Inspection on 08/04/10 for Buchanan Court Nursing Home

This is the latest available inspection report for this service, carried out on 8th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buchanan Court Nursing Home 25/04/08

Buchanan Court Nursing Home 13/11/07

Buchanan Court Nursing Home 04/06/07

Buchanan Court Nursing Home 12/10/06

Buchanan Court Nursing Home 09/02/06

Buchanan Court Nursing Home 28/06/05

Buchanan Court Nursing Home 18/01/05

Buchanan Court Nursing Home 28/07/04

Buchanan Court Nursing Home 02/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Buchanan Court Nursing Home Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR     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: Ram Sooriah     Date: 1 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Buchanan Court Nursing Home Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR 02084233311 02084232299 buchanoncourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 85 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 85 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 - Code OP Date of last inspection Brief description of the care home Buchanan Court is part of Ashbourne Homes Ltd, a subsidiary of Southern Cross Healthcare which is a national provider of care homes mainly for the elderly. The care home is found in Sudbury Hill and is easily accessible by public transport as the area is well served by buses. The closest underground station is Sudbury Hill, which is about 10 minutes walk away. There is an extensive parking area in the grounds of the home Care Homes for Older People Page 4 of 37 Over 65 85 0 1 5 0 4 2 0 0 9 Brief description of the care home and there are maintained lawn/shrub areas in the front and at the back of the home. There are some shops and amenities in Sudbury but Harrow on the Hill, where more shopping facilities and amenities are available, is about five minutes drive from the home. Buchanan Court is purpose built and consists of three floors. Accommodation is provided in a mixture of single and double bedrooms with en-suite facilities although most of the double bedrooms tend to be used as single bedrooms. As a result even though the home is registered for 85 elderly residents requiring nursing care, only about 60 beds are in use. Each floor accommodates an average of 20 residents. The home had a newly appointed manager, Martin Lewis at the time of the inspection. He is supported by the deputy manager and the area manager. The home charges fees ranging from 600 to 750 pounds weekly, depending on the needs of the residents and the fees structure of the placing authority, if the resident is publicly funded. On the first day of the inspection there were 44 residents in the home. Care Homes for Older People Page 5 of 37 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: This report contains the findings of a key unannounced inspection that took place on Thursday 8th April 2010 from 12:45-18:15 and finished on Monday 12th April from 09:45-15:00. The last key inspection took place in April 2009 when the service was rated as providing adequate outcomes for residents who live in the home. After the last inspection, we have been monitoring the home from notifications that we received and from contact with the home and other social and healthcare professionals. During this inspection we talked to at least eight residents and four relatives, toured the premises, looked at a sample of records, inspected some aspects of the management of medicines and talked to about ten members of staff. We requested the home to send ten satisfaction questionnaires to residents and ten to staff. We received one residents satisfaction questionnaire back. Care Homes for Older People Page 6 of 37 The home was also requested to complete an Annual Quality Assurance Assessment (AQAA). This was not completed and returned to us. We would like to thank everybody who contributed to the inspection. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Preadmission assessments were on the whole appropriately completed to demonstrate that the needs of prospective residents were appropriately assessed before they were offered a place in the home. In one case however, the home had not fully considered the needs of a prospective resident which meant that the resident was admitted when they were not suitable for the home. Care plans were on the whole clear and easy to follow where these were in place. These appropriately addressed the diversity and equality aspects of the provision of care and the end of life care of residents. Staff were clear that these needs are inherent of the whole approach to care. All suction and first aid items of equipment available in the care home, were appropriately prepared and were ready to use in an emergency, should first aid be needed. This is good practice. People with Healthcare Acquired Infection (HCAI) were on the whole cared for appropriately. A care plan was however not in place for a person with an HCAI and the home had not yet completed the infection control audit as per the Department of Health Essential steps to Safe, Clean Care self-assessment tool for care homes. During the last inspection it was noted that not all residents who required an Care Homes for Older People Page 8 of 37 adjustable bed were provided with one. During this inspection we observed that frail residents were provided with adjustable beds and we were informed that the home has ordered ten more adjustable beds to replace some of the divan beds. The training matrix provided by the home showed that most members of staff were up to date with mandatory training. We noted that training was also provided in clinical areas such as end of life care and medicines management to ensure that staff were competent to care for residents that live in th home. Whilst, some records have improved with regards to the recording of the valuables and property that are brought into the home by residents or their representatives, some records were still lacking. As a result, the home may not be fully supporting residents with regards to ensuring the safety of their valuables and possessions. What they could do better: One immediate requirement was imposed on the home regarding recruitment checks. Our inspection of personnel files showed that recruitment checks were not always carried out comprehensively before new members of staff start work in the home. This could be putting residents at risk. While, an improvement was noted with regards to the content and quality of care plans, we noted that plans of care were not always in place to address all the identified needs of residents. The care plans and risk assessments were also not always drawn up and reviewed with residents, their relatives or representatives. During this inspection we noted that the home admitted a resident whose needs were different from the needs of the usual residents that live in the care home, despite a preadmission assessment having been carried out. In this case there was not enough information available during the preadmission assessment for a decision to be made about whether the home would be suitable for the resident. The home has not had a registered manager for more than 3 years to ensure that the home is managed in a consistent manner and for it to meet its aims and objectives. A manager appointed shortly before the last inspection in April 2009, left shortly afterwards and had not been replaced, until the second week of April. Whilst, the deputy manager and the nurse practitioner tried to run the home within their abilities in the absence of a manager, there is little evidence of senior management support and guidance to the home in following legislation and Southern Cross own policies and procedures and in monitoring the standard of service that was being provided in the home. For example regular monthly visits and regular validation audits were not being carried out. Southern Cross has a quality assurance procedure but we noted that the home was not complying with the procedure. Two monthly validation audits were not carried out as per the procedure, and the result of the last satisfaction survey carried out in August 2009 was not available to the home, to address areas that needed improving. Investigations were generally carried out in circumstances when residents were observed with unexplained injuries, to find the causes of the injuries so that action could be taken to prevent these from recurring and to rule out abuse. In at least two Care Homes for Older People Page 9 of 37 cases where residents sustained bruises, there was no clear indication how the bruises occurred. 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 10 of 37 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 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered information about the service for them to decide if they would like to use the service and to understand their rights and obligations. Although the needs of prospective residents are assessed before they come into the home to make sure that the home will be able to meet their needs, residents have at times been admitted when the home is not always able to meet their needs. Evidence: The statement of purpose and the service users guide (SUG) have been updated following a restructuring of Southern Cross when the responsible individual was also changed. Copies were available in the bedrooms of residents and we were informed that all residents are offered a copy of the SUG. We asked a number of residents if they chose to come into the home and whether they received enough information about the home before they became residents. Two Care Homes for Older People Page 12 of 37 Evidence: said that their relatives visited the home to ask information about the service and they were then able to make an informed decision about moving in. A few said that the home was chosen for them by their local authority. The home has a contract to provide respite care to people in the Harrow area. They are normally sent to the home after an admission to hospital for them to recover, have rehabilitation or for their homes to be adapted before they are discharged back to their homes. They therefore have limited choice in choosing a care home. However, they are offered information about the service that is provided in the home once admitted. We checked whether residents receive a contract when they are admitted to the home by sampling the records of two residents. We noted that the two residents contracts were drawn up and filed as evidence that these were issued but the signed copies had not yet been returned to the office for filing. We were informed that the signed copies will be chased up. We looked at the care plans of four residents, three of whom were relatively new to the home. They all contained a preadmission assessment. The three recently admitted residents preadmission assessments were completed by the deputy manager who had visited the residents. The preadmission assessments were on the whole appropriately completed. During the inspection we noted that one resident had been admitted to the home when they had dementia care needs while the home is not registered for people with dementia care needs. The preadmission assessment showed that there was limited information available about the needs and the medical history of the resident at the point of the preadmission assessment. We were informed that staff became aware of the actual needs of the resident after their admission when it became clear that the home was not able to meet the needs of the resident. Action was then taken to ensure that this matter was rectified. We noted that staff experienced some difficulty in engaging with the resident, mentioned previously and in meeting their needs although, the latter was clearly at risk because of their poor cognition level. For example the resident was left to walk without supervision over the unit and even access restricted areas. The above therefore reinforces the importance of ensuring that as far as possible, all residents needs are fully assessed and that all relevant information is received about a prospective resident before they are offered a place in the home. Care Homes for Older People Page 13 of 37 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. Whilst, an improvement is noted in some areas of care planning, there are still some areas where improvement is required to ensure that these accurately reflect the needs of residents. Residents receive the necessary support with their healthcare needs to ensure that these are met. Improvement is noted in some areas of medicines management but the medicines management policy of the home is still not being fully complied with. Some instances are noted when the privacy and dignity of residents is not maintained as fully as possible. The end of life care needs of residents are appropriately addressed in the care records to ensure that these will be met when these needs arise. Evidence: We looked at the care records of four residents. All were kept in good order and maintained. It was noted that the assessment of residents needs were not always comprehensively completed and it would be difficult to understand the needs of residents based on the information available in these records. We also found that one Care Homes for Older People Page 14 of 37 Evidence: resident who had been in hospital and whose needs had changed did not have a new assessment of his needs after they returned to the home and his medical history had also not been updated to reflect the recent changes. The actual plans of care contained more information about the needs of residents and the action to take to meet the identified needs. Where plans of care were in place these were generally clear and easy to follow. For example there was a clear care plan for each of the pressure ulcers that a resident had and these were simple and clear to follow. We would have commended the home for the care plans on the management of pressure ulcers if these had addressed the management of pain that is often associated with pressure ulcers. Whilst one resident said that they did not have pain, they did say that they were in discomfort and would have liked to take a medicine for the discomfort. We later found that the resident was not on any medication for the management of pain. Otherwise, the care plans were clear about the equipment to use for the management of the pressure ulcers and the dressing to use. Photographs were in place and wound progress notes were also kept. There was evidence of the input of the tissue viability nurse in the management of the pressure ulcers. We noted that a resident stayed in a wheelchair for about three hours without any pressure relief. While there may have been circumstances for the resident to stay in their wheelchair, there should have been some attempts to offer pressure area care to the resident. The care records contain a range of risk assessments to ensure the safety of residents and of staff. These include nutritional, falls, manual handling and pressure ulcer risk assessment. Other risk assessments are in place according to the needs of residents. For example there are risk assessments for the use of bed rails and about residents being offered keys to their bedrooms. Out of the four care plans seen, three were not agreed with residents or their representatives. Two of the residents who had bed rails did not have bed rails risk assessments that have been agreed with the resident or their relatives. One resident who was at a particular risk because of his behaviour, did not have a clear risk assessment in place. Another resident who had cognitive problems and was disorientated to place, had a care plan in place with regards to the risks that they faced. However, little was noted in practice to ensure the safety of the resident. The Care Homes for Older People Page 15 of 37 Evidence: resident was observed walking in a restricted area without the supervision of staff. The weight of residents is generally monitored monthly but one resident whose care plan was sampled, had not been weighed for more than 3 months. We were informed that this was because the hoist scale was broken and that agreement had just been received to arrange for the scale to be repaired. The home kept weight tracking as a way of monitoring those residents who are most at risk with regards to loosing weight. Residents were referred to the GP for weight loss when this was noted. The care plans of residents contained information about the physical needs of residents as well as some information about the cultural and spiritual care needs of residents. For example there was some information about the residents religions and cultural backgrounds and care plans were in place about meeting these needs. Residents were referred to the GP, the district nurse service or to other healthcare professionals when required. Care records contained information about the outcome of the involvement of healthcare professionals in the care of the residents. We noted that staff engaged appropriately with residents and that they responded appropriately when residents called them or asked something. Residents said that they are treated with dignity and respect. Residents indicated that there are some areas where they are offered choice and others when they are not. For example they are normally asked about their choices for meals but are not always asked about the clothes that they would like to wear. Most residents presented with a good standard of hygiene and were appropriately dressed but two female residents were not appropriately dressed to maintain their privacy and dignity. Male residents were appropriately shaved and female residents were appropriately groomed. During a tour of the premises we noted that three residents did not have their call bells to summon help if that was required, when sitting in their room or lying in bed. Risk assessments were not in place to address the fact that they were not given their call bell. We also noted that at times modern music was played and we were not sure whether this was according to residents tastes. On another occasion a radio was not tuned properly and played distorted music for some time before, a member of staff put a CD to play. Care Homes for Older People Page 16 of 37 Evidence: An area that has improved in the home is the approach to end of life care. We found that care plans have been updated and now contain information about the end of life wishes and instructions of residents or of their relatives and about their fears and hopes for the future. Although there is a section in the care plan to record the decision of residents or the residents representatives with regards to resuscitation, we noted that this section was not always completed. As a result it is not always clear whether the resident should be resuscitated or not should the need arise. The home had the necessary equipment to use in an emergency ready, should this be required. The suction machines and equipment for resuscitation were clean and ready to be used, if required. We inspected the management of medicines in all three clinical rooms by randomly sampling the medicines of residents and looking at the medicines administration record (MAR) sheets. We noted that the temperature of the clinical rooms and of the medicines fridges were regularly monitored. The fridges were defrosted usually monthly. The management of controlled medicines in the home was good and all the related records were maintained as required. We noted that The MAR sheets were on the whole signed when medicines were administered and codes were used when the medicines were not administered to describe the reasons for not administering the medicines. In one case a code was used but the code was not described and therefore one was not sure of the reason for the medicine not to be administered. The amount of medicines received in the home and brought forward from a previous cycle was generally recorded but the amount of liquids brought forward was not always recorded. We noted that a number of residents did not receive their medicines on one night during the previous month. It seemed that their medicines were forgotten and not administered. We looked at the records of two residents that needed their medicines crushed to be administered via a percutaneous endoscopic gastrostomy tube (PEG). There were no risk assessments in place for the crushing of medicines to be administered via the PEG. Care Homes for Older People Page 17 of 37 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. Residents are able to take part in appropriate recreational and social activities according to their tastes and choices, for them to lead fulfilling lifestyles. They also receive a varied and nutritious diet that takes their choices into consideration. Evidence: Care records of residents contain a section that addresses the assessment of the social and recreational needs of residents. Care plans were then formulated to address the identified needs of residents. There was also records of what residents actually did with regards to leisure and recreation. The last manager stated that the home would be introducing Personal Preferences Plan for each resident, but this were yet implemented in the home. The home employs a full time activities coordinator. She is responsible for drawing up and arranging the activities programme. On the first day of the inspection there was a drawing and colouring session in the afternoon and on the second day there was a visiting entertainer. Some residents were aware that an entertainer would be visiting and were looking forward to this. A few residents who spoke to us said that they enjoy taking part in the recreational Care Homes for Older People Page 18 of 37 Evidence: and social activities that are provided. They also say that they have the opportunity to go for outings when the weather is nice. We were informed that an outing was being planned for the week following the inspection. Residents choices with regards to whether they wish to take part in activities were respected. We noted during the inspection that some residents preferred to stay in their rooms and did not wish to take part in activities. The home receive regular visits from representatives of the main churches and a programme of their visits is available on the notice boards. We noted many visitors in the home and the regular visitors seem to know the home and staff very well. We spoke to a few and they all said that they are made to feel welcome in the home. Some visitors sat in the communal areas, others in the bedrooms of the residents and a few took residents out to enjoy the nice weather. The home has a four weekly menu cycle that has taken choices and variety into consideration. For example breakfast generally consists of a cooked English breakfast or of cereals. On the second day of the inspection lunch consisted of celery soup, chicken in wine and mushroom sauce with seasonal vegetables and potatoes. There was salmon fish cakes as a second choice and for those who did not want neither of the above, were offered omelette with salad. Desert consisted of fruit cheese cake. Fresh fruits were also given to all residents who wanted these. The meals for supper was also varied. On the first day of the inspection there was lentil soup, scrambled eggs and ham, mixed sandwiches and plum crumble and custard. We also noted that fresh cakes were served with tea in the afternoon. Residents who gave us feedback said that they are satisfied with the meals that they receive and that they are able to choose what they want to have. During the inspection we noted that the dining areas were appropriately prepared to provide a congenial environment for residents to have their meals and residents were encouraged to eat in the dining areas, except for the music which at times was played without a lot of consideration to the taste of residents. While observing the serving of meals on one floor, we noted that soup was served in cups and saw a resident trying to use a spoon with the soup. Care Homes for Older People Page 19 of 37 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. People who use the service can be confident that complaints are taken seriously and will be investigated, as required. Staff are familiar with the safeguarding adults policy and are aware of the action to take when there are allegations and suspicions of abuse. Evidence: Since the last inspection, the home has received one complaint that was also referred as an allegation of abuse to the safeguarding adults team of the local authority. The home investigated the complaint and found that the complaint was not substantiated. The complaints procedure is available in the brochure of the home. Residents said that they would speak to the nurse in charge or to management if they had any complaints or concerns. Although the home has not had a manager for some time, we received feedback that the deputy manager was visible in the home and who was known by residents. Visitors who talked to us told us that they would speak to her if they had any concerns. The training records show that most members of staff have had training and updates on abuse. They told us that they new that they had to report any suspicions or allegations of abuse to management. Management also knew that they had to report all allegations or suspicions of abuse to the safeguarding adult team of the borough Care Homes for Older People Page 20 of 37 Evidence: and to the commission. In one case however, the commission did not receive a notification about an allegation although there was evidence that a notification form had been completed. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a maintained and decorated environment for residents to enjoy, but a redecoration and refurbishment plan was not available to offer the reassurance that the home will continue to be maintained and decorated to a high standard. The home has an infection control procedure but an infection control audit has not been completed to ascertain compliance with its infection control procedure. Evidence: The parking areas and the grounds of the home were maintained and kept tidy. The lawn was tidy and the many bushes and shrubs were trimmed. The exterior of the building was in an appropriate condition. The home was in an acceptable state of decoration but we noted that there has not been any major redecoration apart, from a number of bedrooms that have been repainted. At the time of the inspection there was no redecoration and refurbishment plan and one was not forwarded after the inspection to offer assurances that the standard of decor and maintenance of the home will be addressed as required. Each floor has a lounge and a dining area. All the communal areas were appropriately furnished and decorated. We observed many residents using the lounge areas. Some sat in wheelchairs, armchairs and specialised chairs to watch TV, to look outside or chat with other residents that they have befriended. Care Homes for Older People Page 22 of 37 Evidence: Bedrooms of residents were on the whole in an appropriate state of decor. Many were well personalised but a bedroom that had been decorated about a month ago had not had the pictures, photographs and items of decoration put back. This was addressed when we pointed it out. Residents told us that they like their rooms and enjoy the privacy that the rooms and the en-suite offer. The home has sluices on each floor, including sluicing disinfectors. There was evidence that staff have had infection control training and that equipment was provided as required to ensure compliance with the infection control procedures. At the time of the inspection the home had at least one resident with a healthcare acquired infection. There was no care plan in place to address this need. A requirement was imposed on the home during the last inspection for it to carry an infection control audit such as the Safe and clean Care audit by the Department of Health. This has yet to be completed. Care Homes for Older People Page 23 of 37 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 homes provides appropriate numbers of staff to care and support residents. Staff receive training as required to ensure that they are competent to care for residents, but induction records were not always kept to demonstrate that staff receive an appropriate standard of induction before they start work with residents. Recruitment procedures are not adhered to robustly to ensure the safety of people that use the service. Evidence: At the time of the inspection there were 20 residents on the first floor, 12 on the second and 12 on the ground floor. Staffing consisted on 4 carers and 1 trained for the ground floor, 2 carers and 1 trained nurse for the second floor and 1 trained nurse and 2 carers for the ground floor. At night there is 1 trained nurse and 2 carers for the ground floor and 1 trained nurse and 3 carers for the first floor and second floors. These staffing numbers seem adequate with regards to the number and needs of residents that were accommodated in the home at the time of the inspection. Staff that spoke to us also told us that staffing was acceptable except on the first floor where they felt that there was not enough staff because of the need of one resident. Feedback from residents and visitors about staff was good.They rate the attitude and approachability of staff as good. Two residents said that staff come and see to them whenever they call for one. Care Homes for Older People Page 24 of 37 Evidence: The personnel files of three members of staff were inspected. These were for members of staff who have started work in the home after the last key inspection. We noted that not all the recruitment checks as, required by Southern Cross own recruitment policy and care homes legislation, were in place. Two members of staff only had one reference each, another had two references but one of the references was incomplete. One member of staff did not have any evidence in their personnel file to show that they were allowed to work in the UK at the time of the inspection. There was also a gap in the employment history of one applicant that had not been explored at the time of the interview. An immediate requirement was imposed on the home to address this issue. We asked about the induction of the members of staff whose personnel files were inspected. There was no evidence that induction has taken place. Two of the members of staff have worked in the home for more than five months and one of them was a domestic assistant. We would have expected to see evidence that induction has taken place and that the carer would have completed the common induction standards. Figures provided by the home show that it has a total of 30 carers and out this number, 11 have an NVQ level 2 and 7 have an NVQ level 3 in care. In addition to these numbers, 12 care workers are enrolled on an NVQ level 2 in care programme. The home therefore has more than 63 percent of care staff with an NVQ qualification. A copy of the training matrix was kindly provided to us. We noted that the home was on the whole up to date with regards to the provision of mandatory training. Training has also been provided to some members of staff in other areas such as medicines management, palliative care, pressure area care and dementia care. The home has a programme for the supervision of staff. All staff that spoke to us told us that they receive supervision, except for the deputy manager as there was no manager in the home or line management to carry out supervision with her. The new manager said that he would address this issue. Care Homes for Older People Page 25 of 37 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 home has not been consistently managed to offer clear direction to staff and to bring out the homes full potential. The home has not been scrutinised rigorously by the organisation to ensure that it provides a quality service. The quality assurance system is not consistently used as a tool to ensure improvement of the service. The personal money of residents is appropriately managed to ensure the safety of residents personal money. The valuables and possessions of residents are however, not recorded appropriately to provide a record of what residents brought into the home. Health and safety issues are appropriately dealt with in the home to ensure the safety of residents, visitors and staff. However, some unexplained injuries are not always explored deep enough to identify the causes so that action can be taken to make sure that these do not occur again and to rule out the possibility of abuse. Evidence: A new manager started work in the home one after the inspection started. He reported Care Homes for Older People Page 26 of 37 Evidence: that he has worked extensively in the NHS in managerial positions and has also worked in care homes in a senior managerial position. Prior, to the new manager the home has not had a manager since May 2009, when the manager who was in post during the last inspection in April 09, left. The home was managed by the deputy manager and the practice nurse. Residents, visitors to the home and staff said that considering that there was no manager, the home was run relatively well. During the inspection there was little evidence of the support that was being offered by senior management staff to the home in the absence of a manager and to monitor the quality of service that was being provided. The home did not have regular monthly visits by the provider. Records in the home showed that there were 2 visits since August 2009 (in August 2009 and December 2009) that were carried out by deputy managers from other homes. The Southern Cross quality assurance system is used in the home. This consists of monthly audits by the home, two monthly validation audits by line management and an annual satisfaction survey. The last validation audit took place in October 2008. There had been a customer satisfaction survey in August 2009 but a report of the survey was not available to summarise the findings of the survey. Care homes are required to complete an AQAA which must be returned to the commission. An AQAA was requested from the home in December 2010 and this has not been completed yet. This again demonstrates how the home is not meeting its statutory obligations in the absence of a manager. There was some evidence that representatives of residents were offered an opportunity to meet with the homes management and to discuss their concerns if they had any or to contribute to the management of the home. A relatives meeting was last held in November 2009 but it was reported that no one attended the meeting. We were informed that the home also arranges twice monthly managers surgeries for residents and their relatives. We were informed that attendance to the meetings is poor. We did however note that the management staff or nursing staff of the home are always available to talk to residents representatives. We looked at the management of residents personal money by randomly checking the accounts of two residents and noted that the accounts were appropriately maintained and that receipts were kept for all expenses. The management of the personal money of residents was last audited in December 2009 when the last regulation 26 took place. Care Homes for Older People Page 27 of 37 Evidence: The home has an up to date fire risk assessment and health and safety risk assessment. There was evidence that fire detector checks, fire emergency lights test and water temperature checks were being carried out. There was a certificate to show that the water system in the home has been treated and maintained to prevent Legionnaires Disease. A Portable Appliances Test, electrical wiring and Gas safety certificates were available for inspection. There was evidence that hoists were maintained and tested as required by legislation. The manager confirmed by email that the lifts were also tested regularly according to the required schedule. We looked at the accidents and incidents records that the home keeps. An audit is usually carried out monthly to look at trends and at types of accidents. The accidents and incidents were generally clearly recorded but on a few occasions the recording was not very clear to describe the nature and cause of the accidents and incidents. For example there were two occasions when residents sustained bruises and it was not clear how the bruises were sustained and whether the accidents or incidents were sufficiently explored to identify the causes of the injury so that action could be taken to make sure that these do not occur again and to rule out the possibility of abuse. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 4 14 That the home carefully 01/07/2009 considers the needs of prospective residents with regards to whether the home is suitable for the residents and whether staff are competent and skilled enough to meet the needs of the residents, before offering them a place in the home. To make sure that the home will be able to meet the needs of residents that are admitted. 2 26 17 All members of staff must have all the relevant checks prior to them being offered employment in the home. To ensure compliance with the recruitment procedure and to ensure the safety of people who use the service 07/07/2009 3 26 13 The home must carry out an 01/07/2009 infection control audit as per guidance from the Department of Health in the document: Essential step to safe, clean care. To ensure that the home has effective infection control system in place. 4 35 17 An up to date record of the 06/07/2009 Page 29 of 37 Care Homes for Older People 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 valuables and property that are brought into the home, must be kept. To ensure the safety of residents possessions Care Homes for Older People Page 30 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 All new members of staff 12/05/2010 must have all the necessary recruitment checks as stipulated by the recruitment procedure and care homes legislation before they are employed. To ensure that only suitable people are recruited to care and support residents. 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 4 14 The home must not admit a resident unless it can be sure that the needs of the resident will be met in the home. To ensure the safety and wellbeing of all residents that are admitted to the home. 30/06/2010 2 7 15 There must be plans of care in place to address all the residents needs that have been identified. The plans of care must include plans for the management of infection, for those who require this. 30/06/2010 Care Homes for Older People Page 31 of 37 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 Care plans must be updated as required and must be agreed with residents or their representatives. To ensure that all the needs of residents are appropriately addressed for these to be met and for residents or their representatives to be fully involved in the care planning process. 3 8 12 Pain management must be considered as an integral part of the management of pressure ulcers. To ensure the comfort of residents as much as possible. 4 8 3 The home must have comprehensive risk assessments in place to address all hazards that residents may face, and the hazardous activities that residents may be engaged in. All risk assessments, including bed rails risk assessments, must be agreed with residents or with their representatives. To ensure the safety of residents at far as possible 30/06/2010 30/06/2010 Care Homes for Older People Page 32 of 37 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 5 9 13 The medicines management policy must be complied with at all times. There must be appropriate risk assessments in place, when medicines are being administered in an alternative state, such as when being crushed. To ensure the safe management of medicines. 30/06/2010 6 10 12 Residents must always be dressed appropriately. Residents must always be given their call bells, unless a risk assessment is in place. To ensure the modesty, privacy, dignity and safety of residents as far as possible. 30/06/2010 7 19 23 The home must have a redecoration and refurbishment plan. To offer the reassurance that the home will continue to be maintained and decorated to a high standard. 31/05/2010 8 26 13 The home must carry out an 31/05/2010 infection control audit as per guidance from the Department of Health in the Care Homes for Older People Page 33 of 37 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 document: Essential step to safe, clean care. To ensure that the home has effective infection control system in place. 9 30 18 Evidence must be kept that staff receive appropriate induction when they start work in the home. To ensure that new members of staff are competent to care and support residents in a safe manner. 10 31 6 The home must be managed 30/06/2010 in a consistent manner and to a high standard. To ensure that the home meets its aims and objectives. 11 33 26 There must be monthly visits by the provider. For the provider to carefully monitor the quality of the service that is provided. 12 33 24 The home must complete an 31/05/2010 Annual Quality Assurance Assessment and forward this to the Commission. To comply with current legislation. 30/06/2010 31/05/2010 Care Homes for Older People Page 34 of 37 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 13 33 24 The quality management system must be used effectively and according to the quality assurance procedure. To monitor the quality of the service that the home provides and to ensure continuous improvement. 30/06/2010 14 35 17 An up to date record of the property and valuables that are brought into the home for residents or their representatives must be kept. To ensure the safety of residents possessions as much as possible. 30/06/2010 15 38 13 All unexplained injuries must 31/05/2010 be fully explored to find the possible cause. To prevent these from happening again and to rule out the possibility of abuse. 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 2 The home should ensure that signed copies of the homes contracts given to residents are returned to the office to show that the residents or their representatives have agreed to these. Care Homes for Older People Page 35 of 37 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 2 3 The home should, as far as possible, ensure that the needs of prospective residents are fully assessed before they are offered a place in the home. The care plans for the pressure relief of residents should be complied with and pressure area care should be provided as required to ensure the comfort of residents. Equipment that is required to monitor the condition of resident such as the weighing scale for the hoist must be repaired as soon as possible, instead of the three months that it has taken to approve the repair. The home should always consider residents tastes and wishes when playing music for them. The resuscitation status of residents should always be clearly identified and recorded to make sure that staff are sure of the action to take if a decision is required. Food should always be served in the appropriate receptacle and according to the needs of the resident. 3 8 4 8 5 6 10 11 7 15 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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