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Version 5.2

Key inspection report

CARE HOMES FOR OLDER PEOPLE

St Clements Nursing Home

8 Stanley Road Nechells Birmingham West Midlands B7 5QS

Lead Inspector Kerry Coulter

Unannounced Inspection8th May 2009 09:30

DS0000024892.V375341.R01.S.doc Version 5.2

This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:

• Be safe • Have the right outcomes, including clinical outcomes • Be a good experience for the people that use it • Help prevent illness, and promote healthy, independent living • Be available to those who need it when they need it.

We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:

• Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice

• Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983

• Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.

• Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money.


Reader Information Document Purpose Inspection Report Author Care Quality Commission Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright Copyright © (2009) Care Quality Commission

(CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified.

Internet address www.cqc.org.uk


SERVICE INFORMATION

Name of service

St Clements Nursing Home

Address

8 Stanley Road Nechells Birmingham West Midlands B7 5QS

Telephone number

0121 327 3136

Fax number

0121 328 1461

Email address

[email protected]

Provider Web address

Name of registered provider(s)/company (if applicable)

Noblefield Limited

Name of registered manager (if applicable)

Mrs Allison Grace Davies

Type of registration

Care Home

No. of places registered (if applicable)

37

Category(ies) of registration, with number of places

Dementia (37), Old age, not falling within any other category (37)


SERVICE INFORMATION

Conditions of registration:

1. 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: Dementia (DE) 37 Old age, not falling within any other category (OP) 37

2. The maximum number of service users who can be accommodated is: 37

Date of last inspection 17th November 2008

Brief Description of the Service:

St Clements is a purpose built three-storey home situated in a residential area of Birmingham. The home provides nursing care and accommodation for up to 37 older people, some have dementia and some have general nursing needs. There are twenty-five single bedrooms and six double rooms, one of which is located on the lower ground floor. All have en-suite facilities consisting of a toilet and wash hand basin but these are not large enough for people with restricted mobility to access safely. Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floors. There are six covered parking spaces on the lower ground floor to the front of the property and unrestricted parking on the adjoining roads. There is a small garden with steep elevations that is accessed from the ground floor. Communal facilities consist of a large lounge on both the ground and first floor. There is also a dining room situated on the ground floor that is adjacent to the kitchen, from all the meals are provided. The people living there can have their meals on either of the upper floors or in their own room. A laundry facility is situated on the lower ground floor, where washing of people’s personal clothing is undertaken. There are assisted bathing facilities on each floor. The home has pressure relieving equipment and a range of moving equipment to assist those persons who have restricted mobility.


The statement of purpose stated that the fees are £368. It stated that the fee structure is a guide only and all room prices quoted are negotiable. Fees do not include: hairdressing, dry cleaning, toiletries, chiropody, phone calls, medical supplies, physiotherapy, individual newspapers and aromatherapy. The most recent annual quality assurance assessment for the home states that copies of our reports our available in the home for people to read.


SUMMARY

This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The fieldwork visit took place over one days and was undertaken by two inspectors. The home did not have prior knowledge of our visit. There were 35 people living at the home, one person was receiving care in hospital. This visit was the homes first key inspection this inspection year. Our last visit to the home was a random inspection in January 2009. This was to check that the home had done what was required of them following the issuing of two statutory requirement notices with regard to care planning and health needs. At this visit information was gathered from speaking to and observing people who lived at the home. Four people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. During our visit we also undertook a Short Observational Framework for Inspection (SOFI). This is where we sit and observe peoples experiences in the home for about two hours looking at their wellbeing, activity and interactions. It is difficult to get peoples views about the home due to differing levels of dementia and peoples communication needs. However some people spoken with were able to give their views of the home. Prior to our visit we sent surveys to five people who live at the home, three surveys were returned. During the visit we spoke with the manager, a visiting health professional, one relative and several staff. Prior to our visit we sent surveys to ten staff but unfortunately only one survey was returned to us. Staff files, training records and health and safety files were also looked at during our visit.


We did not require the home to complete an Annual Quality Assurance Assessment (AQAA) prior to our visit. This was because it had not been that long a time gap since they had returned one to us. The AQAA tells us how well the home think they are performing and gives us some information about the home, staff and people who live there as well as improvements and plans for further improvements. What the service does well: People who live in the home have access to external health and social care professionals. This means staff can receive the necessary advice so they should be able to provide appropriate care. A GP visits the home on a weekly basis to assess peoples health needs and to prescribe any necessary treatments. This promotes people’s health and wellbeing. People are encouraged to personalise their rooms with items that are familiar to them so that they live in an environment, which they prefer. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. This promotes people's privacy and dignity when personal care is required. Some staff have been employed by the home for a long time. This ensures that people know the staff who will be helping them in meeting their needs. Over 50% of staff had achieved National Vocational Qualification level 2 or above in Care. This means that people are supported by staff who have the right qualifications to meet their needs. The recruitment procedure helps to ensure that people are safeguarded from harm. Maintenance records are well maintained and equipment is serviced regularly to ensure that it is safe to use. What has improved since the last inspection? There have been a number of improvements made since we last visited. This shows that the organisation and staff are keen to run a home that meets regulatory requirements and is run in the best interests of the people who live there. They have kept us informed of changes and improvements made at the home since we last visited. Some care plans have been improved so that staff have more information about how to meet peoples needs.


People are referred to external healthcare professionals when needed so that that they receive specialist advice to meet their individual needs. Some people have had more opportunities to go on outings so that their lifestyle is more enjoyable. The home has improved how it responds to complaints so that people know their views are listened to and acted on. Some areas of the home have been redecorated and re-carpeted in order to enhance the living environment for people. The home is providing an extra nurse on duty in the afternoons so that there are more staff on duty to help meet people’s needs. Staff have received more training so that they have more knowledge and skills to help them meet peoples needs. The manager has now been successfully registered by us and has a clear vision of how the home can move forward and improve so that it is run in the best interests of the people who live there. Each person now has a plan of how they should be moved if there was a fire so that staff can help them to be safe. What they could do better: The home needs to continue in developing the assessment process to ensure that individuals know their needs can be met at the home before they move there. Care plans need to be further improved to ensure that staff have good information on meeting people’s needs. Levels of interaction for some people in the home needs to improve to help ensure people’s social and emotional well being is maintained. Staff practice needs to improve to help ensure people receive the personal care they need so they can feel good about their appearance. The further development of activities needs to be continued so that people can lead an interesting and stimulating lifestyle, which meets their individual needs. People should be assisted to eat their meals in a way that meets their needs to help people enjoy their meals.


Cleaning arrangements should be improved so that people can be sure there are good infection control procedures in place. Some staff need more training so that they have the skills and knowledge appropriate to their role and ensure that the needs of the people living there are met. The home’s fire risk assessment needs to be reviewed to make sure that fire precautions are satisfactory and the risk of people being harmed is reduced as much as possible. When people are assisted to move this must be done in a safe manner so that people are not put at risk of injury. 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 [email protected] or by telephoning our order line – 0870 240 7535.


DETAILS OF INSPECTOR FINDINGS

CONTENTS

Choice of Home (Standards 1–6)

Health and Personal Care (Standards 7-11)

Daily Life and Social Activities (Standards 12-15)

Complaints and Protection (Standards 16-18)

Environment (Standards 19-26)

Staffing (Standards 27-30)

Management and Administration (Standards 31-38)

Scoring of Outcomes

Statutory Requirements Identified During the Inspection


Choice of Home

The intended outcomes for Standards 1 – 6 are:

1. Prospective service users have the information they need to make an informed choice about where to live.

2. Each service user has a written contract/ statement of terms and conditions with the home.

3. No service user moves into the home without having had his/her needs assessed and been assured that these will be met.

4. Service users and their representatives know that the home they enter will meet their needs.

5. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home.

6. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home.

The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to help them decide if they would like to live at the home. The assessment process generally helps to ensure that people can be confident that their needs can be met by the home. EVIDENCE: The home has a service users guide available. The guide had been updated in April 2009. This ensured that it included up to date information so that people thinking of moving to the home would have the information they need to make a choice as to whether or not to live there. It was produced using text only so may not be accessible to all the people living there. Consideration should be given to providing it in alternative formats.


The manager told us that a copy of the guide is given to all new people living at the home. We saw that one new person had a copy of the guide in their bedroom. Two of the three people who returned a survey to us said they had received enough information about the home. Following our last key and random inspections of the home we were concerned that the home was not meeting the personal and healthcare needs of everyone that lived there. We asked the provider if they would suspend any future admissions to the home until things had been put right. The provider was responsible in their response and agreed to this request. Before this agreement had been reached some new people were admitted to the home. We looked at the assessment procedure followed for one of those new people. We found that the pre-admission assessment had been completed to an adequate standard to enable the home to make a decision about if they can meet the person’s needs. However as identified in the home’s audit we found that some of the detail within the assessment could be improved. Sampling of records and discussion with the manager show that the home is currently producing a new draft admission assessment form.


Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. The service user’s health, personal and social care needs are set out in

an individual plan of care. 8. Service users’ health care needs are fully met. 9. Service users, where appropriate, are responsible for their own

medication, and are protected by the home’s policies and procedures for dealing with medicines.

10. Service users feel they are treated with respect and their right to privacy is upheld.

11. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect.

The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with some information but are not always consistent and may mean that some people do not always get the care that they need when they need it. People usually receive their medication as prescribed to help meet their healthcare needs. EVIDENCE: At previous visits we have found that care planning needed to improve and that people did not always get the care they needed or in a way that they prefer. At this visit we found that improvements have been continued but that there is still work to do to make sure that outcomes for people are good. We case tracked four people who live at the home. We found that each person had a care plan that had been subject to regular reviews. The plans provided some details of people’s individual needs, likes and dislikes but this was not consistent. Improvement is needed to show that people are involved in


planning their care where possible. However we did find that the detail in plans is improving following the home undertaking detailed care plan audits and advising staff on what needs to get better. Plans are more individualised and work on improving care plans is ongoing. Plans were in place for most of the assessed needs of people. For example mobility, communication, pressure care, continence, falls, night time support needs and nutrition. Some people had brief plans in place regarding their activity and social needs. These need to be completed for everyone and need to be in sufficient detail to enable staff to know the support each person needs. Some plans were detailed in content but a minority of plans still used terminology such as ‘regularly’ for example when directing staff as to how often one person needed oral care. Plans need to be specific so that staff know the exact support that is needed. Care planning and monitoring of people’s health care needs had improved. One person had been treated for an infection with antibiotics and a short-term care plan had been written so that staff could monitor progress. One person had detailed care plans in relation to sore skin and there was evidence that specialist advice had been sought from the tissue viability nurse. Regular evaluation of their care plan had taken place and staff were monitoring to ensure the sore was improving. At this visit we found that referrals to other health professionals are being made as needed. For example one person’s nutritional assessment indicated they needed dietician involvement. Records showed that the home had referred this person to the dietician. One person who we case tracked had epilepsy and we saw that a care plan was in place for this. This should be improved to record the type of seizures the person has and how long staff should stay with them following a seizure. This will help to ensure the person receives the healthcare they need should they be unwell following the seizure. One person we spoke with told us that they had been unwell the previous week and that staff had made sure they had seen the GP. One person told us ‘staff look after me well’. Surveys we received from people told us they either always or usually receive the support they need. Two people told us they always receive the medical support they need, one told us this was usually. During our visit we had the opportunity to speak with a health professional who visits the home regularly. They told us that they thought the home was continuing to improve. They said ‘Carers have good knowledge but communication could be improved. Health wise things are okay, I have no concerns. The home has very few hospital admissions and few deaths, also have low incidence of pressure sores. The home has not always been aware of the services that are on offer to them from other professionals but I have been assisting them with this’.


Assessments had been completed for risks to people. This included risks such as pressure sores, falls, use of bed rails and choking. The assessments were generally adequate and are reviewed on a monthly basis. Moving and handling assessments were detailed with the type of equipment that should be used to assist people safely. One assessment sampled was found to be inaccurate and recorded that the person was at a high risk of falls. When we added up the scores on the assessment we found that this indicated the person was actually at a medium risk. The manager said she would ensure this was reassessed. We looked at the home’s systems for administration of medication. Qualified nurses administer the medication to people. At the front of each persons Medication Administration Record (MAR) there is a photograph of the individual so that unfamiliar staff would know who to give the medication to. Medication records sampled and tracking of medication in stock appeared to show that people had been given their medication as prescribed. The home undertakes its own internal audits of medication. An audit undertaken in April showed that some errors had been identified. The manager was able to show us that action had been taken to put things right and that the staff concerned had been spoken with. The most recent medication audit for the home indicated that no errors had been found. During our visit we noticed that some creams and ointments had been left unattended in a shower room for a considerable length of time. One of the creams was without a top leaving it open to contamination. The home needs to ensure that all creams and ointments are stored safely. Observation during our visit showed that the way in which people were treated with respect and privacy was variable. We saw some good staff interation with people at the home but some people had long periods when they had no interaction with anyone. This does not give people a sense of wellbeing and may be a contributing factor as to why some people were often asleep in the lounge. It was good however that people were gently woken up by staff for their lunch in a manner that would not startle them. Staff observed to say goodbye to the people living there when going off duty. Previously we saw that staff were struggling to communicate with one of the people at the home. There were no communication aids but the persons preference sheet suggested that these may be useful. At this visit we saw the person using picture cards and staff picking them up to ask them things so this is a big improvement in their quality of life. We overheard one person being told by a carer who was assisting her to go to the toilet 'It's alright you are not being a nuisance, ask me when you need to


go.' However not all people were supported with their personal care needs when they needed to be. One person had spilt a drink down their top at breakfast. They had not been supported to change and at lunch staff put an apron over their dirty clothing. We also noticed this person had dirty fingernails that needed cutting.


Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. Service users find the lifestyle experienced in the home matches their

expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs.

13. Service users maintain contact with family/ friends/ representatives and the local community as they wish.

14. Service users are helped to exercise choice and control over their lives. 15. Service users receive a wholesome appealing balanced diet in pleasing

surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not ensure that all of the people living there experience a meaningful lifestyle that meets their individual needs. EVIDENCE: The home has an activity co-ordinator who is responsible for organising the activities. Records and discussion with staff show that the activities on offer include arts and crafts, indoor and outdoor gardening, visiting entertainers, walks out, music and reading newspapers. A hairdresser regularly visits the home so that people can have their hair styled in the way they prefer. The ‘Pets as Therapy’ service has visited the home bringing rabbits with them so that people could have some interaction with rabbits. The manager told us that the home is going to extend this activity further by buying some rabbits of their own so that people will be able to hold and stroke them. We saw photo’s on display showing people enjoying themselves at the ‘war time’ entertainment evening when the home was decorated with flags and the entertainers were in war time costume. Other photo’s showed people enjoying


themselves on a visit to the German market in Birmingham. During our visit some people had the opportunity to participate in activities such as drawing or potting up seeds. One person told us 'its not extra special here but its okay, it’s the average'. Since we last visited the home many of the people who live there have been registered with the ring and ride transport service. The manager said it is hoped this will help in getting people out into the community. We spoke with one health professional who told us she had noticed that there were more opportunities for people to go out now such as shopping. One person’s records showed they had recently been out to lunch and a pint at the pub. Whilst there is improvement in the variety and level of activities on offer to people further improvement is still needed. Records are kept of activities undertaken by people. These did not show that people are offered things to do every day. As previously said in this report some people go for long periods without any interaction from staff or other people. Review minutes for one person recorded a discussion with their relative who was concerned they where often seated where they could not see the television. During our visit this person had not been assisted by staff to sit in a position where they could see the television. Staff said and it was evident from sampled records that some people have regular contact and visits from their family and friends. We were able to speak with one relative during our visit to the home who told us that they were always made to feel welcome when they visited. Records showed that the manager had organised a relatives meeting in the home. The manager said this had not been well attended so she has produced a newsletter to send to relatives to keep them up to date with what is happening at the home. Staff did offer people some choice in day to day matters such as what they wanted to watch on television. Choices with regards to drinks had improved since the key inspection. Staff asked people what they wanted to drink, if they wanted sugar in their drink or not and if they wanted a big or small cup. Biscuits were offered and people were asked which they would like. It was however disappointing that people who were asleep did not get a drink mid morning. One person told us that there is a choice of meal but sometimes staff forget to come and show them the menu and ask what they would like. We found at this inspection that meal time practice had improved.People now have more fruit in their diet as they are offered fresh juice with their breakfast as well as cordial. Since our last key inspection information about people’s food preferences is now available in the kitchen. Kitchen staff spoken with were aware of people’s individual dietary needs and had a list of what meal people had chosen for their evening meal. The meals on offer matched the menu for the day. A rotating four week menu was in place so that this offered


variety. Alternative choices were available on the menu and meals were varied. In the kitchen there were good stocks of fresh fruit and vegetables as well as a lot of tinned fruit. This ensures that people can be offered a healthy and nutritous diet to help them keep well. At the last key inspection no aids were provided to help people to eat so they could maintain their independence in a dignified way. At this visit people were provided with lipped plates where they needed them but were not given adapted cutlery. The manager said that adapted cutlery had been obtained and she would remind staff to use it where it needed. We saw that one person was struggling to eat their meal due to the height of the table they were sitting at. The home needs to make sure people are in a comfortable seating position so that they can enjoy their meals. We noticed that at this visit staff interaction and support for people at the meal time was improved however some people were given their meal without being told what it was and one person did not have their food cut up although they needed staff to do this for them. We also saw that one person was not closely supervised whilst they eat their meal even though their care plan said this needed to be done. Surveys we received from people indicated they are generally happy with the meals on offer. During our visit people commented: 'lunch was nice' ‘lunch was nice, I loves fish and chips. Some food is beautiful but not always, there is a menu but sometimes staff forget to bring it in and ask what you want’.


Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. Service users and their relatives and friends are confident that their

complaints will be listened to, taken seriously and acted upon. 17. Service users’ legal rights are protected. 18. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is available to people and they can be confident their complaints will be listened to and acted on. There are systems in place, which should protect people from harm. EVIDENCE: A copy of the complaints procedure is available in all bedrooms. It contains enough information to guide people in how to make a complaint and how long they can expect to wait for an outcome. Two people who live at the home who returned surveys to us told us they were aware of the complaint procedure but one said they were not aware. However all people indicated they knew who to speak to if they were unhappy. Minutes of a meeting held with relatives show they have been made aware of their right to complain. At this meeting the manager emphasised that if anyone had any concerns they should be assured that the home does not tolerate any bad behaviour towards the people who live there. Our previous key inspection to the home found that documentation in the home about complaints received did not fully show the action the home had taken in response to the complaint. Since that visit the home has received two complaints. The complaint log detailed the nature of the complaints and what action had been taken. Evidence was available to show that the complainants


had been told about the outcome. We have not received any complaints about the home since the last key inspection. Recently there has been a safegurding issue raised by the home. This did not relate to practice within the home. The home followed safegurding procedures and reported the matter to social services. The outcome of this is not yet known. We spoke with three staff about what they would do to keep people safe should they witness abuse taking place. Whilst staff gave quite basic answers the action described should help to keep people safe. Most of the staff at the home have received training in safeguarding adults from abuse. The manager told us that all staff should have received this training by September.


Environment The intended outcomes for Standards 19 – 26 are: 19. Service users live in a safe, well-maintained environment. 20. Service users have access to safe and comfortable indoor and outdoor

communal facilities. 21. Service users have sufficient and suitable lavatories and washing

facilities. 22. Service users have the specialist equipment they require to maximise

their independence. 23. Service users’ own rooms suit their needs. 24. Service users live in safe, comfortable bedrooms with their own

possessions around them. 25. Service users live in safe, comfortable surroundings. 26. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a comfortable environment in which to live that generally meets their needs. EVIDENCE: Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floors. There is a lounge and dining room situated on the ground floor and a combined lounge/dining room on the first floor. There is no specific area for activities and these have to be undertaken in the lounge or dining areas. Discussion with staff during our visit also indicates that the home lacks storage space. During our visit we saw that call bells were within easy reach of toilets and people’s beds so that they could call for assistance if needed.


We saw at previous visits to the home that décor was of an adequate standard but that some parts of the home were worn. The home was also decorated throughout in the same colour. We looked around parts of the home and since we last visited some improvements to the environment have taken place. The manager told us that further improvements are planned. New carpets have been fitted to the stairs and new carpets have been ordered for four bedrooms. Some of the hallways have been repainted in a different colour to other parts of the home making it look a little more homely. The manager told us that one bedroom is going to be redecorated every three weeks. Colour charts have been obtained so people can choose what colour they would like their room. We looked at some people's bedrooms and these were found to be personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them. Some people have difficulty in remembering where their room is due to their dementia. To help people remember, the home as begun to put pictures on people’s bedroom doors of things that interest them such as flowers, football or fish. This will help people to know which is their room. People cannot currently lock their bedroom doors from the inside and part of the homes action plan for improvement states they are going to be installing new locks. The home needs to ensure these are of a type that can be opened in an emergency. The home has dedicated domestic and housekeeping staff to help with the laundry and keep the home clean. When we first arrived at the home there was a strong smell of urine outside the laundry area. However the smell later reduced so it may have been from soiled laundry. People who live at the home told us it is usually clean. However during our visit we saw that one person’s bed had been stripped but that faeces had not been cleaned from the side of their bed. Although the person was not in their room anyone visiting the home could see this due to the door being open. This remained until lunchtime when we brought this to the managers attention who said she would arrange for it to be cleaned. This is not an isolated incident as the complaint log recorded something similiar where a mattress had not been properly cleaned.


Staffing The intended outcomes for Standards 27 – 30 are: 27. Service users’ needs are met by the numbers and skill mix of staff. 28. Service users are in safe hands at all times. 29. Service users are supported and protected by the home’s recruitment

policy and practices. 30. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who receive some training to help ensure they have most of the knowledge they need to meet peoples needs. The recruitment process should ensure that people are protected from harm. EVIDENCE: The manager said and rotas showed that in the morning and afternoons there are six care staff. There are also two nurses on duty in the morning. Previously in the afternoons there was only one nurse on duty but with the recruitment of two additional nurses the home is now trying to provide two nurses. This helps people’s health and personal care needs to be better met. In addition to care staff and nurses cleaners, laundry, kitchen and maintenance staff are also employed so that care staff are able to concentrate on providing care to the people living there. The manager said that they only use agency where they are unable to cover staff sickness by using bank staff or staff working extra hours. There were no agency staff on duty during our visit. This helps to ensure that staff know the people living there. One relative told us that when they visit they can always get hold of the staff if they need them. One health professional told us there are enough staff on duty when they visit.


Just over 50% of staff had achieved National Vocational Qualification level 2 or above in Care. This meets the standard that at least 50% of staff have achieved this qualification and should ensure that they have the skills and qualifications to meet the needs of the people living there. People told us 'staff are all nice, very good, but day staff are more caring than the night staff', 'staff come in and check I am okay' and ‘staff come quickly in the day if you ring but not as quickly at night’. We observed some good interactions between staff and people who live at the home during our visit and there was a pleasant atmosphere in the home. However as already stated earlier in this report some people at the home had little interaction from staff. Staff need to ensure they interact with everyone at the home as sometimes people who had high dependency or were withdrawn appeared to be left out of social interactions. We looked at three staff files and these were found to have all the required checks prior to employment beginning to ensure that people were safeguarded from harm. The home has a matrix in place that shows what training staff have done. This should be updated as it still showed some staff who no longer work at the home. We spoke with one new member of staff who confirmed they had received an induction when they started working there. Training records sampled and discussions with staff indicate that they receive most of the training they need to do their jobs. Training that has been undertaken by some staff that includes dementia, manual handling, safeguarding people from abuse, first aid, fire, food hygiene, supportive care pathway and wound care. As stated earlier in this report not all staff have received safeguarding training, a minority of staff still need manual handling training. The manager told us this is being arranged. One staff who we saw undertaking manual handling tasks told us they had not yet received manual handling training. Not all of the staff have received dementia care training and this should be arranged for those that need it as the home accommodates some people who have dementia. Records and discussion with staff show that additional clinical training is on offer to nursing staff. Training has been undertaken or scheduled that includes nasal gastric tubes, blood glucose monitoring and catheter care.


The frequency of staff meetings has been improved but they are not yet held at least every other month. One staff told us staff can say what they want to at the meetings. However they also thought that meetings should happen more often as ‘more team building was needed’.


Management and Administration The intended outcomes for Standards 31 – 38 are: 31. Service users live in a home which is run and managed by a person who

is fit to be in charge, of good character and able to discharge his or her responsibilities fully.

32. Service users benefit from the ethos, leadership and management approach of the home.

33. The home is run in the best interests of service users. 34. Service users are safeguarded by the accounting and financial

procedures of the home. 35. Service users’ financial interests are safeguarded. 36. Staff are appropriately supervised. 37. Service users’ rights and best interests are safeguarded by the home’s

record keeping, policies and procedures. 38. The health, safety and welfare of service users and staff are promoted

and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and provider are keen to make and sustain improvements so that the home is run in the best interests of the people who live there. EVIDENCE: The home has had several managers in recent years so staff and the people who live there have not benefitted from having a settled management structure. Since our last visit to the home the new manager has successfully completed her registration with us to manage the home. This shows she has a commitment to the home. The manager is a Registered Nurse who has experience in home management and care of older people. It is clear that a number of improvements have been made since the manager has been in


post. The home now needs to sustain these and work on other areas that still need improving. There was evidence of regular visits being carried out to the home by the operations manager. The reports were noted to be comprehensive and included discussions with people who live in the home and staff. A variety of in-house audits are completed to include the medication and care planning system. Audits sampled were generally detailed and issues for improvement had been identified. The home sends out annual quality assurance questionnaires to people’s relatives. At the previous key inspection the manager told us she intended to review the content so that the questions were more relevant to the home. The manager showed us that this has now been done and said the new questionnaires were in the process of being sent to people. We have previously recommended that the home needs to consider how it can seek the views of health professionals external to the home. The manager said this was still to be done. The home also needs to look at how it seeks the views of the people who live there and show their views are considered in how the home is run. The home has the facility to look after small amounts of money for people. The personal finances of two people were checked. Money in people’s wallets matched their records. Receipts showed that people had not bought items that the home should pay for. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Water temperatures are checked monthly to make sure that the water is at a safe temperature for people to use. Discussion with the manager indicates that first aid training has been improved for staff so that they now receive a full days training when previously it had been two hours. This means that staff should now have better knowledge. Staff receive fire drills and training to ensure that they have the knowledge to safeguard people in the event of a fire. At the last key inspection we saw that the home had a fire risk assessment in place but this was overdue for review. At this visit we saw that this had still not been reviewed. This needs to be done to make sure fire precautions in the home are satisfactory. However as recommended previously individual fire evacuation plans have been completed so that staff know how to support them to keep safe should a fire occur. At the random inspection in January we saw that moving and handling practice had improved. At this visit the majority of practice we saw was safe, however we did see one person being assisted to move in an unsafe manner by staff. Some staff who were assisting people had not received training in moving and handling. The home’s own monthly report shows that they have established


that the current training received by staff is not robust enough and are searching for an alternative training provider.


SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:

4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls)

“X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable

CHOICE OF HOME ENVIRONMENT

Standard No Score Standard No Score

1 3 19 3 2 X 20 X 3 2 21 X 4 X 22 X 5 X 23 2 6 X 24 3 25 X

HEALTH AND PERSONAL CARE 26 2 Standard No Score

7 2 STAFFING 8 2 Standard No Score 9 2 27 3

10 2 28 3 11 X 29 3

30 2 DAILY LIFE AND SOCIAL

ACTIVITIES

Standard No Score 12 2

MANAGEMENT AND ADMINISTRATION

13 3 Standard No Score 14 2 31 3 15 2 32 X

33 2 COMPLAINTS AND PROTECTION 34 X Standard No Score 35 3

16 3 36 X 17 X 37 X 18 2 38 2


Are there any outstanding requirements from the last inspection?

No

STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

No. Standard Regulation Requirement Timescale for action

1 YA15 13(4) Ensure people are assisted with their meals in line with their assessment from the Speech and Language Therapist. This will help to ensure people are not put an increased risk of choking whilst eating and drinking.

08/06/09

2 OP38 13(4) When people are assisted to move this must be done in a safe manner so that people are not put at risk of injury.

08/06/09

RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

No. Refer to Standard

Good Practice Recommendations

1 OP3 Pre admission assessments should contain enough details so that people know their needs can be met prior to moving in.

2 OP7 Care plans need further detail about people’s needs, the person should be included in their development and should provide details about personal preferences so that people


receive care in a way that they need and prefer. 3 OP8 Where people have epilepsy their care plan should record

the type of seizures the person has and how long staff should stay with them following a seizure. This will help to ensure the person receives the healthcare they need should they be unwell following the seizure.

4 OP9 Creams and ointments should be stored safely so that they are not left open to contamination.

5 OP10 Levels of interaction for some people in the home needs to improve to help ensure people’s social and emotional well being is maintained.

6 OP10 Staff practice needs to improve to help ensure people receive the personal care they need so they can feel good about their appearance.

7 OP12 The range and frequency of activities should be further improved so to meet individuals needs and ensure their well being.

8 OP15 People should be assisted to eat their meals in a way that meets their needs to help people enjoy their meals.

9 OP18 All staff should be trained in safeguarding people from abuse so that they know how to keep people safe.

10 OP24 It is recommended that the programme of installation of suited bedroom door locks be completed so that people can choose to lock their doors if they want to.

11 OP26 Cleaning arrangements should be improved so that people can be sure there are good infection control procedures in place.

12 OP27 Staff meetings should be held more regularly to ensure that all staff are kept updated about the changing needs of the people living there, ‘best practice’ and changes within the organisation.

13 OP30 Appropriate training should be provided for each member of staff so that they have the skills and knowledge appropriate to their role and ensure that the needs of the people living there are met.

14 OP33 The quality assurance system should be reviewed and consideration should be given to including the views of people who live at the home and care professionals. This will ensure that the views of the people living there are represented and can be used to improve the home.

15 OP38 The fire risk assessment should be regularly reviewed to ensure that all action is taken to minimise all risks of there being a fire.


Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: [email protected] Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified.

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