Care Home: The Beeches (Wath)

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What the care home does well The manager had the qualifications required of the person in day to day control of the delivery of care and their approach to the management of the home was based on openess and respect. Generally, there was an experienced, trained and stable staff team to support people and people and their representatives spoke highly about most of them. 77% of care staff had achieved NVQ Level 2 and/or 3 in Care. People were treated as individuals. They were assisted to make choices and decisions in their daily life and were able to keep in touch with family, friends and representatives. People had meals that were of a good quality. 75% of kitchen staff had achieved NVQ Level 2 in catering and hospitality and the home currently holds a very good rating from Rotherham Environmental Health. People were able to express their concerns and had access to a complaints procedure. Their complaints were recorded and investigated appropriately. The living environment was clean, with living areas well maintained and a comfortable environment for people to live and enjoy. What has improved since the last inspection? People`s dignity was much better observed with the majority of people wearing appropriate footwear, including stockings and slippers. There had been some progress in the management of medicines, in that people did have supplies of their medication and it was being stored at the correct temperature, but further improvements were needed in respect of storage, maintaining accurate records and making sure people received their medication at the right time. What the care home could do better: There were aspects of management and administration of the home that were lacking, which had resulted in not meeting the legislative requirements and National Minimum Standards of a registered care home to ensure the health, safety and welfare of people and staff. These are identified below. People must have a full needs assessment undertaken before they move into the home, that is dated and signed, so that the service have full and accurate information about them and know their needs can be met. People must receive the care as identified in their care plan, so that their health and personal care needs are met. The plan must include what action to take and when to manage behaviour that challenges. There must also be a plan where moving and handling needs have been identified and a plan for what action to take to minimise people`s confusion. So that people`s dignity is not compromised continence wear should not be on display and others should be protected from seeing their undergarments when they are being hoisted. Staff could engage people better in meaningful activities of daily living and social activities to improve their quality of life. The dining experience could be improved, by staff engaging in a better way to assist people with their meals, people who have liquidised meals having them better presented and providing pictures of the meal for people, if they cannot understand the written format. Staff need to be more aware of situations that may need to be considered for referral to safeguarding, so that people are protected from distress. This includes having satisfactory records to support this. Consistently follow a robust recruitment procedure, so that people living at the service can be assured they are sufficiently protected. Induction training should be more thorough and include training to Skills for Care specifications within the first six weeks of appointment. Make sure the certificate of insurance is sufficient in order to cover the amount of money held by people at the home, so that they are sufficiently protected. Their comments to the draft report told us this had been immediately increased. Key inspection report Care homes for older people Name: Address: The Beeches (Wath) The Beeches Residential Care Home Carr Road Wath-Upon-Dearne ROTHERHAM South Yorkshire S63 7AA     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: Jayne White     Date: 0 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 34 Information about the care home Name of care home: Address: The Beeches (Wath) The Beeches Residential Care Home Carr Road Wath-Upon-Dearne ROTHERHAM South Yorkshire S63 7AA 01709761803 01709761804 paulhulbert@ntlworld.com www.winniecare.co.uk Winnie Care (Highgrove) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Amanda Hawkes Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of users who can be accommodated is 44 The registered person may provide the following category of service: Care Home: Care Home only - 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 catergory - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Beeches is registered to provide residential care and accommodation for up to forty four older people with dementia. Care Homes for Older People Page 4 of 34 Over 65 0 22 22 0 1 7 0 3 2 0 0 9 Brief description of the care home The home is purpose built and is located on the main road in the town of Wath Upon Dearne area of Rotherham. There are community amenities close by which includes local shops. The Beeches is operated by Winnie Care (Highgrove Ltd), who also own other homes in the surrounding area. The home is built on two floors with access via a passenger lift or stairs and accommodation is provided in two units, each with its own lounge and dining room. Both units have twenty two single bedrooms, each with en-suite facilities. Two of the single bedrooms have adjoining doors in order to provide two double rooms if they are requested. There are assisted baths, which helps people with physical limitations to bathe more easily. There are also showers on each unit. There is a small, enclosed garden with a patio area for people to use and car parking spaces are provided at the side of the building. Fees range from £366 to £411 per week as at 16 February 2010. Additional charges are made for hairdressing, chiropody and taxis. For further information contact the home. Information about the service was available for people and their families in the Statement of Purpose and the Service User Guide. This information was available in the reception area including the last published inspection report dated 17 March 2009. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection. We visited without giving the service any notice from 09:15 until 17:15. Amanda Hawkes, manager was present during the visit. In normal circumstances, the service are provided with the opportunity to complete an Annual Quality Assrance Assessment (AQAA). This gives the service the opportunity to tell us what they do well, how they have improved in the last twelve months and their future plans for improvement. The Beeches were not given this opportunity, because of administrative errors within the CQC. During the report the term the we is used. This refers to the inspector, acting on behalf of the Commission. We inspected various aspects of the service during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care Care Homes for Older People Page 6 of 34 practices and inspecting a sample of policies and procedures. Surveys regarding the quality of the care and support provided were sent to: Ten people who used the service. None were returned (0 ). Ten to representatives (this could be either a relative or a friend). None were returned (0 ). Six to staff. Four were returned (67 ). Six to social and health care professionals. One was returned (17 ) We have used this information to inform our judgements about the service. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as was one of their representatives. The care provided for four people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations but only when it is considered that the people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The manager was provided with initial feedback from the inspection during and at the end of the visit. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: There were aspects of management and administration of the home that were lacking, which had resulted in not meeting the legislative requirements and National Minimum Standards of a registered care home to ensure the health, safety and welfare of people and staff. These are identified below. People must have a full needs assessment undertaken before they move into the home, that is dated and signed, so that the service have full and accurate information about them and know their needs can be met. People must receive the care as identified in their care plan, so that their health and personal care needs are met. The plan must include what action to take and when to manage behaviour that challenges. There must also be a plan where moving and handling needs have been identified and a plan for what action to take to minimise peoples confusion. So that peoples dignity is not compromised continence wear should not be on display Care Homes for Older People Page 8 of 34 and others should be protected from seeing their undergarments when they are being hoisted. Staff could engage people better in meaningful activities of daily living and social activities to improve their quality of life. The dining experience could be improved, by staff engaging in a better way to assist people with their meals, people who have liquidised meals having them better presented and providing pictures of the meal for people, if they cannot understand the written format. Staff need to be more aware of situations that may need to be considered for referral to safeguarding, so that people are protected from distress. This includes having satisfactory records to support this. Consistently follow a robust recruitment procedure, so that people living at the service can be assured they are sufficiently protected. Induction training should be more thorough and include training to Skills for Care specifications within the first six weeks of appointment. Make sure the certificate of insurance is sufficient in order to cover the amount of money held by people at the home, so that they are sufficiently protected. Their comments to the draft report told us this had been immediately increased. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not always individually assessed prior to moving into the home to ensure their needs could be met. Evidence: Generally, when we spoke to people they said their family had taken the responsibility for making the decision about the choice of home. Although one person we spoke with said they didnt like living alone, which is why they came to live at The Beeches. They said, Id heard about this place. Another person told us they came in because of the pot on their leg. They couldnt remember if someone had visited before they were admitted. A discussion with a representative told us they had visited various homes. Finally, they went to Sandygate, their sister home, but it was full and they were told about this home. They said, we werent expecting too much, so were quite impressed. Care Homes for Older People Page 11 of 34 Evidence: The health and social care survey that was returned stated the care service assessment arrangements sometimes ensured that accurate information was gathered and the right service was planned for people. When we spoke to the manager she told us she carried out the admission assessment or her deputies did if shes not there. We looked at three files to determine that the home did carry out admission assessments before people were admitted, to make sure they could meet their needs. There was a needs assessment on one of the files, but the information detail was brief and did not provide sufficient information about the persons needs. It was not signed or dated. There was no admission assessment for the other two people, other than an A4 sheet of paper with scant and unexplained information on it. For example, one of the peoples files had information recorded that there were safeguarding issues. This information had not been formalised as part of the assessment process. The service told us this was because they had responded to the sudden closure of another care home and worked with social services to facilitate the residents safe transfer. A social care assessment had been received from the placing authority for all of the people, but after they had been admitted. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally had their health and personal care needs met, although improvements in medication procedures and privacy and dignity are needed to make sure individuals complete needs are understood and met. Evidence: The health and social care survey that was returned stated peoples social and health care needs were sometimes properly monitored, reviewed and met. The service usually sought advice and acted on it to meet peoples social and health care needs to improve their wellbeing. The service usually respected peoples privacy and dignity. In what the service did well they commented, patients always look clean. In what they could do better they commented, needs more communication between staff so they know what is going off with all patients. This supports what we found in peoples care plans. Three staff surveys stated they were always given up to date information about the needs of the people they cared for, one survey said that they sometimes were given information. Two stated the ways information is shared about people they cared for Care Homes for Older People Page 13 of 34 Evidence: always worked well, two stated that it usually did. We looked at four care plans to look at how peoples needs were met. There was a significant amount of conflicting information, which meant the reviews of the care plans were being ineffective and didnt confirm to us peoples health and personal care needs were being met. For example, on the assessment that had been carried out, it stated the person was allergic to penicillin, but this information had not been transferred to other documentation. When we spoke to the manager they were not aware of this. This meant the person was at risk of receiving the wrong medication. A social care assessment had been received for the person from Rotherham that stated they needed a high protein diet, with milky drinks. This conflicted with what was in the care plan as this stated well balanced normal diet. How the persons nutritional needs had been identified was unable to be ascertained, because a nutritional risk assessment had not been carried out. The manager told us the previous manager had said this wasnt necessary. The persons multi disciplinary visits told us glasses had been delivered, but we saw the person wasnt wearing them. The care plan did not tell staff that she needed to wear them, to make sure she could see properly. A representative we spoke to said, theyre very good. Theres always little niggles, but nobodys perfect. An example they gave was their representative not wearing their glasses. In another file, a pressure area plan that had been in place from 31.01.09 stated to change the persons position every 2 hours and elevate their foot in bed. We saw their leg was not elevated when they were in bed. This was a concern, as a previous referral had been made by the tissue viability nurse about pressure area care for the person, although the manager stated no further action needed to be taken by the home. There was no plan in place for the person about how staff should deal with behaviour that challenges, where this was necessary. A behaviour chart was completed, that stated medication was to be given at times when they were aggressive, but no information about what determined aggressive. This meant staff themselves decided at what point it was necessary to give medication to change the behaviour, which could lead to inconsistency and misuse of the medication. In another file, there was conflicting information about contact information for family, which itself could lead to conflict and the person not being sufficiently protected if the correct relatives are not contacted. In a different file, the initial information identified moving and handling problems and Care Homes for Older People Page 14 of 34 Evidence: confusion. There was no care plan in place for these areas. Daily records were brief and provided little information about the care that people had received that day. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. On the whole, people were well dressed and their hair and nails were clean. This indicated respect and dignity by staff when caring for people. However, the communication between two members of staff regarding medication (see below) did not demonstrate they always promoted peoples welfare before their own. We saw when we looked round the building that incontinence wear was displayed in toilets and peoples rooms. This does not promote the dignity of the person. Also, when people were hoisted and were wearing skirts, their dignity was sometimes compromised because you could see their undergarments. There were procedures in place for ordering, receiving, administering and disposing of medicines, which the service state were rewritten and revised in March 2009. The service had obtained The Royal Pharmaceutical Society of Great Britain and CQC professional advice documents on handling medicines in social care, to identify current best practice. Despite this we saw staff administering medication that demonstrated they did not fully understand what was expected of them when handling and giving medication. For example, they signed the medication administration record before they administered the medication to people. On three occasions we saw people either refusing all or part of their medication. This meant the medication administration record gave the impression the medication had been administered, when in fact it hadnt. No drinks were offered to people when they were taking their medication. The staff member recorded refused medication for someone, when actually they were asleep. Our observations of medication told us everyone was not receiving their medication at the right time. In the dementia unit lunch time medication was still being administered at three oclock. The staff member administering medication asked another carer who was writing in care plans if she could finish off because she needed to leave. The carer refused saying she was busy writing up the daily reports and needed to be away at 17:00 herself. This did not show staff were prioritising meeting peoples needs, before their own. Care Homes for Older People Page 15 of 34 Evidence: There were other examples of poor recording in the medication administration record. There was sometimes no explanantion why people hadnt received their medication that day or the medication administration record had been signed, but people hadnt been given their medication. We saw that a locked medication trolley had been left out and not put back in a safe place. The member of staff put this away immediately they were told about it. Downstairs, medication pots had been left drying on a radiator, in the main corridor where people had access to them. This does not promote good infection control measures. When we spoke to a staff member who had responsibility for medication. They told us they had done no formal training on the safe handling of medicines. They described their training as following a deputy. They said the deputy had got to be satisfied they were competent and pass about a 20 item list. We saw that this was in place, but that the date of reviews were not always carried out. This was not proving effective, because of what we observed whilst watching the administration of medication. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people were assisted to make choices and decisions about their daily life, but social activities and the dining experience could be improved. Evidence: When we spoke to people about their lifestyle and the choices they could make they said, its not bad here, meals not bad, staff not bad, couldnt be better looked after - hand and foot - everythings done and Ive a comfy bed. One told us they liked their own company and watching TV. We spoke to a representative who told us people do what they want. They described how there was bingo, baking, painting, entertainment, Lost Chord and other singers. They said this suited their representative because they loved music. The health and social care survey that was returned stated the service sometimes support people to live the life they choose. In what they did well they commented, they are fed well. We sat in the lounges to observe what took place. In the lounge for people with dementia, people just sat. There were two staff in the lounge, but they werent Care Homes for Older People Page 17 of 34 Evidence: interacting with them. Six of the nine people sitting in there were asleep. The home employed an activity co-ordinator who had responsibility for developing leisure activities within the home along with outings and outside entertainment. We spoke with them. They told us a weekly activity schedule was in place that included bingo, sing a longs, video, reminiscence, crafts, chats, media events, dominoes, baking, hairdressing, armchair exercise, skittles, manicures and nail brushing. They said they used to do a lot more outdoor activities, but now they dont have a minibus to respond to this quickly, it has to be much better planned. They told us they had received some training on providing stimulation for people and what might be appropriate. However, despite the activity co-ordinator being in post we saw that she had only delivered those duties for half of their time since August 09. This was because there had been 74 days without any specific activities. This was due to the staff being deployed to do care duties. We saw that this had affected the social stimulation that people received. We looked at the social care plans in peoples files and saw their social interests that had been identified in their care plan were not always delivered, although they had received some stimulation. One person had taken part in eight activities, three of these being individual activities. For another person no individual attention had been provided. We spoke to a representative who told us they could visit the home at any reasonable time. They said they were made to feel welcome. The service told us 75 of kitchen staff had achieved NVQ Level 2 in catering and hospitality and the home currently holds a very good rating from Rotherham Environmental Health. We had dinner with people on the dementia unit. The manager had acted on recommendations from the last inspection, because of it being disorganised and chaotic. They had placed tables against walls, to help people move or be moved more safely. However, the dining area was still very busy with staff, with lots of staff being present, but many watching as opposed to taking part in the mealtime occasion. This meant the atmosphere was not conducive for people to enjoy their meal. We saw that meals served to people who needed their meals liquidising were served in a bowl, with all the contents mushed together. This was not pleasant to look at and Care Homes for Older People Page 18 of 34 Evidence: may not encourage people to eat and taste the different tastes. The cook came into feedback and said it wasnt served like that, the carers must mix it together. The menu was written on the menu board to let people know what this was, but for people who had lost their reading ability, there were no pictures to aid the process. The cook again showed how they had pictures of meals, but this was in the entrance hall and not where it might be needed. The service stated this would be taken to the unit as and when required. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service could access the complaints procedure and the manager ensured complaints were recorded and investigated appropriately. Policies and procedures were in place to keep people safe, but this hadnt always protected people. Evidence: The health and social care survey stated the service sometimes responds appropriately if they have raised concerns. All the staff surveys stated they knew what to do if someone had concerns about the home. The home had a good complaints procedure. We looked at the complaint record. It told us two complaints had been made about the level of care. Both had been by the same complainant. A further complaint had been received this week about the attitude of a member of staff. This was being investigated by the area manager. In May 2009 we received an anonymous complaint. There was no evidence to support this, through our findings during the inspection. The home had safeguarding adults procedures in place and discussions with the manager told us she operated to those standards. She stated staff had received training to recognise the signs of abuse with Rotherham Council. She stated it was Care Homes for Older People Page 20 of 34 Evidence: mandatory training. When we spoke to staff it told us they were aware of what to do if an allegation of abuse was made. However, there was information in a care plan of situations where language had caused distress to someone. Staff need to be more aware of situations that may need to be considered for referral to safeguarding, so that people are protected from distress. This includes having satisfactory records to support this. We discussed this with the area manager who stated she would monitor the situation. When we spoke to a representative they said theyd not seen anything out of order, otherwise theyd report it. They said, Amanda would be the first point of call and confident she would deal with it. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a clean and comfortable environment for people to live and enjoy. Evidence: When we spoke to people they said they were satisfied with their living environment. They said their bedrooms were comfortable and some people had personalised these with pieces of their own furniture and possessions. We saw this when we looked round the environment. People told us there was hot water and they were kept nice and warm. The health and social care survey commented in what they do well: the home always looks clean. A comment in the staff surveys was the home is kept exceptionally clean. When we looked round the home the physical environment was appropriate to the needs of people that lived there, although the environment could be developed to help orientate people with dementia better. Also, the layout in the communal lounges was quite institutional with chairs arranged around the edges. Aids and equipment were provided to meet peoples needs. The home was pleasant with sufficient living space. It was well lit, clean and tidy and smelt fresh. Care Homes for Older People Page 22 of 34 Evidence: We spoke with the manager about infection control measures. She told us staff were currently undertaking a distant learning course. To control the spread of infection she said staff hand wash and have gloves and aprons available. They have different coloured gloves for different tasks. She stated a soiled waste contract was in place. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had the skills and knowledge to fulfill their roles within the home, but induction training needed improving. Recruitment procedures were not always followed, which didnt ensure the safety and protection of people. Evidence: Two of the staff surveys that were returned stated there were always enough staff to meet the needs of people, two that there usually were. We looked at the staff rota for December 09 and January 10. In the main we saw that 4 care staff were on duty for the morning and afternoon shift. Discussions with manager told us three of them worked downstairs on the dementia unit and one upstairs. A deputy worked on some shifts, plus the manager was available Monday to Friday during the day. Discussions with the manager told us staffing levels were determined by the residential staffing forum. However, our observations showed that although this was met, peoples needs were not always met in a timely way, for example, receiving their medication at the right time. Also, having one member of staff in the unit upstairs for most of the time on their own can present risks, by people being left unsupervised. Currently, the staff group are not assigned to specific units and we discussed that having a designated staff group for each unit would be good practice. The health and social care survey that was returned told us the manager and staff Care Homes for Older People Page 24 of 34 Evidence: sometimes have the right skills and experience to support peoples social and health care needs. They commented in what they do well, most staff are helpful when we visit the home and some are eager to learn. For what they could do better they commented, more training for all staff, so that they (people) get continuity of care. The service told us: The service achieved the externally verified Investors in People recognition. 77 of care staff have achieved NVQ Level 2 and/or 3 in Care. Four of the staff surveys that were returned stated their employer carried out checks, such as a CRB and references before they started work. Three stated their induction covered everything they needed to know to do the job when they started very well, one that it mostly did. Three stated they were given training relevant to their role, that helped them understand and meet the needs of people and kept them up to date with new ways of working, one didnt answer. Two stated the training gave them enough knowledge about health care and medication, one said it didnt and one didnt answer. One commented, all the seniors and carers do a good job and look after the service users really well. When we spoke to staff they described their induction. They said they were shown the ropes, followed a senior and werent left alone. They couldnt confirm their induction included Skills for Care specifications. When we looked at their files and spoke with the manager, it was apparent they didnt complete an induction to Skills for Care specification. There didnt seem to be a consistent approach to what staff covered on their induction. In the two files we looked at one received fire and food training, another just fire. There was no assessment regarding the level of induction training required because of prior learning, but prior training and qualifications had not always been verified. Two staff had commenced employment since our last inspection. One file demonstrated a thorough recruitment process, with a satisfactory ISA first (independent safeguarding authority check), to say they were suitable to work with vulnerable people, a full employment history and two written references. The other file, didnt demonstrate a thorough recruitment process with the person commencing work before satisfactory checks were in place. After their induction staff told us they had on-going training. This included NVQ 2 in Care and moving on to NVQ Level 3, dementia and palliative care. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home was not consistently in the best interests of people due to the health, safety and welfare of people and staff not always being met. Evidence: The manager was registered with the Commission on 3 December 2009. She was deputy from 3 November 2003 and started as acting manager on 7 April 2009. She said she was awarded her Registered Manager Award in February 2009. The manager was supported by two deputy managers. Comments in the staff surveys that were returned included in what the home did well, on the whole, I feel it is a well run home, we have a very good food hygiene certificate, carers have up to date training, the home seems to be filling up with the new manager. She is doing a really good job. In what they could do better they commented, improve communication skills and admonish people who persistently phone in sick. When we spoke with staff during the visit they said, well run home Care Homes for Older People Page 26 of 34 Evidence: and happy to work here. There was evidence that the home actively sought the views of people who use the service as the home conducted their own quality assurance audit, seeking stakeholders views of the service. The last one, undertaken in October 2009 and the published results showed overall good satisfaction levels. The area manager undertakes quality assurance audits (Regulation 26 reports) on behalf of the organisation. She reports on the outcomes for people who use the service, which includes speaking to people that live at the home and looking at records. People who use the service were able to manage their own finances, although some preferred to the manager to assist. Records were looked at and they were an accurate reflection of the accounts held on peoples behalf. However, the insurance policy did not cover all monies held for people. This needs addressing by the company to make sure peoples finances are sufficiently safeguarded. Their comments to the draft report told us this had been immediately increased. During our visit we saw that wheelchairs were clean, which promoted the control of infection. Wheelchairs had footplates, which meant people could be moved safely. This meant audits that had been put in place for this since the last inspection were working. A health and social care professional survey that was returned commented in what they could do better, more equipment needed i.e. hoist. When we looked round the building fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. The staff training matrix told us people had received an annual update for fire training. When we looked at the training matrix it told us a programme of staff training was in place to promote and protect the health, safety and welfare of people and staff. It included moving and handling, first aid and food hygiene. We noted infection control was not included, but the manager stated staff were currently undertaking a distance learning course for this. Food hygiene training needed renewing for a number of staff as they all dealt with food at meal times. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 People must have a full needs assessment before they move into the home. So that the service have full and accurate information about them and know their needs can be met. 10/03/2010 2 7 15 Where there is information that a person has confusion a plan of care as to how this need must be met must be in place. So that staff know what action to take to minimise peoples confusion. 10/03/2010 3 7 15 Where there is information that identifies a person has moving and handling needs a plan of care as to how this must be met must be in place. So that staff know how to move people safely. 10/03/2010 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 7 15 Where people have 10/03/2010 behaviour that challenges, what action to take to manage that behaviour and when to take the action must be included in the plan of care for the person. So that consistent action is taken by staff to manage the behaviour. 5 7 15 People must receive the care 10/03/2010 as identified in their care plan. So that their health and personal care needs are met. 6 9 18 Before staff are given the responsibility for dealing with medication they must receive training in the safe handling of medicines. So that they receive training appropriate to the work they perform, so that people are cared for safely. 11/05/2010 7 9 13 Medication trolleys when not in use must be stored safely. So that medication is stored safely. 10/03/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 9 13 Medication administration 10/03/2010 records must be signed after people have been administered their medication. So that an accurate record of what medication they have taken can be maintained. 9 9 13 People must receive their 10/03/2010 medication at the right time. To maintain their health. 10 18 13 Staff must report to adult safeguarding information, which indicates degrading treatment, through deliberate intent. So that people are protected from harm. 11/02/2010 11 29 19 Staff must not commence 15/03/2010 work until a satisfactory CRB has been issued, two written references have been obtained and there is a written explanation of any gaps in employment. So that people are protected by the homes recruitment procedures. 12 30 18 Staff must receive structured induction training, which meets Skills for Care specifications. 15/05/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that they receive training appropriate to the work they perform, so that they are trained and competent to do their jobs. 13 35 25 The certificate of insurance 15/03/2010 must be sufficient in order to cover the amount of money held by people at the home. So that their financial interests are sufficiently safeguarded. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The admission assessment should be signed and dated by the person undertaking the assessment, so that people know who has completed the assessment. A nutritional risk assessment should be completed, to demonstrate how peoples nutritional needs have been determined. People should have a drink of water available when they take their medication, to aid the process and clean their mouth from medication that leaves an unpleasant taste. Medication pots should not be left to dry on radiators, in corridor areas, so that the control of infection and cleanliness is maintained. Peoples allergies to medication should be recorded on the medication administration record, so they are not at risk of receiving the wrong medication. Continence wear should not be displayed as this compromises peoples dignity. Page 32 of 34 2 8 3 9 4 9 5 9 6 10 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 10 12 When people are hoisted, there undergarments should not be on show, so their digntiy is not compromised. The provision of transport would enable a more spontaneous approach to activities at a time when people want and the weather is appropriate. Staff should engage more with people to improve their day to day quality of life. The activity co-ordinators time should be protected, so that they have time to engage people in activities of their choice to maintain a good quality of life for them. Picture menus should be available on the unit, so that people, if they have not retained the ability to read, can see what the meal would look like. Staff should be encouraged to sit and eat a meal with people, if possible, at tables where people need assistance and encouragement to eat. This could help make it a better dining experience for people. Where people need their meals liquidising, each item of food should be served individually, so that it looks attractive to people and they can taste the different types of food. Review staffing levels, so that peoples needs are met, by having sufficient staff on duty. 9 10 12 12 11 15 12 15 13 15 14 27 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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