Care Home: Stennards (Mos)

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What the care home does well Surveys, people and visitors on our visit were all very positive about the home, including health professionals. One person summed up what the home does well: "food, care, cleanliness and time for me". Relatives told us: "they keep residents clean and tidy, making sure they have the right medication"; "...[after] several bad falls she was nursed back to health with care and attention...dignity and understanding"; "Stennards provides good care in a homely environment." Our findings confirm many of these views. People are lively and have choice of stimulation in the home and community such as reminiscence, music and exercise, and some go to a local day centre funded by the home, or clubs of their choice. Visitors are welcome and the home keep in touch with relatives. Care plans are formed from assessments of needs and risks, which are reviewed regularly and agreed with people. There is good access to health services. People have support when they want it, and requests they make are responded to. There have been no complaints or safeguarding concerns. The home is well run and well maintained and there is commitment to sustain improvement. What has improved since the last inspection? After research and training the home improved assessments of risk to health and safety. As a result people have more thorough screening and specialist health advice to prevent falls and about nutrition. Staff have detailed guidance to monitor physical health conditions such as diabetes, to use equipment and to help people to mobilize safely. A new assessment prevents unnecessary restrictions on people`s rights.. The medication system was changed and the manager now checks staff and medication to protect people. A Primary Care Trust pharmacist also visits quarterly. There are more inter-home activities for people to take part in. The owners started a log about their quality monitoring checks and actions taken. The views of people and interested parties are now sought in a variety of ways to develop the service including a new suggestions box and stakeholder survey. People were consulted about public information about the home, and changes will make a new service user guide easier to read when it is published. There is an ongoing refurbishment plan and during the past year beds were replaced. Leadership improved to update practice and to promote health and safety of the premises, and infection control. The home sustained their excellence award from Environmental Health for food safety. The home kept us well informed of matters affecting people during the past year and following on from our visit. What the care home could do better: People and families need all the legally required details about Stennards Mos to answer all their questions so they can decide if specialist services and staff training for instance can meet their needs. People are treated as individuals but some need a higher level of professional care because the home asked to be registered to provide specialist services, and because people`s needs are more complex as they grow older. Strategies, policies and training need to reflect services designed for their needs and prevent interlinked risks associated with people`s conditions and any deterioration. Staff also need ways to tell whether people who have communication difficulties are in discomfort or are unwell. The medication system is safer but when there are discrepancies the home must ensure the person`s health is protected and identify how to prevent a recurrence. Patterns from other types of incidents also need periodic analysis for similar reasons. We pointed out a few examples where infection can harbour and cross-contamination risk in the laundry and we were assurred that maintenance and refurbishment would address this quickly for added protection of health. We made suggestions to plan for further space for archiving and medication, particularly as the temperature where it is stored is only just within the safe range to remain effective. We also suggested an audit of staff records so that all the legally required checks to protect people are in the home. Key inspection report Care homes for older people Name: Address: Stennards (Mos) 133 Anderton Park Road Moseley Birmingham West Midlands B13 9DQ     The quality rating for this care home is:   two star good 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: 0 8 1 2 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Stennards (Mos) 133 Anderton Park Road Moseley Birmingham West Midlands B13 9DQ 01214494544 F/P01214494544 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 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide personal care and accommodation for service users of both sexes whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 16 Dementia (DE) 16 Mental Disorder (MD) 16 Date of last inspection Brief description of the care home Stennards Mos is in a residential area in Moseley, near shops, public transport and there is car parking. Care and accommodation is provided for up to 16 older people, and specialist care for dementia or mental disorder. There are ten single and three double bedrooms, eight of which have ensuite facilities and others have wash Care Homes for Older People Page 4 of 30 2 4 1 1 2 0 0 8 16 16 0 Over 65 0 0 16 Brief description of the care home handbasins. Toilets are located near bedrooms and communal areas - a lounge, dining room and conservatory. There are three bathrooms and a shower. The well maintained enclosed garden is accessible from the conservatory. On our visit there was no published service user guide. People are advised to ask management about the fees. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 24/11/08 when 11 requirements were made and the quality rating changed from good to adequate. An improvement plan was provided on time to the Commission. 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 analysis and commitment to improvement. Information from the AQAA and from other sources was used when forming judgments on the quality of the service. We received a good response from people and their relatives, staff and health professionals in surveys. The home improved notifications to us about events that affect people, and we receive reports from other sources. One inspector visited the home on 08/12/09 between 10:00 am and 8:00 pm. They did not know we were coming. We looked around, observed mealtimes and checked the Care Homes for Older People Page 6 of 30 medication system. We spoke with five people, one visitor, staff on duty and examined two peoples care and health records. We also saw the complaints log, incident reports, quality surveys and public information. There were 14 people in the home. We checked records and certificates about staff, maintenance, fire prevention, the homes registration, insurance, and other regulator reports. Policies and procedures were seen or discussed about nutrition, falls risk, Deprivation of Liberty Safeguards, infection control, complaints and training. We discussed our findings with the manager and another Stennards manager, present throughout our visit. We agreed information which the manager provided within 48 hours as some information was not available. No immediate requirements were made as the manager took or planned action on matters we raised. Nine previous requirements were met. Two were replaced and a new requirement was made as a result of our visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? After research and training the home improved assessments of risk to health and safety. As a result people have more thorough screening and specialist health advice to prevent falls and about nutrition. Staff have detailed guidance to monitor physical health conditions such as diabetes, to use equipment and to help people to mobilize safely. A new assessment prevents unnecessary restrictions on peoples rights.. The medication system was changed and the manager now checks staff and medication to protect people. A Primary Care Trust pharmacist also visits quarterly. There are more inter-home activities for people to take part in. The owners started a log about their quality monitoring checks and actions taken. The views of people and interested parties are now sought in a variety of ways to develop the service including a new suggestions box and stakeholder survey. People were consulted about public information about the home, and changes will make a new service user guide easier to read when it is published. There is an ongoing refurbishment plan and during the past year beds were replaced. Leadership improved to update practice and to promote health and safety of the premises, and infection control. The home sustained their excellence award from Environmental Health for food safety. The home kept us well informed of matters affecting people during the past year and following on from our visit. Care Homes for Older People Page 8 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 assessments which are more thorough. They visit and decide for themselves about the home. A service user guide is being designed with people and will be easier to read but people and families may have some questions unanswered. Evidence: People and visitors were satisfied with the admission process and said they were made to feel very welcome. We saw the records of someone who came to stay during the past few months, and sometime who has lived in the home for several years. We also discussed the admission of people with dementia and mental health conditions. We were impressed by the homes promotion of peoples rights to make an informed decision. The AQAA told us about the admission process, which was confirmed by the records we saw. People visit the home without relatives present, so that they can really see what it is like, ask questions and meet other people living there. A pre-admission form Care Homes for Older People Page 11 of 30 Evidence: is used to learn about the person and their needs, their mental capacity and to ask about their impressions before deciding if the home can meet them. Rooms are offered to suit preferences. Information was gathered from health and social care agencies. Terms and conditions and more detailed assessments and care plans were completed and signed on admission and are reviewed with people monthly. This shows that the home involves people in making care decisions. This year we wanted to see if people had information that accurately described the home and complied with the law to answer peoples questions. The home told us that they consulted people about this after our last inspection, which is good practice. We were told that there was no written information for people other than a small brochure. A draft service user guide was brought to the home. This is a high quality, corporate guide in large print, which people find easier to readable. It has a lot of useful information but is still in design and is not in use. We were told that people currently see a small brochure. The guide includes an updated statement of purpose which describes needs that can be met but is not specific enough about the training of staff for people and families to make informed decisions. Staff are trained in dementia care but not mental health to deliver the service set out. The homes approach to specialist services is guided by their philosophy about treating people as individuals. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the support they want and need to promote their independence with a safety net for their health. There is good access to health care, but care planning about interlinked risks could improve to prevent deterioration in physical and mental health. The medication system is safer and usually ensures medication was given as prescribed. Evidence: People looked well groomed on our visit. They said that they are very well fed and staff are always nearby if they need them. A number of people undertake personal care with minimal support, and their independence is respected. In records there were instructions to staff not to overpower...let her comb her hair, wash her hands and face. People can bathe or shower as often as they want, and continence is prompted. This year there were better instructions to staff about using a handling belt, helping people to transfer from a wheelchair, and appropriate sling sizes if the hoist is occasionally needed. We complimented good practice, unrushed support and dignified care. Doctors and mental health services visit regularly to review people and district Care Homes for Older People Page 13 of 30 Evidence: nurses are involved daily at present. Health appointments are kept, well recorded and escorts are provided. Health professionals told us that the home seek and follow their advice. On our last visit more balance was needed to promote independence, something the home does well, as well as to recognise and respond at early points to prevent injuries and stabilise health conditions. This year we saw more balance regarding physical health, but a similar approach still needs to be applied to diagnosed mental health conditions to recognise and prevent deterioration the way people want. There is good social stimulation to retain memory and intellect, physical abilities with support and encouragement to participate. Written instructions for staff have clarity about the aim and monitoring measures agreed with people and sometimes health professionals. For example a diabetes plan had the optimum range for staff monitoring blood sugar, and when tests were to be undertaken so that monitoring is accurate. Dietary provision, health checks, signs of deterioration and actions to be taken were robustly followed - we could tell this from good records. We saw instructions about mental capacity and personal decisions about food and medication that ensure there is a safety net if peoples health could be at risk. Monitoring measures were effectively evaluated periodically and health advice was sought when necessary. Staff finished nutrition training and best practice was researched about falls prevention and infection control. Their approach changed to promote healthy living with more focus on diet and exercise, steps to prevent for example swine flu and influenza. Risks are now screened in more depth, for instance using three tools about falls, reviewed regularly. This resulted in referrals to a local falls clinic and care plans that address footwear and footcare, aids, mobilizing and sensory needs. Last time we saw information about peoples health conditions and medication, but on this visit it was often used to provide sufficient written guidance for staff. We were notified about falls and hospital admissions this year, so we could tell what action was taken to meet sudden changes in needs or health. This shows us that the home understands their boundaries. Two people transferred to a nursing home. People are regularly weighed and the records we checked showed that people gained or re-gained weight and changes in eating and sleeping patterns were considered. Turn charts and pressure relieving aids were in use but it was not clear whether preventative measures were introduced early enough. We were told it is early days as the home are still trialing new screening tools. They intend to use body mass index to assess risk of malnutrition. On our visit we were not made aware of anyone at risk. Care Homes for Older People Page 14 of 30 Evidence: We queried a few matters that had not been taken into consideration or were not evident from risk assessments and care plan, and sometimes practice was more up to date than care plans. Actions were taken or planned by the manager and owner during our visit to prevent falls out of bed and avoid or respond to skin breakdown when a persons mobility deteriorated. They could do more to monitor hydration in these circumstances, and to monitor the effects of some medications on dizziness and appetite. Two people were followed up with doctors. When we asked how long gaps are avoided between meals for people with diabetes, a nutrition policy and a care plan were amended. There was no overarching policy to ensure consistency in using scoring tools open to interpretation, and to ensure interlinked risks are addressed in a timely way. They were receptive to setting standards for prevention plans addressing the levels of risk, monitoring that plans are followed and effective so people have good outcomes. The medication system also changed so that trained staff prepare and administer medication and sign the homes medication administration record (MAR). Key security improved. On our visit no one was managing their own medication. We clarified that the manager audits medication and observes staff to confirm they are competent, and Stennards managers assess each other, rather than a Primary Care Trust (PCT) pharmacist as we had been told. The PCT told us about their quarterly checks of various aspects of the medication system and care home policies. The PCT report September 2009 shows perfect medication administration records (MAR) and a policy of no homely remedies. However on our visit we were told that one person does not have any prescribed medication, although a cream was prescribed by the doctor and district nurses attend for skin care and cream is remarked on in records. One medication out of several we checked had a minor excess of stock where the MAR shows that medication was given to the person when it may not have been. Readily available guidance on the blood thinning drug says not to stop taking it without health advice and to take it at the same time each day. The manager investigated the next day and reported to us that they were unable to explain an extra tablet, but did not explain what they did to check on the persons health or to prevent this happening again. So we could not confirm that a previous requirement was fully met to protect people but the medication system is safer. Temperatures are now taken where medication is stored, showing 23 to 24 degrees routinely in the winter. We advised that during hot weather this storage place may exceed the safe range to keep the medication stable. Temperatures could be taken twice daily to establish this. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with opportunities to lead flexible lifestyles and to take part in activities they enjoy in the home and community. Everyone likes the food, people have the support they want at mealtimes, and their dietary needs are catered for. Evidence: People get up for the day at different times, and choose when they go to bed. We were told that staff always make my family and visitors very welcome, and a visitor who has been coming weekly confirmed this. One survey told us that the home gets busy sometimes and I go to my room to read. During our visit some people were keen to go on an outing - a Christmas Party arranged by a local day centre in a pub, and they were lively and talkative when they returned. Others preferred the peace, and some had visitors. The home funds attendance at a day centre that provides transport for people who want to attend. The home have sustained last years level of satisfaction about peoples lifestyles. Our visit confirmed all the surveys telling us that there are activities people can choose to take part in. People were keen on chat sessions and progressive mobility an instructor comes to the home monthly and staff also run exercise sessions. The TV is only put on in the lounge if people want it on. The home is aware that people would Care Homes for Older People Page 16 of 30 Evidence: like more outings, which they particularly enjoy. We saw in the owners log and resident meeting minutes that people are regularly consulted about activities and the menu. Food is nutritious, freshly prepared and well liked. The home promotes healthy eating and has a balanced menu. There were sufficient staff to assist at mealtimes and staff clearly knew people well in terms of portion size, use of a food guard to maintain independence, and people had help in different ways. Dietary needs and preferences are catered for. On our visit the home provided low fat and diabetic diets as well as soft food, which had improved. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel safe and there have been no complaints or safeguarding concerns. Unnecessary restrictions on liberty and movement are avoided. A wider safeguarding strategy is needed to promote and protect rights. Evidence: People told us that they felt safe and well respected in the home, and that requests they make are attended to rapidly. There have been no complaints or safeguarding concerns since our last visit, and there is now a suggestion box. Staff all had training to recognise abuse and understand the company code of conduct. Someone living in the home asked for our help to return to their own home which they had not raised with staff. With their consent we spoke to the manager, who phoned the council to request a re-assessment on their behalf. We saw information on advocacy and advice services on display, and the manager knows how to arrange statutory advocates. This shows us that people have access to independent support whenever they want. The manager attended council training on mental capacity and Deprivation of Liberty Safeguards (DOLS) and understands new legal duties about seeking peoples consent as well as council authorisations. Daily records show that daily consent is sought from people before care, stimulation, medication and health treatment appointments. Refusals are accepted and the home improved their safety net since last year, so that Care Homes for Older People Page 18 of 30 Evidence: concerns about health are followed up with health specialists in the best interests of people with fluctuating mental capacity. The manager created a DOLS assessment form which is now used after admission to prevent restrictions and restraint if they are not necessary. This is good practice. We discussed mental capacity for a decision to leave the home when there may be risk in the community. Authorisations safeguard peoples rights as well as protect people, and we found that staff and managers need more clarity about emergency authorisations by the home. The home has general information about mental health conditions but some assessments and care plans lacked depth of analysis of how conditions affect people, relevant risks and monitoring measures. Care plans need individualised guidance for staff to recognise and respond to signs of self harm, self neglect, mental health deterioration. Plans should be agreed about what the person would prefer to happen at those times, and what the home and health services will do. Some people have regular reviews by health professionals. We observed and spoke to someone during dinner who had two sensory disabilities, and learned that pain was preventing them eating. As there were no homely remedies staff said they would contact the doctor for pain relief and would follow up the cause of the problem. We recommend that people with communication difficulties have agreed and documented ways of communicating with staff so that their wellbeing can be checked daily. We were unable to confirm that checks on staff through the homes recruitment process protect people during our visit. Progress on updating screening tools and environmental health and safety shows us that the home realize the importance of safeguarding people through all the homes systems. We asked to see an incident audit but were told that this was not undertaken following a recommendation made on our last visit to identify and act on patterns and avoidable risks that may cause injury or harm to anyone. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 warm, comfortable, safe and well maintained with high standards of hygiene sustained. People have privacy when they want it and lockable facilities for valuables. We pointed out a few areas to improve infection controls to protect peoples health. Evidence: Relatives said that This is a very comfortable home and never smells ; they provide a warm , safe environment and one relative commented that car parking facilities could be better. Privacy is maintained by locks on most bedroom and toilet doors, privacy screens in shared rooms, and use of the conservatory or bedrooms for visitors if preferred. There is a lockable facility in bedrooms for valuables. Relatives are requested to manage valuables. We confirmed that there have been no reports of things going missing. The home is well maintained, with an ongoing refurbishment plan - this past year concentrating on new beds. All the essential servicing checks were up to date. Fire prevention is taken very seriously and an owner is the Fire Marshall who trains and spot checks staff, conducts fire drills and plans ahead for improved precautions. The visitors book is now regularly used. We queried the smell of gas in one bedroom which we were told will be checked. We were able to confirm that hot water temperatures have been maintained within the safe range to prevent scalds, but the manager Care Homes for Older People Page 20 of 30 Evidence: agreed that the standard of these records have lapsed a bit and could improve. The home has an infection control plan. Extra precautions and posters were in evidence because of the swine flu epidemic - information was obtained from the Health Protection Agency. Environmental Health found excellent food hygiene standards sustained. There are cleaning schedules and high standards; people told us it is always this way. There were no outbreaks of contagious illness. We pointed out in some toilets and bathrooms areas where infection can harbour - bandaged and rusted handrails, a few cracked tiles, a bath needing sealant, and a toilet raiser that could be replaced. The laundry walls have mildew due to condensation and were in close contact with clean clothing. We recommended that the walls are cleaned and a means of reducing the condensation is found as the expelair was not working. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Consistent and competent staff meet peoples needs in a way that promotes dignity. Staff have additional training and good qualifications but training in mental health is needed to deliver the service. Recruitment checks protect people but records must be held in the home. Evidence: The AQAA said that all staff records are now held in the home rather than Head Office. Out of three staff records we saw, one was missing two references so we could not confirm that there were sufficient checks to protect people, although police checks were clear. Managers thought this may be at another Stennards home and sent this after the inspection. We suggested an audit of staff files is undertaken to ensure legally required documents are in the home after similar issues last year. There is a low staff turnover and agency staff are not used. Staff knew people well and had good relationships with them and with their visitors. We checked staff rotas and saw that staffing levels are usually maintained each day of the week, with some overlap in the morning for two hours at peak times, which is good practice. On our visit people had sufficient support at mealtimes. Two staff are on duty at night. People all felt staff were available when they were needed. All staff have NVQ qualifications, which exceeds minimum standards. Mandatory Care Homes for Older People Page 22 of 30 Evidence: training is kept up to date and refreshed. Staff have first aid awareness training to provide basic first aid. We were told last year that the manager was undertaking a college course on mental health and we asked about progress. The manager explained that she was unable to complete the course and is no longer enrolled. There are no current plans to train staff about mental health to deliver the service set out in the homes statement of purpose and registration. Our discussions with the manager and records we saw about people show us that more knowledge is needed to improve care planning about mental health needs. No one was at risk on our visit and the home has access to the advice of mental health services. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 well run and people benefit from improved leadership of health, safety and quality and the supervision and appraisal of staff. Training needs to be planned to deliver the service in the statement of purpose. Further policy development and monitoring of updated systems will safeguard people and sustain quality Evidence: The manager has appropriate qualifications, long experience and is registered by the Commission. This year they updated their knowledge on a range of best practice matters in this report to benefit peoples health, welfare and rights. We complimented creative use of a body chart to demonstrate to staff where to apply cream, and a DOLS form to protect rights. Policies and procedures were reviewed in light of changing laws. The AQAA provided us with everything we asked about and some analysis. Value for money is understood in relation to local comparisons, and the home offer additional services included in the fee for stimulation. When the provider sought registration for specialist services it was expected that the Care Homes for Older People Page 24 of 30 Evidence: homes approach would be set out in the statement of purpose and staff development planned accordingly. Priority needs to be given to mental health training so that staff have the necessary knowledge to give people and the Commission confidence that their needs will be met. There is a code of conduct and staff are prevented from involvement in peoples financial affairs or benefiting from wills. People manage small amounts of money independently and families assist with their financial affairs. The home now provides a statement of hairdressing accounts to be more transparent. There was a noticeable improvement in creativity, professionalism and leadership. Health and safety of the environment, quality assurance, and care planning improved. Management are trying new tools and are updating their systems and skills. In addition to resident and staff meetings, and the owners daily visits and log, this year a stakeholder quality assurance survey was used but it needs a larger font and more meaningful questions to be able to make use of views to develop the service. There is still lamenting in the AQAA about paperwork detracting from time with people, but we discussed this. There are ways of simplifying record keeping and making it meaningful to maintain the high standards we saw that protect people. The manager would also benefit from an office at times so that interruptions are minimised to complete tasks. This year the home kept us well informed but we advised that the latest version of the Regulation 37 report and guidance should be used. The legal framework for care services is changing this year which we explained. Stennard Mos could have a wider safeguarding strategy. As re-registration will involve on-line processes we suggested technology is reviewed. We also suggest that more storage for archiving records and temperature controls of medication are planned for. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 13(2): Medication administration records (MAR) must be accurate to account for medicines received into the home. Discrepancies need to be followed up in a timely way to protect health and prevent recurrence. People must have medication prescribed for their health. 09/01/2010 2 26 13 13(3),(4)(c): Suitable 08/01/2010 arrangements must be made to prevent crosscontamination, toxic conditions and the spread of infection in the laundry room. This is to minimise unnecessary risks to peoples health from mould and mildew. 3 36 18 18(1)(a) (c)(i) The training of staff and managers must 08/03/2010 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action match the needs of people specified in the homes statement of purpose and registration in line with their roles. This is to ensure peoples needs are recognised and met. 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 are legally required documents. Care regulations require information about staff training and fees, for example so that people can make decisions about how their needs will be met. Information should be gathered about diagnosed mental health conditions and treatment so that the home can decide if needs can be met. An over-arching policy should identify when to review multiple risks so that prevention plans are holistic, addressing nutrition, falls, pressure sores, mental and physical health and night time care as relevant, for example. Strategies should be agreed with people who have communication difficulties so that their wellbeing can be accurately checked. Incidents should be reflected upon and audited periodically to identify any patterns that can be acted upon to prevent recurrence in the home and to individuals. Strategies should be agreed with people who have relevant diagnosed mental health conditions so that signs of deterioration can be recognised and have appropriate response to prevent self harm or self neglect. 2 3 3 8 4 17 5 18 6 18 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 36 An audit of staff files should ensure there are legally required checks as in Schedule 2, in staff records held on the premises. The home should be using the most up to date Regulation 37 form and guidance to make legal notifications to the Commission (www.cqc.org.uk) 8 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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