Key inspection report

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oaklands Nursing Home - KWD 82 Wartell Bank Kingswinford Dudley West Midlands DY6 7QJ The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a key inspection. Lead inspector: Date: Ann Farrell 3 0 0 4 2 0 0 9

This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38

Reader Information Document Purpose Author Audience Further copies from Copyright Internet address Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Care Homes for Older People Page 3 of 38

Information about the care home Name of care home: Address: Oaklands Nursing Home - KWD 82 Wartell Bank Kingswinford Dudley West Midlands DY6 7QJ Telephone number: 01384291070 Fax number: 01384291070 Email address: Provider web address: Name of registered provider(s): Cotdean Nursing Homes Limited Type of registration: care home Number of places registered: 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category 0 10 0 62 physical disability 13 0 Additional conditions: The maximum number of service users who can be accommodated is: 62 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) 62 Mental Disorder, excluding learning disability or dementia - over 65 years of age - (MD(E)) 10 Physical Disability (PD) 13 Date of last inspection Care Homes for Older People Page 4 of 38

Brief description of the care home Oaklands is a care home that can provide both nursing and personal care on one site. The building is divided up into two distinct sections, The Lodge and the Manor, although the former has not been used to accomodate people for some time. The home offers accommodation to older people, people with a disablement or terminal illness in both single and double rbedrooms, but full occupancy is dependent on the future of the Lodge. There is one large communal lounge/ dining room and a smaller lounge in a wing of the home that has recentley been refurbished. There is a passenger lift that gives access to all areas, adapted bathing facilities, hoists, grab rails etc for people with mobility problems. The home is situated close to the centre of Kingswinford in the centre of a residential area. There is access to bus routes following a short walk. At the time of inspeciton it was not clear bout the future of the lodge. Information about the services and facilities were available on entering the home. The service user guide did not provide information about the range of fees etc. and this will need to be explored when making enquiries. Care Homes for Older People Page 5 of 38

Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The last key inspection was undertaken in May 2007 and an annual service review (ASR) was completed in May 2008. The ASR does no involve a visit to the service, but information is obtained from various sources in order for us to make an assessment as to whether there has been any changes in the service since the previous key inspection and at the time there were no significant changes. At this key inspection a number of areas for improvement/development were identified they are outlined in the section below (What the service could do better). Findings from this inspection indicate that people receive adequate outcomes and a further key inspection will be undertaken within one year. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was Care Homes for Older People Page 6 of 38

completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. Surveys were forwarded to staff, people who live in the home, their relatives and health professionals in order to gain feedback about the services and fourteen were returned. In addition, people were spoken with at the time of the fieldwork visit. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 people's needs and focuses on aspects of service provision that need further development. One inspector undertook the fieldwork visit over two days. The Care Manager was not available on the day of inspection, so a nurse and another manager assisted with the process. The home did not know that we were visiting on the first day of inspection. At the time of inspection it was stated there were eleven people requiring nursing care and twenty people requiring residential care. Information was gathered by speaking to and observing people who lived at the home. Three people were "case tracked" and this involves discovering their experiences of living at the home by meeting or observing the care they received, 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. Staff files, training records and health and safety files were also examined. At the time of inspection six people who live in the home, two visitors and six staff were spoken with in order to gain comments. The inspector would like to thank the manager, people who live in the home and the staff for their hospitality throughout this inspection.

What the care home does well: Documents were available on entering the home, which provides people with information about the services and facilities they could expect upon moving into the home. People stated they enjoyed the meal and they received a choice each day. People living in the home stated the care staff were good and comments included: "The care staff are very good" "His care has been excellent" Arrangements for visiting were flexible enabling people to maintain contact with friends and relatives at a time that suited them. People are able to bring personal items and small pieces of furniture into their bedrooms so providing a home from home atmosphere if they wish, which reflects their individual personalities. The arrangements for managing peoples money was satisfactory and records were accurate demonstrating peoples money was safeguarded. There is a regular music to movement session held in the home if people wish to attend, which helps with maintaining mobility. What has improved since the last inspection? One wing of the home has been refurbished and some of the bedrooms have had ensuite facilities fitted and it was stated an assisted bathing facility was in the process of being commissioned, so enhancing the environment for people living in the home. What they could do better: One of the managers stated they will be providing new bed tables, commodes and beds in the near future with 6-10 bedrooms being completed at any one time. The assessment process should be completed before the day of admission, unless it is an emergency admission, so that staff have the relevant information about peoples needs and can ensure the appropriate equipment etc. is in place and peoples needs can be met on moving into the home. Following the pre-admission assessment a letter confirming admission should be forwarded to the person or there relatives, so they can be assured their needs will be met upon moving into the home. Care plan need to be individualised and person centered outlining in detail the action required by staff, so that peoples needs are met consistently and effectively. Evaluations of care should be meaningful and indicate the progress/effectiveness of the plan of care. Risk assessments should provide consistent information and be fully completed, so that appropriate action can be put in place to reduce risk to people living in the home. A review of manual handling procedures must be undertaken and appropriate action taken to ensure staff have the appropriate equipment and training to undertake Care Homes for Older People Page 8 of 38

procedures safely and people are not put at risk. Adjustable beds should be used for people with high nursing needs to ensure there comfort and safety and that of the staff. Also a review of all bed rails should be undertaken and appropriate height equipment or alternatives put in pace to ensure peoples safety is maintained when in bed. Staff should seek specialist advise regarding the appropriateness of the wheelchair where a lap strap is in constant use, to ensure the person has the appropriate equipment to meet there needs. Robust systems for regular monitoring of peoples bowels should be introduced and action taken where necessary to ensure peoples well being. Slides sheets used for moving people in bed should be for individual use to reduce the risk of cross infection. A review of communication systems in the home should be undertaken and appropriate action taken to improve dissemination of information to staff and relatives to enhance outcomes for people living in the home. One comment received from relatives was; "They could communicate better" The manager must ensure a robust system of medication is in place to ensure people receive the medication they have been prescribed by medical staff and their well being is maintained. The arrangements for social activities needs to be developed further to provide adequate stimulation for people living in the home and enhance their well being. A system for recording informal complaints/concerns should be introduced to demonstrate a pro active approach and continuous improvement. Systems should be in place to ensure staff have the appropriate knowledge and understanding about the Mental Capacity Act and the Deprivation of Liberties Safeguards, commensurate with their position in the home, so that people are supported to make decisions who lack capacity and staff are up to date with legislation. A review of the lighting in all areas should be undertaken and action taken to ensure it is sufficiently bright to meet peoples needs. A review of the staffing levels must be undertaken and appropriate action taken to ensure there are adequate numbers of all grades of staff on duty at all times to meet peoples needs. Comments received included; "Need to make sure there is adequate staff on duty for the needs of residents as I feel personally the staff that are on duty are always busy and some residents have to wait a while, and they can get frustrated and upset". "Don't like to use call bell as staff have lots to do". The manager must ensure there are at least two satisfactory references obtained for all staff before they commence employment in the home. A review of the arrangement for in house training should be undertaken to ensure it is Care Homes for Older People Page 9 of 38

effective in providing staff with the knowledge and skills required to meet peoples needs and undertake procedures safely. The quality assurance process should be developed further to provide opportunity for the management team to identify areas of improvement and put strategies in place for continuous development. All areas of servicing and checks on equipment must be undertaken on a regular basis to ensure the health and safety of people in the home. 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 set out 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 10 of 38

Details of our findings Contents Choice of home (standards 1-6) Health and personal care (standards 7-11) Daily life and social activities (standards 12-15) Complaints and protection (standards 16-18) Environment (standards 19-26) Staffing (standards 27-30) Management and administration (standards 31-38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38

Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is made available to people before they move into the home enabling them to make an informed decision about moving into the home. The assessment process should be undertaken prior to admission to ensure staff have the appropriate information to meet peoples needs initially on moving into the home. Evidence: The home had a service user guide, statement of purpose and our last report on display in the entrance hall, which provide information about the home. The service user guide is provided in size 14 font to make it more accessible to people with poor eyesight. It was also stated that it could be provided in large print if requested. This gives people information about the services and facilities to enable them to make an informed choice about moving into the home. Copies of the service user guide were also available in some of the bedrooms for reference purposes. Care Homes for Older People Page 12 of 38

Evidence: The home provides care for people who require long term or respite care. People can visit the home before moving in, so they can view the facilities, meet staff and other people who live there, in order to sample what it would be like to live there. The people who were spoken with stated their relatives had visited the home on their behalf. Documents indicated that staff undertake pre-admission assessments for people before they move into the home, so they can determine if people's needs can be met appropriately. On inspection of the records for two people who had moved into the home recently it was found that the assessment had been completed on the day of admission to the home. The assessment was based on physical needs and enabled the service to determine if these needs could be met. There was no evidence of assessment from social workers or information from other sources to demonstrate a person centered approach, we were informed that there is at times a delay in this. In one file there was evidence of a letter indicating the home would accept the person based on the assessment, but it did no appear to be addressed to anyone. On discussion with the nurse on duty she stated these documents were not forwarded to anyone. The purpose of these documents are to give assurance to people that their needs can be met when they move into the home. It is recommended that this process be reviewed. Following admission to the home there is a trial period of one month and a review is held at the end of the month with the person living in the home, their relatives, staff and social worker. This provides an opportunity to discuss whether the person would like to continue living in the home and if their care needs were being met or any changes are required. Care Homes for Older People Page 13 of 38

Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for planning peoples care and meeting health care needs need further development to ensure a person centered approach. The medication system needs to be more robust to ensure people receive medication that is prescribed for them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Following admission to the home a care plan is drawn up based on the pre admission assessment. The care plans were found to be pre printed documents for all areas of care. They had not been personalised to provide detailed information for care staff as to the action required to meet people's individual needs. Three peoples care files were looked at in detail. There was evidence that risk Care Homes for Older People Page 14 of 38

Evidence: assessments had been completed in respect of manual handling, nutrition, skin etc. for all the files looked at. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being is promoted. Generally it was found that the planning of care was inconsistent and therefore we could not be certain that each person had care plans that were up to date, accurate and addressed their needs. All care plans need to be personalised and provide detail of the action required by staff to support people as this could result in poor care practices and evaluation of care may not be accurate. A care plan for manual handling for one individual stated to follow moving and handling assessment, use correct sling and hoist, checks aids for safety, monitor footwear, change use of equipment as necessary. However, comments added stated they were non weight bearing and the hoist is used for all transfers. On discussion with staff they stated they were not told what size sling to use for individuals and used one based on what they thought was appropriate for the size of the person. During the inspection it was noted that handling belts were not being used appropriately and staff were unable to describe the criteria for the use of such equipment. A review of the manual handling practices will need to be undertake, appropriate equipment and training provided where necessary to ensure the safety of people living in the home and staff. One person was being fed by means of a tube (PEG) and there was a core care plan for nutrition and PEG feeding. There was no indication that a pump was in use, the type and rate of feed, positioning during feeding, rotation of tube etc. It was found that lemon glycerin sticks were being used for oral care and the person had a dry mouth. Research has shown that these can cause drying of the mouth. Also the syringe in use for feeding had not been dated and this could have implications in respect of infection control. Practices will need to be reviewed to ensure they are in line with current guidance. Some discrepancies were found in risk assessments e.g. a Waterlow risk assessment indicated a person had an average appetite and the general assessment and nutritional risk assessment indicated their appetite was poor. This could be misleading for staff and could lead to inappropriate interventions. It is recommended that this be reviewed and training provided where necessary to ensure accuracy, so appropriate strategies are implemented and peoples needs met effectively. One person's records indicated they were of a low body weight on admission, they were at a very high risk nutritionally, dietetic advice should be sought and the care Care Homes for Older People Page 15 of 38

Evidence: plan stated they required dietary supplements. There was no evidence of dietary advice being sought, no dietary supplements had been prescribed on the medication chart and there was no record of dietary supplements given. The record of food taken was only for breakfast, so it could not be confirmed that they were taking a nutritious diet. Another person who was nutritionally at risk was prescribed calogen, foticrem and fortisips by the GP. The medication chart indicated the calogen and forticrem had not been given as they were not needed and the fortisips had been given. However, on discussion with the person they stated they had not received the fortisips as the home was having trouble getting a supply of the flavor they liked. The nurse on duty stated that person had refused the calogen and forticrem as they did not like it, but there was no evidence that this had been discussed with the GP or any other health professional, as these are prescribed by G.P's where nutritional intake is of concern. One persons care plan stated staff were to monitor bowel action, but on inspection and discussion with the nurse of duty there was no record of this occurring regularly. There were no care plans indicating dressing regimes for wounds and in one instance some instructions were rather confusing and the nurse agreed they did appear confusing. In some cases risk assessments had not been fully completed e.g. the bed rail risk assessment only had the consent part completed. On inspection it was noted that bed rails on one bed were not sufficiently high enough to protect the person as pressure relieving equipment was in use. This will need to be reviewed and appropriate action taken to ensure people are safe at all times when in bed Evaluation of care plans was taking place, but they did not provide robust information and included comments such as "skin integrity continues to be observed", but there was no comment on the condition of the skin. Further information is available in seperate folders related to wound dressings and progress of this. One person was sitting in a wheelchair with a lap belt on all the time. On discussion with them they stated that it was used as they slipped out of the chair. There was no risk assessment in respect of this and it raises the question as to whether the wheelchair was appropriate to meet their needs. It is recommended that specialist advice be sought. Divan beds were in use for all categories of people living in the home and some people had high nursing needs. At the time of the last inspection it was recommended that Care Homes for Older People Page 16 of 38

Evidence: profiling beds should be obtained for such people to ensure their comfort and safety and the safety of staff, but this remains outstanding. One comment received about the beds was; "There is no backrest on the bed to sit up and it is more difficult to get out of bed". Staff stated slide sheets were used to move people whilst they were in bed, but they did not have individual ones. Using slide sheets for a number of people has implications in respect of cross infection and the manager will need to review this practice. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP is in agreement). There was some evidence of visits by health and Social Care professionals such as chiropodist, dentist and optician, but the information did not indicate that it was occurring on a regular basis. There was no evidence available to demonstrate monitoring of chronic diseases such as diabetes, high blood pressure etc. by medical staff. Such follow up ensures peoples health and well-being and advice should be sought from health professionals about such monitoring and clear records should be kept in the home to demonstrate where this is occurring. On discussion with staff some had a good knowledge about aspects of care, but others lacked information about aspects of health care e.g. one member of staff did not know about the reason for a gluten free diet. There was no evidence of training about health conditions etc. Feedback indicated staff were only sometimes given a handover or up to date information about the needs of people and they do not access care plans. Lack of good communication, both verbal and written, can impact on the care provided to people. Some relatives feedback also indicated some concerns with communication with comments such as "Could communicate better". It is recommended that communication systems are reviewed and action taken to ensure staff receive up to date information about people living in the home and their needs. The manager should also consider providing staff with training in respect of people's health conditions, so staff have a greater understanding and peoples needs are met effectively at all times. Feedback from people living in the home was satisfactory about the care being provided. Staff were generally observed to communicate well with people. Comments from people living in the home included; "The staff are very nice". "Sometimes staff Care Homes for Older People Page 17 of 38

Evidence: take a long time to come". "Need more staff are certain times" "Need to make sure there is adequate staff on duty for the needs of residents as I feel personally the staff that are on duty are always busy and some residents have to wait a while, and they can get frustrated and upset". "Don't like to use call bell as staff have lots to do". During the inspection there were times when a member of staff was not available in the lounge to supervise people and they did not have access to a call bell to call for help if required. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Medication was stored in locked cupboards in a locked room ensuring safety of drugs. On inspection of the medication for the current month was undertaken with the nurse on duty. It was found that audits for blistered medication were correct, but the audits for boxed medication were not correct in a number of instances. Also one persons care plan stated to use barrier cream and there was no barrier cream prescribed on the MAR chart. The record of variable dose medication had not always been recorded and could not be audited. One medication was prescribed four times a day at regular times and on occasions an extra dose had been given at night. When required medication for agitation had been prescribed in one instance, but there was no care plan and no instructions about when it should be used, to ensure consistency in practice. Creams were found in bedrooms with no date of opening; some had no name on to indicate they had been prescribed and were not prescribed on MAR charts. This suggests they were being used without medical knowledge. The record of destroyed medication could not be audited properly as it was not comprehensive. One person was administering their own eye drops and inhaler and staff were signing for the administration of them. Where people administer their own medication staff need to ensure a risk assessment is completed and monitoring systems are in place to ensure the person is able to administer them appropriately. The home has a supply of oxygen and the nurse stated that no one was prescribed oxygen at the time of inspection. The home's policy indicated that it would be obtained where it was prescribed for named people. The manager will need to review this practice, obtaining advice from the Primary Care Trusts pharmaceutical adviser if necessary, to ensure they are adhering to current guidelines. Care Homes for Older People Page 18 of 38

Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a choice of meals that meets people's needs. Social activities need further development to provide people with adequate stimulation and enhance their well being. Evidence: Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. There was good interaction between staff and visitors making them feel welcome. Comments from visitors included; "I can come when I want and staff are friendly". People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedrooms providing a home from home atmosphere reflecting their personality. Bedrooms were individualized and personalised according to people's wishes. There was a four week rotating menu that provided a choice of meals and on the day of inspection there was a choice of turkey or fish fingers for lunch. Alternatives were also available which included cold meat or cheese salad, jacket potato, omelette, chop, chicken breast or soup. Snacks and drinks were available between meals and Care Homes for Older People Page 19 of 38

Evidence: supper was also available from 7pm with a choice of biscuits, sandwiches, toast or cake. Special diets can be arranged for reasons of health, taste and cultural/religious preferences and some special diets were being catered for at the time of inspection. The dining room is adjacent to the kitchen and tables were laid with condiments, cutlery and table decoration. Comments about the meals were positive with people indicating they enjoyed the meals and were offered a choice each day.. "The food is good" Records included a section about peoples social history, which was not consistently completed to give full details about peoples preferred activities and hobbies etc. Where some areas of interest had been identified there was no evidence to demonstrate that staff had made arrangements for them to occur. Records of activities to date included movement to music, bingo, reading, watching television, icing cakes, chopping vegetables for soup and visit by an organ player. The nurse on duty stated they do obtain talking books and staff take in magazines for people to read. On discussion with people in the home they stated they had developed friendships with others living in the home, but they did get bored at times. Feedback from surveys indicated activities were only sometimes available and one comment was "Would like the home to arrange more activities". This area will need to be developed further to provide people with appropriate stimulation to enhance their well being. At the time of feedback it was stated that a member of staff had recently taken up responsibility for activities. The hairdresser visits on a regular basis enabling people to have their hair tended to professionally if they wish, which enhances self-esteem. The hairdresser was visiting on the day of inspection and people were sitting in the first floor corridor to have their hair dried. Consideration should be given to an alternative place for hairdressing, so corridors are not obstructed. Religious needs are met with regularly visits from clergy and some people go out to church. Care Homes for Older People Page 20 of 38

Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate systems in place, so people are protected from harm. Evidence: A complaints procedure was on display in the hallway and details of how to make a complaint were in the service user guide. This will need to be updated with our new details. On discussion with people living in the home they were not aware of the procedure, but stated they would probably speak to the manager. There was a complaints book where staff record any complaints and one formal complaint had been recorded. This had been forwarded to the manager from us and she had responded to us in writing. There was evidence that the managers had made one safeguarding referral since the last inspection, which had been dealt with appropriately. However, there was no record of any informal complaints/concerns in the home. This could suggest staff only record formal written complaints and concerns may not be recorded. It is recommended that suitable systems be developed to record informal complaints and concerns and the action taken in order to demonstrate a pro active approach and continuous improvement. Records indicated that most staff had undertaken training in respect of safeguarding and on discussion with some members of staff they had a satisfactory knowledge of the procedure within the home. There was no evidence of training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards. Systems will need to be Care Homes for Older People Page 21 of 38

Evidence: put into place to ensure all staff have a knowledge and understanding of these pieces of legislation and how in impacts on them, so they can support people appropriately commensurate with their role in the home. Care Homes for Older People Page 22 of 38

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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and comfortable environment. Lighting needs to be improved in some areas and there needs to be a more robust approach to infection control procedures. Evidence: The home is a detached two-storey building with adequate off road parking to the front of the building for visitors. The exterior is very well maintained with level access to the building for wheelchair users and seating outside for use when the weather permits. A partial tour of the home was undertaken and it was found to be warm, clean and maintained to a good standard. A new wing had been opened since the last inspection with new carpets, decor etc. The bathroom in this area was not accessible to people with mobility problems and it was stated that a new bathroom with an assisted bathing facility was in the process of being commissioned. There were assisted bathing facilities and showers in other parts of the home and a passenger lift enables people to access all areas of the home. There are nineteen single bedrooms and six double bedrooms, some of which have ensuite facilities whilst others have a wash hand basin. A call bell facility was available in each bedroom to call for assistance if required. All bedrooms doors did not have locks or lockable facilities that could enhance privacy and provide for the storage of valuables etc. Some of the beds were not suitable for the needs of people residing in Care Homes for Older People Page 23 of 38

Evidence: the home and the lighting was poor in some areas. One person living in the home stated "It's not a very bright room; I can't read the news paper unless I sit right under the window". On discussion at feedback it was stated there were plans to provide new commodes, over bed tables and new beds in the near future with 6/10 bedrooms being completed at any one time. The main kitchen was clean, well located and adequately equipped for its purpose. There was one large lounge/dinning room and a second lounge on the ground floor providing a choice of areas to sit. The laundry is well equipped with industrial capacity washing machines and tumble driers that meet the requirements for sluicing and disinfection of linen. Whilst touring the home it was noted that a range of toiletries were found in bathrooms and shower rooms, wash bowls were on the floor and there was a lack of liquid soap and paper towels in some areas. These issues will need to be addressed in order to reduce the risk of cross infection. Care Homes for Older People Page 24 of 38

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. The recruitment procedure needs to be more robust to ensure people are protected. A review of the training arrangements and staffing levels needs to be undertaken to ensure there are adequate numbers of trained staff on duty at all times to meet peoples needs. Evidence: The manager works on a full time basis and is supernumerary for three days, working as a nurse on the floor for the remaining two days. When she is supernumerary she is supported by another nurse on duty. The duty rota indicated there was one nurse and five carers on duty during the morning, one nurse and four care staff in the afternoon and one nurse and two care staff overnight. From the rotas seen this was usually achieved and occasionally there was six care staff during the morning. Ancillary staff such as domestic, laundry, catering, administration and maintenance staff support care staff. At the time of visiting there were eleven people requiring nursing care and twenty people requiring residential care. On occasions is was noted care staff also have to undertake some kitchen, laundry and cleaning duties. On discussion with people living in the home they voiced no complaints and comments included; "Staff are very nice" Care Homes for Older People Page 25 of 38

Evidence: "Sometimes staff take a long time to come" "The care staff are very good" "His care has been excellent" "They could communicate better" "Need to make sure there is adequate staff on duty for the needs of residents as I feel personally the staff that are on duty are always busy and some residents have to wait a while, and they can get frustrated and upset". "Don't like to use call bell as staff have lots to do". A review of staffing arrangements should be undertaken and appropriate action taken to ensure there are adequate staff on duty at all times to meet people's individual needs in a timely manner. The information provided by the home indicated two staff had ceased employment in the last year, which provides a stable staff group and continuity of care for people living in the home. A small sample of staff files for newly employed staff were inspected and it was found that two of the three files only had one reference in place. The manager on duty was unable to provide a second reference. Criminal Record Bureau Checks had been completed before the employee began work. The checks on nurses registration was up to date demonstrating they were registered to practice as nurses. Following employment new staff undertake the homes induction training, which provides them with the knowledge to meet peoples needs when commencing employment. There is a rolling programme of basic training to provide staff with the skills and knowledge to care for people living in the home, which included fire safety, manual handling, health and safety, food hygiene, infection control, abuse, first aid etc. some of which is provided in house and some by external employers. The in house training utilises a range of video cassettes and on discussion with staff they stated the sessions could last up to one hour. However, these videos are designed to be used as part of a training session lasting approximately three hours in total. This area will need to be reviewed and appropriate action taken where necessary to ensure staff are provided with the appropriate knowledge and skills to meet people's needs. Records indicated that thirteen care staff had completed National Vocation Qualification (NVQ) 2 in care or above, three were in the process on undertaking NVQ level 2 training and four care staff were in the process of undertaking NVQ level 3. Training provides staff with the knowledge and skills to meet people's needs appropriately and leads to improved outcomes for people living in the home. As identified in other parts of the report training should be given in respect of the Mental Capacity Act, Deprivation of Liberty Safeguards and conditions affecting people living in the home, so people are supported appropriately. T Care Homes for Older People Page 26 of 38

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. Systems need to be developed further to ensure the health, safety and protection of people living in the home. Evidence: The manager works on a full time basis and is supernumerary for three days, working as a nurse on the floor for the remaining two days. When she is supernumerary she is supported by another nurse on duty. The quality of the service is monitored via some audits. Evidence of visits on behalf of the proprietor had not been undertaken monthly. A small sample of staff files were inspected and it was found that staff supervision had not occurred over the past year. Feedback from staff indicated that they did not meet with the manager for support and to discuss progress. There was only evidence of one staff meeting and two meetings with people living in the home over the past year. It was stated that questionnaires were in the process of being sent out as part of the quality assurance process and records indicated they were last sent out in 2005. These processes need Care Homes for Older People Page 27 of 38

Evidence: to be developed further to provide opportunities for monitoring of the home and enable action to be taken to provide continuous improvement. Small amounts of money are held on behalf of people living in the home. It was stated that no one acts as appointee or agent for any one living in the home. The systems in place for the safekeeping of people's money appeared to be robust with receipts for purchases and regular audits. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed. The document gave some information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home and further information was obtained at the time of inspection. There are systems in place for servicing and maintaining equipment to ensure the health and safety of people living and working in the home. A sample of records were inspected and some areas were not up to date and need to be followed up; the gas safety certificate was dated 1/2/08 and was therefore out of date, there was no evidence of the servicing of the mobile hoist, there were periods when the in house checks on fire and emergency lighting equipment were not completed, there was no record of servicing of wheelchairs or recent checks for legionella testing and there were a number of issues outstanding from the electrical wiring check in 2006. These areas will need to be addressed to ensure the health and safety of everyone living and working in the home. home Care Homes for Older People Page 28 of 38