Care Home: The Poplars Nursing Home

Similar services:

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

What the care home does well The process for admission to the Poplars is very thorough. The Home conduct a preadmission assessment which gives them information about the person`s needs and abilities. People are then given information about the Home and are encouraged to visit and stay for the day, this helps them decide whether The Poplars would be a suitable place for them to live. Details about the Home are made available in large print to help those with visual difficulties access important information. The owner of this Home also has a number of other Homes which allows support and information sharing regarding best practice with other staff and managers. Visiting times are open and flexible and maintaining contact with family and friends is encouraged. There is a variety of communal areas available for people to spend their day. The Home was warm, clean and had a welcoming, homely atmosphere and people seemed to be at ease in their surroundings. Care plans contained detailed information that would enable staff to meet people`s needs in a way in which they prefer. People are encouraged to be involved in the care planning process. Records showing care provided were up to date and in good order. They also demonstrate that people have access to external professionals such as GP, dentist, optician and chiropodist as is necessary. People are offered a range of activities on a regular basis. This helps people occupy their time with activities which they find meaningful and enjoyable. People commented "there is always something to do", "I enjoy the entertainment put on". People commented that they liked the food, menus show that a variety of foods are served and fresh seasonal vegetables used. Staff on duty appeared to have a good relationship with those under their care, they were attentive to people`s needs and also spent time chatting to people. The atmosphere at the Home was relaxed and friendly. The staff group at the Poplars is stable, there is a very low turnover of staff and a majority of staff have been employed by the Home for a considerable time. Training is encouraged at this Home and all but one care staff members have attained the NVQ qualification at level 2. The remaining staff member is working towards this qualification currently. Some staff are enrolled on the NVQ level 3 course to further update their skills and knowledge. The manager has set up systems and practices to ensure the smooth running of the Home. Time is set aside to ensure that those visitors to the Home who are unable to visit during the day are able to meet the manager. The manager is motivated and dedicated to meeting the needs of those under her care. People made the following comments on our survey, "it is well organised and appears to have struck the right balance between resident and organisational needs", "I have only been at the Home a very short time but I like it very much". "I am very happy". What has improved since the last inspection? This Home was rated as "excellent" at the last inspection of the Home, and the following issues for action identified have since been addressed. Abuse training has been undertaken by staff. Medication issues such as date labelling of medication bottles once opened, referring people to the GP if they do not wish to take their prescribed inhalers, medications not being counted and checked when received on the premises, amounts recorded on medication administration records when a variable dose is prescribed, security of the medication room needs to be reviewed, have all been addressed. The Home`s AQAA records that the following improvements have been made at the Home within the last twelve months - produced a booklet "what to do after an expected death" which gives information to relatives. A therapist visits every fortnight to give hand massages, particularly to those people who are in bed and cannot join in other activities, we have developed a business continuity plan so that in the event of an emergency, care will be disrupted as little as possible and staff will now where to go for help. The AQAA also records that all corridors have been re-carpeted, three new flat screen TVs have been bought for communal areas (small and large lounge and conservatory, new arm chairs have been purchased for the lounge and dining chairs for the dining room, three new leather recliner chairs have been purchased for the comfort of certain residents and their needs. We have added a further two en-suites and purchased equipment to enhance nursing care. What the care home could do better: Issues for action identified at this inspection include the commencement of medication audits on a regular basis. These should be undertaken to ensure that medication received, administered and balance remaining is correct and records are up to date. Staff should no longer administer medications for constipation (for everyone who has been prescribed this medication) from only one bottle. These medications are individually prescribed and should be administered from individually labelled bottles. The flooring leading from the large lounge to conservatory is uneven and requires relevelling. Key inspection report Care homes for older people Name: Address: The Poplars Nursing Home 66 South Road Smethwick West Midlands B67 7BP     The quality rating for this care home is:   three star excellent 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: Deborah Shelton     Date: 1 5 0 3 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 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: The Poplars Nursing Home 66 South Road Smethwick West Midlands B67 7BP 01215580962 01215584128 pop@carltoncaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr A Billingham Name of registered manager (if applicable) Ms Gillian Williams Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One service user identified in the variation report dated 29.12.04 may be accommodated at the home in the category of PD. This will remain until such time that the service users placement is terminated or until the home can continue to meet the service users needs. Date of last inspection Brief description of the care home The Poplars Nursing Home is a substantially extended property, currently registered for 35 older people requiring nursing care. The premises were originally two Edwardian houses, which were converted to provide the accommodation. The home is located close to Smethwick town centre and within easy access to local amenities including public transport. The property stands in its own grounds, with ample car parking at the front, with two tiered gardens to the rear. Care Homes for Older People Page 4 of 36 Over 65 35 0 Brief description of the care home The communal accommodation is provided on the ground floor and comprises: One large and a small lounge, dining room, conservatory and quiet room. Laundry and kitchen areas are on the ground floor with a maintenance area in the basement. The service users bedrooms are located on the ground and first floors. There are 25 single rooms, of which 9 are en-suite, and 5 shared bedrooms, of which one is en-suite. There are a number of communal bathrooms with assisted bathing and showering facilities over two floors. Toilets are situated throughout the home and close to communal areas. The first floor can be accessed by a passenger lift, located off the foyer. The present scale of charges are GBP 477 - GBP 524 per week. However these may be subject to an annual increase. Additional charges are made for items such as newspapers, toiletries, haidressing and chiropody. Care Homes for Older People Page 5 of 36 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: three star excellent 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 visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Monday 15 March 2010. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Assessment (AQAA) was completed by the manager to a good standard. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During the Care Homes for Older People Page 6 of 36 key inspection we used a range of methods to gather evidence about how well the service meets the needs of those people who use it. Time was spent sitting with people in the dining room watching to see how they were cared for and how they spent their day. Ten surveys were sent out before this inspection and face to face discussions were held with people who use the service, staff and the management team. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Two people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 36 What the care home does well: The process for admission to the Poplars is very thorough. The Home conduct a preadmission assessment which gives them information about the persons needs and abilities. People are then given information about the Home and are encouraged to visit and stay for the day, this helps them decide whether The Poplars would be a suitable place for them to live. Details about the Home are made available in large print to help those with visual difficulties access important information. The owner of this Home also has a number of other Homes which allows support and information sharing regarding best practice with other staff and managers. Visiting times are open and flexible and maintaining contact with family and friends is encouraged. There is a variety of communal areas available for people to spend their day. The Home was warm, clean and had a welcoming, homely atmosphere and people seemed to be at ease in their surroundings. Care plans contained detailed information that would enable staff to meet peoples needs in a way in which they prefer. People are encouraged to be involved in the care planning process. Records showing care provided were up to date and in good order. They also demonstrate that people have access to external professionals such as GP, dentist, optician and chiropodist as is necessary. People are offered a range of activities on a regular basis. This helps people occupy their time with activities which they find meaningful and enjoyable. People commented there is always something to do, I enjoy the entertainment put on. People commented that they liked the food, menus show that a variety of foods are served and fresh seasonal vegetables used. Staff on duty appeared to have a good relationship with those under their care, they were attentive to peoples needs and also spent time chatting to people. The atmosphere at the Home was relaxed and friendly. The staff group at the Poplars is stable, there is a very low turnover of staff and a majority of staff have been employed by the Home for a considerable time. Training is encouraged at this Home and all but one care staff members have attained the NVQ qualification at level 2. The remaining staff member is working towards this qualification currently. Some staff are enrolled on the NVQ level 3 course to further update their skills and knowledge. The manager has set up systems and practices to ensure the smooth running of the Home. Time is set aside to ensure that those visitors to the Home who are unable to visit during the day are able to meet the manager. The manager is motivated and dedicated to meeting the needs of those under her care. Care Homes for Older People Page 8 of 36 People made the following comments on our survey, it is well organised and appears to have struck the right balance between resident and organisational needs, I have only been at the Home a very short time but I like it very much. I am very happy. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 36 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 10 of 36 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 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessment processes help to ensure that the Home have the information needed to be able to meet peoples needs. People have the opportunity to visit the Home before they move in, to access the facilities available. Evidence: The care file of the last person to move into the Home was seen and a discussion was held with the manager to find out the processes for admission. We were told that a vacancy form is completed when an initial enquiry is received. This form records basic information about the persons medical history, where they currently live and other contact details. A completed vacancy enquiry form was seen on file. The manager or deputy then complete an assessment of peoples needs before they decide that they can move in to The Poplars. This assessment takes place at the persons current address. People are given information about the Home in the form of a brochure, the Homes Statement of Purpose and Service Users Guide. These Care Homes for Older People Page 12 of 36 Evidence: documents are available in large print to help those with sight difficulties. People are told where they can get a copy of the last inspection report. This helps people make an informed choice as to whether they think The Poplars is the right Home for them. People are invited to come to visit for a few hours, stay for lunch and have a look around. They are introduced to staff and other people who live at the Home. There is a copy of the last inspection report for them to look at. This helps people decide whether they would like to move in to the Home and also helps staff find out further information about peoples needs, mobility, likes and dislikes. A trial visit form is completed following the persons visit to the Home. A completed form was seen on file which recorded that the person had enjoyed a lunchtime meal, looked at and agreed their bedroom and decided on a moving in date. This is evidence that people are able to have a look around the Home before they decide to move in. When both parties have agreed that The Poplars would be able to meet their needs and they wish to move in, a letter is sent confirming the placement. This was evident on the files reviewed. There was a copy of a social services care plan on file. This shows that social workers had been involved in the admission process. The social worker care plans gave staff detailed information about the needs of the individual. The pre-admission assessment paperwork completed by the Home was also on file. This is used to find out about an individuals needs and abilities and helps the Home decide whether they would be able to care for the person. The assessment covered a range of areas such as personal safety and risk, personal hygiene and appearance, eating and drinking, mobilising and foot care amongst other things. The form has space for comments about the individuals needs. Detailed information was recorded under each heading about equipment to be used, personal preferences and the number of staff required to provide assistance. Information obtained during the pre-admission process is then used to form initial plans of care upon admission to the Home. A discussion was held with a relative and a person who had recently come to the live at The Poplars regarding their experience of moving in to the Home. We were told that staff on duty come and introduce themselves to you when you first come in to the Home, this makes you feel at ease. They make sure you settle in well. Both people said that they had wanted this Home as their first choice as it had a good reputation. Two care files were seen on this occasion, both included copies of agreements that Care Homes for Older People Page 13 of 36 Evidence: detailed the terms and conditions of residency at this Home. One had been signed and one had not. We were told that the person was still undertaking their trial stay and the contract would be signed as soon as this had finished. Before this inspection we sent out ten surveys asking for peoples views about the Poplars, we received nine completed surveys. Eight of the people who replied confirmed that they had received enough information to help them decide if this Home was the right place for them before they moved in. One person replied that they didnt know. All of the people who responded to our survey said that they had been given written information about the Homes terms and conditions (contract). Care Homes for Older People Page 14 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health needs are met so ensuring their well being. Medication systems are well managed and records were up to date Evidence: As part of the inspection process we decided to case track two people. This involved looking at their care files and other information such as medication records and information about meals and activities amongst other things. We were told that everyone who lives at this Home has a care file. The two care files seen contained an assessment undertaken before admission to the Home. This shows that the Home have found out about the person to ensure that they would be able to meet their needs. Records show that people had a look around the Home before they made a decision to move in. A plan of care is developed when the person comes to live at The Poplars. Care plans are developed with input from the person and/or their relative and are signed to demonstrate agreement to the care to be provided. Those seen had been regularly Care Homes for Older People Page 15 of 36 Evidence: reviewed and updated as necessary. People who live at the Home and their relatives are invited, by letter, to attend the review of their care plan. This enables them to have a say in their ongoing care and express any preferences in the way in which it is to be provided. Care plans seen recorded very detailed information about various aspects of daily life, for example, communication, eating and drinking, personal safety and risk, continence, mobility, personal hygiene and any health related issues. They record details of any equipment needed to provide care, what the person is able to do independently and what support is required from staff in order to meet their needs. Personal preferences and any routines are recorded such as times for going to bed, preferences regarding showers or baths and activities. Risk assessments are also completed. These identify the risk to the person and record the action that staff should take to reduce the risk. Risk assessments were seen regarding falling, developing a pressure area, use of bed rails and nutritional risk. Consent for the use of bed rails had also been signed as applicable. A moving and handling assessment was completed which recorded whether the person is able to mobilise unaided, any equipment needed to help the person mobilise, and the number of staff to provide any assistance. Dependency assessments are completed and can be used to monitor changes in peoples health and may highlight the need for an increase/decrease in the number of staff on duty. Those people who are cared for in bed have records in their rooms which staff sign to show that they have completed half hourly checks, completed two hourly turns if necessary and any assistance regarding feeding, continence or personal care. Daily records are made three times per day and staff write a comment about the persons general health and wellbeing during the day and night. Those seen were up to date. Five people who responded to our survey said that they always receive the care and support they need with the other four people saying that they usually receive the care and support they need. Eight people said that the Home always makes sure that they get the medical care that they need and one person replied usually to this question. Records and discussions with people who live at the Home demonstrate that people have access to external professionals such as dentists, opticians, chiropodists and GPs as necessary to ensure health and wellbeing is monitored. Some people had their feet Care Homes for Older People Page 16 of 36 Evidence: checked by the Chiropodist on the day of inspection. People spoken to were happy with the care given and spoke positively about life at The Poplars. The medication and records of the people being case tracked were reviewed and found to be up to date and accurate. Medication Administration Records (MAR) detail medication taken and any times when medication is not taken with codes recorded. Medication was appropriately stored in a lockable trolley, cupboards and a fridge. Controlled drugs and the record book were checked and found to be correct. The practice of sharing prescribed medication for constipation and keeping unopened medication in the storage cupboard should be stopped. The manager was made aware of this following a visit from the Primary Care Trust and has purchased an additional medication trolley to ensure that individually named medication can be taken out and used at medication rounds. This trolley is not yet in use as security measures need to be put in place first. The temperature of the medication fridge and the medication room were taken and recorded on a daily basis. Records show that medication is stored within the required limits. Key custody practices were satisfactory and safe. Copies of prescriptions were available and we were told they are used to check against medication received into the Home to ensure that the correct medication is received. We were told that only nursing staff give out medication; this includes the manager and deputy. Medication audits are not undertaken by staff at the Home. There were no audits to demonstrate that the manager has checked to ensure that records are being completed correctly and that the balance of stock is the same as records held. However, the pharmacy who provide medication to the Home complete regular audits of storage and recording keeping and provide a report to the Home. The Primary Care Trust have recently undertaken an audit and made some recommendations for improvements which the manager was in the process of addressing. Currently the Home do not have a homely remedies policy but we were told that there are no homely remedies on the premises and nobody wishes to take any. The manager was advised to develop a policy as any new people who come to live at the Home may wish to take homely remedies occasionally. Staff appeared to have a good relationship with those under their care, during the Care Homes for Older People Page 17 of 36 Evidence: afternoon staff were seen spending time sitting and chatting with people in the lounge. People were dressed accordingly for the time of year and had their hair brushed and were neat and tidy. Care Homes for Older People Page 18 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to keep in contact with family and friends and visiting is flexible. Activities take place to ensure that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at the Home and enhances their quality of life. Meals are wholesome and nutritious. Evidence: Two people living at The Poplars were asked for their views of the activities. One person said that they did not wish to join in any activities and another person said we play bingo on Tuesday and Thursday and they do word searches sometimes but I prefer to come to my room to do them. People who responded to our satisfaction survey commented entertainment is good, we have two ladies come, one to play bingo and another to play games and darts, I enjoy the entertainment put on, Our survey also identified that five people thought that the Home always arranges activities that they can take part in if they want, three thought that this usually happens and one person said that this only sometimes happens. Care Homes for Older People Page 19 of 36 Evidence: We were told that an activity co-ordinator is employed for six hours per week. This person is responsible for organising and completing activities for two hours on a Tuesday, Wednesday and Thursday. As well as the activities organised by the Home, external entertainers visit on a weekly basis. On a Monday a singer/organist visits and on a Wednesday there is exercise to music. In addition to this the hairdresser visits each Tuesday and church services are held regularly. Details of the activities arranged for the month are on display in the dining room, this informs people of up and coming events, and enables them to decide whether or not they wish to join in. Activity records are kept. Details are recorded for everyone showing the activity they have joined in with the date. Activity records were not available for one of the people being case tracked as this person had stated a preference not to join in activities. Records for the other person showed that hand massages had taken place but there were no records for 2010. This person is being nursed in bed. We were told that an aromatherapist visits once per fortnight to see four people who are cared for in bed and details of these visits are noted in daily records. The activity records for two other people were chosen at random to review. One persons records showed that they had joined in fifteen activities so far in 2010 and seventeen activities for another person. Activities such as bingo, books from the library, jigsaw, easter activities, valentines activities, made calender were recorded. During the afternoon some people had their feet attended to by the visiting chiropodist and we were told that the remaining people would be seen by the chiropodist the following day. The manager said that they aim to provide up to four outings during the summer months and last year people enjoyed pub lunches as well as other trips out. We were told, and records demonstrated, that residents meetings are held on a fairly regular basis. Discussions are held regarding activities provided. Satisfaction surveys are also used to obtain peoples opinions of the activities. The manager said that people also have the opportunity to discuss the activities whilst they are doing them. This enables activities to be provided suitable to the wants and needs of the people who live at the Poplars. The atmosphere at The Poplars was relaxed and friendly. People can choose where to spend their day and a number of communal areas are available. There is a large lounge with adjoining dining room and conservatory. A smaller lounge, which we were Care Homes for Older People Page 20 of 36 Evidence: told is mainly used by the gentlemen who like to watch sport on the television, and a quiet lounge. Everyone seen in the lounge and conservatory appeared to be at ease in their surroundings and were watching television or chatting amongst each other and with staff. Peoples religious needs are met by visiting clergymen. A catholic service is held in the Home on a weekly basis and a Church of England service once per month. We were told that religious tapes are played for one person but currently there are no other religious or cultural needs to be met at the Home. The Home has an open visiting policy, people can visit at any time. Any people who visit later at night are asked to make night staff aware when they enter and leave the building. Night staff are then able to secure the premises after the last visitor has left. Relationships with friends and family are encouraged and they are invited to attend special occasions and events within the Home. The Homes phone is taken to peoples bedrooms as required to enable them to speak to their loved ones. Two visitors spoken to said that staff make them feel welcome and keep them updated regarding the health and wellbeing of their relatives. Meals are eaten in the dining room or in peoples bedrooms. At lunchtime people were sitting in the dining room eating their meal. Staff were seen offering discreet assistance to people. Meals are brought to dining tables on a staggered time basis as a large proportion of people require assistance with feeding. This helps to ensure that meals do not go cold whilst they wait for help. Everyone appeared to be enjoying their food which was nicely presented and smelt appetising. We were told that there is a choice of meals on a daily basis. At breakfast there is a choice of cereal, cooked breakfast and toast . This was demonstrated as people were seen eating both cereal and cooked breakfast on the morning of our inspection. There is also a choice of two main meals at lunchtime, the choice on the day of inspection was liver and onions with vegetables or bolognese pasta bake with vegetables with a soup starter. We were told that there is no choice of pudding but if people did not like the pudding on offer they could have ice cream or yogurt. A snack type smaller meal is provided for the evening meal plus a desert. Cake or sandwiches are also available at 7pm with an evening drink. We spoke to people about the meals served and were told that the food is good, there is actually too much of it, I have put on weight since I have been here, the food is generally good but you cant expect to like all of it all of the time, it is mostly good but it depends who is cooking on the day. Care Homes for Older People Page 21 of 36 Evidence: People who responded to our survey undertaken before the inspection said the food is always nice, the food is good, I enjoy the food, as far as meals are concerned there is always a range of choice and meals are usually well prepared. Six people responded that they always like the meals at the Home and three people said that they usually like the meals. Meals came out from the kitchen plated with gravy already added. One person was asked if they were asked if they wanted gravy on their meals, they said no, but they didnt mind that because they really liked gravy any way. People appeared to be enjoying their meals and there was little waste. The manager said that they use fresh seasonal vegetables wherever possible and try to have three different vegetables with every meal. The Home has again been awarded the Gold Standard Award for food and food hygiene and has achieved the five for life healthy eating award since the last inspection. Care Homes for Older People Page 22 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that their concerns and complaints will be taken seriously and resolved. They can be confident that they are safe and that training and processes ensure that staff are aware and trained to deal with adult protection. Evidence: A discussion was held with the manager and people living at the Home regarding complaints. People spoken to were aware of how to make a complaint. One person said I know how to complain, I have spoken to the manager before and she has sorted things out for me, I dont like to complain, this is your lot and you have to get on with it, another person said I have no worries or complaints, everything is OK, I would speak to someone if I did. A visitor said the manager is approachable, it is good to be able to work with the Home and get things sorted the way you want them. A complaints folder is used to log any complaints. Two complaints have been received by the Home since the last inspection. The manager was aware of the complaints and the action taken to address any issues raised. Details of the investigation and outcome were recorded for one complaint. We were told how the other complaint had been resolved and the information given suggested that the complaint had been addressed to the satisfaction of all involved. We were told that the manager works one weekend every month and makes herself available on the last Wednesday of every month between 6pm - 8pm so that those Care Homes for Older People Page 23 of 36 Evidence: relatives who work and are unable to visit in the day are able to speak to her if they wish. This helps to ensure that those who wish to raise concerns face to face with the manager have the opportunity to do so. The manager said that she prefers to work with people to ensure that complaints do not arise. People are encouraged to speak to her to work together for the best interests of the residents. The complaint procedure is available to those that live at the Home in the Service Users Guide. This is available in large print so that people with poor eyesight have access to this information. Records show that staff have done training about the protection of vulnerable adults. This training is important as it guides staff of the action to take if they suspect abuse. The manager and deputy have undertaken training regarding the mental capacity act and deprivation of liberty. Other staff have received updates regarding this during staff meetings. The Annual Quality Assurance Assessment (AQAA) reports that policies and procedures regarding adult protection and whistle blowing are available at the Home. These policies were not reviewed at this inspection. We were told that they are reviewed on an annual basis. Staff appeared to have a good relationship with those under their care. Moving and handling practices seen protect people from the risk of harm. People spoke positively about their relationship with staff. Care Homes for Older People Page 24 of 36 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 benefit from living in a safe, clean and well maintained environment. Evidence: The Poplars is located in a residential area of Smethwick and is close to shops, churches, public houses and transport links. The Home is made up to two converted Edwardian Houses which have been adapted to meet the needs of those that live there. Bedrooms are located on the ground and first floor of the Home. There are five shared bedrooms, one of which has ensuite facilities and twenty five single bedrooms, nine of which are ensuite. Communal areas consist of a large lounge with adjoining conservatory and dining area, a smaller lounge and a separate quiet lounge. Communal areas were bright and clean and no unpleasant odours were noted. The flooring between the main lounge and conservatory, and the area leading into the conservatory were uneven and could present a trip hazard. The manager said that this flooring is going to be re-levelled. People seemed at ease in the lounges which had a homely and welcoming feel. Seating was arranged in social groupings allowing people to chat or watch the television as they wish. All communal areas seen were comfortably furnished. There are four bathrooms in the Home, three of which are wet rooms providing Care Homes for Older People Page 25 of 36 Evidence: showering facilities and one bathroom. Wet rooms have been tiled and new flooring laid since the last inspection. All bathrooms and toilets had liquid soap and disposable hand towels which when used should help reduce the risk of spread of infection. It was noted at the last inspection that wallpaper and paintwork in landings and corridors was damaged. New carpets have since been laid and a majority of corridors have been re-decorated. Five bedrooms were seen, all were clean and no unpleasant odours were noted. Some of the rooms had been personalised with pictures, ornaments and soft toys. Four people were seen in their bedrooms. Two people were mostly confined to their bed due to ill health and the other people prefer to spend some time in their bedrooms. All those who were able to speak to us said that they were happy with their bedrooms, everyone seen appeared to be comfortable. People who responded to our survey commented my room is kept tidy and clean, I do have a very nice bedroom where I can keep my belongings and books, domestic staff keep the premises clean and usually odour free. They also play their part in interacting with residents rather than ignoring them. A discussion was held regarding laundry. It was noted that laundry assistants are employed to wash and iron laundry. This is brought into laundry room in laundry skips, soiled laundry is transported in red washable bags. This helps to reduce the amount of times staff have to handle soiled laundry and therefore reduce the risk of spread of infection. All equipment in the laundry was in good working order, currently there are two washing machines and two tumble dryers. We were told that the handyman cleans and changes filters on the tumble dryers every week. Staff were seen wearing disposable gloves and aprons throughout the day of inspection. We were told that these were available in the laundry for use by laundry staff. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be assured that they are cared for by staff who are suitably employed and trained to carry out their job. Evidence: The number of staff on duty each day was discussed with the manager. It was noted that staffing could be increased or decreased depending upon the dependency levels of people living at the Home. There were thirty three people living at The Poplars on the day of inspection. The number of staff on duty on the day of inspection was in accordance with the number recorded on the duty rota. We were told that the Home do not use agency staff, however they had needed to cover one shift last week due to a high number of staff on sick leave currently. Staff on duty each day are as follows:AM - 7 carers and 1 nurse PM - 5 carers and 1 nurse. Nights - 3 carers and 1 nurse. Discussions with people living at The Poplars and duty rotas indicated that staffing Care Homes for Older People Page 27 of 36 Evidence: levels were adequate for the needs of the people living there. People said that they had their needs met but said staff were always very busy but helped you out whenever you needed it, staff are attentive but always busy, they try their hardest and are always kind and friendly, they try hard but they are a bit short staffed at the moment because there are a few off sick, that means that staff are always rushing but it is not their fault it is because they are so busy, they still come when they are called and they help you out. Three of the people who responded to our survey said that staff are always available when you need them, whilst six people said that they are usually available. People also commented I like the staff they are friendly, staff very friendly, you can always have a laugh and a joke with the staff, the staff work well together and because most of them are experienced, they are receptive to day to day issues involving residents. In addition to care and nursing staff, ancillary staff work the following shifts:Catering staff (7 days per week) Laundry 7am - 1pm (7 days per week) Domestic 8am - 2.30pm (7 days per week) Maintenance 9.30am - 3.30pm (5 days per week) Admin 9 - 1pm (5 days per week) Gardener (1 day per week) The number of ancillary staff appeared to be sufficient for the size of the Home and the number of people cared for. All areas of the Home were clean, people commented the laundry is taken away and brought back the same or next day. Clothing does not go missing, there is never a smell here like you get in some other places, it is always fresh and clean. The manager and the information received on the AQAA evidenced that there has been little staff turnover at the Home. The manager said that two staff have been employed since the last inspection. These peoples personnel files were reviewed. It was noted that a Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB)check has been completed with the vettings and barrings scheme. Two written Care Homes for Older People Page 28 of 36 Evidence: references were available as well as proof of identity and application form and interview notes. One of these staff members was previously employed at another Home owned by the company. All personnel information for this staff member was transferred from the other Home. A member of nursing staff is in the process of being employed and is due to start working at the Home shortly as soon as the CRB has been returned. People spoken to were complimentary about staff and said I have seen the Dr since I moved in here and everything is OK. The people who work here are nice, staff are kind and helpful. A visitor said I am happy with the care XX is receiving and I do not feel worried that care needs will be missed. I like to take an active part in XX care I have discussed the care plan with staff and made written comments which are kept in the care file. Training was discussed with the manager and we were told that everyone is encouraged to undertake training and they have been pleased with the number of care staff who have undertaken a National Vocational Qualification (NVQ). We were told and the AQAA records that all care staff apart from one have obtained an NVQ in care at level 2. Fourteen of these care staff have enrolled on the NVQ level 3 training course which is due to start in the near future. Providing staff with appropriate training helps to ensure that the workforce has the knowledge and skills to meet the needs of those under their care. A training matrix records mandatory training undertaken. This shows that all care staff have undertaken training regarding fire safety, manual handling, health and safety, food hygiene, first aid, abuse, dementia, infection control and palliative care. Individual training plans are also for each person these record mandatory and other training undertaken. All staff undertake an in-house induction to the company upon employment. Those care staff who do not already have an NVQ also undertake induction training in line with skills for care requirements. Records for one of the newly employed staff members were seen to demonstrate this. The other staff enrolled on the NVQ course upon commencing her employment and therefore did not undertake this induction training. Care Homes for Older People Page 29 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that the running of this service involved all those who are involved and considers what is best for those who live there. Evidence: Management arrangements for the Home were discussed and we were told that the current manager has worked at the Home for approximately eight years. The manager has the relevant qualifications and experience to be in charge of a Care Home. This includes an NVQ level four in management and a level one nursing qualification. Since the last inspection the manager has updated her knowledge and undertaken training courses regarding infection control at work, safeguarding vulnerable adults and deprivation of liberty safeguarding. The manager was knowledgeable about the needs of those people living at the Home and is motivated to provide care suited to individual needs. The manager takes a hands on approach working amongst staff completing nursing and care duties and is also responsible for completion of management paperwork. Care Homes for Older People Page 30 of 36 Evidence: A nurse deputy and administration staff are in place to support the manager and lines of accountability in the Home are clear and understood by all. The manager is on call when not on duty but said that staff are sufficiently experienced to handle most emergency situations and she is rarely contacted when off duty. People spoken to said that the manager is very supportive, listens to everything that is being said and is helpful, if you speak to the manager she sorts things out. Through discussion, the manager demonstrated an awareness of areas that needed to be addressed and was keen to ensure that peoples needs are met in a way in which they prefer. The manager was open to suggestions for improvements and evidence was available to demonstrate that actions had been taken once suggestions made. The manager returned the AQAA to us within the required timescale. The AQAA recorded information about the Home which was consistent with our findings. Quality assurance systems in place are well developed and monthly audits are undertaken. These audits include accidents, pressure ulcers, comments, service users leaving the Home, violent incidents, staff training, dependency levels, a kitchen audit, infection control, enteral feeding and an after death analysis. A selection of the current national minimum standards are reviewed each month. Records showed that the manager reviews each area and places a tick on paperwork to demonstrate that it has been reviewed. Comments are also recorded if any action needs to be taken. Sandwell Primary Care Trust recently completed an audit of care plans and medication prescribed to residents. The administering pharmacy complete six monthly review of medication systems and practices within the Home and leave a report for the manager to review. As well as audits there are regular meetings (approximately every three months) held with the people living in the Home. These are used to find out peoples views of the Home and to update them regarding any changes that are due to take place. The last meeting was held in October 2009 and a meeting is planned for March 2010. Staff meetings are held every two months. Staff are also updated regarding changes, working practices are discussed as well as other staffing issues. The minutes of the last staff meeting were reviewed. Annual satisfaction surveys are sent out to people living in the Home, their relatives and to staff. The surveys and results for 2009 were seen and generally showed Care Homes for Older People Page 31 of 36 Evidence: positive feedback. Survey results were summarised, however where people had responded negatively there was no details of any action taken or explanation as to why people had responded this way. We were told that an action plan will be developed which records details of any action taken and this action plan will be kept with the satisfaction surveys. A newsletter is produced and distributed to residents and relatives four times per year. A copy is also available in reception for people to read if they wish. The newsletter updates people of forthcoming events and things that have happened. The Home holds small amounts of personal money for people. We looked at the records for one of the people being case tracked to see how this was managed. The Homes does not hold personal allowance monies for all people. Monthly invoices are sent out to some family members to pay for items such as hairdressing, chiropody etc. Records checked were in good order and up to date and balanced with funds available. The manager and administrator audit records every few months to ensure records are correct and up to date. A selection of health and safety and maintenance records were checked. These records are kept to demonstrate that equipment is safe and in good working order. An external company undertake routine servicing and maintenance of fire systems. These records were up to date. In addition to this the Home undertake checks of fire alarm and emergency lighting. Lifts and hoists are serviced on a regular basis and were all in good working order. Records also show that the sluice disinfector was last serviced in January 2010 and a gas safety check undertaken in January 2010. The Landlords Gas Safety Certificate had not been issued as work needs to be completed on the boiler in the staff room. This would entail closing of the heating system to half of the Home. It has therefore been decided not to undertake this work until the weather warms up and the heating system is not relied upon. We were told that the system is still safe to use. An external company has undertaken a check on water storage and a Legionella water disinfection certificate dated June 2009 was available on file. All records seen were in good order and up to date. Care Homes for Older People Page 32 of 36 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 33 of 36 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 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 9 A homely remedies policy should be developed in agreement with the GP to ensure that those people who wish to take homely remedies are able to do so. Audits of medication received, administered and available should be undertaken on a regular basis to ensure that correct medication administration and recording pactices are being undertaken and errors identified. The practice of sharing prescribed medication for constipation and keeping unopened medication in the storage cupboard should be stopped. People should only take medication from the bottle which has been prescribed and labelled for them. People should be given the option of having gravy and sauces added to their meals before they are served to them. The flooring in between the main lounge and conservatory should be made good so that it is not uneven under foot. Works should be undertaken on the boiler in the staff room. This will ensure that all gas services and appliances in the Home have been checked and found to be safe and a Page 34 of 36 2 9 3 9 4 15 5 6 19 38 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 Landlords Gas Safety Certificate should be obtained. Care Homes for Older People Page 35 of 36 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. Care Homes for Older People Page 36 of 36 - 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!