Care Home: The Bush

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well People can be assured following the pre admission assessment that their needs will be met by the service. Each person admitted to the service will have a care plan developed from the assessment and based on individuals needs. The service has access to other professional agencies to gather information. This practice ensures that peoples health needs can be fully met. We observed during the day the interaction between the staff and the response of the people using the service which was positive and relaxed. The medication process since the previous key inspection has been reviewed and measures have been put into place to protect the people receiving prescribed medication. The accommodation continues to be refurbished by the provider; there is an ongoing programme to ensure that people live in a comfortable and well maintained environment. Recruitment procedures were robust, with the required checks made prior to employment. This ensures that people using the service are protected from unsuitable staff working at the home. Staff records identified that staff training has improved since the last key inspection. Staff training records identified that staff receive training to recognise and respond to any suspected abuse. The manager monitors the health and safety aspects of the service with audits. The manager is supernumerary to the rota, although she is available to provide hands on care. This practice allows the manager to have a daily oversight of the service, paperwork, records and supervision. What has improved since the last inspection? The service had addressed the three requirements made on the last key inspection, the recommendations made had been reviewed actioned and were on going.The BushDS0000064824.V378104.R01.S.docVersion 5.2The service continues to update and refurbish the environment. All the bedrooms had been refitted with new furniture, bed linen, and carpets. Decoration is on going. The care plans continue to be developed, with individuals needs being recognised and addressed. People told us that; ‘The ‘girls’ are good’, ‘I have been here sometime and like it’, ‘I am settling in well’, ‘They help me to get ready’. The service had developed a key worker system to commence in November 2009. The service had received good reports from the audits conducted by the Primary Care Trust, and local pharmacist. The majority of the details in the Statement of Purpose had been updated to reflect the commissions’ details. The staffing levels have been increased for the night time. This will continue to be reviewed with occupancy of the service increasing. What the care home could do better: Information in the Statement of Purpose and Service Users Guide should contain the current fees for the service. This was a recommendation made in the last key inspection which had not been addressed. The manager was able to provide the information from a list displayed in the office. It was recommended that written protocols were developed for any as required medication and placed onto individuals file and Medical Administration Records (MAR). The care plans could be developed further to ensure that the risk assessments clearly identified the action to take to protect the individual. Staff responsible need to ensure that every effort is made to control odours identified during the inspection. The communal bathing/toilet areas could be less clinical in their decoration.The BushDS0000064824.V378104.R01.S.doc Version 5.2 Staff should be given guidelines of the hazard of leaving solutions/shampoos in the bathrooms. This practice puts people using the service at risk. The bedroom doors identified to the manager require urgent attention to ensure they are effective in the event of a fire. It is important that the service ensures that all the wardrobes are secured to the walls, thus protecting the individual using the room. Key inspection report CARE HOMES FOR OLDER PEOPLE The Bush 37 Bush Street Darlaston West Midlands WS10 8LE Lead Inspector Wendy Grainger Key Unannounced Inspection 07:30 14th October 2009 DS0000064824.V378104.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 2 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 The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bush Address 37 Bush Street Darlaston West Midlands WS10 8LE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 526 5914 0121 526 5914 Rajan Odedra Usha Odedra Manager post vacant Care Home 44 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (44) of places The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 44 2. Dementia (DE) 12 The maximum number of service users to be accommodated is 44. Date of last inspection 4th March 2009 Brief Description of the Service: The Bush is registered to provide personal care for 44 people over the age of 65 years and is jointly owned by Mr Rajan Odedra and Mrs Usha Odedra, trading as ‘Bush Residential’. Currently the home does not have a registered manager in post. The property is a large, extended, detached building, once used as a Public House, from which the Home takes its name. Situated within walking distance of Darlaston Town Centre it is within easy reach of public transport and local amenities. The accommodation comprises of 30 single and 7 double occupancy bedrooms over two storeys, with a shaft lift to facilitate access between floors. There are no en-suite facilities. Communal facilities include a large lounge, a large dining area, a small lounge, a small dining room and a conservatory. A garden area at the rear of the property is accessible to people using the service. A car parking area is available at the front of the building. Information about the home and the provision of the service are available in the statement of purpose and service user guide, both documents can be The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 5 obtained from the home. The statement of purpose or service user guide does not include information on the current level of fees for the service. The reader may wish to obtain current information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that the people using the service experience good quality outcomes. This key inspection was unannounced. This means that the service was unaware that we would be visiting. The inspection took place on the 15th October 2009 between 7:30am and 16:00pm. The inspection process concentrates on how well the service operates against the key national minimum standards and outcomes for people using the service based on their experiences and chosen lifestyle. Prior to the inspection taking place we looked at all the information available to us this included: The Annual Quality Assurance Assessment (AQAA) document, ‘notifications’. The AQAA provides us with information on how well the service thinks it is performing. The AQAA used was within the current nine month timescale for use. During the inspection we used a range of methods to gather information and evidence on how well the people using the service were supported. We conducted the inspection with the care manager, deputy and staff. We observed the interaction between the staff and the people using the service and their responses. We looked a the premises, medication system, care plans, staff files, risk assessments, menus and food served, records required to be completed, audits, and the training matrix. We chose three care plans including one for a person on respite care to case track, this means we read and gather evidence from the records, risk assessments and health care needs to enable us to make a judgement on how well these people’s needs are being met. We spoke to two visitors during the inspection and obtained their comments about the service, which will be incorporated into the report. The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 7 What the service does well: People can be assured following the pre admission assessment that their needs will be met by the service. Each person admitted to the service will have a care plan developed from the assessment and based on individuals needs. The service has access to other professional agencies to gather information. This practice ensures that peoples health needs can be fully met. We observed during the day the interaction between the staff and the response of the people using the service which was positive and relaxed. The medication process since the previous key inspection has been reviewed and measures have been put into place to protect the people receiving prescribed medication. The accommodation continues to be refurbished by the provider; there is an ongoing programme to ensure that people live in a comfortable and well maintained environment. Recruitment procedures were robust, with the required checks made prior to employment. This ensures that people using the service are protected from unsuitable staff working at the home. Staff records identified that staff training has improved since the last key inspection. Staff training records identified that staff receive training to recognise and respond to any suspected abuse. The manager monitors the health and safety aspects of the service with audits. The manager is supernumerary to the rota, although she is available to provide hands on care. This practice allows the manager to have a daily oversight of the service, paperwork, records and supervision. What has improved since the last inspection? The service had addressed the three requirements made on the last key inspection, the recommendations made had been reviewed actioned and were on going. The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 8 The service continues to update and refurbish the environment. All the bedrooms had been refitted with new furniture, bed linen, and carpets. Decoration is on going. The care plans continue to be developed, with individuals needs being recognised and addressed. People told us that; ‘The ‘girls’ are good’, ‘I have been here sometime and like it’, ‘I am settling in well’, ‘They help me to get ready’. The service had developed a key worker system to commence in November 2009. The service had received good reports from the audits conducted by the Primary Care Trust, and local pharmacist. The majority of the details in the Statement of Purpose had been updated to reflect the commissions’ details. The staffing levels have been increased for the night time. This will continue to be reviewed with occupancy of the service increasing. What they could do better: Information in the Statement of Purpose and Service Users Guide should contain the current fees for the service. This was a recommendation made in the last key inspection which had not been addressed. The manager was able to provide the information from a list displayed in the office. It was recommended that written protocols were developed for any as required medication and placed onto individuals file and Medical Administration Records (MAR). The care plans could be developed further to ensure that the risk assessments clearly identified the action to take to protect the individual. Staff responsible need to ensure that every effort is made to control odours identified during the inspection. The communal bathing/toilet areas could be less clinical in their decoration. The Bush DS0000064824.V378104.R01.S.doc Version 5.2 Page 9 Staff should be given guidelines of the hazard of leaving solutions/shampoos in the bathrooms. This practice puts people using the service at risk. The bedroom doors identified to the manager require urgent attention to ensure they are effective in the event of a fire. It is important that the service ensures that all the wardrobes are secured to the walls, thus protecting the individual using the room. 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. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people who choose to move into The Bush received information about what is provided additional information would enable them to make a more informed choice as to its suitability for them. No person would be admitted without a full assessment of their needs. EVIDENCE: Information n the AQAA told us that people can obtain information about the service, needs will be assessed to ensure that The Bush is suitable to meet their requirements. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 12 People who choose to live at The Bush can be assured that their health and personal needs can be met. Details of what the service can offer are contained in the services Statement of Purpose and Service Users Guide, with the exception of the current fees. This omission was discussed with the manager who assured us that this will be rectified. No person would move into the service without a full assessment of their needs. This would be conducted by the manager or deputy. The service has a tool used to gather information to assess the individual person’s needs. This practice also includes any person choosing to experience respite care. The manager told us that she was going to further develop this form. This will ensure that all aspects of care can be assessed. An invitation is offered to people who may wish to move into the service to spend a day at the service with others so that they can experience what it is like. Also a trial period of settling in is in place which gives people a longer time to decide if the service is right for them. We looked at the file for one of the people on respite care, the person had been admitted following an assessment of needs and her personal circumstances. The file contained the assessment, details of family contact, personal needs, mobility, and risk assessment. We spoke to the person who told us that ‘she was settling in well and was looking forward to having her hair done’. The service does not provide intermediate care. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements and care plans were in place which give people confidence that their health and personal needs to be met. The medication system ensures that people receive their prescribed medication safely and correctly. EVIDENCE: Information in the AQAA told us that each person had a care plan based on their individual personal and health needs. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 14 We looked at two care plans for people that had been at the service for sometime. Each plan had a signed agreement confirming information in the AQAA that the people had been involved in producing their care plan. We evidenced in the care plans that staff observed and recorded changes for one person. Risk assessments were current, we discussed with the manager that they need further development to ensure the staff were aware of the measures to take to prevent the risk and if the measure in place was achievable. The manager has plans to develop the care plans ensuring that, while they are corporate to the company they will be individualised for The Bush covering all the elements of care including emotional needs, to ensure the plans are user friendly for the staff and the people using the service. The manager agreed that each care plan should be an ‘active’ outcome for individuals and will ensure that the reviews incorporate this practice. From observation made during the day of the inspection people living at the service were relaxed and comfortable with the staff supporting them. Staff demonstrated their awareness of individuals needs, people using the service were seen to interact with the staff and respond to them positively. People were seen to walk around the service freely, they came to the office and were involved in the inspection. We spoke to visitors who told us that, ‘I feel welcome when I come’, ‘the staff are always cheerful and helpful’, ‘Very pleased with everything the staff are kind and understanding’. Comments recorded by visiting professionals included: ‘Very cheerful and busy home, people look happy and supported by all the staff (impressed). Records we evidenced and people using the service confirmed information in the AQAA, in that they had full access to other professional agencies including specialist consultants. We observed the medication system, storage and administration. Since the previous key inspection the medication system has been reviewed. The service was recently inspected by the Primary Care Trust and the local pharmacist the reports provided evidenced a ‘good’ result. Medication was only administered by the trained senior care staff. We advised the person on duty that to further protect the people the medical administration record (MAR) should identify where any creams were to be applied. Evidence from the training matrix told us that all the staff had undertaken accredited safe handling of medication training. The service has the required storage facilities for medication maintained at the correct temperature. The controlled medication cupboard was due to be delivered within the week. One person chooses to remain in her room; we discussed with the manager a method of administering her medication without decanting it into an open pot. This will protect the staff and ensure that medication is administered correctly from the blister pack. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 15 The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15. People using the 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 people using the service are given choices in respect of their daily routines and lifestyle. They can be assured that their preferred lifestyle will be supported by the staff. Meals presented on the day offered choice and a balanced diet. EVIDENCE: Information in the AQAA told us that the service had a daily activity programme. We observed the programme displayed on the notice board and near the kitchen hatch. The hairdresser visited to day, the results were very good and the people spoken with were satisfied. This is a weekly event and available to all the people. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 17 Other events included a monthly entertainer who was booked for the Christmas party. Two of the people told us they were going into the community to the local shops; this was a regular practice and part of their chosen lifestyle. This further confirmed that people have a choice of lifestyle. We spoke to two sets of visitors during the inspection each person was satisfied with the service offered to their relative/friend. ‘I find the staff very helpful and they always have a smile’, ‘My mother has settled in so well, better than we thought she would’. We had access to the monthly menus, at the time of this inspection the home was advertising for permanent catering staff. People were seen to be offered a choice for breakfast and lunch. We observed the catering person asking each individual their choice from the menu, giving them an option. The manager is developing an alternative pictorial format enabling people with less ability to make a positive choice for meals. The current menus were in the process of being reviewed for the winter period. We spoke to people after breakfast and lunch each one was satisfied with the meal they had chosen. ‘I always enjoy my meals’, ‘The meat was tender’, and I can have a full cooked breakfast if I want, I only have to ask’. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18. People using the 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 can be assured their concerns will be taken seriously and addressed. Processes were in place to protect the people who use the service from abuse. EVIDENCE: We evidenced in the Statement of Purpose, service user guide and information displayed within the service that people are enabled to raise a concern to the management. We spoke to people who use the service and visitors who informed us that they were aware of the complaints procedure if they had a concern or complaint. One visitor told us ‘If I have mentioned anything to the manager it’s been dealt with’. Some of the staff spoken with were aware of the action to take if they were concerned about the conduct of other staff in respect of the welfare and safe guarding of the people using the service. They told us that they would not The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 19 hesitate to implement the process not withstanding the person’s status at the service. Staff training records identified that since the last key inspection, the majority of the staff had received Protection of Vulnerable Adult training, this training remains on-going for a small number of the staff. Staff spoken with confirmed that this had taken place earlier in the year. There had been no referrals to the safe guarding team or to us since the last key inspection. The service had received no complaints in respect of the service or care provided. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were provided with a warm and comfortable environment. Minimal areas of improvement would further enhance the comfort for people living at the service. EVIDENCE: The service is located near to a local public house and shopping centre in Darlaston. Two people who use the service accessed the town centre during the inspection. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 21 The service is sited on a quiet road. Parking is located at the front of service. During our inspection with the exception of one person who chose to remain in her room we saw that people were relaxing in the large communal area and dining room. Each area had a large television or choice of music. One person preferred to assist the staff with light dusting and wiping tables, she told us that she ‘liked to do this or she gets bored’. We looked at parts of the premises which included some bedrooms. We identified in two areas odours, we were satisfied that the manager and housekeeping staff were taking the appropriate steps to counteract these odours. We saw that three bedroom doors were not closing effectively; one had hinges that were loose. These doors puts people living at the service at risk in the event of a fire. Staff need to be aware of the hazards of shampoos, talc, bath/shower items are left in the communal bathrooms as this practice puts people who use the service at risk of infection spread or illness if the solutions were swallowed. We identified in a minimal of two bedrooms wardrobes that were not secured to the wall. This is a hazard and puts people using the service at risk as the wardrobes could fall on people and cause an injury. Bedrooms were seen to contain many personal possessions of the individual. Within the last twelve months we were told the provider had purchased new bedroom furniture including bed linen new towels and carpets. Decorating had been undertaken and was on going. The garden had been landscaped and the sensory garden completed. The bathrooms and toilers are somewhat clinical in design and would benefit from an inclusion of some alternative decoration. The provider had plans to enhance the corridors and other areas in the next twelve months with more decorating. People spoken with told us that they liked their room, ‘I like to keep it tidy for the girls’, ‘My room is upstairs but I can go in the lift’, ‘I am pleased with my mother’s room’. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the robust recruitment process. Staff were trained and competent to safe guard people using the service. Staffing levels were appropriate to meet the current needs of the people using the service. EVIDENCE: The service has a weekly rota, which identifies the number of people on duty at any one time. At the time of this inspection the manager was advertising for housekeeping and catering staff. Since the last key inspection the night staffing levels had been increased to meet the needs of the present people. We were assured by the provider and manager that this will further increase when the service numbers increased to full occupancy. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 23 We saw staff during the inspection interacting with all the people. People’s responses were different, but each was relaxed and comfortable with the interaction. Staff had knowledge and training to meet the people’s needs. Since the previous key inspection there had been a commitment to staff training ensuring they were competent in their role. This had included First Aid, Fire, Moving and Handling, Food and Hygiene, Adult Protection and Challenging Behaviour; three people had undertaken the Mental Capacity /Depravation of Liberty; more is planned for other staff. Information in the AQAA told us that the majority of staff had the National Vocational Qualification (NVQ) levels two and three. This was confirmed from information in the staff records and training matrix. We asked the manager to select two staff files at random these contained, application forms, a Criminal Records Bureau (CRB) medical, references, and where required a work permit. We saw an induction booklet that was being worked through. That this was being worked through was confirmed by the person who was completing it later in the inspection. Four staff signed for a palliative care course during the inspection, this will be undertaken as distance learning over a number of weeks. We spoke to staff who told us that they felt well supported by the management who ‘operates an open door for us to talk to them if we want’, ‘We work as a team to look after the people here’. Staff confirmed information contained in the AQAA, supervision takes place on a regular basis. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38. People using the 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 service is operated and managed effectively in the best interest of the people using the service. Positive working practices are demonstrated by the staff who are clear about their roles and responsibilities. EVIDENCE: The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 25 At the time of this inspection The Bush does not have a registered care manager. The prospective care manager was the deputy manager and had accepted the manager’s post since the last key inspection. Her skills include her undertaking the Registered Managers Award. She has achieved an NVQ level 3 in care and management; she continues to update her knowledge with mandatory and other training relevant to her role. An application to register her as the person responsible is in the process of being made. The enhanced CRB has been received; she is waiting for her medical examination to be completed. We discussed the need to follow up the application as soon as possible. This will further stabilise the service. She came to the service during her annual leave to support the staff and to assist us with the inspection and provide information about the future plans for the service. We confirmed the information in the AQAA informing us of the certificates current for the servicing of equipment, lift, GAS, policies and procedures. The manager had in place audits for health and safety, planned supervision dates, which was confirmed by the staff during discussions. We checked monies of two of the people using the service that were held for safekeeping in the safe by the management. We identified that records and monies were accurate. Transactions were recorded for individual withdrawals and deposits. Audits were evidenced to be carried out on a regular basis. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations .For the service to ensure that the terms and weekly fees are included in the Statement of Purpose and Service Users Guide To further develop the risk assessments identifying any action to take to protect the individuals. For the service to develop protocols for the administration of any PRN medication. To monitor effectively the control of any odours identified at the inspection For the service to ensure the safety of the people by returning any toiletries to the person bedroom or ensure that it is locked away in a cupboard. DS0000064824.V378104.R01.S.doc Version 5.3 Page 28 2. 3. 4. 5. OP7 OP9 OP26 OP38 The Bush The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. The Bush DS0000064824.V378104.R01.S.doc Version 5.3 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!