Inspection on 23/06/09 for Edendale Residential Care Home

This is the latest available inspection report for this service, carried out on 23rd June 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Edendale Residential Care Home 19/06/06

Edendale Residential Care Home 19/12/05

Edendale Residential Care Home 15/06/05

Edendale Residential Care Home 21/01/05

Edendale Residential Care Home 28/07/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Deepdene Care Centre

Aldwick House

49 Glendale

Ferndale Residential Care Home

David Gresham House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Edendale Residential Care Home 5-6 The Green St Leonards-on-sea East Sussex TN38 0SY     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: Michele Etherton     Date: 2 3 0 6 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 34 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 34 Information about the care home Name of care home: Address: Edendale Residential Care Home 5-6 The Green St Leonards-on-sea East Sussex TN38 0SY 01424429908 01424778797 info@edendalecarehome.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Andrea Fettiplace Name of registered manager (if applicable) Mrs Sheila Elaine Feeley Mrs Andrea Fettiplace Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of residents to be accommodated is 31 The registered person may provide the following category of service: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection Brief description of the care home Edendale is registered to provide accommodation for up to 31 people of 55 years old and over who suffer from dementia or mental illness and admits people with low to high dependency needs. The premises consist of two large separate detached properties situated in St Leonards using the numbers of 5 and 6 as they correspond to Care Homes for Older People Page 4 of 34 31 31 Over 65 0 0 Brief description of the care home the street number. Edendale has 13 single rooms and nine doubles situated on three floors all of which have a wash hand basin. Residents in one house have the use of a ground floor lounge and a dining room and first floor smaller lounge/diner. In the other house residents have use of a ground floor lounge and dining room and a second floor smaller lounge and dining area. Smoking is allowed for residents in each house in the designated area .The home has a secure rear garden accessed by steps with seating and lawn area for residents to enjoy. The home is currently exploring levelled access to assist wheelchair users and those with higher mobility needs. The home also accepts pets. The house does not have lifts but has a number of ground floor rooms. The home benefits from having a large car park. The buildings are located a five minute walk from the nearest shops and is on a bus route with a bus stop just outside the home. The current fee scale is #405.00 #465.00 per week. The lower rate is based on what East Sussex pays. The higher rate is based on what London boroughs pay. Those who are self funding [private] pay between #420 and #425 and receive the same facilities as those funded by Social Services. The latest inspection report is sent out to any enquirer who expresses an interest in the home. A copy of the report is obtainable via the manager. The home is currently reviewing management arrangements following the death of one of the joint owners/managers who worked there full time. It is anticipated that the assistant/deputy manager will shortly move forward for registration possibly jointly with the current registered man Care Homes for Older People Page 5 of 34 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 reader should note that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Edendale are referred to as residents a preferred term. A key inspection of this service has been undertaken that has taken account of information received about and from the service since the last inspection. This includes an Annual Quality Assurance Assessment (AQAA) form submitted by the Registered Manager. Unfortunately we are unable to comment on the quality of the whole document as difficulties with the postal system meant we received only half of the document sent. The information we did receive from the home has been completed to a reasonable standard telling only some of what we needed to know within its summary,this could Care Homes for Older People Page 6 of 34 be enhanced by improved detail to better illustrate some of the development s and planned improvements. We have discussed these omissions with the registered provider and manager. Our inspection of the service has included an unannounced site visit on 23RD June 2009 between 09:40 am and 17:00 pm. During this time all key standards were assessed in addition to progress made by the service in addressing outstanding requirements issued at the last inspection in July 2007. During our visit to the home we were able to see both houses that make up the service but spent most of our time in house No. 5 which has a more dependent resident group, we were able to spend time there with residents in groups. We were also able to speak to individual staff members, the Registered manager and Registered provider. In view of the cognitive difficulties of some residents we undertook a Short observational Framework for Inspection (SOFI), a methodology we use to understand the quality of the experiences of people who use services. We have distributed surveys to residents, staff and health and social care professionals, and we have received a good response to these. Unfortunately only one resident has been able to comment. We have also received feedback from relatives who visit the service and wished to express their views. All feedback has been taken into consideration in informing the inspection and comments have been incorporated where possible into the report. We have examined samples of records and documentation including care plans, risk information, medication records, staff recruitment, training and supervision records, in addition to complaints, accidents and health and safety records. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Whilst there is evidence that the home has made progress since the last inspection in regard to addressing shortfalls, this is not always to a good standard or sustained, consequently further requirements or recommendations are now issued for similar omissions in the service. Care Homes for Older People Page 8 of 34 When we visited we found risk information we viewed to be inadequately completed. This information fails to inform staff of the risk reduction measures that should be in place and whether risks to residents remain. We noted a strong odour of urine in house No. 5 which is unpleasant. A programme of mandatory training is in place for staff, but, some staff would seem to be opting out of attending courses on the grounds that they have undertaken the same training elsewhere; as there is no evidence to support this we are not satisfied for this arrangement to continue. An observational exercise that we conducted whilst at the home highlighted a lack of stimulation for residents and the need for staff to become more actively engaged in offering quality time to all residents. We also observed some unsatisfactory moving and handling practice, which we brought to the attention of the registered owner and manager, we have made clear the need for all staff to be trained by a certified trainer in this key area of health and safety. Requirements have been issued for these shortfalls. We have also made some further recommendations where further improvements to current practice would be of benefit to residents and overall practice within the home If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Assessment of prospective residents would benefit from inclusion of more detailed information to inform decision making and development of a suitable plan of support. Local authority funded residents would benefit from access to terms and conditions information. Evidence: When we visited the home we met with someone who has come to live at the home within the last six months, they reported that although they had been unable to visit the home for themselves prior to admission, their relatives had done so on their behalf, they commented that they were satisfied with what their relatives had told them about the service and were happy that they have come to live at the home. We looked at examples of assessment information for three residents including the newer person we spoke with. We found that assessment information did not make clear whether assessment information is gathered prior to admission to inform Care Homes for Older People Page 11 of 34 Evidence: decisions about whether the staff have the relevant skills to support the prospective resident effectively. We discussed the importance of the home ensuring that the initial needs assessment is sufficiently detailed to inform the homes decision to admit,we have also highlighted the need for the service to take a more holistic view of prospective residents to ensure their overall quality of life and needs associated with this are fully taken account of. We found that in regard to the new resident we spoke with the home had sought to gather additional information from a previous home where they lived, and this was very detailed giving good information about individual preferences and routines, and highlighting specific needs. Unfortunately this information had not been used to inform the support plan developed for the resident. We surveyed a range of stakeholders including general practitioners who have contact with the home this is what they told us: A very caring Environment look after people with dementia Caring environment for older dependent clients, I have no concerns with what this home does The home has addressed a previous requirement to ensure that privately funded residents are provided with a contract of the terms and conditions of their residency and this is signed by a representative where they are unable to do so for themselves. When we undertook an annual review of the service last year we asked the home to consider extending this to those residents who are funded by local authorities, the home has tried to do this without success because a contract already exists between the local authority and the home. It is important that these residents also are made aware of the terms and conditions of their residence and we have recommended that this is provided to them or their relatives without the pre-requisite to sign if local authority funders are not supportive of this. Care Homes for Older People Page 12 of 34 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 content of care plans has improved but there is still an over reliance on information about resident preferences being relayed verbally, they would benefit from being more person centered and holistic in their view of residents needs. Risk information is underdeveloped and fails to inform staff of risk reduction strategies. Medication arrangements around storage and recording need strengthening. Evidence: We examined four care plans across the two units, three of these being for people who live in house No.5. The home has made progress in improving the content of care plans but there is still an over reliance on personal routines information being relayed verbally between staff rather than being documented to ensure staff all support consistently. There are omissions in information that would benefit staff in working more effectively with individual residents and also ensure a better quality of life for those individuals. There is a need for the service to take an holistic view of residents needs and not just focus on the physical needs they may have. Care Homes for Older People Page 13 of 34 Evidence: Relatives surveyed commented: little individual care or addressing relatives particular needs e.g. they dont enjoy sitting down doing nothing but spends most of their day doing just that with the TV blaring in the background My relative does not receive sufficient one to one care and attention and their personal needs to suit their personality arent addressed There is evidence that care plans are being routinely reviewed and evaluated monthly. Files examined informed us that residents are in receipt of routine health interventions but some like Chiropody and optician appointments are not recorded in one place and we suggest this is implemented for ease of monitoring. We noted some infrequency in the recording of resident weights and this is a source of concern particularly where residents have a poor diet and there has been clear weight loss, we have discussed with the provider and manager the importance of routine monitoring of those residents where risks are identified to ensure appropriate health or social interventions are obtained as needed. Risk information was noted on three out of four files examined this is basic and we found not always completed in some areas even where issues e.g nutrition exist. Whilst our examination of accident records highlighted no specific resident whose level of falls is a source of concern, the home has recorded 31 falls since January for a variety of residents, no falls monitoring system is in place to enable staff to look for patterns and make links between general state of health and falls. Whilst the homes current risk format highlights risk from mobility,continence, and nutrition, this is not always completed. The current format does not enable an assessment of residents skin integrity, and fails to provide detail of risk reduction measures implemented, and whether a level of risk remains. Moving and handling assessments are not sufficiently detailed to ensure staff and residents are kept safe, and staff are clearly not routinely using equipment for the safe lifting of residents who have fallen. We require that the provider ensures that a robust system of risk assessment is implemented that takes account of nutrition, falls, skin integrity, and continence in Care Homes for Older People Page 14 of 34 Evidence: addition to other identified risks and makes clear the strategies in place to manage these risks. The provider must ensure that where risks are highlighted, clear monitoring is in place to ensure the welfare of residents is maintained. We looked at medication arrangements within the home. We noted that whilst there is currently only a small amount of controlled drugs in use, the home is appropriately recording these with two signatures for administration and a controlled drugs book in use. The storage of such medication is not currently in keeping with the medicines Act 1968. We have discussed this with the current provider and manager, who understands the need to ensure the storage of such medication is compliant and has agreed to review this; it is our recommendation that this is progressed. Medication records are generally well maintained however we found three handwritten entries onto the MAR chart which were undated and unsigned. Whilst we found no omissions in recording, there is a need for staff to make clear when using other codes on MAR records, that they makes clear what this is for. We have also recommended that individual PRN guidelines and medication profiles are developed for residents, to inform staff and ensure that PRN medication is administered in a consistent manner. Care Homes for Older People Page 15 of 34 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. Residents are under stimulated with little opportunities to promote independence and maintain skills. Residents are supported to maintain contact with relatives, and relatives feel welcome in the home. A nutritious and varied diet is provided but menu information is not accessible to all residents to inform decisions and choice of meals, residents would benefit from improved availability of water and juices outside of meal and break times. Evidence: Whilst at the home we undertook an observational exercise to monitor the mood states of a target group pf residents and their interactions with others or their environment. Time constraints meant we were only able to observe for a one hour period but this provided good insight into the daily routine within the home. We found that only one person within our target group received any interaction with staff during this period, staff were observed from time to time coming into the lounge but their interactions with residents were of a reactive rather than spontaneous or proactive kind. Staff were not seen to engage with residents offering quality time. It was a very hot sunny day and yet at no time did we observe any residents being Care Homes for Older People Page 16 of 34 Evidence: taken out of the home into the garden. Some residents were provided with papers and were seen to read these thoroughly, magazines were also available but only one other resident made use of these. Apart from three residents who were able to make use of written material and could engage with each other the majority of other residents spent their time dozing, staring blankly at the wall or television, or wandering from room to room. When we asked staff what activities were on offer to residents we were advised they receive motivation sessions but staff could not explain what this consisted of. The registered provider and manager have identified the need for additional stimulation for residents within their Annual Quality assurance information but have been unsuccessful in recruiting to the activities organizer post. In discussion with staff the registered person and the registered manager we were informed that some residents are being taken out regularly, but daily records fail to evidence activities undertaken by individual residents and how these might support expressed goals and aspirations. It is our view that residents are generally under stimulated and bored with limited opportunities for them to maintain skills and independence and we have issued a requirement for this to be improved. relatives have commented through survey responses that: There is little variety in entertainment is offered to these EMI residents Was promised a busy programme of entertainment outside visits etc. My relative hasnt been taken out once I dont think since they arrived in 2008. They look after the needs of Dementia patients well Staff are very caring and treat all the residents with respect and consideration Carers are very caring and they are friendly and look after my mother I have no complaints they keep my aunt clean and tidy and well fed Ive always had all the help I need from the owner and the staff Care Homes for Older People Page 17 of 34 Evidence: Staff are always friendly They could take them out more into the gardens on nice days Ensure everyday needs are catered for, toileting, feeding, grooming. Could improve by trying to entertain more Examination of records indicates that contact with relatives is supported but recording of such contacts is ad hoc, the development of a contact sheet for important people in the life of the resident would be useful in monitoring frequencies of contact. The home employs a cook and residents receive a varied and nutritious diet. An alternative option is offered at lunchtime but residents do not have access to an accessible menu. and although asked about what they want to eat may not be able to visualize the food offered. Consideration should be given to providing menu information in alternative formats suited to the needs of residents, with those who have difficulty in absorbing written information provided with picture references to aid decision making. Some residents are not eating a good diet and some thought should be given to providing small finger food alternatives, to encourage residents to eat little and often where they are finding difficulty in eating a full meal. Similarly, we heard residents commenting that they had not had a drink since coffee break, as it was a hot day residents would have been thirsty but there was no evidence of residents having access to regular jugs of water or juice, and the home needs to ensure this is available to residents to maintain good hydration. Care Homes for Older People Page 18 of 34 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. A complaints procedure is i place but may not be accessible to residents, residents are unlikely to complain and staff need to be more proactive in doing so on their behalf. Shortfalls in some areas of practice could compromise the safety of residents and improvements are needed Evidence: Historically the home experiences a low level of complaints and only one has been received in the last twelve months from a social care professional visiting the home, the registered person has ensured this has been investigated and action taken to resolve it. The complaints procedure has been displayed previously for residents but has been torn down, consideration should be given to how this information can still be made accessible to residents. We discussed with the registered provider and manager the likelihood of any of the present residents being able to actively make a complaint, and this is thought to be extremely low. Staff have a reasonable understanding of individual residents and when they are expressing distress or anger, where this can be linked directly to a specific incident or event, staff should be proactive in deciding whether in a more able person this would have prompted a complaint; if this is likely, staff should award a similar status to such incidents and record a complaint on the residents behalf, looking Care Homes for Older People Page 19 of 34 Evidence: at ways in which concerns can be resolved for their benefit. Staff generally manage aggressive outbursts well but lack written policy and procedures in how to manage aggression from residents to support current practice. The manager is well informed about the deprivation of liberty act and has sought advice in respect of one resident, currently none of the residents are subject to a deprivation of liberty authorization. We have reminded the registered provider and manager of the need to ensure that any restrictions placed on residents are clearly documented and discussed within a multi disciplinary forum, such restrictions should be reviewed regularly for their effectiveness. Improvements are needed in the recruitment and training of staff to ensure the safety of residents is not compromised. Two adult safeguarding alerts have been raised at the home in the last twelve months and these have been investigated and are now closed. The manager has an understanding of her reporting responsibilities under adult safeguarding and is reporting such incidents appropriately to the relevant agencies. The reporting of incidents under regulation 37 of the Care Homes regulations 2001 has also improved. Care Homes for Older People Page 20 of 34 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. Residents live in a comfortable and homely environment that will benefit from planned upgrading and improvement to cleaning routines that will reduce odour. Access within the houses and to the garden are in need of review.Infection control within the home is compromised by the unsatisfactory condition of some toilet and washing facilities in the home, and shortfalls within the management of soiled laundry by staff. Evidence: Both houses which make up the service provide a comfortable and homely environment and will benefit from ongoing and planned upgrading. The home is unsuitable for residents with significant mobility problems because of the lack of access to the upper floors other than by stairs, two residents in No 5 are currently confined to the first floor where they have dining lounge and washing facilities alongside their bedrooms, as they are no longer able to manage stairs, this means that the residents are prevented from access to any activities or entertainments that may be provided in the home, and cannot make use of the garden area. We have asked the provider and manager to consider moving both clients to the ground floor as rooms become available, in consultation with the residents and their respective families and representatives. We would recommend that consideration be given to making the home more accessible to all residents by the installation of e.g. stair lifts. Prospective residents should be made fully aware of access issues. Care Homes for Older People Page 21 of 34 Evidence: Currently residents of house number 5 have limited access to the garden, as this can only be gained by negotiating two flights of concrete steps with staff support, the provider has indicated a ramp is planned but this is not scheduled to happen soon. Residents are encouraged to personalize their own space. There are some shared rooms and residents privacy in these rooms is maintained through the use of mobile screens. We visited both houses in the service and found them to be generally clean and tidy, house No.5 has a strong and unpleasant odour of urine, we have discussed with the provider and manager who have ensured that present carpeting within the home is waterproof and durable. Some of the toilets and bathrooms we visited smelled strongly of urine, and thought needs to be given to the frequency of cleaning in this areas. We have also discussed the need for the emptying of commodes to be restricted to particular toilets and more robust cleansing regimes implemented to minimize risk of infection to residents. We have issued a requirement for the home to take steps to reduce odour within the home by reviewing current cleaning regimes and frequencies. We noted that some toilets within both houses lack hand wash facilities for residents and tiling and seals are cracked and split in some bathrooms areas, which will compromise good infection control. We discussed laundry arrangements with staff and whilst the laundry is well equipped to manage the laundry needs of the resident group, staff are not managing soiled laundry appropriately. We discussed the importance of ensuring soiled laundry is separated out from normal laundry at the point of source, to minimize cross infection. The provider has assured us that she has provided staff with cloth bags for the collection and separation of soiled laundry, these were not in evidence on the day of our visit, and staff made no reference to their use when describing laundry routines, We must conclude therefore that these are not in common everyday use. Care Homes for Older People Page 22 of 34 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. Shortfalls in the recruitment and training of staff could compromise the well being of the residents. Evidence: Residents benefit from some continuity within the staff team. Staffing levels need review as Carers are also expected to undertake laundry duties. We are not satisfied from our observations made during the site visit that the level of staffing is being utilized effectively, to ensure residents receive a good quality of life. Consideration must be given to releasing staff from other domestic tasks to be available at all times to support residents. From a short observational Framework for inspection (SOFI) exercise we undertook during a fixed period in house number 5, we noticed residents were repeatedly ushered back into the lounge where the only entertainment was the TV. We found of our target group only one experienced any interaction with staff during the hour we observed, although four other residents did receive some spontaneous but brief interaction from staff. There is a need for a culture change within the home from that of making sure residents are well presented and fed to one of also enriching their life by improved stimulation and promotion and maintenance of independence. Staff are not Care Homes for Older People Page 23 of 34 Evidence: implementing what they have learned through their NVQ training about person centred care, into their everyday practice with the people they care for. Staff commented in survey responses: The home offers a good environment and sufficient food for residents The home offers standard care for residents communication is an area that could be improved upon The home should offer adequate equipment and facilities to staff and residents We examined staff recruitment files for new and longer term staff and found that whilst the procedure has the potential to be robust it is not being adhered to. Consequently although all necessary vetting and checks are completed, the quality of references is not good, and the content of staff files needs improving in line with schedule 2, of the Care Homes Regulations 2001. When we spoke with individual staff they reported that they received training, however, discussion with the registered manager indicates there is a problem with some staff attending training and clearly the manager will need to address this with individuals. A review of the training matrix indicates that whilst some staff have received a good range of training, two out of four files viewed could provide no evidence that some workers who are also working in other care environments have completed all mandatory training, and have copies of certificates to prove this. A requirement has been issued for the home to evidence that all staff have received updated mandatory training that encompasses: fire safety, first aid, food hygiene, infection control, medication ( if relevant to their role) and adult safeguarding training. Moving and handling training has been provided by the registered manager who is not currently certified to do so. Our observations of poor lifting practice during our visit, has highlighted the need for staff to be provided with updated moving and handling training from a certified trainer; this is a requirement. The registered manager reports subsequent to the inspection that this has now been organized. Staff report: Care Homes for Older People Page 24 of 34 Evidence: management is approachable and supportive in all aspects of care both to residents and staff been happy working at Edendale for the last 20 years I am happy and content Care Homes for Older People Page 25 of 34 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 provider and manager are aware of the need for improvement within the service and have commenced developing strategies to address this, but more work is needed to ensure the health safety and wellbeing of residents is being appropriately supported. Evidence: The manager is qualified and has the necessary experience to run the home, she has now been registered to do so by the Commission. The provider and manager are keen to express their aspirations for the improvement and development of the service, limited only from progressing quickly with this by financial concerns. They have responded positively to addressing those areas identified at the previous inspection. Our inspection has highlighted a need for a more proactive than reactive management approach, as some shortfalls identified are due less from a lack of finance than lack of Care Homes for Older People Page 26 of 34 Evidence: implementation of procedures, record keeping omissions and the lack of a culture within the home; that sufficiently promotes the independence of residents, and is supportive of improving their quality of life above and beyond that of ensuring they are adequately housed and fed. The provider and manager have an understanding of person centered planning but have been unable to translate this into practice to make a difference to the way in which staff work and outcomes for residents of the service. The AQAA dataset informs us that a full range of policies and procedures have been developed and reviewed, we note that this does not include for managing aggression toward staff from residents. As there are reported instances of aggression from residents the development of policy and procedure to inform staff and support practice is now overdue. The registered manager has developed a good quality assurance report but underpinning systems for the internal audit and review of the service are undeveloped, and we have discussed these shortfalls with the manager. The registered provider has a daily presence in the home. Whilst not in operational day to day control she undertakes monthly health and safety audits with the manager. This needs to be formalized to ensure that responsibilities under regulation 26 of the care homes regulations 2001 are being fulfilled and this is a recommendation. Systems are in place to safeguard residents monies although these were not inspected in depth on this occasion. The manager has implemented regular 1 to 1 sessions with staff and was able to evidence that this is happening although still in its infancy at present. The AQAA dataset informs us that all health and safety checks and servicing has been undertaken, a sampling of some of these has confirmed this to be accurate. A cursory examination of the fire log highlighted this is being maintained although recording has drifted slightly in the last few months, this has been brought to the managers attention. Fire drills are being held regularly. The home is now reporting events appropriately to the commission. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered person must 26/09/2009 ensure that a robust and comprehensive system for the assessment and reduction of risks to residents is in place. There is an expectation this will routinely include assessment of risks in relation to falls, skin integrity, continence and nutrition, and moving and handling, and that appropriate monitoring of these areas is maintained to ensure interventions are sought as needed Regulation 13(4)(c)The Registered person shall ensure that - unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 2 12 16 The home must develop a programme of activities that takes account of individual 23/09/2009 Care Homes for Older People Page 29 of 34 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 residents needs, interests and abilities, helps promote independence and provides interest and stimulation. There is a need for staff to engage more with residents and to be proactive in providing interesting and stimulating activities for residents to enrich the quality of life they currently experience Regulation 16(2)(m)(n) Care Homes Regulations 2001 to enrich the qulity of life experienced by residents 3 26 16 The registered person must 26/07/2009 take action to reduce offensive and unpleasant odours within house No.5 by the implementation of robust cleaning schedules in all toilets and bathrooms used by residents, in addition the emptying of commodes should be confined to specific toilets in the home and these should be subject to more intense cleansing regimes. Commodes in bedrooms must be thoroughly cleansed and disinfected regularly Care Homes for Older People Page 30 of 34 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 Regulation 16(2)(K) The registered person shall having regard to the size of the care home and the number and needs of service users (k) keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste 4 30 18 The registered person must ensure that all care staff have attended and completed all mandatory training which includes fire, first aid, infection control, food hygiene, moving and handling, adult safeguarding, medication. These should be updated at required intervals and the registered person should be able to evidence completion of required training for individual staff Regulation 18(1)(c)(i) 18(1)The registered person shall, having regard to the size of the care home, the statement of Purpose and the number and needs of service users (c)ensure that the persons employed by the registered 26/09/2009 Care Homes for Older People Page 31 of 34 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 person to work at the care home receive (i) training appropriate to the work they are to perform 5 30 13 The registered person must ensure that staff receive updated moving and handling training from a person certified to provide this training and this should contain a practical element Regulation 13 (5) The registered person shall make suitable arrangements to provide a safe system for the moving and handling of service users. To ensure staff have the necessary knowledge and skills to fulfill their role competently and safely protecting the safety of the residents and themselves 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 26/09/2009 1 2 Local authority residents should be provided with a copy of the terms and conditions of their stay to know what they are entitled to from the service. Care plans would benefit from providing a more holistic Page 32 of 34 2 7 Care Homes for Older People 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 view of residents needs and reflecting personal preferences in regard to personal and daily routines 3 9 Medication storage of controlled drugs needs to be compliant with the medicines Act 1968. The use of the other code on Mar sheets should be made clear as to what this refers to on sheets. Any handwritten changes entered onto a Mar sheet which affect the prescribing instructions must be signed and dated by the person making the change 4 16 There is a need for complaints information to be made more accessible to residents and for staff to be proactive in making complaints on residents behalf where a clear link can be identified between an incident and the cause of distress or anger in a resident. The home should be fully accessible to the residents who live there and consideration must be given to how this is to be achieved to all floors and also in the provision of access to the garden for residents of both houses Staffing levels and the utilisation of staff time need review The registered person should ensure that the recruitment procedure can evidence that gaps in employment have been explored and references obtained are only considered where they are in response to a direct request from the home and are directed to a named individual. The registered provider should be ensuring that monthly visits to assess service quality are conducted unannounced and are recorded in keeping with regulation 26 of the Care Homes Regualtions 2001 5 19 6 7 27 29 8 33 Care Homes for Older People Page 33 of 34 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!