Inspection on 13/05/10 for Francis Lodge

This is the latest available inspection report for this service, carried out on 13th May 2010.

CQC found this care home to be providing an Poor 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Francis Lodge 02/12/08

Francis Lodge 06/12/07

Francis Lodge 19/02/07

Francis Lodge 03/05/06

Francis Lodge 27/09/05

Francis Lodge 12/05/05

Francis Lodge 21/10/04

Francis Lodge 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Francis Lodge 4 Belsize Road Harrow Weald Middlesex HA3 6JJ     The quality rating for this care home is:   zero star poor 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: Jane Collisson     Date: 0 3 0 6 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: Francis Lodge 4 Belsize Road Harrow Weald Middlesex HA3 6JJ 02089312108 02089312108 francisservicesltd@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Monica Maxwell Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care home only - Code PC 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 Dementia - Code DE Date of last inspection Brief description of the care home Francis Lodge is a semi-detached house located in a quiet residential street in Harrow Weald. It is registered as a care home to provide personal care to four adults aged 65 years and over and is registered to care for people with dementia. There is a ground floor lounge, additional seating area and a small conservatory for meals. Two bedrooms, with ensuite facilities, are located on the ground floor and the other two Care Homes for Older People Page 4 of 37 Over 65 0 4 4 0 2 3 1 1 2 0 0 9 Brief description of the care home bedrooms are on the first floor. There is a bathroom and toilet on the first floor for the use of the two residents and staff. A stair lift provides access to the first floor. The home has a garden that can be accessed by steps, through the conservatory, and the laundry is located in an outbuilding. The staff office is located on the first floor. The care home is fairly close to community and leisure facilities within Harrow Weald and Stanmore. There is off-street parking on its driveway, in addition to unrestricted street parking. Ms Maxwell is the Registered Provider. The fees start from £650.00 per week. 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: zero star poor 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 unannounced inspection was commenced on the 13th May 2010 with two inspectors. We concluded the inspection on 3rd June. We were in the home for a total of nine hours. We carried out an inspection of all of the key standards in November 2009, when we issued three Statutory Requirement Notices (SRNs). We visited on 30th March 2010 to check these. There had been compliance with two of the SRNs but one had required further enforcement action and another SRN was issued. This was in respect of inaccurate staff rosters. On this inspection, we again found inaccurate record keeping in respect of the rosters. We have made a decision to leave a requirement on this issue instead of issuing another Statutory Requirement Notice However, the service is still not meeting the National Minimum Standard for the complement of staff and must continue to make improvements to ensure that residents rights and interests are safeguarded by the homes rostering processes. We found from an examination of the Care Homes for Older People Page 6 of 37 rosters that the home was short of staff, with the provider working long hours to fill vacancies. She was in the process of inducting two staff, one of whom was the Activities Organiser and the other the Administrator, to work as care workers and they were currently working through an induction period. The provider was also interviewing new staff for night cover. The provider was present on both visits to the home. There has been no registered manager in post for more than a year and the provider was managing the home. From the information available, we found that there had been an occasion in May when the provider had worked two days shifts, followed by a waking night, and where she had been the only member of staff on duty for twenty four hours. All four residents were present on each visit. We saw them in involved in some colouring activities and they using all three of the seating areas. We saw that there had been more recording in relation to the outings and there was an activities programme in place. We looked at a range of records, including care plans, staff records, rosters, training records and toured the home. One of the inspectors sampled the food on the first visit, which was satisfactory. We did not, however, find evidence of good menu planning which provided a varied diet with a good choice for the residents. We did not find all of the records we required available on the first visit and returned to check on these. Those we had required were mostly available but a number of records were not being kept in good order or readily accessible when we required them. We found that some of the requirements from the November 2009 inspection had not been met or fully met, and the others had not all been completed within the timescales given. Some of these were in relation to health and safety issues. These are detailed in the what the service could do better section. We have repeated seven requirements from the November 2010 as they are not yet complied with. Although a number of issues had been addressed, most were not completed within the timescales we had given. The Registered Provider did not inform us where she could not comply with the timescales. We have made a further sixteen requirements in addition to those repeated. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Seven requirements have been repeated from the last inspection. We are taking action by writing to the Registered Provider with a Warning Letter and requiring that an updated Improvement Plan is received by the 31st July, telling us what has been done since the last inspection and what is outstanding. The home needs to demonstrate that staff have the specialist training and skills to work with people with dementia. It must also demonstrate that the home has the environment, staffing and activities to show that the needs of people with dementia are being met. It must to be demonstrated that the care plans, health records and risk assessments fully record the needs of the residents, and demonstrate that any risks are minimised and any treatment that is required. The care plans need to be reviewed regularly to show how peoples needs are considered and they benefit from regular assessments and changes to their support. There have been staff shortages, resulting in single staff cover. There must be sufficient staff to provide enough cover to ensure needs are met and people have the opportunity for outings and support. The lack of a permanent manager has not supported consistent management. The home needs to be seen to be managed efficiently with all of the required information available and up-to-date, which should help to maximise the support to the residents. Staff need to be shown to be supported and to have the chance to discuss their work and develop their skills. Regular, recorded supervision should be seen to be taking Care Homes for Older People Page 8 of 37 place. We have made these new requirements, some of which were made at the November 2009 inspection but were not fully completed. The information on the Statement of Purpose and Service Users Guide was revised but does not have all of the items required by the Care Homes Regulations 2001. There are a number of training courses outstanding, which were not fully evidence to have taken place for all of the staff. These include medication and safeguarding. People are not always provided with a choice about their personal care needs and may have cross gender care. Peoples choices need to be ascertained and recorded. The menu we saw was very limited and there only a choice for one week available. The provider must have menus provided which show there is a choice and the meals are varied and nutritious. There was little information on safeguarding and the provider must ensure that this information is available for staff to access. Other policies and procedures must be available, which are up-to-date. While the recruitment processes had improved, there were still some shortfalls in the information on references, for instance. There are no quality assurance processes in evidence. Surveys have now been sent to families which need to be collated into a report, as part of the review of the quality of care. All of the required health and safety improvements must be completed, to minimise any risks to the residents, staff and visitors. 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with all of the information to help them to make a judgement about the facilities provided by the home, particularly in regard to the physical environment. People are not supported by staff trained in dementia care. There is a lack of evidence that current good practice is used to support the people with dementia. Evidence: We looked at a sample of the Statement of Purpose and Service Users Guide, which were required to be revised in November 2009. Although some changes have been made, there are still some shortfalls in the information and it does not fully meet the National Minimum Standards and Care Homes Regulations. Information on the environment, such as room sizes, en suite and other bathing facilities, and access to the garden, need be included to enable people to make an informed decision about whether the home would meet their needs. Better information is required to be included regarding any additional costs which may be required to be paid. These Care Homes for Older People Page 11 of 37 Evidence: should be contained in the Guide or in the terms and conditions, together with an estimate of the costs involved. There have been no vacancies in the home, so no new residents have been admitted. We could not, therefore, assess these National Minimum Standards regarding admissions, assessments and trial visits. The home is registered for dementia care and we made a requirement at the last inspection in November 2009 that all of the staff needed to have appropriate training by the end of February 2010. We did not find that the staff had all had this training, although two have certificates from other employments. The Registered Provider said the training had been due to be held recently but the trainer had not been available and it was due to be held after the second visit of this inspection. As the home is registered for dementia care, there must be evidence of a good level of training to ensure that the staff have the skills and knowledge to support the residents. It also needs to be demonstrated that the homes environment and activities are suitable to meet the needs of people with dementia, and this is based on current good practice. Care Homes for Older People Page 12 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place but do not fully reflect the needs of the residents. There is little evidence that the care plans and risk assessments are the result of regular reviews and consultation with people or their representatives. People are not protected by robust risk assessments or the use of suitable equipment. The assessments do not demonstrate that all of the risks are considered. People are offered limited choices in regard to personal care. Medication procedures were satisfactory but not all staff have recent training. Evidence: We examined all four of the residents care planning files. We found that the majority of the care plans were dated in 2008 and have not been rewritten to accommodate any changes in needs or the way in which the support is delivered. A monthly note is made on the care plan and the majority say that no changes have been made. However, we saw from the assessments which had been introduced that some changes to these had been recorded and would indicate that changes had taken place. There were a number of assessment forms for measuring peoples changing needs, such as mental capacity and skin integrity, but we did not see that, where there were Care Homes for Older People Page 13 of 37 Evidence: significant changes, the care plans had been changed accordingly. Overall, the information of the care plans and other related documents covered the necessary headings for holistic care. However, the files were not presented in an orderly fashion and we did not find it easy to access. Files contained basic information, which covered eating and drinking, personal care and guidance on emotional care, mobility and preferred activities. We found that the care plan information was not structured to enable staff to read the guidance clearly. These are currently all written by the provider and we recommended that staff become involved, as the key workers, in supporting her to write the plans. For legibility, we recommended again that they are typed and produced in a more user friendly way. Although some information on the residents personal histories had been obtained, these had not been used to inform the way in which their care plans were written. On the second visit to the home, the provider had introduced a new system of care planning files, dividing them into a file for care plans and another to record peoples health needs. As these had only just been commenced, and there was limited information recorded, we could not make a full assessment of them. The provider said that she was in the process of transferring the information. We had made requirements in November 2009 about the improvement of care plans by the end of February 2010, but did not find that any changes had been made until our visit in June. On one care plan, we noted an individual risk assessment was presented in a care plan format. We discussed with the provider the need to assess fully the level of risk and put in action points to reflect how a risk will be modified. We also noted that moving and handling assessments were written as guidance and did not show any actual risk assessments had been carried out. This was particularly relevant to the risk assessment for moving and handling in the bathroom. The individual risks pertaining to this had not been identified. There is a removable seat bench that goes over the bath this is not attached to the bath. People have to climb in to the bath and sit on this. We require that this activity is properly assessed and a full risk assessment is produced for the health and welfare of people who use the service. The provider informed us that the residents who have bedrooms on the first floor would be able to use the stairs, which have a stair lift and a platform and safety gate at the top of the stairs, in the event of an evacuation of the home. We did not see that this had been fully assessed and whether this would be practical and likely to be safe. When we discussed the need to have full risk assessments, we asked the provider Care Homes for Older People Page 14 of 37 Evidence: about her training to undertake practical manual handling training and risk assessing, which she currently does. She agreed that she had no formal training in this area for some years. We have repeated the requirement that the staff must be trained in manual handling and that staff must be trained to carry out the work they perform. We saw information on the health needs of one person which recorded that the person had an illness but, on another document, it was recorded that she did not have it. As the illness is one which requires monitoring, and possibly treatment, the information provided must be clear and the provider must ensure that health details are recorded accurately and demonstrate that the person is having the appropriate treatment. We saw very limited information about any of the residents specific dementia to show that any specialist knowledge and skills are being used to support the person. We looked at all the health care records and looked at evidence of health care appointments. People had seen their general practitioner, optician and chiropodist in late 2009 and 2010, although for one person there were no GP appointments in evidence. Some of the health records had been archived so we could not look at a full years records. We recommended that these are kept readily available should they be required for future use. We checked the medication on the first visit to the home and found that it was kept in satisfactory order. The medication is supplied in pre-packaged containers from the pharmacy. The provider confirmed that no PRN as and when medication is being given. The records provided to us in the form of certificates did not demonstrate that all of the staff still had training in medication administration. This had been a requirement in November 2009 and had not yet been completed. We noted from the staff roster that people do not always have choice regarding same gender care and the provider said that she had interviewed a male carer for night work. We discussed with her the need to offer choice in regard to peoples dignity and privacy and it needs to be discussed with people, their relatives, advocates and Social Services. The provider has, since the last key inspection, provided information from families on peoples wishes regarding their funerals. Care Homes for Older People Page 15 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. People are supported to undertake activities with staff. There are limited opportunities, mainly because of space constraints, for people to retain any independent living skills. There is little evidence of a planned menu, based on variety and choice. Evidence: The person previously working as a regular volunteer in the home to provide activities has now been employed, both as an Activities Organiser for fifteen hours a week, and also as a care worker. The provider showed us a programme of planned activities. We recommended that the member of staff who is designated to carry out planned activities with people is included on the rota when in this role, as it was not clear from the rosters we saw. Although the person has worked for some time as a volunteer, she has not yet had any training to work with people with dementia and we recommend that a course on specialist activities is also accessed to help to develop her skills. Some indoor activities were taking place on both days of the inspection, including colouring-in on the first day. There is a large television, radio and a keyboard in the main lounge area which now has an additional armchair as the desk has been moved Care Homes for Older People Page 16 of 37 Evidence: to the first floor. One resident has a regular newspaper. The activities are being recorded and we saw recordings of people being taken out of the home. On the second day of our inspection, when the weather was pleasant, the provider said that the residents had used the garden the day before. Although the first set of steps to the garden had been changed since the key inspection in November 2009, people would not be able to gain access to the garden without assistance. We sampled a meal of the first day of the inspection; this was sausage casserole, mashed potatoes and peas. The meal was reasonably cooked and of a texture that would not make it difficult to eat. We asked for a copy of the menus and were provided with one for May 2010. This only had meals for seven days and we asked if it was the practice to repeat the same meals each week. The provider said that they do change them. We recommended that a three or four week rolling menu is planned, so there can be shown to be a good variety of food available and that people can have a choice. We saw some information in the files of food and fluid intakes, but we did not see that they were all completed regularly or used to provide evidence to support the persons care plan. The care plans had basic information requiring food and drink and whether people needed assistance. All of the staff are involved in cooking food for the residents and it was a requirement from the Environmental Health Officer that training in food hygiene was provided as soon as possible. It was not seen that all of the staff have this training and we have made a requirement in the Staffing section for this to be carried out. There are limited opportunities for the residents to maintain daily living skills, due to the small size of the kitchen, which is kept locked when staff are not present, and the position of the laundry which has two sets of steps to negotiate. Relatives and friends visit the home and one person was present at the second of our visits. Care Homes for Older People Page 17 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 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 in place and available to residents and their families. Insufficient information is available for staff to access in relation to safeguarding the people they support. A lack of clear care planning, or evidence of professional interventions, may not support people whose behaviour may upset others or those affected by it. Evidence: The Safeguarding of Vulnerable Adults protocol for Harrow Social Services was not available in the home, or from the other authority with whom it contracts. The inhouse safeguarding adults procedure required updating as the information on the relevant contacts was not correct. The information must be made available for staff to reference in the case of any safeguarding incident and should be easily accessible. We could not see from the records made available to us that all of the staff have safeguarding training. This included the newer care staff, two of whom have worked in the home, in other capacities, for some time. We saw information recorded that that some challenging behaviour may take place from time to time between residents. None had been reported to the Care Quality Commission but we did not see that any active measures were in place to reduce the risks or that it had been reported to Social Services if the person needed more support. Some measures we saw written could be seen to be restrictive, such as Care Homes for Older People Page 18 of 37 Evidence: removing a walking stick. The provider must ensure that any action taken is in line with the persons needs and does not restrict their movement around the home. It must be shown that these have been discussed with their representatives, medical professionals and with Social Services. The provider informed us that there had been no complaints made in the home since the last inspection. The complaints information is available in the Statement of Purpose. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements to the environment have been made but not with the specified timescales. Residents cannot access all areas of the home without support, even if mobile. Maintenance issues are not always addressed in a timely manner or provide evidence that health and safety is paramount. Evidence: Since our last key inspection in November 2009 the desk, chair and equipment, which was used by staff in the main lounge, has been moved to the first floor small bedroom. There is now room for two armchairs and a settee in the main lounge which would seat all of the residents. On the two days of our inspection, the residents were seen in the lounge, the seating area outside of the kitchen and the conservatory. Blinds had been fitted to the conservatory, to stop the glare of the sun, when we visited on 30th March 2010. We saw all areas of the home on this inspection and they were clean and tidy. There were a number of environmental requirements made at the November 2009 inspection that had not been completed when we visited for a Compliance Visit in March 2010 or the first visit we made on 13th May 2010. We required in November 2009 that action was taken to made the first flight of steps to the garden safer as there were gaps each side of the steps and no rails. In March 2010, we saw that work Care Homes for Older People Page 20 of 37 Evidence: had commenced on them but we found the new steps are of uneven sizes and some edges have started to crumble. A rail has been added on one side of the steps. The edges need to be repaired and we suggested that a brightly painted edge to each step might support people to see the edges more clearly. There is also a second flight of steps to negotiate to the garden and there is no wheelchair access to the garden. We had made a requirement for the laundry, which is in an out-building in the garden, to be cleaned and its surfaces made impermeable. On our first visit, on 13th May, the room had been tidied, cleaned and cleared. The fridge/freezer and other items had been removed. The provider told us that floor covering would be laid that weekend and we saw this on our June visit. The walls have been lined but the surfaces cannot be made impermeable due to the wooden structure of the building. However, the building is now easier to keep clean. On the day of our random inspection visit on 30th March 2010, the Environmental Health Officer (EHO) from the local authority visited. The home was asked as soon as possible to have staff trained to Level 2 catering standard, even if this was in-house training. One staff member was seen to have done this and the provider said she had not yet been able to access more places on the training course. The EHO also asked for the extractor hood to be cleaned, dry food decanted into closed containers, and it was found the kitchen was excessively warm. The kitchen is small and was also warm on the day of the second visit. The provider said that she finds the kitchen temperature acceptable in which to work. We found it to be reasonably clean and tidy although the pedal bin for rubbish was in need of replacement as it was damaged. Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff rosters do not always provide accurate information about who is on duty. There are insufficient staff employed to always cover the roster. Health and safety may be compromised by staff working excessive hours without a break. Staff do not benefit from a regular training and development programme. Evidence: We looked at the staff rosters in relation to the Statutory Requirement Notice (SRN) we made at the inspection on 30th March 2010 when following up a previous SRN from November 2009, on staff rosters. On this inspection, we found evidence in rosters examined, for three weeks in May 2010, that there were inaccuracies in the recording. The times of shifts or the person working were not recorded on some occasions. The provider said that she believed the rosters to be accurate and that they had been updated by the administrative assistant. The rosters we examined also showed occasions when there had been staff shortages. On one Sunday in May, the provider was shown to have worked alone all day and followed this with a shift as the waking night staff. She said that this had been an emergency situation. Where staff work excessive hours without a break because they are working alone, or they do not have the opportunity to sleep, this is potentially a health and safety issue for the residents and for the staff member. In this case the shift appear to be a twenty four hour waking shift. The provider said she had been Care Homes for Older People Page 22 of 37 Evidence: working shifts to cover vacancies but she said she hoped to have night staff employed by July 2010. It had been a requirement in November 2009 that the sufficient staff must be employed to cover the staffing rosters. She had recruited two staff from her activities and administrative staff recently to commence as care workers and informed us that both of them were still undertaking their induction. No staff are employed for domestic or catering work and this is work is carried out by care staff and the provider. The provider was cooking the lunch on the first day of the inspection. We have made a decision to leave a requirement on this issue instead of issuing another Statutory Requirement Notice. However, the service is still not meeting the minimum standard for staff complement and must continue to make improvements to ensure that residents rights and interests are safeguarded by the homes rostering processes. We checked a sample of recruitment records. The staff have Criminal Records Bureau disclosures and references but the dates of employment were not given on the references, so could not be checked against the employment histories. We asked the provider to supply us with evidence of staff training. There was some information, in the files we examined on the first visit, of certificates but there was no training and development plan to demonstrate that each staff member had undertaken all of the core and specialist training required. We recommended that a training matrix, spreadsheet or other form of recording would be useful to demonstrate the training staff have had. On the second visit, a wall chart was in use but did not provide evidence of the dates on which the training had taken place. Where there were gaps, the provider said that staff had undertaken the training although the boxes were not ticked. From the records we could examine, we saw that there are still gaps in the training of some of the staff and the deadlines set at the November 2009 inspection to meet these shortfalls had not been met. We have made a further requirement that the provider must ensure that there is evidence that the staff have the training required to carry out their roles and that it is recorded fully. Each staff member must have a record of their induction and training available for inspection. The provider showed us a copy of training planned for the forthcoming months. The majority of the training is being done in-house by the provider, using DVDs. There is limited space in the house to undertake this but the provider said she would obtain an outside venue if this was required. Care Homes for Older People Page 23 of 37 Evidence: We did not see the information on the training chart, but the provider informed us there were three staff with National Vocational Qualifications, and one who is registered to take it. Care Homes for Older People Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home would benefit from being better managed, by records being accurate and kept up-to-date, in order to evidence the outcomes for residents. Staff do not benefit from regular supervision or a consistent training programme which helps them to develop their skills. No quality assurance systems are in place to develop and improve the service. Policies and procedures do not reflect that they are checked on a regular basis and updated taking into account good practice. Evidence: The home is currently being managed by the registered provider who is also the manager of her domiciliary care agency. There has been no registered manager in post for more than a year. Although there have been appointments, the last one in October 2009, there is no-one currently in post. The provider said that she has the job placed at the Job Centre and will also probably be advertising locally. We found that a number of the requirements made in November 2009 had not been met within the deadlines given. The record keeping in the home does not evidence Care Homes for Older People Page 25 of 37 Evidence: compliance with the Care Home Regulations 2001 or provide evidence of good outcomes for the people who live in the home. There is limited feedback from them because of their dementia. The provider said that she had recently sent out surveys to relatives to gain their views of the home. There has been no quality review of the care in the home since the last inspection and we have made a requirement for this. Although we saw that the provider had introduced a supervision contract since the last key inspection, we did not see any further evidence of regular staff supervision on a one-to-one basis. We saw that some dates had been planned. It was a requirement in November 2009 for it to commence with a deadline of February 2010. The provider had undertaken some observations of the staff at work. However, we did not see evidence that the staff have the opportunity to discuss their work with the residents, or their training and development needs, with the provider on a regular basis. The National Minimum Standard of a minimum of six staff supervisions a year needs to be demonstrated by the provider to show that staff have the support to develop their roles. We looked at this inspection at a number of the policies and procedures and found a number of shortfalls. The home did not have available for inspection all of those which should be in place. The provider was asked to ensure that all of those shown in the Care Homes Regulations appendix are in place and available, together with any others that are in accordance with more recent legislation or relevant to the homes services. We have been informed by the provider that no money is retained on behalf of the people in the home and that charges are made to their representatives or families if money is spent on their behalf. Some environmental risk assessments had been completed. We had made a requirement in November 2009 for the provider to look at the risks in having the radiators left uncovered. She arranged for some of them to be covered but a number remain exposed. She said that she had not been able to find covers of a suitable size for them. We were informed by the provider that the water temperatures will be kept on a low setting and may be unsafe. This will be unacceptable in colder weather and the provider must ensure that, having accessed the risk as high, she must take action to cover the remaining radiators or provide those with low surface temperature type. We found that only some of the hot water outlets had been regulated when we visited in May 2010. It had been a requirement in November 2009 that action was taken but this was not done within the timescales we made. The wash basins had been regulated but the bath has not been. The showers in the en suite rooms still had very Care Homes for Older People Page 26 of 37 Evidence: hot water. These were changed by our second visit and are now regulated. We saw some health and safety issues in the homes office. We pointed out to the provider on at least two occasions that the shelves in the office required fixing to the wall as they were not secure and over loaded with files. At one point during the inspection the shelf tilted and a heavy file fell off. We did not see that the risk of using the stairs had been individually assessed, taking into account the narrow width and stair lift equipment on the stairs. The provider said that the residents who have their bedrooms upstairs would be able to use the stairs in the event of an evacuation of the home, caused by the fire alarm. The provider needs to keep this under review, in view of the mobility of the residents. We did not see any of residents use the stairs or stair lift in the course of the two days of this inspection. There have been no night fire drills in the information we saw, although five had been held since December 2008. The fire detection system had not been serviced, although this had been a requirement by the London Fire and Emergency Planning Authority at its recent visit. On the second day of our inspection, the provider told us that the person was on his way although he did not come while we were present. We looked at sample of maintenance records and found that the stair lift was serviced in February 2010, the extinguishers checked in September 2009, and the small electrical appliances in December 2009. Care Homes for Older People Page 27 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 4 The Registered Provider must 31/08/2010 demonstrate that the home is able to meet peoples specialist needs in relation to their dementia or other disabilities and illnesses. This must include reference to the staffing, environment, training and activities to demonstrate the homes capacity to meet these needs. (Timescale of 28th February 2010 not met). To ensure that any specialist needs are met by appropriately trained and sufficient staff, and the environment. 2 7 15 The Registered Provider must 31/08/2010 ensure that the care plans are reviewed and changed as required to reflect the care and support being provided. (Timescale of 28th February 2010 not met). To ensure that people have their care needs met. 3 8 13 The Registered Provider must 31/08/2010 ensure all of the potential areas of risk are assessed and action is recorded to show how the risks to the people using the service and to staff are minimised. Page 28 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 (Timescale of 28th February 2010 not met) To minimise the risks to people living in the home, to the staff and to visitors. 4 27 18 The Registered Provider must 31/07/2010 demonstrate that there are sufficient staff on duty to meet the needs of the residents. (Timescale of 31st January 2010 not met). To ensure that the people living in the home are supported appropriately. 5 30 18 The Registered Provider must 30/09/2010 ensure that there is staff training plan in place which ensure that all of the staff have the basic training courses and the required refresher training. This must include manual handling, first aid, fire awareness, food hygiene, infection control and any other courses required to carry out the work undertaken. (Timescale of 28th February 2010 not met). To demonstrate that staff have the training and skills to meet the needs of the people they support. 6 31 10 The Registered Provider must 31/08/2010 ensure that the home is managed efficiently, with the information required to meet the Care Home Regulations Care Homes for Older People Page 29 of 37 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 2001 which must be available for inspection. (Timescale of 31st January 2010 not met) To provide evidence that the home is well managed. 7 36 18 The Registered Provider must 30/09/2010 ensure that there is evidence of regular staff supervision to demonstrate that staff are supported. (The timescale of the 28th February 2010 not met). To demonstrate that staff have the support they require. 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Registered Provider must ensure that the Statement of Purpose and Service Users Guide are in accordance with the Care Homes Regulations 2001. To ensure that people have all of the information they require to make an informed decision about moving to and living in the home. 31/07/2010 2 8 12 The Registered Provider 31/07/2010 must ensure that peoples health needs are accurately recorded and an appropriate support plan put into place. To ensure that their support needs are recorded and show that appropriate care is in place. 3 9 13 The registered provider must ensure that all staff are trained in medication adminstration and there is evidence that their 31/07/2010 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 competency has been assessed. To ensure that staff have the knowledge of medication procedures. 4 10 12 The Registered Provider must ensure that peoples preferences, in regard to their personal care, are ascertained and recorded. To ensure that people have their privacy and dignity respected in a way they would wish. 5 15 16 The Registered Provider 31/07/2010 must ensure that there is a varied and nutritious menu, with choices, provided to the residents. To ensure that there is a choice of meals, and they are varied and nutritious. 6 18 18 The Registered Provider must ensure that all staff have training in safeguarding. To ensure that staff have the knowledge to understand and prevent abuse. 7 18 13 The Registered Provider must ensure that no unnecessary restrictions are 31/07/2010 31/08/2010 31/07/2010 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 imposed on residents. These must be discussed with the persons representatives and support sought where additional assistance is required. To ensure that people have their needs assessed where additional support is required. 8 18 13 The Registered Provider 31/07/2010 must ensure that all of the information regarding the safeguarding of adults, including the policies and procedures, are available for use. To help staff to have knowledge of the safeguarding adults procedures and to have the information available in the event of an issue arising. 9 19 23 The Registered Provider must ensure that the steps to the garden are repaired to ensure that no further damage to the edges takes place. To ensure safer access for the residents. 31/07/2010 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 10 21 23 The Registered Provider 31/08/2010 must ensure that the bathing facilities are suitable to meet the needs of the residents. To ensure that people have suitable facilities provided which ensure any risks are minimised. 11 27 18 The Registered Provider must ensure that there are sufficient staff employed to have the number on each shift to meet the needs of the residents, including the opportunity for outings. To ensure that people have their needs met. 31/07/2010 12 29 18 The Registered Provider must ensure that the recruitment processes ensure that employment histories are checked against references. To ensure people are protected by robust recruitment practices. 31/07/2010 13 33 24A The Registered Provider must provide an Improvement Plan to the Care Quality Commission to inform them of what has been completed since the 31/07/2010 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 last inspection and what is outstanding. To ensure that there is compliance with the Care Homes Regulations 2001. 14 33 24 The Registered Provider must ensure that there are quality assurance processes in place. A report of the monitoring, with a report, must be produced to show how the home is developing and improving, taking into account peoples views and experience. To ensure that peoples views are used to improve the qualitry of care in the home. 15 37 17 The Registered Provider must ensure that all of the records which are required for an inspection are available for examination as and when required. To demonstrate that the home has up-to-date and orderly records. 16 38 13 The Registered Provider must ensure that all health and safety issues, including maintenance checks, are addressed. These must be 31/07/2010 31/07/2010 31/08/2010 Care Homes for Older People Page 35 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 carried out within the agreed timescales. To minimise any risk to residents, staff and visitors to the home. 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 7 That the care plans and associated information is produced on the computer to ensure that it is easy to read for all concerned and can be updated as and when required. We also recommend that the care staff are involved in helping to write the care plans. That the edges to the steps to the garden are painted to provide a guide for the residents. 2 19 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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