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Inspection on 18/11/09 for Aquarius Nursing and Residential Care Home

Also see our care home review for Aquarius Nursing and Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 18th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Statement of Purpose and service users guide is kept under review to ensure it accurately details the present management structure of the home. People living at the home have a choice of varied and nutritious meals. The home does all it can by following relevant recruitment procedures to ensure staff recruited have the skills and experience and are suitable to work in the care industry. The present management structure keeps people living at the home, their representatives and staff informed about the running of the home by holding regular meetings.

What has improved since the last inspection?

A record of people`s allergies is now detailed on their medication administration record charts. The home has been notifying the Commission about events adversely affecting the wellbeing of people living at the home. Staff are receiving training about the protection of vulnerable people.

What the care home could do better:

Information provided to people interested in living at the home must be provided in an accessible format so they can have some understanding about the service provided at the home. Care plans must detail the present health and personal care needs of people living at the home. There must be relevant, individualised care plans or guidelines to inform staff as to when as required medications should be administered. People must have dietary supplements or thickening agents added to their food and drinks as prescribed by the relevant health care professional. People living at the home must have opportunities to take part in activities and social interactions that are of interest to them. It must be assured that all staff receive training to equip them with the skills and knowledge to support and care for people living at the home. The home must demonstrate quality assurance processes are being used effectively to promote and improve the welfare of people living at the home. The home must demonstrate compliance with relevant fire safety authority legislation. Improvements made following the last inspection must be sustained and embedded into care practices at the home to ensure the welfare of people living at the home continues to be protected.

Key inspection report Care homes for older people Name: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gina Pickering     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN (023)92811824 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Qualitycare Management Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following category/ies of service only: Care home with nursing - (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) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The Aquarius Nursing and Residential Care Home is a care home providing nursing care for up to 38 people over the age of 65 years who have a diagnosis of mental frailty or Care Homes for Older People Page 4 of 32 Over 65 0 0 38 38 38 0 1 0 0 3 2 0 0 9 Brief description of the care home mental disorder, excluding learning disabilities. The registered provider is Qualitycare Management Ltd but since September 2009 has been in administration. The administrators are managing the home with the intention of selling it as a care home. The home is located in a residential area of Southsea, close to the sea front and the local amenities of the city of Portsmouth. The home consists of three large houses that have been joined together as a large town house. There is a pleasant courtyard at the front of the house and an enclosed patio area at the rear of the home. Nine of the eighteen single bedrooms have en-suite facilities. There are ten double rooms seven of which have en-suite facilities. There is a passenger lift fitted from the ground floor to the first floor only. Chair lifts are in place on some of the other flights of stairs that access other floors. Rooms that have been identified as having only access via a flight of stairs can only accommodate service users who are fully mobile. There are extra charges for items such as chiropody, hairdressing, toiletries, which are not included in the fee. The current fee charged is £560 - £900 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection process considered information received about the home since the last key inspection in March 2009. This includes provided from the service about the management arrangements at the home. Information received since the last inspection also includes details provided by Social Services as a result of ongoing safeguarding meetings being held about care provision at the home. Information from both these sources raised concerns about the management of the home and welfare of people living at the home, therefore a key inspection was planned urgently. A visit was made to the service on 18th November 2009. We looked at documentation relating to five people living at the home, had conversations with the person managing the home at that time, the representative from the administrators, four staff members and four people living at the home. We looked documentation that related to the management of the home and viewed several areas of the home. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Information provided to people interested in living at the home must be provided in an accessible format so they can have some understanding about the service provided at the home. Care plans must detail the present health and personal care needs of people living at the home. There must be relevant, individualised care plans or guidelines to inform staff as to when as required medications should be administered. People must have dietary supplements or thickening agents added to their food and drinks as prescribed by the relevant health care professional. People living at the home must have opportunities to take part in activities and social interactions that are of interest to them. It must be assured that all staff receive training to equip them with the skills and knowledge to support and care for people living at the home. The home must demonstrate quality assurance processes are being used effectively to promote and improve the welfare of people living at the home. The home must demonstrate compliance with relevant fire safety authority legislation. Improvements made following the last inspection must be sustained and embedded into care practices at the home to ensure the welfare of people living at the home Care Homes for Older People Page 7 of 32 continues to be protected. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Processes are in place to assess peoples needs before they move into the home. The service does not provide people with information about the services offerred at the home in an accesible format. Standard 6 is not applicable as the home does not offer intermediate care. Evidence: Following the last inspection in March 2009 we had been told by the service that a new form had been designed to ensure that the effect a person moving into the home will not impact on the health and well being of people presently living in the home. At this inspection we were unable to make a conclusion about the assesment processes prior to a person moving into the home. This is because the service has made a voluntary agreement not to admit people into the home at the present time to ensure the protection of the welfare and wellbeing of those people presently living there. Care Homes for Older People Page 10 of 32 Evidence: We looked at the statement of purpose and service guide that provides information to people interested in living at the home about the service provided. Information about the management structure at the home has been ammended to reflect the present management arrangements. The manager confirmed with us that these documents are not provided in an easy to read format at present which means the information is not accesible to people who have problems reading small print and are unable to understand the written word. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people living at the home are at risk of not being met because of conflicting information detailed in care plans and the plans not always detailing the current care required by the individual. Some areas of the management of medications means it cannot always be assured people are receiving the medications they require. Dignity of people living at the home is not always considered. Evidence: We looked at the care plans for five people living at the home. These contained risk assessments and details of actions to be taken by staff to meet the peoples needs or reduce an identified risk to people living at the home. We found the organisation of the plans difficult to follow and concluded that it would be difficult for a new member of staff or an agency staff to locate the relevant information about the support and care required by individuals. The manager told us she had reached the same conclusion, but that staff at the home were able to use the care plans effectively. Care plans are maintained in the nurses office, we did not observe any care staff accessing these plans during our visit to the home. We were told there are basic care plans Care Homes for Older People Page 12 of 32 Evidence: located in the wardrobes in peoples bedrooms that assist in informing care staff. However some care practices we observed indicated that some people living at the home are not always receiving the care and support they need to meet their personal, health and social care needs. This means that despite care plans being available in both the nurses office and peoples bedrooms it is not assured that staff are always informed about the actions they need to take to meet the needs of people living at the home. Some care plans contained conflicting information which would make it difficult to ensure each person is receiving the care and support they need in the manner they prefer. Examples of this include one person having two plans for continence needs. One stated the person was fully continent and wears a pad for safety. The other detailed the person was unable to maintain continence and wears a continence pad day and night. There was use of two different nutrition assessments which have different scoring systems resulting in people having two different scores regarding nutritional needs. This has the potential to cause confusion resulting in people not having their nutritional needs met. The manager agreed it is not best practice to have multiple assessments for one area of need. Some peoples nutritional needs were detailed in their care plan documents. For some people this included the use of thickening agents in their drinks and food to reduce the risk of inhaling fluid into their lungs which could consequently cause a form of pneumonia. For one person whose plan detailed the need for thickening agents in fluid we observed drinks being provided that were not being thickened. We notified the manager who addressed the issue with the relevant members of staff. We were told that the member of staff had forgotten to add the thickening agent. The person living at the home was being exposed to the preventable risk of developing a pneumonia due to inhaling fluids. For other people despite assessments detailing the need for thickening agents in their food and drink there were no guidelines as to the amount that needs to be added to their food and drinks. For another person details about nutrition included providing nutritional supplements if intake insufficient. There were no guidelines about how insufficient was measured and what was meant by insufficient. This means the person is being placed at risk of poor nutritional intake. Fluid balance records that we looked at detailed people had not had any drinks Care Homes for Older People Page 13 of 32 Evidence: between the hours of 8pm and 8.30am the next morning. The manager told us people are assisted to have drinks over night and that staff had forgotten to record this. But the lack of records meant it could not be assured that people living at the home were having sufficient fluids to maintain their health and well being. There was evidence that care plans are being reviewed, but it was not clear that they are always being updated to detail the current care needs of the person. The community nurse responsible for assessing people for continued nursing care was present in the home during our visit. She told us that care planning had improved under the leadership of the previous manager, but she had noted that the care notes sometimes told a story of care provided that is different from that detailed in the care plans. She provided us with one such example. She also told us that despite some issues with the detail in care plans she has had no concerns with the care provided by staff to people living at the home. In all care plans there was signed permission from the persons next of kin or legal representative for the use of specific equipment such as hoists, wheelchairs, bed rails and for the taking of photographs. For each person there were assessments for the risk of falls from a variety of situations. These included risk of falls from bed, chair, hoists and wheelchairs and the action to be taken to reduce these identified risks. The home employs a member of staff whose role is quality auditing. In each persons care plans an audit check list had been completed by this staff member. However the information we looked at indicated the auditing process is not ensuring the care planning process is fully informing staff about the care and support required and wished for by people living at the home. Within the care plans there was evidence that people living at the home have access to external health professionals. Records detailed the involvement of opticians, community nurses, continence nurses, general practitioners, dentists, dietary and chiropody services. A monitored dosage system is used by the home for management and administration of medications. We looked at the Medication Administration Record(MAR) charts for five people living at the home. Following the last inspection peoples allergies are now indicated on the MAR chart. For some people care plans have been developed for the administration of as required medications such as pain killers or asthma relieving medications. However this was not consistent and the omission of such care plans or Care Homes for Older People Page 14 of 32 Evidence: guidelines puts people at risk of receiving medications when they do not need them or not receiving medications when needed. There was one instance of eye drops not having the date of opening, this will pose a risk of the person receiving ineffective medication if the medication has been open longer than should be. Medication fridge temperatures were not been recored correctly meaning that medications could be stored at an incorrect temperature resulting in them possibly becoming ineffective. For one person who takes an as required medication to ensure his/her medical condition is stable, this medication was omitting from the MAR chart. It was confirmed by the nursing staff that this medications was still required and they were unable to explain why it was not included on the MAR chart. Storage and monitoring of controlled medications complied with the relevant legislation. Observation of interactions between staff and people living at the home indicated that people are spoken to with respect. But some care practices indicated that the dignity of people is not always respected. This included people being left in their lounge chairs for periods up to 2.5 hours with no interaction from staff members, with one person remaining in a lounge chair with a plastic apron covering their clothes for 2.5 hours. However shared rooms do have screens to allow for privacy and staff were observed using screens to maintain peoples privacy and dignity during moving and handling in communal areas. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It cannot be evidenced that people living at the home always have the opportunity to take part in activities and social interaction that they have an interest in. People are able to receive visitors when they wish. There is choice of varied and nutritious meals. It is not assured that people who require additional dietary supplements receive them. Evidence: Care plans contain information about peoples daily routines and life history including previous interests, hobbies and work experience. Activity organisers are employed for sixty hours a week. An activity organiser was observed interacting with people in one of the lounge areas. In the morning people were listening to music and the activity organiser was facilitating conversations and art work. In the afternoon arm chair exercises and a visit from the hairdresser were planned. Records are kept of activities that people living at the home take part in. However the details in individual records was variable and did not always evidence that people were having the opportunity to take part in meaningful activities and socialisation. For one person it as detailed that he/she only engages in one activity per week. One person living at the home told us he/she generally does not do a lot at the home, spends the day sitting in a chair in the lounge and can get bored. We observed people sitting in Care Homes for Older People Page 16 of 32 Evidence: the lounge area and observed that for some people over a period of 2.5 hours there was no interaction from staff towards the person. The statement of purpose details that people can receive visitors whenever they wish. This was confirmed in conversations we had with a visitor at the home. The visitors book detailed that people living at the home receive visitors at varying times of the day. People living at the home told us they enjoy the meals provided at the home and they have a choice of menu at meal time. The menu for the day is displayed on a chalk board in the dining room. We observed staff offering people choice of meals at lunch time. People living at the home do not have to make a choice about their preferences at meal time prior to the meal being served. Choices offered were meat pie, curry, liver and onions, baked potatoes with various fillings and an assortment of sandwiches. We observed people who required assistance at meal time being offered it with sensitivity. Plate guards and spoons are provided to assist people with maintaining their independence at meal times. However it has been noted in the health and personal care section of this report that there are concerns about people not receiving the correct additions to their meals such as thickening agents and dietary supplements. People were observed having their meals in a variety of locations throughout the home, the dining room, the various lounges and their bedrooms. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints received are responded to promptly and appropriately. It is not evident that all staff will know what action to take to protect people living at the home from the effects of abuse. Evidence: The Statement of Purpose and information provided to people living at the home gives information about how to make a complaint about the service offered at the home. However for people living at the home it is unclear whether they are able to comprehend the written information in these documents. It would be better practice to provide this information in different formats to assist people with understanding the information. The manager told us that since the administrators took over the running of the home no complaints have been received. A record of complaints is maintained that details the complaint received, the action taken to resolve the complaint and the responce to the complainant. Procedures are in place about safeguarding that include the actions staff should take if they suspect an act of abuse has occurred. This needs to be amended to clearly detail the organisation (Adult Social Services) who is responsible for managing and coordinating the investigation of any suspected acts of abuse. Care Homes for Older People Page 18 of 32 Evidence: At the last key inspection in March 2009 records indicated that incidents that should have been reported to Adult Social Services under safeguarding procedures had not been reported. This related to incidents of shouting and hitting between people living at the home and staff members being physically assaulted in front of people living at the home. These were retrospectively referred to Adult Social Services under safeguarding procedures. Following that inspection Social Services have been monitoring the provision of care at the home. Evidence was available that the management of the home are informed, have attended and have received minutes from safeguarding meetings. However there were no clear records available about what action the home has taken to deal with these serious issues once the investigations have been completed. Placements by Social Services at the home have temporarily been suspended and the home has made a voluntary agreement not to admit people to the home until it has been assured that procedures at the home are robust to ensure that people are safeguarded from the effects of abuse. During the course of the inspection we found details of an incident concerning staff members and one person living at the home that had safeguarding concerns related to it that had occurred prior to the administrators managing the home. The incident had not been referred to Adult Social Services nor had we been informed about the incident. The incident had not been documented in an appropriate way, with the information being stored in a file that was unrelated to safeguarding or the reporting of incidents. The manager and the representative for the administrators were not aware of this incident and were made aware of the information we had found. The manager told us she would refer the incident to Adult Social Services. We received communication from Adult Social Services the following day confirming that this incident had now been referred to them. It is considered that the representatives of the administrators acted swiftly and appropriately once they were aware of this incident. Training about safeguarding people has been provided for staff at the home. But the training matrix that we were provided with did not indicate that all staff members had received this training. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home contributes to restrictions in mobility and freedom of movement. However it is clean, comfortable and well maintained. Evidence: The home offers a mix of single and shared (twin) accommodation. Rooms that are shared have access to additional screening to ensure privacy is promoted during the delivery of personal care. All bedroom doors have been fitted with locks that appear suitable for the use of the occupant should they wish and which still allows the staff to gain access in case of emergencies. There are WC facilities located close to bedrooms and communal facilities. Bedrooms are provided on three different levels, ground, first and second floors with different levels accessed by short flights of stairs on these floors. The home has been created by joining three previously individual house to create one home. This has led to a large number of stairways being located around the home, which can restrict the freedom and independence of people with restricted mobility. Because of the stairways and people being at risk of falls bedrooms have been fitted with alarms. If a person wanders or comes out of their room an alarm will go off based on the electrical safegaurds built into the alarm system installed. There is sufficient moving and Care Homes for Older People Page 20 of 32 Evidence: handling equipment to meet the needs of people living at the home. The home has a passenger lift which covers the ground to first floor and bedrooms are then accessed via a series of stair lifts to additional floors and levels. There are however, a series of smaller flights of stairs around the home which are neither covered by the lift or stair lifts and which can only be negotiated by some service users via a stair climber. Access to the home is via a small flight of stairs to the front door and then a small flight of stairs to the communal areas. This would pose difficulties for people living at the home who wish to access the community for example in the warmer months visiting cafes on the sea front. It would also pose difficulties to people wishing to visit the home who have mobility problems. We were told that for those people who are unable to access the building through the front door they are able to use the patio doors that enter onto the garden area, but this would the mean they would have to exit the property by the side exits that take them past the laundry, workshops and waste bin areas. Concerns we also raised about the emergency exits from the building which were adressed at the time of our visit. This issue is detailed in the management and administration section of this report. The communal lounges provide social space for service users although there is limited dining space. Consequently some people have their meals in the lounge chairs. The home is generally clean and tidy throughout. The home employs a team of domestic staff who also undertake laundry tasks. The laundry is located outside the main building and was noted to be clean and tidy. The training matrix evidenced that staff have undertaken infection control training and staff confirmed this as well as stating that they have adequate supplies of infection control equipment such as gloves and aprons. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. By following relevant recruitment processes the home does all it can to ensure new staff have the skills, knowledge and are suitable to care and support people living at the home. It is not always evidenced that staff have received the training or there are sufficient numbers of staff on duty to meet peoples needs at all times. Evidence: Previous inspections had raised concerns about the home ensuring there are sufficient staff on duty at any one time to met the needs of people living at the home. We looked at the duty rota that detailed two registered nurses on duty during the day and one registered nurse on duty at night with six care staff in the morning, five care staff in the afternoon and three care staff at night. No concerns were raised from people living at the home about the number of staff employed at the home. Staff were observed responding to call bells activated by people living at the home. We activated a call bell that was responded to promptly. But the lack of detail on fluid charts at night indicates that either staff do not have time to complete essential paper work at night or there are insufficient staff to ensure people receive drinks to maintain their wellbeing. This means it cannot be assured there are sufficient staff at all times to meet the needs of people living at the home. Recruitment records were looked at for five staff members. These detailed that all Care Homes for Older People Page 22 of 32 Evidence: required information about a prospective employee is obtained prior to them commencing employment at the home. This includes the receipt of two satisfactory written references, and receipt of checks against the Criminal Records Bureau(CRB) and Protection of Vulnerable Adults(POVA) list. Some CRB checks were over three years old and a discussion was had with the manager about the good practice of renewing CRB checks.There was written evidence detailing that gaps in employment or reasons for leaving employment had been explained. The previous inspection a requirement was made that the training staff receive adequately equips them to meet the needs of people living at the home. We were told that all training is detailed on the staff training matrix which we looked at. This indicated that most staff have completed mandatory training and some had completed additional training to meet the individual needs of people living at the home. This included areas such as dementia care, managing challenging behaviour and nutrition. It was noted that other than the mandatory training limited training had occurred since the last inspection. The manager explained that the administrators had initially concentrated on ensuring staff were up to date with mandatory training to ensure the safety of people living at the home. However when we compared the training matrix to members of staff detailed on the duty rota we noted that there staff members missing from the training matrix that were included on the staff rota. The home needs to ensure the training matrix does detail all staff employed at the home. Staff we spoke confirmed they receive training to equip them with the skills to meet the needs of people living at the home. The training matrix indicated staff had undertaken induction training. Records in staff files that we looked at detailed completion of a local induction programme relating to the environment and working practices at the home. The manager and staff confirmed that new care staff complete an induction programme that complies with the Skills for Care common induction guidelines. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is not registered with the Commission and the present management arrangements have not been fully protecting the health, wellbeing and safety of people living at the home. The present management of the home is ensuring people living at the home and their representatives are informed of changes in the running of the home. Evidence: Since the last inspection there have been significant changes in the management of the service. A manager was registered by the Commission who has since left employment. The responsible individual as appointed by the Director of Qualitycare Management Ltd has left employment. Since September 2009 the company has been in administration. The administrators are managing the home with the intention of selling it as a care home. We had been kept informed of the management situation by the Director of Qualitycare Management Ltd prior to administrators being instructed and since that date we have been kept informed of the management situation by the representative for the administrators. The administrators have appointed a manager Care Homes for Older People Page 24 of 32 Evidence: who is overseeing the running of the home. The manager is not registered with the Commission and is only present at the home for one or two days a week. The manager was present during our visit to the home. She told us that she had assessed the running of the home and competency of staff in her first week of employment during which time she had spent a full week at the home and had concluded that the safety of people living at the home is being protected with the present management arrangements. These management arrangements consist of her being present one to two days a week at the premises, with a senior nurse managing clinical issues, a quality assurance manager and a support services manager. The manager told us staff can contact her via telephone if there are any concerns. However this report indicates that present management arrangements are not fully meeting peoples needs and protecting people living at the home. We were also informed that a new manager has been recruited but is unable to commence employment until February 2010. The home employs a Quality Assurance manager. We saw little evidence that the role of the Quality Assurance manager is improving outcomes for people living at the home or that their welfare is being consistently protected. Auditing of care plans had not identified any shortfalls in the care planning process and thus failing to ensure staff are fully informed of actions needed to meet peoples needs. Quality audit surveys for people living at the home and their relatives are being completed six monthly. However there was little detail to indicate the service is acting on the results of these surveys. We were told by the senior nurse managing clinical issues that she had no involvement in the management of the home. Regulation 26 reports that include a visit to the service and a report about the conduct of the service are being completed by the manager. These should be completed someone who is not responsible for the day to day running of the home. A requirement was made at the previous inspection that the Commission is notified of all events which adversely affect the well being of people living at the home. We have been receiving such notifications since the last inspection. However there was an incident as detailed in the complaints and protection section of this report that we had not been notified about. It is acknowledged that as soon as the present management of the home was aware of the issue appropriate action was taken promptly. The process of notifying incidents affecting the wellbeing of people at the home now needs to be sustained and embedded into care practices at the home. We observed that emergency exits have a key pad system so that people living at the Care Homes for Older People Page 25 of 32 Evidence: home can not leave the home undetected. These keys pads are attached to the fire alarm system and are deactivated if the fire alarms sound to enable easy exit from the building. However in discussion with some staff members they were not aware of this and believed they have to insert the key pad number to exit the building in a fire alarm situation. There was also a chain system securing these doors, which would impinge emergency exit from these doors. The Support Services Manager arranged for these to be removed during our visit to the home. The Support Services manager is responsible for the environment of the home. Risk assessments for the environment are completed weekly and include the general environment and individual bedrooms. We were told that health and safety checks of the environment are being completed daily at the present time to ensure people living at the home are not being placed at risk due to the environment. This was confirmed in records we looked at. Other than some items in one of the bathrooms that were promptly removed when we spoke with staff, we did not observe any risk factors from the environment. Risk assessments are also completed for individual staff members relating their work role and are kept under review. Since the administrators have taken over the management of the home two relative meetings and two staff meetings have been held to inform people about the management of the home and plans for the home. The administrators have demonstrated a commitment to keeping people informed about the present situation of the home, realising that for all involved the present situation produces uncertainty and stress. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 Information provided to people living at the home about the service provided by the home must be in an accesible format. So all people have an understanding about the service provided at the home. 16/01/2010 2 7 15 Care plans must detail the current care needs for people living at the home. So people living at the home receive the care and support they need to meet their health and welfare needs. 16/01/2010 3 9 13 Arrangements must be made for the recording , handling, safekeeping, safe administration and disposal of medications received into the home. This includes , but is not exclusive to, ensuring medication fridges are stored at the correct 16/01/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action temperature and ensuring for people prescribed as required medications there are written guidelines about the use and administration of these medications. So peoples health and welfare is protected by good management of medications. This includes, but is not exclusive to, ensuring the effectiveness of medications is not diminished by incorrect storage and people do not received medications when not required and ensure they receive them when needed. 4 12 16 Activities and social 16/01/2010 interaction must be relevant to the interests and wishes of people living at the home. So people have the opportunity to take part in activities that interest and stimulate them. 5 15 16 People who require dietary 16/01/2010 supplements must receive them in line with instructions with from the relevant health professional. Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So people receive the nutritional intake to maintain their health and wellbeing. 6 30 18 All staff working at the home 16/01/2010 must receive relevant training to enable them to meet the needs of people at the home. So people living at the home are being supported and cared for by staff members who have the relevant skills and knowledge. 7 33 26 Visits to the home and 16/01/2010 reports in line with Regulation 26 must be completed by some one who is not involved in the day to day running of the home. So there is an effective and unbiased auditing of the service provided at the home. 8 33 26 The home must demonstrate 16/01/2010 quality assurance processes are being used to effectively promote and improve the welfare of people living at the home. So people living at the home are listened to and the management of the home is Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action developed to improve outcomes for people living there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Entrance to the home should be made accessible to all people. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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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