Inspection on 28/06/10 for Higher Park Lodge

This is the latest available inspection report for this service, carried out on 28th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Higher Park Lodge 06/06/06

Higher Park Lodge 09/02/06

Higher Park Lodge 19/07/05

Higher Park Lodge 03/03/05

Higher Park Lodge 01/09/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Higher Park Lodge Devonport Park Stoke Plymouth Devon PL1 4BT     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: Clare Medlock     Date: 2 8 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: Higher Park Lodge Devonport Park Stoke Plymouth Devon PL1 4BT 01752606066 01752606066 care@higherparklodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Higher Park Lodge (Plymouth) Limited Name of registered manager (if applicable) Mrs Deborah Ann Norman Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service Users may be admitted who are 60 years of age or above. Date of last inspection Brief description of the care home The service is a limited company called Higher Park Lodge Plymouth Ltd. The home is a large detached building, approximately 100 years of age, overlooking Devonport park, with an attached purpose built extension. The home is close to Stoke village in central Plymouth. A full range of amenities and facilities are within walking distance of the home in the Stoke village shopping area. Care Homes for Older People Page 4 of 37 Over 65 25 25 25 0 Brief description of the care home The home can accommodate up to twenty-five people over three floors. It has a shaft lift reaching all three floors. The main lounge is by the front entrance of the building and the second quiet lounge is on the first floor. The dining room area is close to the kitchen on the ground floor. There is one double bedroom in the home and all the others are single bedrooms. The ground floor of the extension opens onto a patio area, overlooking well maintained driveway. The home does not have a garden area but is adjacent to the large parkland area of Devonport park. The service offered by the home is primarily for people with dementia or significant mental frailty needs. Some people at the home have mobility difficulties. The current fees range approximately between GBP375 to GBP408 according to assessed need. A copy of the last report can be requested from the manager and the service user gude is located in each persons room. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a random inspection performed to ensure compliance before the transition to the Essential Standards of Quality and Safety used under the Health and Social Care Act 2008. However, concerns noted during the site visit meant that we converted the inspection to a full Key inspection, as per current methodology. The unannounced site visit took place on Monday, 28th June 2010. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Prior to this inspection we sent surveys to people who use the service and to staff who work there. The findings of the surveys returned to us are incorporated within the report. Care Homes for Older People Page 6 of 37 During the inspection we spoke to the deputy manager, four members of staff, four people who live in the home and two visitors. We looked at care plans, four staff recruitment records, training records, medication processes, policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Higher Park Lodge. 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: Many of the issues found at this inspection could have been identified if an effective monitoring and quality assurance system was in place at the home. A quality assurance programme was also recommended at the previous key inspection. Therefore, introducing such monitoring systems should be a priority. These processes would then be used to ensure people are safe and well cared for. Safety must be of paramount importance at the home. The provider must adhere to Care Homes for Older People Page 8 of 37 fire authority and Environmental Health Authority guidance and regulation. The provider must ensure effective fire training sessions are introduced for staff, and ensure that areas of non-compliance identified by the fire authority, last year, are addressed as a matter of urgency. Fire safety in the home could also be improved by the introduction of an easily accessible, up-to-date, fire evacuation plan to use in the event of a fire. The provider must ensure that food hygiene and kitchen safety is made a priority at the home. Staff must be kept up to date and food hygiene training, and kitchen hygiene checks must be performed in line with good practice guidance provided by the food standards agency. Food stored in fridge areas must also be improved at the home. Systems must be in place to ensure that the home is hygienic and clean at all times. This must include flooring and bathroom areas. Cleaning staff must be reminded to keep bathroom and toilet areas hygienically clean, to reduce the spread of infection and unnecessary odours. Systems must be in place to ensure that floor areas are kept clean at all times. Infection control training must be kept up to date for all staff. Staff must have easy access to protect personal equipment to reduce the spread of infection at the home. Staff recruitment processes must be improved to show that staff have had all the preemployment checks necessary to demonstrate they are suitable to work with vulnerable people. These checks must include providing evidence of; proof of identity, appropriate references prior to employment, and evidence of a criminal records bureau check and protection of vulnerable adults check- before a member of staff works. Staff must have access to an induction programme to help them understand how to care for vulnerable people. Staff must also receive training in the safe moving and handling of people before they work. This will protect both people who are being moved and the staff themselves. Once employed, staff must have access to effective supervision, as an opportunity to discuss training needs and an opportunity to discuss aspects of care. Care planning at the home must be improved to provide a more accurate set of records relating to a person and their care. Care plans and assessments must be reviewed regularly, be dated, signed and contain the name of the person they refer to. This will help staff to review and monitor a persons condition effectively. Care Plans should also clearly show how decision making processes are made at the home for people who lack capacity who have locks on their bedroom doors. Accurate assessments must be performed on all people moving to the home including those on a temporary basis. Care Plans must also be provided for all people in the home, including those on temporary basis. The management of medications must also improve as a matter of priority at the home. Storage facilities must be reviewed to ensure that controlled drugs are stored appropriately, the drugs trolley is securely stored when not in use, and their medicines Care Homes for Older People Page 9 of 37 arriving at the home are securely stored until they are able to be put away. Staff must be diligent when administering medicines to ensure that any tablets dropped on the floor are discarded of immediately. The medicine administration records (MAR sheet) must also be improved to show why medicines have been missed, what controlled medicines have been returned to the pharmacy and show accurate controlled drug balance. Staff must be reminded to ensure that any hand written entries on the MAR sheet are checked with another member of staff to ensure they are accurate. The information provided for people should also be improved. This should include updating the statement of purpose with up to date information including contact details for the Care Quality Commission. Systems should be in place to continually monitor that people continue to be satisfied with the level, amount and frequency of activities and show that people who can not provide feedback have access to meaningful stimulation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available to people could be improved by ensuring it is up to date. Improvements are needed to ensure that all people in the home have an in depth preadmission assessment. Evidence: A Statement of Purpose and Service User Guide were available for inspection. The deputy manager explained that she had updated the Service User Guide. This document contained all the information necessary for people to make a decision about moving to the home. Each person is provided with a Service User Guide, which is left in their bedrooms. A Statement of Purpose was also inspected, which the deputy manager explained needed to be updated. Care Homes for Older People Page 12 of 37 Evidence: Each persons file contained a preadmission assessment, with the exception of one file for a person that had been admitted on a temporary basis. This person had been at the home for over one month. A discussion was held regarding the importance of obtaining detailed information, to ensure that staff can assess whether they can meet the persons needs before they move to the home. People spoken to said they had been involved in the decision to move to the home. Seven of the nine surveys stated that people (or their relatives) had been provided with sufficient information before moving to the home. The same respondents said they had received written information regarding the terms and conditions of the home. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although personal care is provided to a satisfactory standard, improvements are urgently needed to improve the management of medication systems and care planning records at the home. Evidence: People looked well cared for on the day of inspection. The finer details of care had been provided, for example, clean nails, appropriate foot wear, men were cleanly shaven, and attention to personal hair styles. People being cared for in bed appeared comfortable, pain free and warm. People told us that they thought the care provided was a very good standard. Six of the nine surveys said they thought people always received the care and support people needed, with the remaining three respondents ticking usually or sometimes. One person wrote I am very happy with the care I receive. People appreciated the attentive staff, and said it did not take long for call bells to be answered. People who were left in their bedrooms had easy access to a call bell and drink. Care Homes for Older People Page 14 of 37 Evidence: Existing health care professional stated that he visited the home on a regular basis, and thought that the standard of care was very good. All interactions seen and heard on the day of inspection were calm, gentle and appropriate. The appropriate use of humour and affection was seen to be shared between staff and people at the home. People have access to healthcare services both within the home and in the community. People told us they had received immunisations recently and see their doctor when necessary. One person told us that she had been admitted to hospital unexpectedly, and that staff facilitated this very efficiently. The AQAA read if any problems occur, we contact the GP or district nurse when required. We have very good relationships with our GPs and district nurses and we provide any equipment needed through ourselves all the community when needed. Records showed us that people have access to NHS services and healthcare specialists. Each person has an A4 folder which contains care plans and risk assessments. Although the structure of the care planning system was good, all three sets of records were poorly maintained. Many of the care plans and risk assessments had not been named, dated or signed, meaning that review and monitoring is difficult. One person who had been admitted on a temporary basis, had been at the home for over one month and still did not have a plan of care written about them. A discussion was held regarding the importance of ensuring all people at the home have a clear plan of care which states have their needs will be met. Medication is at the home were poorly managed. A tour of the building confirmed that a small number of loose medications were found in peoples bedrooms on the floor. Records were not clear whether these medicines had been provided again or missed. On the tour of the building, the medication trolleys had not been securely attached to the wall. In one-bedroom there was a carrier bag located with six empty pots of paracetamol, and one box containing paracetamol. This person was not self medicated. It was noted that a new supply of medications had arrived on Friday afternoon, and were left within the office area, which was unlocked. Discussion with staff confirmed that usually medications that arrive on Friday afternoon are checked and put away on Care Homes for Older People Page 15 of 37 Evidence: Monday morning. This means that medications are left and supervised in the home. A check of controlled drugs confirmed that the balance of current controlled drugs was correct. However closer examination of records showed that remaining balances had not been recorded as being returned to the pharmacy. This could result in an error being made. It was also noticed that controlled drugs were being inappropriately stored in the general medicines cupboard. There was no clear record of when these controlled drugs had been returned to pharmacy. The medicine administration records (MAR) were also not maintained to an adequate standard. Some gaps in the MAR sheet did not indicate why the medicine had been missed or refused. Hand written entries on the Mar sheet had not been signed by two members of staff, which would reduce any errors being made when copying a prescription on to the Mar sheet. People spoken to said that generally they receive their medicines on time, and that repeat prescriptions are organised by the staff. Care Homes for Older People Page 16 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. Although activities are provided, checks could be made to ensure they are still to the satisfaction of people living at the home. Evidence: People said that there were organised activities held at the home on a regular basis, although all the people we spoke to see that there did not always seemed to be enough activities. One person said that sometimes activities were cancelled without notice. We were told that there are trips organised by the home, although these are not as frequent as they used to be in previous years. One person told us they were looking forward to the trip to Paignton that was being arranged. A tour of the building confirmed that and orientation board in the dining room was displaying the wrong date and day. This was highlighted to the deputy manager, who changed the board. We noted that there was equipment is located within the communal areas to show Care Homes for Older People Page 17 of 37 Evidence: that informal activities were held regularly at the home. A reminiscence corner, with memory books was located in the main lounge, and board games and puzzles were located within the dining area. On the day of inspection a game off magnetic darts was being played by some people. Other people informed us that they liked to arrange their own entertainment. One person enjoyed a bit of gardening on his terrace area, whilst another person appreciated that the garden area in front of his bedroom window had been cleared and fitted with bird boxes and birds tables. We were told that the home employs an activities coordinator, who organises the activities. Each person had a personal activity record, but records beyond October 2009 were not seen. The AQAA stated that we have various churches that visit its service users so wish. People told us that there were regular religious services held at the home. The majority of people were satisfied with the food provided at the home. A small number of people said that food varied, depending on who was cooking it. We were told that there was no choice of the meal served, but should staff be aware that a person does not like the meal of the day, alternatives can be found. On the day of inspection a beef stew with dumplings followed by home-made trifle was being prepared. People spoken to after lunch, commented that the food had been delicious that day. Kitchen areas were well stocked with tinned, dried and fresh produce. Freezers and fridges were also well stocked. The dining area was clean and tidy. Tables were covered in cleanable plastic coverings and set out in a long table. Care Homes for Older People Page 18 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be managed effectively at the home. Improvements are needed to show that decisions made on behalf of people who are unable to do so themselves, are done in their best interests. Evidence: People spoken to said they were generally happy at the home. The people we spoke to said if they had any minor grumbles they would speak to the deputy manager, who usually sorted things out straight away. The deputy manager informed us the service had not received any formal complaints. The Care Quality Commission has received one anonymous complaints since the last inspection. This related to the standard of hygiene dropping in the home during recent months. This is reported on in a later section of the report. Feedback is encouraged by the use of a new anonymous complaints box. People told us they generally felt safe living at the home. Some people said if staff were busy they tended to be slightly rougher or quicker when providing personal care, that this was not intentional. Two other people commented that, at times, they did feel slightly anxious with the number of younger, more inexperienced staff on duty. Care Homes for Older People Page 19 of 37 Evidence: We did not see any examples were people were having their liberties deprived, or were being restrained. However, we did notice that a small number of rooms on the ground floor had been locked. One person, who had capacity explained that she likes to hold a key or her room, but the other people could not express the same opinion. Care plans and records could not explain the reasons why bedroom doors were locked, but the deputy manager explained that family had requested the rooms to be locked, to prevent people walking uninvited into their rooms. A discussion was held regarding the importance of ensuring that care plans should clearly show how decision making processes are made at the home for people who lack capacity. Staff spoken to clearly understood what steps to take should allegations of abuse been made. Staff explained that they had been educated to inform their line manager, but were able to correctly identify which external agencies to contact should line manager is not be available. People told us that they are encouraged to manage their own personal financial affairs. The deputy manager explained that the home do not hold personal monies for people. We were told by both the deputy manager and people at the home that individuals, or their representatives were billed for any services such as hairdressing or chiropody. Care Homes for Older People Page 20 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. Improvements within the environment are urgently needed to improve cleanliness, hygiene and safety. Evidence: A full tour of the building was carried out at this inspection. The external areas of the home appeared well maintained. The deputy manager informed us that some children from the community volunteered to clear some parts of the garden area. One personexpressed their delight in having an area of garden outside their bedroom window cleared, and re planted with flowers and fitted with bird feeding tables and nest boxes. Another person appreciated that he was able to maintain his interest in gardening by continuing to garden at the home. On the day of inspection people were enjoying the sunshine in the patio area at the front of the home. We were told that in addition to the front of the house improving, new garden table, chairs and umbrellas had been purchased along with a small barbecue and the introduction of colourful hanging baskets. The internal part of the home was not as well maintained. Some areas of the home appeared in need of redecoration and attention, and did not show evidence routine maintenance and renewal programme had taken place at the home. Care Homes for Older People Page 21 of 37 Evidence: A letter from the fire department in August 2009 expressed non-compliance with certain aspects of fire safety at the home. During the tour of the building it was noted that the laundry door, containing combustible materials and equipment, continued to be wedged open due to a faulty door guard. An immediate requirement was issued regarding this unsafe practice. The home has had an environmental health office kitchen check performed in March, of which, recommendations made had been met. On the day of inspection the kitchen generally appear to clean and tidy. However, kitchen records showed that not all kitchen staff maintain and kitchen records expected by the safer food better business(food standard agency programme). Although the kitchen appeared clean and tidy, storage of cooked foods within the fridge areas had not been labelled with dates of preparation. This is poor practice. These shortfalls were fed back to the manager. The AQAA stated that the service have a high standard of cleanliness around the home. However, a tour of the home also highlighted that cleanliness within toilet and bathroom areas was poor in the home. At least nine toilets and commodes contained dried faeces within the toilet bowl and rim. One ensuite shower room contained stained sink, debris around the base of the tap and a thick layer of dust around the sink unit. An unused shower had been screened off, but was being used as a storage area for such items including: a ladder, incontinence pads, Christmas decorations, carrier bag with unused medications, old vases and other items. The shower plug area appeared covered in black mould. The shower curtain was also dirty. The ensuite floor contained layers of debris and dust. A tab of cream located on the windowsill had a thick layer debris indicating it had been there for a substantial amount of time, which could pose in infection control risk. At least nine bedrooms contained evidence to show that rooms had not been cleaned sufficiently well. Edges of carpets, areas of carpets and furniture contained debris. In one bathroom an unsheathed razorblade had been discarded of in a general waste bin. The sit on scales were covered in dust, as were some commode areas. These shortfalls demonstarte that a robust cleaning programme is not in place at the home. Communal areas appeared more tidy and clean. The laundry area was located in an area of the home well away from the kitchen and dining area. Staff were knowledgeable regarding safe handling of foul laundry, and Care Homes for Older People Page 22 of 37 Evidence: were aware of the importance of using personal protective equipment to prevent this spread of infection. However the same staff, had not been provided with easy access to such equipment, and had not been provided with recent infection control training. The member of staff on duty at last received infection control training seven years ago. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the recruitment procedure and induction programme would show that staff have been checked to show they are suitable and prepared to work with vulnerable people. Evidence: Staff, people who use the service and visitors all stated that they thought there was sufficient staff numbers on duty each day. Some people stated that staff were busy, and sometimes they felt rushed, resulting in some staff treating them more roughly than normal, although this was not very often, as usually staff were very kind, caring and very patient. On the day of inspection there were five care staff on duty, the deputy manager, and additional ancillary staff to care for the 25 people at the home. Off duty records confirmed that staffing levels were stable. Discussion with staff confirmed that extra staff are employed at peak times of the day. New staff uniforms have been introduced, which are colour coded to help people identify the roles of staff. Staff records showed that recruitment practices were not robust at the home. Care Homes for Older People Page 24 of 37 Evidence: Although all four staff files contained an application form, none of the staff files contained two forms of identification or recent photograph. Although each file contained two written references, some of these references were not from previous employers and dates had not been provided to show that references had been provided before employment. One staff file did not contain evidence of criminal records bureau check being performed, although the deputy manager stated that this had been conducted. Dates on the criminal records bureau checks of the other staff showed that these had been performed after the staff start date, but no evidence was show that a POVA first (Rapidly returned pre employment check to show people are suitable to work with vulnerable adults) check had been performed. All staff files contained evidence of health declaration. Two of the fourth staff files contained evidence of an induction programme, however the remaining two files did not provide evidence to show that staff had received a comprehensive induction. Staff spoken to on the day of inspection and said they had received training regarding anger management, medication and station, Parkinsons disease, and afterlife care. Both members of staff spoken to had acquired NVQ two qualifications. Care Homes for Older People Page 25 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Urgent improvements are needed to show that the providers take health and safety issues at the home seriously. Improvements to the supervision programme would mean that staff have access to opportunities to identify any training needs. The introduction of a robust self-monitoring programme would identify, reduce and prevent shortfalls occurring at the home. Evidence: People spoken to said that they thought the home was managed well on a day-to-day basis. People spoke highly about the deputy manager and manager. Staff said is generally the acting manager was more hands-on, whilst people we spoke with also responded that the deputy manager tended to get things done. Care Homes for Older People Page 26 of 37 Evidence: Both the registered manager and deputy manager have the Registered Managers Award and NVQ four. Staff had not received recent supervision to discuss areas of practice, philosophy of care and career development needs. There was not a clear system to show which staff had received what mandatory training. Once obtained, this information confirmed that performance of staff case tracked at this inspection had not received fire safety training. One member of staff had not received moving in handling training and all staff had not received infection control training. Two of the staff had not received food hygiene training and to the staff had not received training in health and safety issues. Two of the staff had not received up to date safeguarding adults training. A discussion was held regarding the importance of ensuring staff are up to date with mandatory training to ensure that staff are aware of how to work safely in the home. Other findings at key inspection also raised concerns regarding health and safety issues in the home. Staff were not able to provide an accurate up-to-date list of clients in the home. The clients and is provided was out of date by over one month. There was no clear evacuation plan for fire safety, to inform the fire brigade of what needs people have at the home. We were told that resident and staff meetings are held, although records could not provide evidence that these had been held in recent months. The AQAA stated that the activities coordinator holds these regular meetings. Resident questionnaires had been sent in March 2010 with a positive response. Although the service had provided an AQAA within timescales, statements within the document did not reflect findings and evidence seen at this inspection. Shortfalls in the care planning system, medication system, environment, recruitment, staff training programme, and fire safety in the home did not show that there was a robust quality assurance programme or self monitoring system operating at the home. Care Homes for Older People Page 27 of 37 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 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person must 29/06/2010 remove the door wedge from the laundry door, and repair the door guard should be drawn needs to be propped open. This will mean that the laundry door can be propped open, but that should a fire take place, be automatically closed reduce the spread of fire. 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 6 The registered person must keep the statement of purpose up to date. This will mean that people who are thinking of moving to the home have all the information they need to decide whether the home can meet their needs. 02/12/2010 2 3 14 The registered person must not provide accommodation to people at the care home unless the needs of the person had been assessed. 02/12/2010 Care Homes for Older People Page 29 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 This will show that the home have assessed the person to show they are able to meet their needs. 3 7 15 The registered person who must ensure that care plans are kept under review and are accurate. This must include ensuring that an unnamed, dated and signed.. This will mean that it is easier to review and monitor a persons condition, and reflect the care that has been provided. 4 9 13 The registered person must ensure that the storage of medicines is safe at all times. This must include systems to ensure: Loose medicines dropped on the floor are disposed of correctly. The medicine trolley is securely locked to the wall when not in use. Medicines arriving at the home are securely stored until staff are free to check and provide adequate storage. These systems will ensure that medicine administration 02/12/2010 02/12/2010 Care Homes for Older People Page 30 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 is accurately recorded, and will minimise risks and errors being made . 5 9 13 The registered person must ensure that controlled drugs are stored in a way that complies with the misuse of drugs (safe custody) regulations. This will mean that controlled drugs are stored correctly and safely. 6 9 13 The registered person must ensure that medications are handled safely in the home. This must include systems to ensure: Accurate records are kept of medicines administered. Accurate records are kept of medicines returned to the pharmacy. Hand written entries on the mar sheets are signed by two members of staff. These systems will ensure that medicine administration is accurately recorded, and will minimise risks. 7 9 13 The registered person must ensure that medications are handled safely in the home. This must include systems to ensure: Accurate records are kept of 02/12/2010 02/12/2010 02/12/2010 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 controlled drug medicines returned to the pharmacy. These systems will ensure that medicine administration is accurately recorded, and will minimise risks and errors being made . 8 19 13 The registered person must ensure that systems are in place to keep the home clean, hygienic and tidy at all times. This will ensure that the risk of infection is kept to a minimum and will provide people with a clean, safe and homely place to live. 9 19 16 The registered person must 02/12/2010 ensure that kitchen hygiene and storage practices are safe and do not place people at risk, by ensuring that kitchen checks are performed and recorded and food is stored appropriately according to good practice guidelines. This will help to prevent food poisoning at the home. The registered person must ensure that systems are in place to keep bathrooms and toilets in the home 02/12/2010 02/12/2010 10 21 12 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 clean, hygienic and tidy at all times. This will ensure that the risk of infection is kept to a minimum and will provide people with a clean and hygienic toilet and bathroom facilities. 11 26 13 The registered person must ensure that personal protective equipment is provided for all staff, including laundry staff. This will prevent the spread of infection in the home and will protect both people who use the service and members of staff. 12 29 19 Staff must not be employed 02/12/2010 at the care home until full and satisfactory information is obtained. This information must include: Proof of that persons identity, including a recent photograph. Two references relating to the person (from previous employers-or appropriate sources). Criminal records bureau and protection of vulnerable adults check. This will show that staff 02/12/2010 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 have had all the preemployment checks performed to show that they are suitable to work with vulnerable people. 13 30 18 Staff at the home must receive training and induction appropriate the work they are to perform. This will mean that staff are aware of how to care for people in a safe way. 14 33 24 There must be a clear self monitoring programme at the home. This will continually review the service to ensure it is running effectively, safely and appropriately. 15 36 18 There must be systems in place to ensure that staff are appropriately supervised. This will mean that staff have access to supervision to cover all aspects of practice, ensure they are aware of the philosophy of care in the home and have an opportunity to discuss their developmental needs. 02/12/2010 02/12/2010 02/12/2010 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 16 37 12 The responsible person must 02/12/2010 ensure that staff have up to date training with regards to safeguarding vulnerable adults. This will mean that staff are able to recognise and prevent abuse occurring, and know what to do if an allegation is made. 17 37 16 The responsible person must 02/12/2010 ensure that staff are up to date with food hygiene training. This will ensure that food at the home is handled in a way that maintains the satisfactory standards of hygiene in the care home. 18 38 23 Systems must be in place to ensure that up-to-date and accurate information on people can be accessed in the event of a fire. This will assist and inform the fire department of a safe evacuation of vulnerable people who may not be able to express their needs. 02/12/2010 19 38 23 The responsible person must 02/12/2010 make arrangements for people working at the home to receive regular, suitable training in fire prevention. 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 This will mean that staff are aware of the procedure to follow in case of fire. 20 38 17 The responsible person must 02/12/2010 ensure that staff have up to date first aid training. This will ensure that there is qualified first aid on duty at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 12 15 15 18 The registered person should consider ensuring that people were satisfied with the activity programme provided. The registered person should ensure that people are aware that there is an alternative meal available each day. The registered person should ensure that people continue to be satisfied with the food provided. Care plans should clearly explain that people have their bedroom doors locked through their choice, or in their best interest, when not being able to consent. Supervision should take place at least six times a year. 5 36 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. 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