Inspection on 15/12/09 for Kersal Dale

This is the latest available inspection report for this service, carried out on 15th December 2009.

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

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

Other inspections for this house

Kersal Dale 05/07/07

Kersal Dale 31/10/06

Kersal Dale 18/03/06

Kersal Dale 03/11/05

Kersal Dale 08/02/05

Kersal Dale 19/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Kersal Dale 48 Vine Street Salford Gtr Manchester M7 3PG     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: Elizabeth Holt     Date: 1 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Kersal Dale 48 Vine Street Salford Gtr Manchester M7 3PG 01617923166 01617923166 kersaldaleresthome@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs N Akram,Mr U Akram care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home provides accommodation to a maximum of 35 service users who require care by reason of old age, not falling within any other category. Date of last inspection Brief description of the care home Kersal Dale is a residential care home, which has thirty-five places for older people. The home has extensive grounds with landscaped gardens to the front and rear of the property and a parking area to the side of the building. The home is situated in a residential area of Salford. Internally, there is a large lounge and dining area running down the centre of the building, which leads to a large glazed patio style lounge. There are twenty-five single rooms and five double rooms, on the ground and first floor. The home has ramped access at the front of the property, and both floors are accessible via a passenger lift, which also goes to basement level. Care Homes for Older People Page 4 of 34 Over 65 35 0 Brief description of the care home The range of fees is between 380.99 pounds and 385.99 per week for an en suite, with additional charges for hairdressing, personal toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We looked at the information we had received from the service, which includes an analysis of any information received by the Care Quality Commission and we made a decision to carry out a Key Inspection. Before the inspection we asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to see if the management of the home see the service they provide as the same way we do. People living at the home and staff were asked to complete survey forms before this visit. We have received five from people living at the home and four surveys from staff who work at the home. Comments from these surveys have been included in this report where posssible. During the visits, which took place over the course of nine hours, we spoke to people about their experience of daily life at Kersal Dale, we spoke to visitors and to some of the staff. We looked at records in relation to the running of the home and health and Care Homes for Older People Page 6 of 34 safety and a partial tour of the premises was made. We spoke to the homeowners and the manager about our areas of concern. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: At the time of writing this report there are some concerns/allegations being investigated under Salford Councils adult safeguarding procedures which have not been fully concluded. Some people had not had an assessment of their needs before they moved in to Kersal Dale which means that staff may not be aware of their needs. Information about the home should be updated and made available to give people more choice. Although some care plans were found to be person centered, the care plans and risk assessments overall needed to be kept reviewed and up dated so they could be used as a tool for the staff to be able to support people. Care plans should monitor and evaluate the progress of a persons personal, health and social care needs. Appropriate risk assessments must be in place, which include nutrition and bed rails to minimise the risks to people using the service. Further consideration is needed to developing the activities provided and social events for people at the home. Consideration needs to be given to the numbers of staff and the deployment of staff. Insufficient staffing levels were reflected in the poor standard of the record keeping and the auditing of care practices. There has been some training provided for staff since the last inspection however some training such as moving and handling, fire safety and first aid was in need of updating for a number of staff. Training in the safeguarding of vulnerable adults had not been made available for all staff employed. Care Homes for Older People Page 8 of 34 Some shortfalls were seen in some of the medication practices. The records in place must be accurate and show that all medicines can be fully accounted for. Some shortfalls were seen in the recruitment practices and a requirement was made for to make sure robust systems are in place to protect people. The staff should be in receipt of regular supervison to monitor their practice to highlight areas for personal and professional development. Audit checks to monitor the care practices should be carried out so that people are not at risk of having their needs met in full. A quality review of the service had not taken place and therefore no report was available to report on the quality of the service provided. The manager should be provided with enough supernumerary hours to allow her to carry out the management duties in the home. We must be provided with information about any adverse events that occur in the Care Home in the form of notifications. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in people having their needs fully assessed before admission to the home may lead to their needs not being met. Evidence: The pre admission assessments were looked at for three people who had been admitted to the home most recently. For one person the assessment that had been carried out was detailed but this did not include the date of the assessment or a signature of who had carried this out. For another person who had transferred from another care home, there was no assessment information on file. The manager stated they had not carried out an assessment on this person. To ensure the service can meet the needs of the person to be admitted to Kersal Dale we recommend that an assessment is carried out for people who transfer from one home to another. One persons relative stated they heard about this service through Word of mouth. They came to see the home without prior notice and were welcomed and made to feel at home. The home owners and the manager visited them before an offer of a place Care Homes for Older People Page 11 of 34 Evidence: was confirmed. A pre admission assessment was in place for this person. The Statement of Purpose was not on display at the time of this visit, the manager stated this was in the process of being reviewed and she had not yet completed this. This was previously recommended at the inspection in 2007. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in the record keeping and the systems for monitoring the care needs of people means that peoples needs may not be fully met. Evidence: The previous inspection showed that improvements had been made to the care planning system and there were some good examples of person centered information in place. This visit showed this improvement had not been maintained. It was not possible to carry out a full audit trail of the care needs and the changing personal, health and social care needs delivered to each person. As part of the inspection process a sample of care plans were looked at. The care plans were overall insufficient for the staff to understand the care they needed to provide and for them to be able to sufficiently monitor the progress of the person and their general condition. The following shortfalls were identified; Care plans were not always signed and dated when the information had been recorded. Updates to show any changes were also not dated or signed. This made it difficult to establish when changes in a persons needs had been recorded. For one person who had been in the home for sixteen days before Care Homes for Older People Page 13 of 34 Evidence: this visit there were no care plans or risk assessments in place. If risk assessments have not been carried out this meant that staff would not be aware of the persons needs. We would expect some risk assessments and care plans to be developed within 48 hours of admission to the home. The GP had been requested to visit in relation to a rash on a persons arm. There was no note of this in the daily statement. The manager stated she did not have time to update all the care plans. Not all care plans included a pressure area assessment and a nutritional risk assessment. A standard nutritional screening tool should be in place for each person on admission to the home and reviewed monthly line with the recommendation from the National Minimum Standards. For one person there was no link between the assessment, risk assessments, care plans, evaluations and comments. This had been improved on the second day of the visit. Where care plans showed that a persons weight should be monitored, these records were not completed properly. One persons weight had not been updated since August. The manager stated the care staff would have done these however these should be looked at in light of the previous month and whether there have been significant changes in a persons body weight. Shortfalls were seen in other areas of record keeping. A body mapping tool was in place in some of the care plans looked at, there were some examples of the staff recording marks, bruises or changes in a persons skin condition, however these were not always accurately filled in. For one person the statement said, Their body odour we think is due to the skin tear on their arm. There is no further description of this although a photograph in the care plan shows injuries from a recent fall. On the second day the manager stated she had updated this persons care plan to show they had Tissue like skin, skin tears and easily sustains bruises and skin tears. Another persons care plan included four photographs of Various recent falls dated November 2009. We discussed the need for this record keeping to show any injuries/marks following each fall and the body map should be updated after each incident to reflect changes in a persons skin condition. For one person who had bed rails in place, there was not an appropriate assessment tool in place to show bed rails were appropriate for this person. A discussion with the manager showed this person did try and get out of the bed when these were in place. The manager stated she would review this following this visit. During the visit we had some concerns that staff were not checking on people as frequently as needed, due to the demands upon them. One person was asleep for a lengthy period of time in their chair and was clearly not comfortable, the manager was then called to see this person and arrangements made for the GP to review this person. For another person, they were visibly seen to have been incontinent of urine. When we pointed out to the with Care Homes for Older People Page 14 of 34 Evidence: the staff, they stated this person was a challenge to manage and was Awkward to move. It is not acceptable practice that a person would be left in a soiled state and no action taken to support or encourage them to be changed. The daily statements were kept in a separate folder and did not reflect the care carried out. There were empty lines in the daily statements, these gaps have the potential for staff to add information and may lead to poor record keeping. Care plans and risk assessments should be assessed and evaluated at least monthly. For one person, although medical attention was sought at the time, the persons risk assessment had not been updated following them chewing steradent tablets. Some care plans had examples of personalised care needs, She applies a serviette herself and is capable of choosing what she likes to eat. Examples were seen of this persons likes and dislikes. Staff were seen to be kind and attentive to some of the needs of people during the visits. Staff used skills in distraction and were sensitive towards a person who had requested a late breakfast. From a discussion with the manager and a review of the records it showed that the manager had lead responsibility for all the care plans for each person living at the home. This was clearly too large a task for one person to keep these accurate, up to date and appropriately detailed at all times. A discussion with the home owner highlighted that consideration must be given to involving the senior staff in this process to make sure care plans accurately show the changing needs of the people living at Kersal Dale. We must be able to clearly audit trail the health, personal and social care needs of people living at the home. The sample of care plans looked at did not show evidence of the person themselves or their representative having been involved in the care planning process. Medication was stored in a locked trolley, secured to the wall in a communal area of the home. There were some examples of good practice seen, care plans were in place which gave details of the medication people were on and side effects of prescribed medications. Medication administration charts included photographs of each person. A sample of medication administration records were looked at and it was difficult to carry out a clear audit trail to show that people were receiving their medication as prescribed. Care Homes for Older People Page 15 of 34 Evidence: The manager stated that all staff, except new starters had received medication training since the last inspection. The manager stated that she did monitor medication but some errors were seen during this visit. Staff need to make sure the system in place to keep track of medicines is followed. For one person on a sedative type medication there were two tablets short when checked. The written instructions for the staff stated, At night when required. A recommendation was made for the staff to request clearer guidance from the GP in relation to them giving this. A record was made of when medicines were received into the home although a recommendation was made for staff to record clearly when a new bottle of medicine was started so that an audit trail could be made to check medicines are given as prescribed. Surveys were received from five people who lived at the home, all five people stated they always received the care and support they needed and the staff listened and acted on what they said. One persons relative added, We are extremely pleased that our Auntie is being cared for in such a caring environment. The staff are very friendly and go out of their way to help in any way they can. We looked at other care homes but they did not compare to Kersal Dale. Another person stated, Everyone looks clean and tidy and the staff are very friendly and kind. A visiting Community Nurse spoke positively about the care provided at Kersal Dale and that staff carried out any instructions they requested in a timely manner. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some opportunities exist for people to engage in social activities, shortfalls in the care planning means peoples social, cultural and recreational expectations may not always be fully met. Evidence: Some of the care plans included an assessment of a persons preferred activities, however for others the information was not available. The home does not currently employ an activities organiser but the manager did say they hoped to provide more hours to meet peoples individual hobbies and interests. The manager stated that people enjoyed listening to music, which was confirmed by one person who said, Sometimes I dont realise it is on. Staff should monitor this as it was on all day on both visits in the main lounge area and may not be pleasant for everyone. Other people chose to sit in a quieter lounge watching television. Some people said they had enjoyed a game of dominoes which the staff encouraged. The staff stated they did their best to squeeze in some activities in between afternoon tasks. Responses in the surveys from the five people who returned them showed that the home sometimes or usually arranged activities that they could take part in. One persons daughter said, I have seen a general improvement in my Dad since he came here, he likes the food and the staff are very kind. Maybe there could be more to keep him Care Homes for Older People Page 17 of 34 Evidence: stimulated mentally though. At the time of this visit a local minister and volunteers visited the home and people who chose, received communion. From observations made and from conversations with people living at the home and members of the staff team, there did not appear to be many opportunities for the staff to sit and chat with people living at the home. As raised at the last visit, staff comments included comments that people may benefit from more entertainment. One staff member stated, We always put residents needs first and we offer a good, friendly service. We could try to find more time to talk to residents and do more activities with them and to keep them more active. Mealtimes were seen to be flexible to meet the needs of people living at the home. One person was seen to enjoy a late breakfast. People were offered a choice at mealtime, however staff walked from table to table carrying the large serving pots. We discussed the potential risk of accidents to staff or people at the home and the need to provide a hot trolley from which to serve the food. This was recommended at an earlier inspection and this recommendation has been reiterated. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives were confident that any issues they raised would be dealt with. People are not fully safeguarded by the staffs lack of training in safeguarding vulnerable adults. Evidence: The complaints procedure was available on display and information on how to make a complaint. The complaints procedure was in need of updating to show the current Commissions role in relation to concerns and complaints. Responses in the surveys from people living at the home showed that all five people knew how to make a complaint about the service and felt there was someone they could speak to informally if they were not happy. One person added, I feel listened too. People spoken to during the visit said they had no hesitation in bringing any concerns or worries to the manager and they feel confident any issues would be addressed. One relative said, If I had any concerns I am sure they would sort these out. A complaints record was available and a record was held in each persons file to record any complaints/concerns and action taken. We have received one concern from a person who chose to remain anonymous in relation to the number of staff available at the home since the last inspection in November 2007. This has been monitored during this visit. During the visit the manager stated they had a copy of Salford Councils joint agency Care Homes for Older People Page 19 of 34 Evidence: safeguarding procedures. These were available for staff to read and staff had signed to say they had read these procedures. We discussed staff training in relation to safeguarding vulnerable adults with the manager and staff who stated that six staff had attended basic awareness training through Salfords training Partnership. The manager stated she had not updated her training for abuse awareness for over two years. Some staff spoken to said it had been some time since they had been trained in adult protection and some had not done this training before. This training needs to be addressed so staff are clearly aware of what the definitions of abuse are and so staff know what to do in the event of an allegation of abuse. At the time of writing this report there is an allegation in relation to care practices under investigation by other agencies. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained home that was clean and homely. Evidence: A partial tour of the premises took place which showed the bathrooms, bedrooms and communal areas to be pleasantly decorated. A number of peoples bedrooms were looked at and these were found to be have some personal possessions and were clean. Of the five people who returned surveys, all five stated the home was always or usually kept clean. One person stated, My bedroom is lovely isnt it, look at these great windows and I have my things around me which I like. The hairdressing salon was used as a smoking room for some people at the time of this visit. During these visits the temperature in the lounge felt uncomfortably warm at times throughout the day. One person said, Its very warm in here and the manager did say she would monitor this to keep a comfortable temperature in the home. The AQAA told us that carpets in some rooms have been replaced with linoleum to assist in the management of odour since the last inspection and to make the environment better for people who lived there. There are plans in place to replace some of the furniture in bedrooms during the next twelve months. Practices were in place to minimise the risk of cross infection, including liquid soap dispensers, paper towel dispensers and acohol gel dispensers. The standard of kitchen hygiene remained high. On the 5/01/09 the home achieved Care Homes for Older People Page 21 of 34 Evidence: Salford Councils 5 star rating (Gold award) for kitchen hygiene. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further consideration is needed to ensure there are enough staff on duty with the skills and competence to meet the needs of the people living at Kersal Dale. Evidence: At the time of the visit there were 26 people living at the home. On the day of this visit there were three care staff and the manager on until 2pm and the duty rotas confirmed this. From observations made and following dicussions with staff members, staff confirmed that there were too many demands upon them and they were, Doing all the time and not able to have the time to sit with people and respond to their needs as they would sometimes like. The manager stated she was unable to keep the care plans and written records up to date because she needed to work with the staff and the people accommodated there. Senior care staff were only currently involved in writing up the daily statements of the care plans and were not involved in the whole care planning and risk assessment process. The manager stated that time can be spent making and responding to phone calls and there is no administrator to support the staff. One staff member did comment that in order to fit everything in they felt they Were spread very thinly. Staff said they made drinks for relatives and they were involved in the preparation and serving of the evening meal. This practice should be reviewed in light of the risk of cross infection when staff are involved in attending to peoples personal care needs. Care Homes for Older People Page 23 of 34 Evidence: Comments from staff showed they felt carrying out these duties did take them away from meeting the care needs of the people accommodated. Staff confirmed they were also responsible to provide mental stimulation and activities when possible. Responses in the four staff surveys returned showed that staff felt there were Sometimes enough staff to meet the individual needs of all the people who use the service. The Responsible Individual and manager must review the staffing levels to make sure there are sufficient people to meet the needs of the people living at the home. The home owners told us that since they had received approximately ten people from another care home, they had not increased the staffing levels, however they had felt the previous staffing levels were above the necessary level. We discussed the need to staff the home in line with the needs of the people accommodated. The manager stated that thirteen staff had left the service since the last inspection and she stated it was taking time to develop a competent, established staff team. She found herself working with the new staff so that she can supervise and assist new starters so the needs of people can be met which did take her away from some of the written work. We listened to the staff handover, for all the people currently living at the home. This was delivered in a professional way and the staff asked questions and contributed positively to add any information they had to share. The staff training plan had not been updated to show the current training undertaken by the staff since the last inspection. We asked the manager how she monitored the training staff had undertaken and she said she had was just in the process of updating a record to show her which staff had done what training. We discussed the need to keep a record so that a training plan can be developed from this so staff receive appropriate training. Staff spoken to gave examples of recent training which included; diabetes, stroke awareness and infection control. One person was currently undertaking NVQ level 4 and one person was doing NVQ level 3. Information provided in the AQAA showed there is a commitment to staff training, 8 of the 16 staff employed had a National Vocational Qualification level 2 or above in Care. The homeowner stated they would provide fire safety training, moving and handling and first aid training for staff and the manager was due to make arrangements for these courses. We were told that approximately four of the current staff had not had moving and handling training recently and were not yet booked on to this. For people to be safe, the staff must be trained in safe moving and handling practices. One person said they had missed fire safety and their moving and handling was out of date, however arrangements for these training courses were now to be arranged. Care Homes for Older People Page 24 of 34 Evidence: Four staff responsded in the surveys to show that the induction training Mostly covered everything they needed to know to do the job before they started. The manager stated she had a copy of the Skills for Care induction programme which she intends to use and three new staff had followed the Common Induction standards at the local college. Examples of completed induction checklists were not available at this visit although staff did confirm they had carried this out. People were all generally pleased with the staff. One person said, They are all very kind and caring towards us, they do help me. Staff commented that the manager was very approachable and was always prepared to listen to any concerns they had. Staff were seen to be patient and kind when they were talking to people and supporting them. A review of a sample of staff files showed there were some shortfalls in recruitment practices and pre employment checks. From the sample of files looked at the following shortfalls were seen, for one person there were no named referees on the application form, although pre written references were held on this persons file. The declaration was not signed in relation to any criminal convictions. There were no interview notes on file for any of the staff recruited and no evidence to show any gaps in employment were explored at interview. Recent photographs were missing for some of the staff files although the manager stated these were on the camera. For one person the reference was a statement to say they worked there, rather than a character or employment reference. For another person who is employed as a care worker, their duties at the previous employment were cleaning and ironing. There was no record to show how their training and development needs were met. There were no copies of birth certificates seen on the staff files for staff employed. There was evidence to show that Criminal Records Bureau checks had been carried out. A discussion was held in relation to not holding these on the staff members file but to store this separately. A requirement was made for an audit to be carried out for the staff files to show that the correct records were in place for each staff member employed. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed in management practices to promote and safeguard the health, safety and welfare of the people accomodated. Evidence: The Registered Manager filled out the homes self assessment (AQAA) as part of this inspection which provides us with information about how the home is run, areas for improvement and plans for future development. This form did not provide enough information about the service and should be completed more fully. The manager has been at the home for a number of years and stated she has worked her way up to the position of manager. Staff and visitors who expressed a view, made positive comments about the manager. One person said, She is always around to help us and supports us when we need any assistance or advice. Although it was clear she takes her responsibilities seriously and is keen to improve the service, the shortfalls identified in this report show she needs additional support for her to be able to carry out her duties effectively. During this visit concerns have been highlighted in relation Care Homes for Older People Page 26 of 34 Evidence: to the on going monitoring of peoples care needs, record keeping and the updating of these records. The manager showed she had a clear understanding and knowledge of the individual personalities and preferences of the people accommodated and showed her skills in managing people when they displayed some challenging behaviour. The manager stated that she saw one of her problems as being that she provided a high number of hours delivering personal care to people. This did not leave her sufficient time to effectively carry out her management duties. It is of concern that these concerns and issues were raised at the inspection in July 2007, improvement was sustained for a short period and this has not been maintained. These concerns were discussed with the homeowners as part of the feedback. A review of a number of accident and incidents showed these were being reported in a logbook that met the requirements of the Data Protection Act 1998, however no accidents were recorded after October 2009. One of the accidents recorded did not include the name of the person to whom this had happened. As raised in a previos report there is still some use of speculation rather than writing how the person was found. A discussion with the manager told us the book had run out and therefore staff had nothing to record these on, she stated a new book had been requested from the homeowner who did not appear to be aware of this request. We asked about the managers monitoring of the accidents and incidents and there did not appear to be a system in place for this. We discussed the need for the manager to monitor the frequency, time and any practices that may reduce the chance of recurrence for people who have had accidents in the home. We have received no information about about the service including any deaths, accidents or incidents under Regulation 37 of the Care Homes Regulations 2001 since the last key inspection in November 2007. This leads to a lack of knowledge about the service and a requirement was made for this to be addressed. There were some shortfalls in policies and procedures in place, for example record keeping, recruitment and employment, dealing with violence and aggression, access to files for staff and service users. The self assessment did not include details of when these were last reviewed and some showed dates of 2007. There was some signs of policies having been updated although changes were crossed out and the policy not fully re written. The manager had developed a questionnaire as a quality monitoring tool to establish the views of people who use the service. The manager stated this survey has not yet been sent out to gather peoples views about the service provided at Kersal Dale. The manager confirmed that no staff had received formal supervision since the Care Homes for Older People Page 27 of 34 Evidence: beginning of the year. Staff spoken to confirmed they had not received what they would call supervision. The manager stated that although she did work with staff and monitor their progress, she had not formalised this as supervision. and had no records currently in place for staff supervision. A sample of maintenance records were looked at, this included gas safety and fire maintenance. A review of the fire records showed regular checks were in place including the alarm system, emergency lighting, means of escape and fire extinguishers. There was no record of when the night staff were last involved in a fire drill and a frecommendation was made to include the hight staff in this practice. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Detailed up to date care plans and risk assessments must be in place for each person to show their identified needs. This must include risk assessments and care plans for pressure care, moving and handling, nutritional needs and social care/stimulation. This is so the changing needs of people are recorded and their care is monitored appropriately. 08/02/2010 2 8 13 The registered Manager 08/02/2010 must ensure that the staff carry out the necessary care and this is monitored. This is to ensure peoples safety and well being is maintained. 3 9 13 The registered person must make sure medication is managed in a safe and appropriate manner. 08/02/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Records about medicines must be kept up to date and be accurate. To ensure people are kept safe and that people are given medicines as prescribed. 4 18 13 The registered manager and the staff must have training/guidance in abuse awareness and the Protection of Adults from Abuse. This is so that staff have the knowledge in relation to abuse and are fully aware of the appropriate course of action to take in the event of an allegation of abuse. 5 29 19 The registered person must ensure that all the information and documents specified in paragraphs 1-7 of schedule 2 are obtained before people are employed to work. So that people are protected by the homes recruitment policy and practices. 6 33 24 Systems must be in place to monitor and check the care practices in the home. This is to make sure any 22/02/2010 08/02/2010 15/03/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action shortfalls are identified and improvements are made particularly in relation to care plans, risk assessments, medication, staffing and notifications. 7 36 18 All staff must receive regular 26/02/2010 supervision. This is to support them in their practice. 8 38 37 We must receive information 29/01/2010 about about the service including any deaths, accidents or incidents under Regulation 37 of the Care Homes Regulations 2001. This is so that we have knowledge about the service. 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 1 An up to date copy of the Statement of Purpose should be made available to the Commission and a copy of this should be available upon request for people who use the service and their representatives. Each person should have a full assessment of their needs carried out before they are admitted to the care home so they are reassured their care needs can be met . The daily statements should not have gaps and should reflect the care carried out in line with the identified problems. Gaps in the record keeping have the potential for 2 3 3 7 Care Homes for Older People Page 32 of 34 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 staff to add information and may lead to poor record keeping. 4 8 It is recommended that records include an appropriate risk assessment for the safe use of bed rails to ensure they are appropriate for the persons needs and to ensure there is no risk of entrapment for the person. It is recommended that for tablets which state,When required have clear guidelines and frequency of administration for staff, to support them when to administer this. And staff should record clearly when a new bottle of medicine was started so that an audit trail could be made to check medicines are given as prescribed. Opportunities for social stimulation should be available for all people living at the home which they can enjoy and are suitable for their needs. Social care plans should be detailed for all people accommodated to identify their social needs and preferences. A serving trolley should be provided to ensure that the risk of an accident is minimised and food remains hot when being served. The practice of staff being involved in the preparation and serving of food should be reviewed in light of the risk of cross infection, particulalry as staff are involved in attending to peoples personal care needs. A record of the training each person had carried should be held so that a training plan could be developed. From this staff would be able to receive appropriate training in a timely manner so they have the skills to carry out their role effectively. The manager should be provided with sufficient supernumerary hours, support and guidance for her to be able to carry out her role in the best interests of the people accommodated. It is recommended that the quality assurance survey is sent out to people who have an interest in the service and that an audit report is written to show any areas for development following this. 5 9 6 12 7 15 8 27 9 30 10 31 11 33 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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