Care Home: Weir Nursing Home The

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What the care home does well The Weir has a friendly atmosphere and care staff and nurses are welcoming and approachable. The house is a lovely building with plenty of space, large bedrooms and lovely views. There are lots of group activities and efforts are made to provide things for people to do that they will enjoy. There is always a choice of menu at mealtimes and the catering team are kept informed about people`s dietary needs and preferences. In surveys sent to us and in letters to the home we saw that lots of people appreciated the care their relatives receive for example one person wrote in their survey "The Weir is always clean, comfortable and warm and (person) is always beautifully clean with excellently laundered clothes. We had a lovely family meal with (person) when he first came which made us all feel most welcome. The activities are excellent and great care and attention shown to (person) who cannot join in the group. The home from home attitude is perfect, with an underlying professionalism." What has improved since the last inspection? The content of the AQAA shows that the owner is aware of and aspires to meet best practice standards but due to a number of staffing changes in the management and nursing teams since our last inspection we did not identify the improvements that we might have expected. We saw no evidence of staff using wheelchairs without footrests as we did at the last inspection. A new phone system has been installed to help reduce the number of interuptions when nurses are dealing with medication and other care tasks. What the care home could do better: Clearer and more thorough information needs to be gathered and recorded before a person is offered a place. This needs to tell staff all they need to know about what care a person needs as soon as they arrive and be used to create a written plan for the person`s care. The care plans need to be reviewed more often, especially when a person has lots of care needs in areas where changes can happen quickly. Staff need to record more detail about what food and drink people who depend on staff to help them maintain their nutrition and hydration have had. This will help staff to monitor their intake. The arrangements for recording and monitoring the medication administered in the home need to be improved and monitoring and auditing of stock needs to be developed to help minimise the risk of errors. All controlled drugs received into the building must be recorded in the CD record book. Further consideration should be given to reducing the impact of interruptions on nurses whilst they are administering medication as being distracted can increase the risk of errors. Further endeavours need to be made to make sure that everyone, including people who live at The Weir, families, staff and professionals feel that their concerns will be dealt with in an open, reassuring and objective way. Staff recruitment procedures need to be improved to help reduce the risk of unsuitable staff gaining employment. An effective system is needed to help the owner review and improve the quality of the service provided at the home. This should take into account the views of people who live in the home and other interested people such as staff and professionals who visit the home. Regulation 37 notifications should be handwritten and sent to us without delay if further computer problems arise in the future. Any fire safety improvements required by the fire authority must be addressed and serious consideration given to any best practice recommendations. Key inspection report Care homes for older people Name: Address: Weir Nursing Home The Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF     The quality rating for this care home is:   zero star poor 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: Denise Reynolds     Date: 0 6 0 5 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 32 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 32 Information about the care home Name of care home: Address: Weir Nursing Home The Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF 01981590229 01981590445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Weir Nursing Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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) 35 Dementia (DE) 35 Physical Disability (PD) 35 Date of last inspection Brief description of the care home The Weir Nursing Home is situated near the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and operated by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust Care Homes for Older People Page 4 of 32 1 8 1 2 2 0 0 8 35 0 35 Over 65 0 35 0 Brief description of the care home gardens with extensive views over the River Wye and surrounding countryside. The Weir is a large country house with large rooms and high ceilings; recent improvements to the building have been done to a high standard. The home is currently registered for up to 35 people. It provides a service for people who need personal or nursing care including people with dementia related care needs and Parkinsons Disease. People at the home are able to choose whether they mix with other people or spend their time mainly in their own rooms. Some of the rooms are much larger than the minimum required and many have enuite facilities. The rural setting means that people visiting need their own transport or to use bus services that pass on the Hereford to Brecon road. Information about what is covered by the weekly fee and what services are charged for seperately should be obtained from the home. A copy of the most recent inspection report is made available at the home. Care Homes for Older People Page 5 of 32 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: zero star poor 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 full inspection of The Weir to look at how the home is performing in respect of the key national minimum standards and at the quality of life the people who live there experience. We, the commission did the inspection on one day and went unannounced so that no-one knew to expect us. The home completed an Annual Quality Assurance Assessment (AQAA) late in 2009 and we used information provided in this to help us plan our inspection. We also took into account surveys we received late last year. During the inspection we spoke privately with two people in their rooms and met others with members of their families who were visiting that day. We observed life in the home and the way that staff treat people who live there. We met the responsible individual for the company that owns the home, Mr Kingham, Care Homes for Older People Page 6 of 32 and the acting manager who had started work at the home late last year. We also spoke with the two nurses working at the home, a carer, the chef and the activity organiser. We looked at parts of the building and at various records. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Clearer and more thorough information needs to be gathered and recorded before a person is offered a place. This needs to tell staff all they need to know about what care a person needs as soon as they arrive and be used to create a written plan for the persons care. The care plans need to be reviewed more often, especially when a person has lots of care needs in areas where changes can happen quickly. Staff need to record more detail about what food and drink people who depend on staff to help them maintain their nutrition and hydration have had. This will help staff to monitor their intake. The arrangements for recording and monitoring the medication administered in the home need to be improved and monitoring and auditing of stock needs to be developed to help minimise the risk of errors. All controlled drugs received into the building must be recorded in the CD record book. Further consideration should be given to reducing the impact of interruptions on nurses whilst they are administering medication as being distracted can increase the risk of errors. Further endeavours need to be made to make sure that everyone, including people Care Homes for Older People Page 8 of 32 who live at The Weir, families, staff and professionals feel that their concerns will be dealt with in an open, reassuring and objective way. Staff recruitment procedures need to be improved to help reduce the risk of unsuitable staff gaining employment. An effective system is needed to help the owner review and improve the quality of the service provided at the home. This should take into account the views of people who live in the home and other interested people such as staff and professionals who visit the home. Regulation 37 notifications should be handwritten and sent to us without delay if further computer problems arise in the future. Any fire safety improvements required by the fire authority must be addressed and serious consideration given to any best practice recommendations. 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 32 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 32 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. Where possible, people who may be considering The Weir for themselves or a relative have the chance to visit before making their choice. Staff gather some information before a person moves in but not in enough detail to make sure that all care arrangements can be planned before they arrive. Evidence: We looked at information for a person who had moved in to The Weir recently. The information gathered was very brief and did not give a full picture of the care they were likely to need. We could find no information from professionals involved in the person moving to The Weir about the persons care needs. The information gathered before the person arrived had not been developed adequately. Most of the ongoing care paperwork was blank, including important information such as the things that had been considered before a decision had been made to use bedrails and also how staff should move the person safely and Care Homes for Older People Page 11 of 32 Evidence: comfortably. However, we did note that one essential area of their care had been put in writing so staff would know about the right care to give. When we spoke to staff about this persons care they could give us the correct information. We spoke to a close family member who told us that they were very happy indeed with how the they were being looked after at The Weir. Care Homes for Older People Page 12 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home generally receive the care they need but the written care records are not always detailed enough or up to date; this could result in staff not having all the information they need to give people the right care. Evidence: The surveys we received from people gave a generally positive view of the care, for example one relative wrote - The home treats my mother as an individual. They try to make and keep her comfortable and pain free which is what she and the family have requested. Another relative told us - The family have been very happy with the quality of care my mother has received. Her individual needs are being met and the constant monitoring by nursing staff is a comfort to us. The surveys also highlighted some issues including this comment - Only one thing - look in on a resident in the room a bit more regularly. When you cant remember how to do things for yourself (ie change a tv channel or take a drink) a friendly face around the door is very important. During our visit we saw numerous thank you letters and cards from friends and Care Homes for Older People Page 13 of 32 Evidence: families saying how pleased they were with the care people had received at The Weir. We also met and spoke with family members of three people who live at the home. Two were wholly pleased with the care being given; the third family were more reserved in their view and had some concerns about delays in things being dealt with. Early in our visit we walked around the home to get an impression of how the morning passes for people who live in the home and to see how busy staff were. We saw that some people were up and and about whilst some were having a lie in or were being cared for in bed. We said hello to three of the people still in bed and checked records in their rooms about the care given. From these we could see that between midnight and midmorning each of these people had been attended to by staff five times. On these occasions they had either been turned, washed, changed or given drinks and had been given their breakfast indicating a good level of attention from staff. We saw that these records included forms to write down what people had eaten or drunk. There were some gaps in these records and not enough detail about the quantity and content of their meal or drink. This reduces the value of the record as a tool to help staff monitor a persons nutrition and fluids. All of the bedroom doors were held open with wooden wedges (see the accommodation and management sections of the report regarding the fire safety implications of this) and this meant we could glance into rooms as we passed. We saw that whilst in some rooms people had drinks and their call bell close at hand, some peoples call bells were out of their reach so they were unable to summon staff to come if they needed them. One lady called out to us as we walked passed the room and asked us to get the staff for her. Her call bell was not where she could reach it. We met some staff a moment later and told them about this lady so they could go and attend to her. We know that the staff handbook says that call bells must be placed where people can reach them and when we told the owner about this he was concerned that this was not always being done. We saw that the care staff and nurses were working hard and communicating with each other about what needed to be done. We also saw and heard that when staff were assisting people they did this kindly and gently. The written care plans kept in the nurses office provided basic information but were not all up to date. For example, the care plans for one person had not been reviewed since December even though the person had a lot of care needs (such as nutrition and moving and handling) which should be checked often. However, one person had Care Homes for Older People Page 14 of 32 Evidence: returned from a stay in hospital with a sore area on their arm; this had been well documented and a recent entry in the records confirmed that this had healed. The two nurses employed at the home told us they realise that some of the care records need to be brought up to date. They were clearly anxious that this was not the case and explained their concerns that only having two nurses employed at present was having an impact on their ability to get everything done. The owner and acting manager explained that the nurses will be having administration time built in to their weekly rota. This is a sensible initiative but not likely to be effective whilst the team is so depleted. When we spoke to staff about the care people need they were able to give us the correct information. For example, we spoke to a carer about a person who has some problems swallowing and they told us the right information about the thickening powder used to make it easier for the person to drink. We looked at aspects of medication management at the home. When we did our last inspection we were concerned that nurses were frequently interrupted whilst doing the medication round and that administering the medication took up a lot of their time. Since then Mr Kingham has introduced a new phone system which diverts administrative calls to himself or the acting manager. Mr Kingham explained that this has reduced the number of calls the nurses need to answer. We acknowledged that this dealt with one reason for interuptions. Nevertheless the nurses again reported that they are often interrupted whilst doing the medication. We say more about staffing levels and what Mr Kingham is doing about this in the staffing section of this report. We checked some items of medication in the home and found some discrepancies between the stock and the records. We found that with three items we checked there were more tablets left in the boxes than there should have been according to the administration records. This indicates that the administration records were signed to say tablets had been given to the person when they had not, ie the person had not received their medication. We were unable to audit some other items because the boxes had not been dated when they were opened and the brought forward box on the administration form had not been filled in. We also saw that there was stock in the controlled drugs cupboard which had not been entered in the controlled drugs book. The nurse who helped us explained that one item of medication concerned had come incorrectly named and there was a query about the dose of the other item. The items should still have been entered in the record to provide an audit trail of them coming into and then leaving the home. All other items in the cd cupboard balanced correctly Care Homes for Older People Page 15 of 32 Evidence: with the stock. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Weir can choose from a varied menu and have the help and attention they need to eat their meals. People have opportunities for a wide range of social activities which are planned for individuals as well as for groups and take into account what people enjoy. Visitors are made welcome and their is a friendly atmosphere. Evidence: In the surveys people gave a fairly positive picture of the food and activities although some indicated that they would like to see more things happening. People are able to choose whether they want to spend time in their own room or mix with other people in the sitting room. The families we met during our visit said they are made welcome. One person told us they found it more relaxing and friendly to visit than the previous home their relative had lived in. The person told us they visit most days and that they always feel welcome. A different activity organiser had been employed since our last inspection and told us Care Homes for Older People Page 17 of 32 Evidence: she had been back at The Weir for a year after a spell doing another job. She came back because she missed it and is employed for 30 hours a week to do activities and act as an escort for appointments. She told us about the range of activities that have happened and that she will be continuing to develop and showed us photographs of some of the events. For example, there had been a fashion show where staff had been models. She told us that when people have a hospital appointment she tries to make an outing of this, for example by taking the person for a coffee afterwards. The day before our inspection four people went with her and another member of staff to the May Fair. The people that went were still chatting about this over lunch and told us that they enjoyed themselves although found it more noisy and crowded than it used to be. The activity organiser is trying to build a better picture about peoples lives and how they might like to spend their time. She is trying to speak with as many people and their families as she can to help her gather this information so she can use it to make peoples lives more enjoyable. As well as small group activities she is also spending time with the people who are in their rooms all the time for example reading or making sure music they like is on in their rooms. She told us that sometimes she just sits and holds a persons hand and talks about the weather, wildlife etc. Other activities include, walks in the grounds, singalongs, professional musicians once a month a visiting aromatherapist, communion once a month, hairdressing weekly, painting , crafts, jigsaws. During the inspection we saw staff sitting with two people doing some art work and chatting and a person being taken out for a walk in their wheelchair. During the afternoon ice cream cones were taken around for those who wanted one. The activity organiser gave us the following example of an individual approach to activities. One man loves rugby so she writes in the diary when a match is on so carers know to assist him to watch matches. She said the carers are very good at following this up. If a television programme of interest is on late in the evening she records it so people can watch in the day - for example when the evening Remembrance Day event at The Albert Hall is on. Birthdays are celebrated with a party if people wish and we saw a thank you letter from one family which said - We were overwhelmed and touched by the trouble taken by your staff to provide food and drinks for those who were able to attend. The activity organiser told us she had arranged postal votes for everyone that wanted Care Homes for Older People Page 18 of 32 Evidence: to vote in the general election and made sure they were able to fill these in and have them posted. A regular newsletter has been introduced to provide another means of involvment communication and entertainment for people and their families. We had a conversation with the chef who was on duty that day. She had a good knowledge of peoples dietary needs and was enthusiastic about the part nutrition plays in helping people stay healthy. She has a professional catering qualifications. There is a four week menu plan and people have a minimum of two options to choose from at each mealtime. It is the chefs role to do the menus and to order the food supplies and she confirmed that Mr Kingham places no restrictions on her regarding the amount she has to spend each week. Meat, milk and eggs are sourced from local tradespeople and all cakes and pastries are home made fresh each day. Care Homes for Older People Page 19 of 32 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. Staff are trained so they understand and recognise the signs of abuse and neglect and how to report this; this helps to keep people safe. More could be done to help people feel confident about voicing any concerns they might have. Evidence: Most, but not all of the people who sent surveys back to us knew how they could make a formal complaint to the home if they needed to and we noted that an old address for us is included in the written complaints procedure. Updating this information would provide a good opportunity to make sure that everyone who needs to is aware of the procedure and how they can raise any concerns they may have. We noted that only one (historical) complaint was recorded at the home. The home has a clear written policy about safeguarding adults and this is consistent with the expectations set out in local safeguarding procedures. Most staff have done safeguarding training with Herefordshire Council so they understand what they should do if they have concerns about how anyone has been treated. The acting manager has done the training aimed at owners and managers of services. One of the families we met during the inspection had some concerns about the delay in getting a piece of equipment for their relatives room and felt they had had to raise this more then they should have. We spoke to the acting manager about this and they assured us it was in hand. Other families we had contact with didnt raise any Care Homes for Older People Page 20 of 32 Evidence: concerns although one person said they would like information and administration relating to the fees at the home to be better organised. When we did our last inspection we spoke to Mr Kingham about a concern raised with us by a relative because they felt anxious about making any complaint. At that time he assured us that he wants people to feel at ease in such circumstances and would endeavour to ensure this was the case. However, some health and social care professionals we have had contact with recently have expressed some concerns about how issues they raise are dealt with. One GP who contacted us some months ago did not feel their concerns about staffing had been adequately dealt with and some people have expressed levels of anxiety about Mr Kinghams reaction to any criticism of the home. Care Homes for Older People Page 21 of 32 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 at The Weir have comfortable and clean accommodation which is generally safe, well maintained and spacious. The rural location and surrounding views provide people with a beautiful setting which is much appreciated. Some aspects of fire safety needs attention to ensure risks in the event of a fire are minimised. Evidence: The Weir is set in large grounds next to a local National Trust beauty spot. Many of the rooms have views of the River Wye, surrounding countryside and the large gardens. Many of the bedrooms have ensuite facilities and either meet or exceed the national minimum standard for space. People are encouraged to make their rooms personal to them by having their own belongings around them. Ongoing improvements to the building were continuing. For example on the day we were there the two handymen were working on the refurbishment of more of the window frames in line with National Trust/listed building requirements. The work Mr Kingham had hoped to start on refurbishing the conservatory had not yet started. All the rooms we saw during our visit were clean and warm. Toilets and bathrooms were clean and hygienic apart from some hand operated bins and a few missing toilet roll holders (we saw toilet rolls stacked on top of a toilet cistern). These things can increase the risk of cross infection. The kitchen recently gained a 5 star excellent Care Homes for Older People Page 22 of 32 Evidence: rating from Herefordshire Council for food safety standards in the kitchen. There is a rolling programme of interior decoration and the rooms we saw were well presented. People like the recent change over of the dining and sitting rooms because the sitting room views are much nicer. We noted that a lot of doors were held open with wooden wedges. We have said more about this in the management section of the report as it relates more to fire safety management. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are not fully protected by the recruitment processes used recently which did not include all of the required checks before some staff started work. Staff have a range of training to develop their knowledege and skills so they can do their jobs well. Evidence: We gained a positive picture of the attitudes of the staff from the people we met during the inspection, from the surveys we received and from the thank you letters at the home. During our inspection we saw staff going about their work and saw they were polite, gentle and attentive to people. On the day we inspected only two nurses were directly employed by the service to work at the home. Another nurse had left two days earlier and a fourth nurse had left a couple of weeks before. There has been a significant turnover in trained nurses at the home in recent months with four nurses in total having left. The two remaining regular members of the nursing team were anxious regarding the impact on their workload. During the inspection we saw evidence to show that the acting mnaager was in contact with an agency to obtain agency staff to cover gaps in the rota due to this. We were shown the agency nurses time sheet from the previous night and the list of nurses booked to cover shifts on forthcoming days. Mr Kingham told us that a new clinical lead nurse had been appointed and was working their notice elsewhere Care Homes for Older People Page 24 of 32 Evidence: and that he had advertised online and at the Job Centre for additional permanent staff. In the meantime Mr Kingham and the acting manager assured us that agency staff would continue to be used to make sure staffing levels were adequate. The training records showed us that safety and care related training for staff is ongoing and that more training has been arranged over the next few months. This is a good thing as the records showed that some topics were overdue for some staff. The training booked includes moving and handling, food hygiene and health and safety. Fire safety training with a fire safety consultant had been booked in advance for October when refresher training is due. All of the staff have done or are booked in this summer to do dementia training with nurses from the Hereford department of mental health for older people who are specialists in dementia care. We looked at the staff recruitment paperwork for four staff who had been appointed in recent months. The information available did not fully comply with the requirements about staff recruitment in the Care Homes Regulations 2001 (as amended) and did not include elements expected in a robust recruitment process. For example, one person had started before a second reference had been recieved, there was no record of the persons interview, no risk asst regarding specific information relating to them and no evidence that the issue was discussed at interview. Another person started before references had been sent for and only one reference had been received. There was no second reference for the third person and there were no references in the fourth personss file. Care Homes for Older People Page 25 of 32 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. Progress in developing the service has been hindered by changes in management arrangements since our last inspection. This has resulted in a number of areas that need to be improved to ensure that people can be confident that all aspects of the service are well managed. Evidence: When we did our last inspection in December 2008 there had been no registered manager in post for some time. An acting manager was working at the home and Mr Kingham told us that person would be applying to us to be registered. We did not receive an application from the person and they subsequently left the home. Late in 2009 we were notified that a new acting manager and a new clinical lead had been appointed. The person appointed as clinical lead left the home in April 2010. During this inspection we met the acting manager and were told that she will be applying to be registered in due course. Because the acting manager is not a nurse Mr Kingham told us he is again appointing a nurse to be the clinical lead in the home as Care Homes for Older People Page 26 of 32 Evidence: previously referred to in the staffing section of this report. We asked to see the most recent in-house quality assurance report for the home. The acting manager provided a copy of the AQAA (see the summary section of this report) and some surveys completed by service users and relatives in October 2009. We explained that what we had hoped to see was a summary report based on the findings of surveys and other consultation carried out by the home. This would normally include details of the actions being taken to address any issues highlighted during the consultation process. This had not been done and as the acting manager pointed out the October surveys were done before she started work at the home. It is important to develop an effective process for finding out the views of everyone involved with the service and demonstrating that this is used to shape improvements in the way the service is developed. We did not look in detail at how the home manages peoples money during this inspection. At our last inspection we learned that as a general rule people either keep their own money or their families deal with this on their behalf. Health, safety and hygiene are generally given the level of attention needed although as highlighted in the accommodation section we did identify some issues relating to infection control and fire safety. We were concerned to find so many doors held open by wooden wedges. This increases the risks to people in the event of a fire because smoke, heat and flames could spread quickly. Whilst acknowledging the problems caused by closed doors eg for people with poor mobility or because they dont like to feel shut away in their rooms, this is something that needs attention. We explained to Mr Kingham that we would contact Hereford and Worcester Fire and Rescue Service about this because they are the regulator for fire safety matters. A fire officer is now in contact with Mr Kingham and has visited the home to give advice. Because this is a management issue rather than structural it has not affected our overall judgement in respect of the accomodation. We had not been receiving statutory notifications under regulation 37 of the Care Home Regulations during 2009 and had then been informed by Mr Kingham that this was due to computer problems. We have since received a large number of backdated notifications. During the inspection Mr Kingham explained that the computer probelm had been solved and that he was confident that all notifications would come to us in a timely manner in future. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 You must ensure that the care plans in use at the home fully reflect the needs and preferences of individuals. This is to help ensure that people get the correct care. 30/09/2010 2 9 13 13(2) You must have effective systems in place for the administration of medication. This is so people can always rely on receiving their medication correctly. 30/06/2010 3 9 13 13(2) You must have effective systems in place to monitor and audit the stock control of medication kept in the home. This is so people can always rely on receiving their medication correctly. 30/06/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 29 19 You must have complete information in place regarding all staff employed to work at the home. This is to ensure that you have all the inmformation you need to assure yourselves of the suitability of staff emloyed to work at the home. 30/06/2010 5 29 19 You must have effective recruitment procedures that meet the requirements described in Regulation 19 and schedule 2. This is to minimise the risk of unsuitable staff gaining employment at the home. 30/06/2010 6 33 24 An effective system must be established to review and improve the quality of the service provided taking into account the views of people who live in the home and other stakeholders. This is to ensure that the views of people who live in the home and other stakeholders are sought and taken account of in developing and improving the service. 31/08/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The information obtained before a person is offered a place needs to be detailed enough to inform staff about their care needs from the day they arrive and to give a good foundation for a written plan for the persons care. Records used to monitor the intake of food and fluid for very unwell people need to contain more detail so they provide a full picture that will help staff monitor progress or decline in a persons health. You should consider further ways to reduce the impact of interruptions on nurses whilst they are administering medication. Further endeavours need to be made to make sure that everyone, including people who live at The Weir, families, staff and professionals feel that their concerns are dealt with in an open, reassuring and objective way. Information about the roles of the owner, the acting manager and the clinical lead should be clearly defined in their job descriptions and in information provided for people using the service, their families, staff and professionals. Regulation 37 notifications should be handwritten and sent to us without delay if further computer problems arise in the future. Any requirements or recommendations made by Hereford and Worcestershire Fire and Rescue Service should be implemented within the timescales set by them. 2 8 3 9 4 16 5 31 6 38 7 38 Care Homes for Older People Page 31 of 32 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. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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