Care Home: Stennards (Kn)

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What the care home does well People and relatives told us what the home does well: "keep us clean, tidy, well fed"; "you couldn`t wish for better managers"; " the staff are all lovely, nothing is too much trouble for them, that includes the owners"; " I would recommend the home to a newcomer". They tell us that the care meets their needs well and they know how to make a complaint. There is a pre-admission process and information about the home and arrangements people need to make about managing their own financial affairs and personal allowances. People take part in care planning and have daily choices about what they do and eat and about worship. Best interest decisions are made with interested parties. Consistent staff support people with feeding and personal care in a way that promotes their dignity. All staff have care qualifications and update their learning. There are safe systems of work and measures to control the spread of infection. The premises and grounds are well maintained. The home achieved a 5H award for food hygiene, which is excellent. Record keeping protects people. What has improved since the last inspection? People helped to design a service user guide being drafted so that is easy to read. A concern, complaint or suggestion can now be reported inside or outside the home, or anonymously. As a result of listening to views, the cook plans weekly menus with people, and there is new equipment and `progressive mobility` sessions for exercise. Activity records are kept . A summer barbecue and an outing to Tewkesbury took place, and monthly discos are run by `Lollipop Jim`. One person was helped to receive TV in their language of choice. Staff refreshed medication training and competence was externally assessed. Nutrition training was used to improve provision for special diets. Screening of risks is regularly reviewed and a system to learn from incidents was introduced. Two falls mats and a hoist sling were purchased to meet people`s assessed needs, and additional grab rails installed. The owners record their visits and actions taken. Comfort and environmental health and safety improved. Lidded laundry baskets and a lockable clinical waste bin avoid cross-infection; a tumble drier was replaced. The water supply had a clear test to avoid build up of bacteria and a thermostatically controlled shower protects people from scalds. The electrical system was re-wired, fire panels and ceiling lights replaced. Five beds and carpets were replaced, along with towels, flannels and bedding. The garden now has a sheltered smoking area, new shrubs and plants and new garden furniture. Two managers overlap so that the home runs smoothly. New laws were embedded in care planning about people`s rights and legal safeguards. Personnel files, policies and procedures were reviewed and updated. What the care home could do better: The service user guide is legally required and needs completion to answer people`s questions about the home. The statement of purpose lacks clarity for the public to distinguish Stennards KN from other Stennards` homes, however their staff training and registration differs. We were unclear how Stennards KN determines people`s primary needs can be met. Progress to update the home`s risk screening system is too slow. We discussed concerns about two people, and about checks to ensure medication is appropriately stored, which managers will follow up for people`s health and wellbeing. Managers and staff need ways to keep procedures up to date with changes in law, safety alerts and best practice. Relatives are not clear on managers names in surveys, and changes made to the complaints procedure confounded clarity. The complaints procedure was amended during our visit to comply with legal timescales. Redress in the event of dissatisfaction needs further consideration. People and relatives told us that the home needs more variety of activities and entertainment to match their interests, "more cups of tea", and "more staff". This did not match findings on our visit, so we advise the home to consult people and stakeholders more meaningfully to continue to learn and meet changing expectations. Key inspection report Care homes for older people Name: Address: Stennards (Kn) 150-152 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN     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: Tina Smith     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Stennards (Kn) 150-152 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN 01214583311 01214590467 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Peter David Lee-Harris,Mrs Dawn Lee-Harris care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 25 Date of last inspection Brief description of the care home Stennards KN is in a residential area near to local shops and public transport, and has a car park. Personal care and accommodation is offerred to 25 older people on two floors via a shaft lift and stair lift. There are nineteen single and three double bedrooms some with en-suite and shower facilities. Toilets are near communal areas and bedrooms. There are five bath and shower rooms; three allow for staff assistance. The ground floor has two interconnecting lounges, dining room and a conservatory, and an enclosed rear garden with smoking facilities. The office is in the dining room. Care Homes for Older People Page 4 of 28 Over 65 25 0 1 3 1 1 2 0 0 8 Brief description of the care home Enquiries need to be made from management about fees, which are in a draft service user guide. Care Homes for Older People Page 5 of 28 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 home was last inspected on 13/11/08 when seven requirements were made. An improvement plan was provided to the Commission in the timescale we set. Prior to our visit, the home sent us their Annual Quality Assurance Assessment (AQAA), with information about running the home, what has improved and is planned for the future. Their self assessment shows commitment to improvement and some analysis. Information from the AQAA and from other sources was also used when forming judgments on the quality of the service. We received 12 out of 30 surveys from people, relatives and staff. The home sends us notifications about legally required events, and we received reports from statutory agencies and professionals. One inspector visited the home on 20/10/09 between 9:05 am and 19:00 pm.. The home was not informed in advance. We looked around the home, observed mealtimes and checked the medication system. We spoke with seven people, staff on duty and Care Homes for Older People Page 6 of 28 examined three peoples care and health records in depth, and aspects of others records and incident reports. There were 24 people in the home and a vacancy in a shared room. Records and certificates were checked about: staffing and training, maintenance, health and safety risk assessments, the homes registration and insurance. We saw the homes public information, quality monitoring audits and records of the views of people, relatives and professionals, including the complaints log. Policies and procedures were seen or discussed about mental capacity and Deprivation of Liberty Safeguards, infection control, complaints and human resources. We discussed our findings with the two Managers, who were present throughout our visit. We discussed specific findings with the owner and Area Manager who were present briefly. No immediate requirements were made as managers planned to act on our concerns. Four requirements were fully met; three were partly met and have been replaced with agreed timescales. A full list of requirements and recommendations are at the end of this report. The Commission will continue to oversee an improvement plan to raise care quality. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 28 The service user guide is legally required and needs completion to answer peoples questions about the home. The statement of purpose lacks clarity for the public to distinguish Stennards KN from other Stennards homes, however their staff training and registration differs. We were unclear how Stennards KN determines peoples primary needs can be met. Progress to update the homes risk screening system is too slow. We discussed concerns about two people, and about checks to ensure medication is appropriately stored, which managers will follow up for peoples health and wellbeing. Managers and staff need ways to keep procedures up to date with changes in law, safety alerts and best practice. Relatives are not clear on managers names in surveys, and changes made to the complaints procedure confounded clarity. The complaints procedure was amended during our visit to comply with legal timescales. Redress in the event of dissatisfaction needs further consideration. People and relatives told us that the home needs more variety of activities and entertainment to match their interests, more cups of tea, and more staff. This did not match findings on our visit, so we advise the home to consult people and stakeholders more meaningfully to continue to learn and meet changing expectations. 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 28 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 28 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 a pre-admission assessment and can try the home. Information about the home is being revised and it will be more accessible but the home need to ensure peoples primary needs can be met. Evidence: People and relatives told us they had enough information to decide about the home and have contracts. The home is all round good, exceptionally. I would recommend the home to a newcomer. At the last inspection information about the home needed updating and detail specific to Stennards KN. On this visit we wanted to see a service user guide as required by law, and whether the homes information answered the publics questions. We saw a draft service user guide in large font, and heard that people were consulted about its design and content. This is good practice and information will be more accessible for people with sight difficulties when it is published. Separate sections for Care Homes for Older People Page 11 of 28 Evidence: each Stennards home are planned, we were told. We discussed the revised corporate statement of purpose as the public cannot differentiate services at Stennards KN from other Stennards homes. Staff training differs, and so does their registration with the Commission about dementia care and mental health conditions. Intermediate care is not provided. The AQAA told us that relatives visit the home first and take a brochure for people to see before they visit for the day. Pre-admission assessments take place at the home. A review is held after four weeks with people, their representatives and social workers. We compared this to peoples current experience by speaking to two people, staff and seeing their records. Both people tried the home for a day, one from hospital and one from the community. Both people had information about the home explained to them when they moved in, after a pre-admission assessment. One person has continuing involvement by health services. There was good information about peoples interests and records of reviews after trial periods. Although information had been gathered from statutory agencies, staff and records were not always clear about peoples conditions and their primary needs. More detailed pre-admission information is needed, including diagnoses so that accurate assessments and decisions are made about whether primary needs can be met. Care Homes for Older People Page 12 of 28 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 take part in care planning. and their dignity is promoted. Improvements have been made to the medication system and screening of risks but do not fully protect peoples health. Evidence: We wanted to check improvements the home told us about since their last inspection. Surveys told us that people are well cared for, clean and well fed, but some said that there are not enough staff to have help when they need it, and some people do not feel there is enough stimulation in the home. On our visit people were appropriately dressed for the weather in their own clothing, and were well groomed. People said they could bathe or shower as often as they liked, and we confirmed this in the homes records. Some people manage personal care independently, including use of the shower, while others have support as assessed from one or two staff. People took part in care planning and three care records had signed care plans. No one had to wait for their needs to be met and there were no concerns made known to us. Care Homes for Older People Page 13 of 28 Evidence: Screening of risks about nutrition, falls and pressure sores are now regularly reviewed but this did not always result in care plan changes or specialist referrals for aids or advice. The care plans of people being treated for diabetes and high cholesterol did not reflect all dietary and exercise needs. Managers researched risk assessments with local health professionals but have not updated policies and systems of preventing and managing interlinked risks. We discussed concerns we had about two people. Care plans do not address medium and high risks identified, such as supporting mobility for someone unsteady to prevent falls, and pressure sore prevention aids. Managers said they will follow up our concerns with health professionals. There are people in the home with significant mental health conditions, histories of depression or self neglect, dementia and learning disability. Some have lived in the home for many years. Their needs are well known and are managed with health and social care services. Some people admitted during the past year did not have clear primary needs which staff could explain to us. Staff did not have sufficient information about psychiatric conditions and medication, or instruction in care plans about stimulation. Supporting independence and choice needs to be balanced by clear guidance for staff to recognise and act on deterioration or self harm. Medication is reviewed by doctors - the home could improve how they contribute to medical reviews by monitoring changes in appetite, dizziness, falls, sleep disturbance and moods. Staff managing the medication system were re-trained and externally assessed to be competent after the last inspection. Frequent audits ensure people have their medication as prescribed, and there have been no medication errors. On this visit we found sustained improvement in the medication system, but some checks are not made to ensure medication is stored in controlled conditions so that it remains effective for peoples health. Care Homes for Older People Page 14 of 28 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 are treated as unique and have privacy. Opportunities for exercise and stimulation take place but could match expectations and individual support needs. People help to plan weekly menus; food is nutritious and tasty. Evidence: Peoples rights are promoted by flexible arrangements to accommodate personal routines, open visiting, and facilities for independence and privacy. Staff help people to keep in touch with relatives and friends by phone or letter. People told us that they have enough clothing and that their families assist them to shop and manage money, or they manage independently. On our visit seven people went out to local social clubs and day centres; other people did not want to attend. The home registered people with Ring and Ride to go out independently, but on our visit no one was making use of this service. Entertainment was arranged twice during the summer, and more is planned for December. Birthdays are celebrated and there are opportunities for worship. There is a visiting hairdresser and chiropodist. Several people told us that they enjoy exercise sessions held weekly or fortnightly. Care Homes for Older People Page 15 of 28 Evidence: Half the surveys told us that there were not enough activities or entertainment in the home, perhaps a sing along or somebody to talk about old times. Managers said that people differ in their capacity for social activity and choose whether to take part; they provide games to suit peoples sensory needs, such as dominoes and bingo. Individual activity records are now kept about peoples choice whether to participate. This showed us that people did not want to play the games on offer. We did not see an activity for people remaining in the home. People choose whether communal TVs and music are used. The home compiles life histories about peoples lifestyles, personalities and interests, but we did not see how this is used to plan activities. People could be consulted in more depth and akin to the way the home has improved planning weekly menus with people, so that variety meets expectations. The service caters for some people with needs to avoid depression and isolation, or to maintain social skills, mental and physical agility but this was not assessed. Their stimulation and contact with the community needs individual planning with personal support to take part. Everyone likes the meals and said that the home keeps us well fed. We wanted to see how nutrition training was put to use since our last visit and we looked at the frequency of meals and snacks as a result of a survey comment. We saw three meals and two snacks served during our visit, which people said was sufficient. Some people provide their own facilities to make drinks and snacks in their rooms. We checked menus and found a healthy diet with nutritional balance. We shared a tasty meal with five people. Appropriate diabetic alternatives were provided at mealtimes and intervals during the day. Care plans about diabetes are still not clear on how long gaps are avoided between meals, but we were told that this was discussed as a staff group. It is not clear whether cultural diets are routinely catered for. We were not made aware of anyone losing weight. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are acted upon but we cannot confirm that the response was timely or promoted peoples rights. New laws about mental capacity and local safeguarding protocols are used, but the Commission needs to be notified so that we work together to keep people safe. Evidence: We confirmed that people know how to make a complaint. Relatives said the home usually respond appropriately to any concerns raised. On our visit we saw changes since our last inspection. The complaints procedure now has details about the Commission so that people can report concerns inside or outside of the home, or anonymously as there is a suggestion box, and an advocate could be arranged. However the complaints procedure on display did not ensure complaints were reported to management or how matters could be taken further if disatisfied. The timescale was raised significantly. Amendments were made during our visit to comply with the law. This illustrated lack of familiarity with responsibilities under care regulations. The AQAA told us that there were two complaints since the last inspection, which were investigated but not upheld. This was not accurate as one complaint we checked led to an apology. We did not see a second complaint but we saw a suggestion, with no outcome. We could not confirm from the complaints log whether timescales were met. The summary log does not accurately reflect how the homes complaints process is Care Homes for Older People Page 17 of 28 Evidence: used, or how learning has been used to develop the service. The Commission was made aware of an anonymous adult protection concern, investigated by the council with the homes full cooperation. Statutory agencies told us that no abuse or concerns were found and good record keeping in the home helped to establish this. The home has kept us informed of other significant events affecting people. Policies and procedures protect peoples human and civil rights. Managers attended council training about mental capacity law and Deprivation of Liberty Safeguards. More recent assessments of people consider whether these safeguards need to be sought on admission to the home. No authorisations have been necessary, and we complimented managers on their efforts to embed new laws in the homes systems. However mental capacity assessments need to be lawful, in accordance with the Mental Capacity Act code of practice which we discussed. People have freedom of movement in the home and garden, and most people go out on their own or with relatives and friends. There is a code of conduct prohibiting staff from involvement in peoples financial affairs or benefiting from wills, which protects people. Recruitment checks also ensure that staff are safe to work in a care home. Care Homes for Older People Page 18 of 28 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. The home is comfortable, safe and well maintained. People have the equipment and facilities they need for independence and privacy. There are best practice measures about food hygiene and to prevent and control the spread of illness, including swine flu. Evidence: Since the last inspection management progressed their plans to improve infection control, equipment and facilities to match peoples needs or health and safety. Refurbishment has also addressed peoples comfort. Stennards KN is homely and well maintained. We checked contractor certificates and the homes maintenance records to confirm this. Premises and grounds are safe and secure from intruders. Most people can open the front door from the inside without assistance. Peoples rooms have door locks and shared rooms have a screen so that people can have privacy when they want. Showering facilities improved so that people can shower independently with safety. Peoples health is now protected by checks about the water supply and bacteria, and scalds are prevented by hot water within the safe range. People have the equipment they need, regularly checked and we saw safe manual handling by two staff using a hoist. Repairs are timely. Risks to people falling were reduced as the laundry is kept locked Care Homes for Older People Page 19 of 28 Evidence: and extra grab rails were installed. Staff have better facilities to manage medication using forceps so they dont touch it, and anti-bacterial gel is on the medication trolley to wash hands in between people. This shows us that high quality standards and oversight has sustained safe working practices. We noted that there is a bed replacement programme, as some bedrooms now appear quite dated. The AQAA told us that all staff have training in infection control. Measures to control the spread of illness or infection were good, along with cleaning schedules and tasks to prevent the spread of swine flu. The home smelled fresh. We drew the managers attention to one matter, and immediate cleaning was arranged. Staff and visitors cant see the Health Protection Agency poster about swine flu, so we suggested this is moved and that visitors are reminded to wash their hands. The home achieved the highest possible award from Environmental Health for food hygiene, and we saw that this high standard is maintained in the kitchen. There are regular fire drills and a phased evacuation plan. An owner is the homes Fire Marshall. New fire panels are in place, and we heard that the owner spot checks workers knowledge of this plan, which everyone considers good practice. Care Homes for Older People Page 20 of 28 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 have help from competent and friendly staff. There are good systems to report peoples changing needs, but staff need learning opportunities to respond using best practice. Staff consistency and robust recruitment checks protect people. Evidence: Staff and managers had respectful and friendly relationships with people on our visit. They offered people choices, knew likes and dislikes and conversed with people. There are effective systems in place to share information when peoples health or wellbeing changes. One person said, the staff are all lovely, nothing is too much trouble for them however some people and relatives told us that there are not enough staff. This did not match observations on our visit, or positive comments made to us by seven people. Sufficient staff were in place at peak times so that people were fed and assisted with medication, personal care and manual handling in ways that were safe and unrushed. Staff are consistent as there is a low turnover and temporary staff are not used. There are three care staff and management during the daytime, and two waking night staff. Men can choose the gender of staff for help with personal care as an owner will assist. We saw sufficient records about staff and management to confirm that there are Care Homes for Older People Page 21 of 28 Evidence: robust recruitment checks which protect people. Newer staff had a two day induction followed by a longer Skills For Care induction within three months. All staff have NVQ qualifications which exceeds the minimum standards. Knowledge is tested. Staff are observed and systems are audited to inform annual appraisal of performance, now undertaken in January. Mandatory training was undertaken and refreshed in accordance with staff roles. A chart about this is kept up to date so we could see how training is planned in advance using in-house purchased tools, external assessment and/or training providers. Four managers and seniors administer medication; other care staff have safe handling of medication training as a back up after they have been in post for one or two years. Staff had additional training about nutrition and health which was used to improve the nutritional care. To update and develop staff, more needs to be learned about health conditions affecting people using the service, such as mental health conditions, strokes, epilepsy, diabetes as well as best practice in falls prevention and social stimulation. Staff need detailed guidance in care plans to identify and respond to peoples needs using current best practice and support from local specialists so that people benefit from a holistic approach. Care Homes for Older People Page 22 of 28 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. Managers are qualified and approachable. The home is smoothly run and there is oversight of staff performance, safe working practices and the environment. Peoples views are sought but progress has been slow to update the service to benefit people. Evidence: Two managers run the home, one of which is registered by the Commission and holds the managers award. Both have long experience and NVQ4 management qualifications. Their hours of work overlap and they are supernumerary, so that the home runs smoothly. Supervision of staff is shared and they audit systems about care standards and medication. All Stennards managers meet to support each other. People and staff find the managers and owners approachable and responsive however some surveys show us that people and relatives are not up to date about managers names. The owners continue to visit the home each day and now record discussions with people, staff and their oversight of health and safety. They are revising corporate Care Homes for Older People Page 23 of 28 Evidence: information about Stennards homes and consulted people about this. Revision of the statement of purpose has blurred rather than clarified the service and registration of Stennards KN. The public and managers need to be clear about service boundaries to make appropriate admission decisions and to plan staff training. The AQAA was completed on time and showed ways in which the home responded to their last inspection. There is commitment to improve, but on our visit managers were not sufficiently familiar with care regulations and cannot easily keep up with changes in law, safety alerts and best practice. Nutritional care improved, but managers agreed that progress has been too slow to update the homes health risk screening system to ensure peoples needs are met. We discussed reasons for this and advised that management facilities are reviewed as they have gathered what they need to make changes. Important legal and registration changes take place over the next year which managers and owners will need to know about and plan for. Some policies and procedures were revised after obtaining professional advice, such as about medication. Policies about falls, pressure sores, weight loss and mental health need to identify preventative measures expected and when specialist advice should be sought, and this needs to be reflected in peoples care plans to manage health risks effectively. Health and safety information from appropriate sources was used to assess and consistently manage risks concerning the water supply and environment. Systems to analyse incidents and hazards resulted in changes to make the environment safer. The home responded to government advice about controlling infections and swine flu and had good measures in place and contingency plans. They also contributed to a local plan coordinated by the Police to manage community emergencies. Views about the running of the home are sought in a variety of ways, such as informal meetings occasionally held with people, new questionnaires for interested parties, care reviews and a suggestion box. Some changes were made as a result of listening to people. We found the new questionnaires less meaningful and hard to complete because the font is very small and comments are not invited. Responses showed that the stakeholders often did not think the questions were applicable, so it is not clear what the home sought to learn. Personal allowances are not managed by the home. People have a named representative or manage their own money. If items are purchased, written invoices and receipts are provided to people or representatives. Transparency improved by changing the way hairdressing is billed and receipted. Care Homes for Older People Page 24 of 28 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 25 of 28 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 12 12: The system of screening, preventing and managing risks of fall, pressure sores and malnutrition should reflect best practice and preventative action should be timely. Peoples health must be effectively monitored, promoted and protected. 20/01/2010 2 9 13 13(2): Medication must be 20/11/2009 stored in accordance with its product license, with timely action if temperatures are exceeded. Medication needs to be stable and effective for peoples health. 3 16 22 22(3)(4)(8): The summary complaints log must reflect how the complaints process has been used: timescales, the issue, findings, outcomes and whether 20/12/2009 Care Homes for Older People Page 26 of 28 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 complainant satisfaction was achieved. Complaints should be used to promote peoples rights and for the home to learn and develop. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide must accurately reflect the homes registration and staff training about primary needs so that the public can decide if the home is suitable. Information from health services is needed pre-admission about peoples conditions and cognitive impairment so that accurate assessments are made about mental capacity and peoples primary needs. Individual plans are advised for people with mental health conditions, sensory and cognitive impairment so that they have the support they need for social, physical and mental stimulation. Mental capacity assessments need to made in accordance with the Mental Capacity Act code of practice. Staff need learning opportunities about significant physical and mental health conditions matching the statement of purpose and the needs of people living in the home. The registered manager needs to understand care regulations and their responsibility to comply within timescales set by the Commmission or explain delays inbetween inspections. Management facilities should enable policies, procedures and self assessment of quality to be accurately reviewed and kept up to date. 2 3 3 12 4 5 17 30 6 31 7 33 Care Homes for Older People Page 27 of 28 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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