Currently the systems in place in regard to monitoring the quality of the service have not been fully utilised. There are quality assurance questionnaires that people using the service and their relatives may complete to offer feedback, however these have not been completed. Currently the only method for people to offer feedback is via the residents meetings or by speaking with staff. There is no evidence of audits taking place to monitor the quality of the service, nor systems in place. We can see that the provider has been visiting the care home on a monthly basis, to check on issues and a report has been completed in regard to this No one at the service is responsible for peoples personal allowances, nevertheless people are able to hold money in the care homes safe, if they wish. Access to this money is currently limited as only the acting manager has the keys for the safe, therefore when she is not at work, no one can access their money. The new acting manager intends to address this issue to ensure that people are able to access their money when they wish. Separate accounting sheets are kept for each persons account, however on checking these accounts we found that there were discrepancies in a number of these. Some receipts had been entered into peoples accounts, however various items on them were not for the specific service user, resulting in them being charged for items they have not had. We also saw one receipt for £40 however it had been taken out their money twice resulting in a £40 deficit. These issues were discussed with the acting manager who agreed that they were incorrect. We could also see that in various accounts approximately £400 was currently out of the building with care assistants who were supposedly purchasing items for people using the service. Again this was discussed with the provider and area manager who were concerned; they immediately began an audit of personal allowances and put up a Care Homes for Older People Page 27 of 34 Evidence: new policy to prevent this happening. The area manager is going to send us the report as soon as the audit has taken place. The provider has assured us that any deficits within peoples accounts will be remedied. This has been discussed with the Local Authority Safeguarding Adults team, who will visit the home in the near future and view the reports of the audit. A requirement was set at the previous inspection in regard to ensuring that staff are supported via supervisions, to ensure that they are developing their skills and knowledge and maintaining good practice when supporting people using the service. When we examined staff files, we could only see evidence that one member of staff has undertaken a supervisions session. During one of these supervision sessions, a deficit in one area of training was noted, however at a further supervision, 6 months later, this has still not been actioned. Another member of staff spoken with tells us that they have had a supervision session recently; they say their work is directly supervised by the homes seniors and they are satisfied with the support they get. To ensure that people using the service are protected, records are kept of untoward incidents and accidents. We can see that minimal incidents are occurring and when they do staff are acting accordingly to ensure that people using the service remain safe. We did note however that the majority of accidents are happening during the night, and have therefore not been witnessed. This was discussed with the area manager and she was asked to consider completing an audit to ascertain if there are any patterns emerging enabling preventative measures to be considered. To ensure that people are protected from unsafe systems and appliances we can see that evidence of servicing and certificates are in place for the lift, electrics, gas, and fire demonstrating that these are all in good working order. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18 You must ensure that staff 30/07/2009 are appropriately supervised. This will ensure that they are supported in their work and development and people using the service receive care that follows good practice recommendation. This requirement has been outstanding for two inspections. We are considering further enforcement action. We will not extend the timescale any further. Care Homes for Older People Page 29 of 34 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 7 14 Care plans must be updated when needs change. This will ensure that staff understand the current needs of people and how to assist them. 30/09/2010 2 7 13 Triggers (where these are known) for challenging behaviour must be clearly identified within all plans of care. This will en ure that people are being supported appropriately and people are not being put at risk. 30/09/2010 3 7 13 Risk assessment must be further developed for all highlighted risks such as managing peoples behaviour. This will ensure that people using the service are fully protected. 30/09/2010 Care Homes for Older People Page 30 of 34 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 9 13 You must ensure that medication that has been administered has been signed for by staff. This will ensure that people using the service receive their medication as prescribed. 30/09/2010 5 12 14 You must continue to utilise 30/09/2010 The Mental Capacity Act 2005 assessments where people using the service are making decisions and choices that may affect their health and welfare. This will ensure that rights of people using the service are protected. 6 16 22 You must ensure that there are systems in place to ensure that formal records of complaints are kept. This will ensure that complaints are acted upon and there is an audit trail. 30/09/2010 7 18 17 There must be records of every expenditure and receipts must be held on individuals records to show how their money has been sent. 30/09/2010 Care Homes for Older People Page 31 of 34 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 This will ensure that people are safeguarded financially and their money is spent appropriately. 8 18 17 You must ensure that records of any safeguarding allegations and the action that has been taken is available. This will ensure that people using the service are protected and safeguarding issues are monitored. 9 30 18 You must ensure that staff have completed compulsory training required to support people using the service. This will ensure that staff have the required knowledge and skills to support peoples complex needs. 10 33 10 The provider must take further action to ensure that the service is running effectively. This will ensure that it runs in the best interest of people living there. 30/09/2010 30/09/2010 30/09/2010 Care Homes for Older People Page 32 of 34 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 7 Personalise plans of care to ensure that people using the service receive care and support according to their specific needs and wishes. Follow up any instances where people using the service are refusing medication on a regular basis, to ensure that their health and welfare is maintained. Recruit a dedicated activities co-ordinator to ensure that people using the service receive varied and stimulating activities if appropriate and those less able have the option to have alternatives suitable for them. Provide one to one activities as well as group activities, so that people who are less able receive dedicated time for them. Forward to the Commission the findings of the audit that has taken place in regard to peoples finances. The acting manager needs to have supernumary hours to ensure there is specific allocated time for her to carry out managerial responibilities. Carry out an audit of falls occurring in the home to see if there is any pattern so that any risks can be assessed and reduced. 2 8 3 12 4 12 5 6 17 31 7 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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