Care Home: Tudor House

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What the care home does well From the surveys we received from people living in the service and their representatives are happy with the care they receive. They said - `staff are very helpful` `yes its very good and I am happy here, I am quite satisfied.` We observed that people were talked to kindly and respectfully. Information is collected about people before they come into the home and that helps people get the care they need. Health and social care professionals told us `They follow our instructions and inform us if concerned.` `They report any problems that require District Nurse input` and ` they will adapt their routines to meet service user needs.` Medication was administered correctly and this helps to keep people well. People were observed to moved from place to place well with staff ensuring that people understood how they could help themselves and what was about to happen. People were happy with the meals provided they said `eating and drinking they do well.` The food options provided for the main meal on the day of the inspection were tasty and well prepared. The building is generally bright, fresh and airy, warm and comfortable and this makes a pleasant place for people to live. Almost all of the care staff have a National Vocational Qualification level 2 in care (NVQ2)which is the recognised qualification and almost half have achieved an NVQ3. Staff are recruited appropriately, few staff leave and this helps to ensure people have a safe and consistent service. What has improved since the last inspection? Since the last key inspection in September 2007 the service has acted on all of the previous requirements. Care plans are now in place for people`s medication and this helps to ensure that people get the medication as prescribed. Most staff have had recent fire and safeguarding training and this helps to keep people safe. A further two rooms now have an en suite facility. Carpets have been replaced in the reception area and on the stairs. The home has a better sign to show where it is located on Monyhull Hall Road. What the care home could do better: Recording with the home needed improvement. People`s care files we looked at showed that information was gained from social care professionals and not transferred on to the home`s own forms. This can make it difficult for staff to find information quickly. Two people did not have care plans about how the home was going to care for them despite being in the home some time. One person had important information about their care on a loose piece of paper and the relevant care plan hadn`t been updated and these shortfalls can mean that people do not get the care they need or in the way that they wish. Some people, whose care files we looked at, were losing weight and there were no plans in place to rectify this. The provision of food needs to be looked at to ensure that meal times are appropriate and that meals are responding to people`s needs. More people living in the home have dementia and the home needs to look at the activities they provide are meaningful and individualised to the needs of people. The environment also needs to consider how people with dementia can be assisted to find their way from place to place. We found that people`s personal money was not managed well. The systems of recording people`s spending and the money brought in for people were not timely enough to prevent mistakes. There were not enough audits and checks of accidents, infections, medication and so on to ensure that shortfalls were spotted quickly and rectified and in some case this has affected people that live in the home. We have made urgent requirements about some of these issues. Key inspection report Care homes for older people Name: Address: Tudor House 159 Monyhull Hall Road Kings Norton Birmingham West Midlands B30 3QN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jill Brown     Date: 2 2 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 31 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 31 Information about the care home Name of care home: Address: Tudor House 159 Monyhull Hall Road Kings Norton Birmingham West Midlands B30 3QN 01214512529 01214593845 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tudor House Limited Name of registered manager (if applicable) Mrs Sally Ann Bishop Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 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) 23 Date of last inspection Brief description of the care home Tudor House is located in a popular residential suburb on the South side of Birmingham and enjoys easy access to public bus routes for local areas and the city centre. There are local shops and community facilities within walking distance of the home. The home was originally two properties, which have been converted to offer residential care for 23 older people. Recent changes to the home mean there are now Care Homes for Older People Page 4 of 31 Over 65 23 0 Brief description of the care home only 22 places available. The home has 2 shared bedrooms all the rest being single. A number of the bedrooms have en suite facilities. There were three bathrooms, two of which had been converted to a walk in shower giving easy access for those service users with mobility difficulties and those who required staff assistance. The other bathroom was equipped with a Parker bath. Toilets were located throughout the home. On the ground floor of the home there was a main kitchen, a laundry and office space. All floors were served by a shaft lift. There was parking available at the front of the home and there was a well-maintained garden to the rear. Fees for this home are £450 per week people funded by social services will have to find a top-up. People will be charged for hairdressing, chiropody, newspapers and toiletries if these are required. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home unannounced on a day in March 2010. We completed a key inspection which means we inspected the homes performance against the key National Minimum Standards. The last key inspection took place in September 2007. The home gave us information in an Annual Quality Assurance Assessment before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During the inspection we case tracked two peoples care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We looked at parts of the homes records for a further two people. We spent time in the lounge observing peoples care, sampled the main meal of the day and spoke to people as we walked around the building. We also looked at other records about the safety of the building, complaints accidents and so on. Care Homes for Older People Page 6 of 31 We sent out surveys to people that live in the home and health professionals and received 11 completed by people or their representatives and 3 from health and social care professionals who come into the home. We have receved no complaints about this service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Recording with the home needed improvement. Peoples care files we looked at showed that information was gained from social care professionals and not transferred on to the homes own forms. This can make it difficult for staff to find information quickly. Care Homes for Older People Page 8 of 31 Two people did not have care plans about how the home was going to care for them despite being in the home some time. One person had important information about their care on a loose piece of paper and the relevant care plan hadnt been updated and these shortfalls can mean that people do not get the care they need or in the way that they wish. Some people, whose care files we looked at, were losing weight and there were no plans in place to rectify this. The provision of food needs to be looked at to ensure that meal times are appropriate and that meals are responding to peoples needs. More people living in the home have dementia and the home needs to look at the activities they provide are meaningful and individualised to the needs of people. The environment also needs to consider how people with dementia can be assisted to find their way from place to place. We found that peoples personal money was not managed well. The systems of recording peoples spending and the money brought in for people were not timely enough to prevent mistakes. There were not enough audits and checks of accidents, infections, medication and so on to ensure that shortfalls were spotted quickly and rectified and in some case this has affected people that live in the home. We have made urgent requirements about some of these issues. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the home and this helps people decide whether the home will suit them. Information is collected about people but not recorded in a standard way and this could lead to peoples needs not being met. Evidence: The Annual Quality Assurance Assessment (AQAA) said that the home has a statement of purpose and service user guide. We noted that service user guides were in some of the rooms we looked at. People had contracts advising them of the terms and conditions of their stay and what their fees covered and this helps to ensure that peoples rights are protected. We looked at the information collected for 2 people before they were admitted to the home. Care Homes for Older People Page 11 of 31 Evidence: The home has its own pre-admission assessment forms as well as receiving information from professionals working with the person. Not all the information is transferred from the written information provided by professionals on to the homes forms. This means essential information can be lost. Information is collected about peoples health conditions, the assistance they need and peoples preferences for example in food or activities. People had assessments undertaken in hospital if needed but there was no record of any preadmission visit. For one person admitted the information supplied by a social work professional indicated that the person had a cognitive impairment and behaviours that need specialised knowledge. This indicated that the persons care needs were outside the homes category of registration and this could mean that the persons needs are not being met appropriately. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people are happy with the care they receive management systems and care plans are not always in place. This may lead to people not receiving a consistent service that meets their needs. Evidence: We looked at the care plans, risk management plans for the two people that had been recently admitted and found that neither had a care plan written by the home. One person had been in the home for 6 months and the home was using the plans written by the social worker. Another had been in the home for over 2 weeks without a care plan or risk management plans being written. Safety risks were identified for both people at the point of their care needs being assessed. This means that information is not available to staff in a consistent way and this could lead to peoples needs not being met. We looked at a further two peoples care plans and found that these were not up dated when peoples need changed or if the detail of how they needed to be cared for had changed and this means that peoples needs may not be met. We found there Care Homes for Older People Page 13 of 31 Evidence: were inadequate records of what happened to people each day especially where people were receiving treatment. Daily care notes were being archived on a monthly basis. Health contacts were sometimes being recorded on the summary of these records and not on the health contact sheet. It was therefore difficult to get an overview of the routine health checks people had. However it appeared that people had access to health professionals when needed. Newly admitted people had eyesight checks. We received two surveys from district nurses who told us that They report any problems that require District Nurse input, they could do better on staff training. They follow our instructions and inform us if concerned. A social work reply was very positive about the homes management of admission into the home. We looked at the weight records in three files. We found that people were weighed on admission to the home and were routinely weighed. However there was little management overview of these records. Peoples weight was not assessed to see if it was of concern on admission. In addition one person had lost 10.5 lbs weight over a period of 6 months and another had lost over 1 stone 2lbs in a year (including 7lbs in one month recently) and these losses had not provoked any recorded inquiry as to how or why this had happened. There was no individual dietary planning to make up these weight losses. We spent about two hours in the lounge with the people that lived in the home. We watched how people were assisted to move from place to place. One person was moved by hoist from a chair to a wheelchair and others assisted and prompted to move from sitting to standing. All of these manoeuvres were undertaken well with clear instructions to people about how they could help and what was happening. This helps to prevent injury to people. A large number of people in the home have short term memory loss and or dementia. Care plans, the environment and activities did not indicate that the home were responding to these needs in light of peoples dementia. We looked at the storage, administration records and stocks of medication for four people. In front of the medication administration records (MAR) there is a photograph of the person and this is an extra check to ensure the right medication is given to the right person. A medication care plan is kept with the MAR and this helps to ensure that staff are aware of any special considerations with medication. Medication is generally administered via a monitored dosage system. Medications are sent from the pharmacist monthly with each medicine for each person set up in a blister pack for Care Homes for Older People Page 14 of 31 Evidence: the right day and time and this helps to minimise mistakes. Generally medication supplies were well stored, recorded and administered however there were some errors on medications that were not in blister packs. There were no recent management audits of medication. The staff member assisting with the inspection of medication had the appropriate training however the training matrix indicated that not all seniors had recent up date training. We observed that breakfast and the morning medication did not start to be administered until 09:30 and this may mean that some people may not have not have the appropriate time between medication administrations. Staff were observed to speak to and assist people well. We received 11 surveys from people that live in the home or their representatives these were generally happy with the service they told us: - staff are very helpful yes its very good and I am happy here, I am quite satisfied. One said they needed to treat the patients better. One indicated that they sometimes get the help they need. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are offered activities but not often enough and for some people activities are not meaningful. People have the benefit of tasty well cooked food but this is not always linked to peoples nutritional needs and this can affect their health and wellbeing. Evidence: The homes AQAA told us that the activities that people are involved in are recorded in the daily care notes. It also told us that people were offered activities but were reluctant to undertake activities outside of the home. We found that there were poor daily care records and these did not indicate if people were involved in activities. There was a programme of activities for the afternoon but there was no indication of who had taken part. We were told that an entertainer comes to the home and progressive mobility and they hope to have some trips in the summer. Three of the eleven surveys we received made the comments: - We sit still. I want more activities. What they could do better to have more things to do. Some people are able to go to the local shop and request an activity others are not. There is not sufficient information in peoples care records to inform staff of what the Care Homes for Older People Page 16 of 31 Evidence: past interests are for people with dementia to ensure that they have activities that are meaningful to them. People can have visitors when and where they wish there is a small area off the main lounge that can be used for visits if not already in use. People are able to go into the own rooms if they wish, and have their meals there. People were able to walk around the home unrestricted. When we arrived in the home at 08:45 people were being taken to the dining room for breakfast and some were already seated. Breakfast was only served when people were in place and this meant that breakfast was delayed for some people and breakfast started 09:30. There was a snack of tea and biscuits shortly after this and the main meal was before 1pm. We were supplied with four weeks worth of menus. These menus only showed us the options for the main meal of the day. We asked for sample plates of the two options for this meal which was fish in sauce or pork chop both with vegetables and mashed potato. Both of these meals were tasty and cooked well. There was either bread and butter pudding or a cold pudding for dessert but these were not sampled. These meal options were not on the planned menu for the day. People were asked what they would like. We looked at the meals supplied to people and they had the same options as given to the inspector, one person had sandwiches in their room. Meals were given on small plates and portions sizes were small. There was not enough information and planning to show that peoples nutritional needs were met and took into account peoples health conditions, behaviour, loss of weight (See outcome area Health and Personal Care) and the timings of meals. People said I like sandwiches. eating and drinking they do well. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel able to raise complaints and have these dealt with and this ensures people feel listened to. People can be assured that they will be kept safe by staff that are well trained. Evidence: We have received no complaints about this home. The homes AQAA stated that they had three complaints and these had been logged and dealt with. The home does not have a record of issues raised with them informally and this means that the home does not have a way of identifying themes of dissatisfaction. The AQAA told us that they have a leaflet in the reception area which people can use to raise issues there were none available on the day of the inspection. We were shown a survey that they intend to send to relatives and professionals to get their views about the home but this is yet to be done. (See outcome area Management and Administration) All surveys suggested that people thought that there concerns would be dealt with. We have had no issues of a safeguarding nature raised with us. The staff training matrix indicated that the majority of staff have received training on the safeguarding of people recently and this helps to keep people safe. There were some concerns about the management of peoples money, further action was needed to safeguard this. Care Homes for Older People Page 18 of 31 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 living in this home have an environment that is comfortable, clean and homely. Evidence: We looked around most parts of the home and found that it was generally clean and fresh and suitable for the people living there. There has been some refurbishment and changes to the home since the last inspection and part of this means the home can only accommodate 22 people. The homes certificate should be varied to reflect this. The improvements have ensured that more bedrooms have an en suite facility and the stair and corridor carpets have been replaced. The front car parking area is becoming uneven and poses some risks to people with mobility difficulties. The main lounge is due for redecoration and we were assured by the manager that this was in hand. The assisted bathroom in the home was being used as a store area for equipment and access to the assisted bath was restricted. We were told that people preferred assistance in shower however care plans did not always support this. Peoples bedrooms were well furnished and decorated. Rooms had differing amounts and types of personal possessions. This showed that people were encouraged, on admission, to bring in items to make it feel more like their own home. All bedroom Care Homes for Older People Page 19 of 31 Evidence: doors were unlocked including those rooms where people were in hospital; meaning their belongings were not safeguarded. We were told that people did not want keys to their bedroom doors. Although one shared room had access to screening the other did not and this means that a person may not have privacy when having their personal care needs or toileting needs attended to. The building does not have enough signage for people to find their way around the home and this may cause difficulties for people with dementia. Doors are not colour coded to indicate their use such as a colour indicating where there is a toilet, or have enough identifying features for people to find their bedroom. Arrangements for the laundering of clothes were appropriate. The kitchen was being cleaned at the time of the walk around the building. From the doorway it looked clean and the last Food Safety Inspection indicated that the kitchen practices were excellent. These measures help to ensure that people are not at risk of infection. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that there are enough well trained staff to assist them and to meet their needs. Evidence: The home has the usual staffing level of 3 care staff on the morning and afternoon shift at least one of which is a senior carer. There is a cook or cooking hours available each day from 8 until 2 pm and a cleaner monday to friday. Management hours are in addition to this but on occasions the manager has also undertaken a cooking role. Rotas indicate that this level is maintained. The homes AQAA stated that the service has a low staff turnover that helps people living in the home have their care provided by staff that know them. The home has a high level of staff trained to the standard of National Vocational Qualification level 2 in care (NVQ2) and almost half the care staff have also achieved an NVQ3 in care. This exceeds the standard and means that staff have had the training needed to ensure they know how to care for older people. We looked at the recruitment of the newest staff and staff had appropriate checks undertaken before they were employed. Staff completed an application form, made declarations as to their health and any criminal convictions, references were obtained and checks were completed with the Criminal Records Bureau. These measures help to Care Homes for Older People Page 21 of 31 Evidence: keep people safe. These could be enhanced by ensuring that all references are dated as they are received and in one case although the manager has worked with the person in the past references are still required. One person had their induction paperwork completed which helps to ensure that the staff member has the information to give appropriate care the other was not available for inspection. We looked at the training matrix supplied to us and sampled some certificates and found that most day staff had most of the up dating training recommended on safeguarding, health and safety, fire, first aid and so on. There were more gaps in this training for night and ancillary staff. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be fully assured that all systems are in place to monitor the care they receive and to keep them safe. Evidence: The manager of the home has worked in the care of older people for a number of years. She has the Registered Managers Award; the recognised training for people that manage care homes. However there were shortfalls in the oversight of key areas of peoples care and inadequate use of monitoring systems to ensure that these shortfalls are identified and rectified. We were told in the AQAA that the home does not have a Quality Assurance system. There are visits by the representative of provider to ensure that standard is maintained. We were shown a copy of a survey the service intended to send to relatives to gain views about the service they provide however this had yet to be done. However all the surveys we received indicated that people were happy in the home. We spoke to a three people who spend time in their room and they said they Care Homes for Older People Page 23 of 31 Evidence: were happy with the care they received and observation in the main lounge showed the relationship between people living in the home and staff was good. We looked at the management of peoples money in the home. We were told that most people living in the home had their personal allowance managed by relatives, who were invoiced for services such as hairdressing and chiropody. Where peoples money was managed we found there were inadequate records of peoples money. We looked at four peoples accounts and the money held for three people did not match the record. There was inconsistent use of receipting book where money was brought in for individual peoples expenses. The receipts given for hairdressing were not on proper numbered receipts. Accounts were not up to date and receipts were presented that had yet to be accounted for. A piece of jewellery was being kept for person this was not detailed on the persons record. These arrangements do not safeguard peoples money. We have made urgent requirements for improvements. We looked at the health and safety documents for the home. We found that the home had appropriate maintenance and inspection certificates for electrical, lifting equipment and fire safety. There was no gas safety certificate available in the home. We looked at the homes recording of accidents in the home and found these to be poorly completed and incidents and accidents that should have been reported to us had not been. There was no audit of accidents and this can mean that measures are not taken to reduce preventable accidents. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 31 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 1 7 15 (1)People admitted into the 09/04/2010 home must have care plans and risk management plans in place without undue delay. This is to ensure that staff receive information in a consistent written way to deliver appropriate care to people. 2 35 13 (6),17(2) Schedule 4(9) The 09/04/2010 management of peoples money and valuables must be reviewed, audited and systems and procedures set up. This is to ensure that peoples money and valuables can always be accounted for as this protects them from abuse. 3 38 37 Where accidents result in the 09/04/2010 need for paramedics the commission must be informed. This is so we can be assured that the home is acting in accordance with the requirements. 4 38 13 (4)(c), 17(1)(a) Schedule 3(3)(j) Accidents and incidents must be recorded accurately, legibly and in sufficient detail in the required accident book. Accidents must be reviewed on a regular basis. 09/04/2010 Care Homes for Older People Page 26 of 31 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 This is to ensure that appropriate details are kept to determine how accidents have occurred and to ensure that risks of the same accident occurring are minimised. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (2)Care plans must be reviewed and changes to care recorded on the plan of care. This is to ensure that changes in need can be identified and appropriate care given. 17/05/2010 2 8 12 (1)(a) There must be management overview of peoples weight losses and gains. This is to ensure that peoples health and wellbeing is preserved. 07/05/2010 3 9 13 (2) A quality assurance system must be installed to assess staff competence in their handling of medicines. 17/05/2010 Care Homes for Older People Page 27 of 31 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 This is to ensure that all medicines are administered as prescribed and this can be documented. 4 15 16 (i)The provision of meals must be reviewed to take account of the needs of the people living in the home. This is to ensure that individual people have suitable amounts of food at the right time to meet their nutritional needs and ensure their wellbeing. 5 19 23 (2)(o) The surface of the grounds to the home must be improved so as to provide a better and safer surface and access for people. This is to ensure the safety of people and ease of use for people that use wheelchairs. 6 19 39 (h) A variation must be applied for to ensure that the certificate reflects the number of people the home can accommodate. This is to ensure that the registration of the home is correct and to ensure that the transfer of the service 28/05/2010 01/07/2010 01/06/2010 Care Homes for Older People Page 28 of 31 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 under the new act can be accommodated. 7 21 23 (2)(j) The assisted bathroom 14/05/2010 must be clear of stored items. This is to ensure that people have the choice of an assisted bath or shower. 8 38 23 2(b)The home must keep on 14/05/2010 the premise an update certificate of the annual Gas inspection. This is to ensure that the premise is safe for the people living there Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Information collected about peoples needs should be recorded in a standard way to make it easy for staff to retrieve the information when needed. Health records should not be archived after a month as an overview of peoples health is needed if any changes are to be identified and planned for. All senior staff administer medication should have regular medication updated training. Good records must be kept of the activities individual people have been involved in to ensure that all have the benefit of activities appropriate to them. This recommendation remains outstanding. Activities should be provided that reflect peoples individual past experience, interests and are meaningful to them. This Page 29 of 31 2 8 3 4 9 12 5 12 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 is to ensure that people are involved in life in the home 6 16 Informations should be completed about peoples dissatisfactions as a way of monitoring and improving the service. As the service has more people living there with dementia consideration should be given to signage, colour schemes and so on to assist people to orientate themselves around the building. Where people are not in the home such as in hospital or so on their bedroom doors should be locked to protect their belongings. Screening must be available and used in shared rooms to ensure peoples privacy and dignity. Training should be given in infection control for all staff. Training should be given to ancillary and night staff in safeguarding to ensure that people are kept safe. The service should ensure that there is a system of audits, monitoring and reviews with people living in the home to identify shortfalls in the service and plan for improvement. 7 22 8 24 9 10 11 12 24 30 30 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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