Inspection on 22/03/10 for Kilkenny Residential Care Home

This is the latest available inspection report for this service, carried out on 22nd March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kilkenny Residential Care Home 04/06/08

Kilkenny Residential Care Home 08/05/07

Kilkenny Residential Care Home 27/06/06

Kilkenny Residential Care Home 05/01/06

Kilkenny Residential Care Home 23/08/05

Kilkenny Residential Care Home 03/02/05

Kilkenny Residential Care Home 20/07/04

Kilkenny Residential Care Home 26/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Kilkenny Residential Care Home 6 Third Avenue Frinton On Sea Essex CO13 9EG     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: Francesca Halliday     Date: 2 2 0 3 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 29 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 29 Information about the care home Name of care home: Address: Kilkenny Residential Care Home 6 Third Avenue Frinton On Sea Essex CO13 9EG 01255672253 01255672253 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Rajalingum Valaydon,Mr Mamode Farouk Emmamdeen,Mrs Christine Joan Emmamdeen Name of registered manager (if applicable) Mrs Teresa Rosaline Jones Mr Rajalingum Valaydon Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One person, under the age of 65 years, who requires care by reason of dementia, whose name was made known to the Commission in April 2005 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 11 persons) Persons of either sex, aged 65 years or over, who require care by reason of dementia (not to exceed 11 persons) The total number of service users accommodated in the home must not exceed 11 persons Date of last inspection Care Homes for Older People Page 4 of 29 Over 65 11 11 1 0 Brief description of the care home Kilkenny is situated in a residential area on the outskirts of Frinton on Sea town centre, close to the sea front and within walking distance of all local amenities. The home has two shared rooms and seven single rooms. Five bedrooms have an en-suite bath or shower and all have an en-suite toilet and basin. Bedrooms upstairs can be accessed by means of a chairlift. There is a hard-standing area at the front of the home, with space for two or three cars. There is an enclosed garden at the rear of the property. The home provides care for 11 older people, aged over 65 years, some of whom have dementia. The weekly charge was between £378 to £550 per week depending on the care needs of the individual and the size of the room occupied. Additional charges were made for private chiropody, visits to day centres, manicures, hairdressing, toiletries, newspapers and confectionary. Information about the fees was provided to the Care Quality Commission in March 2010, for more up to date information please contact the home directly. Care Homes for Older People Page 5 of 29 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 key inspection was carried out on 22nd March 2010. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 27th May 2009, as well as evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. During the inspection we had chats of various lengths with four residents, one relative and three members of staff including the two managers. We sent out surveys prior to the inspection and we received four from residents (some with the assistance of relatives) and nine from staff. Comments from the surveys and conversations have been included in the report where appropriate. Care Homes for Older People Page 6 of 29 The report was written using evidence provided by the managers and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they think they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 29 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 9 of 29 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. Prospective residents can be assured that their needs will be assessed before moving into the home. Evidence: The home had a range of information for potential residents and their families, friends or representatives. This included a statement of purpose and service user guide, which had been updated since the last inspection. The managers confirmed that they carried out a pre-admission assessments prior to offering a place at the home, in order to ensure that they could meet prospective residents needs. We looked at the assessments for three residents who had been admitted since the last inspection. The assessment form had been expanded to include more detail about potential residents mental health, which was particularly important when assessing older people with dementia. In our discussion with the managers it was evident that they carried out a good pre-admission assessment, however one of the assessments we looked at needed more detail in order to evidence this clearly. The home only rarely had beds Care Homes for Older People Page 10 of 29 Evidence: available for respite. Prospective residents were encouraged to spend a day at Kilkenny in order to spend time with other residents and familiarise themselves with the services and care provided. A trial period of between four to six weeks was offered in order that a resident could decide whether their needs were being met and they were satisfied with the care and services provided. The managers said that if they had a spare room they would offer it to the relative of a new resident if this would help the settling in process. They said that sometimes relatives stayed in the hotel opposite the home for a short period if a room was not available. One relative told us that they visited the home and had been given sufficient information to enable them to make a decision about accepting a placement. They said I chose the home after looking at a number of others because Kilkenny was so homely. Care Homes for Older People Page 11 of 29 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. Residents are satisfied that their needs are met but the risks to their health and welfare are not always assessed or minimised. Evidence: Residents we spoke with were extremely complimentary about the support and care they received. Residents who responded to our survey told us that they always or usually received the care and support they needed. A resident told us that staff supported them and encouraged them to be as independent as possible, they said Im very happy here, theyre so kind. If I have to be in a home this is the place I prefer to be. Another resident told us that staff had helped to rehabilitate them. They said I wasnt getting anywhere in hospital. Staff here have given me a new lease of life. I cannot praise the home enough. Its so homely here. A relative told us the home has a nice friendly, informal, family atmosphere. The majority of staff who responded to our survey told us that they were always given up to date information about residents. They told us that the ways they shared information about residents within the home always or usually worked well. During the inspection we noticed staff interacting with residents in a friendly and respectful manner. Residents told us Care Homes for Older People Page 12 of 29 Evidence: that staff treated their room as their private space and always knocked before entering and we observed this occurring during the inspection. One resident who was in a shared room told us that they were happy to share and confirmed that staff used the screens when necessary to protect their privacy. Another resident told us that staff always closed the curtains before assisting them with personal care. We sampled the care documentation for three residents. There was evidence that residents, and relatives where appropriate, had been involved in providing information about residents needs, preferences and interests and that this detail was recorded. The care plans we looked at had generally documented residents care needs and how staff could support them to meet their needs. Some of the care plans contained good detail about individual needs. However, one resident who had a stoma and who used oxygen periodically had no care plan for their management of these needs or a risk assessment for the use of the oxygen. The resident managed their own stoma and oxygen but care staff needed training on how to support the resident should this become necessary. The managers said that they would arrange for training in stoma care. The care and care plans were evaluated monthly and good detail was recorded but when changes occurred the care plan was not always updated. The daily care records contained variable detail. Some records were informative but others did not give sufficient information on residents physical and mental health, the care provided or how they had spent their day. At the last inspection two residents had pressure sores and a requirement was made for staff to have training in the prevention and management of pressure sores (see section on staffing). Three residents had developed grade four pressure sores in the past year. A safeguarding referral was made in relation to one of these residents (see section on safeguarding for details). The home had improved the documentation for monitoring the condition of residents skin and assessing their risk of developing pressure sores since the safeguarding meeting. One resident had a pressure sore at the time of inspection that they acquired prior to admission and they were being treated by the district nurses. The home had improved the range of assessments they used for assessing the risk to residents since the last inspection. The assessments included assessing risk of falls, and risks relating to moving and handling. The moving and handling assessment reflected the residents moving and handling needs in different situations, for example getting into bed or the bath. Risks of malnutrition and the risk of developing pressure sores were also assessed. However, the pressure sore risk assessment tools being used did not fully assess potential risk as the risk did not increase if the resident developed signs of a sore. In the AQAA the managers said that they called the Care Homes for Older People Page 13 of 29 Evidence: dietician for advice if residents had unplanned weight loss that was not corrected by supplementing their diet. Since the last inspection staff were now monitoring residents psychological health, which was particularly important as some residents in the home had dementia. Residents and relatives said that the home always or usually made sure that residents received the medical care they needed. Residents we spoke with confirmed that staff called their GP when they had any medical concerns. The managers said that they received good support from the two local GP practices and residents requiring any nursing care were referred to the district nurses. The diabetic nurses visited the home twice a year to monitor residents with diabetes. There were systems in place for residents to receive chiropody and to have optical and dental checkups, and residents confirmed this. Records were made of all outside professional visits. A hairdresser visited the home every week. One complimentary letter we looked at said Im extremely happy with the care of my relative during their recent illness. I was informed of their condition and treatment throughout and they have recovered very well. The medication administration records were well completed. The home had purchased a controlled drugs (CD) cupboard since the last inspection. CDs were appropriately stored and recorded in a CD register. The balance of the one CD being administered was checked and found to be correct. The date of opening was not always recorded on medicines that had a limited shelf life when opened, for example creams and eye drops. This could mean that medicines were given to residents when they were no longer fit to be used. The prescription label was not always fixed to the actual container but sometimes to the outer carton. If the outer carton was lost or two residents had the same medication there could be a risk of cross infection. The managers said that they would advise the pharmacy that they would only accept medication that was appropriately labeled. Staff had completed a risk assessment for the one resident who was self medicating. Residents had a lockable drawer to store medicines, money or valuables. The instructions for some medication indicated that it should be given regularly but the administration record showed that it had been given as required. Administration must be given in line with the prescription and if residents needs have changed the GP must be asked to change the prescription. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a range of activities including access to the local community. Evidence: Residents and relatives considered that they were always or usually activities that residents could take part in. Staff asked residents about their past life, hobbies and interests and this was documented. If residents had dementia staff obtained information about their background and interests from relatives or friends whenever possible. However, one relative said Staff should listen to relatives more about residents previous life. We know our relative better than they do. Residents told us that there were activities and outings arranged for them. They told us that the home had activities such as an exercise class, ball games, quizzes, bingo, reminiscence sessions and entertainments and they joined in if and when they wanted to. The managers said that they encouraged residents to attend the local day centre in order for them to keep in contact with the local community and meet different people. Three residents attended the local day centre on one day a week and one attended a day centre in Clacton on three days a week. The managers told us that there were planned activities in the home for ten to fifteen hours each week. In the warmer months staff took residents who wished to go out on outings for example to the Care Homes for Older People Page 15 of 29 Evidence: beach, the ice cream parlour, tea rooms, pubs, shopping and to garden centres. The managers said that they were planning to have at least one manager on duty from 09.00 to 17.00, making three staff on duty during the day so that two members of staff could be with residents in the home whilst the third member of staff took residents who wished to go out to places of local interest. The managers said that they had purchased additional games for residents. However, staff must ensure that the games are age appropriate and suitable for individual residents as we observed one resident, with a degree of dementia, who was very obviously uncomfortable and embarrassed with the ball game we saw being played in the lounge. Residents who were able to communicate with us confirmed that staff encouraged them to be as independent as possible and care records reflected this. One resident told us that they could use the chair lift by themselves and that carers just watch to make sure Im alright. Some residents had their own mobile phones so that they could maintain contact with family and friends. Residents we spoke with told us that they got up and went to bed when they wanted to and spent their day where they liked in the home. They told us that they used a mobile call bell in their room and felt happy that they could call for help when needed. Residents said that they generally liked the meals at the home. One resident told us The food is nice and tasty. I look forward to every meal. Its home cooking and its served hot and they keep me supplied with drinks. Residents told us that they were offered choices at meal times and could chose to eat in their room or in the dining area. They said that staff were good at meeting their specific dietary needs and preferences. There was evidence that staff monitored the temperature of the fridge and freezer and the temperature of cooked food. The managers told us that the home had an environmental health inspection in December 2009 and that no requirements had been made. Care Homes for Older People Page 16 of 29 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. Residents can be confident that staff have a increased awareness of safeguarding issues. Evidence: The home had a complaints procedure, which was on display in the home. Residents and relatives knew who to speak to informally if they were not happy but one relative who completed a survey did not know how to make a formal complaint . One resident said Ive had no concerns since I came to the home. All staff who responded to our survey told us that they knew what to do if anyone had any concerns. The majority of residents and relatives felt that staff always or usually listened and acted on what they said but one relative felt that staff only sometimes listened and acted on what they said. It was recommended at the last inspection that staff recorded any concerns raised with them as part of good quality assurance and to aid good communication within the home. If the recommendation had been implemented then possibly this relative might not feel that staff only sometimes acted on what they said. The home had safeguarding vulnerable adults and whistle blowing procedures. In the AQAA the managers said that staff all received a refresher course in safeguarding vulnerable adults every year but five staff had not received safeguarding training in over eighteen months. A requirement was made at the last inspection for staff to receive training in the prevention and management of pressure sores. However, the training was not organised until December 2009 despite the fact that three residents Care Homes for Older People Page 17 of 29 Evidence: had developed grade four pressure sores during the year. A safeguarding referral was made concerning one of the residents who developed grade four pressure sores. This highlighted the fact that staff needed to take more responsibility for initiating and carrying out measures to prevent or heal pressure sores in order to safeguard residents in their care. It also highlighted some communication problems between staff in the home and the district nurses. Since the safeguarding referral the home had introduced much more robust systems to monitor residents skin condition and to regularly turn residents at high risk of developing sores. The managers said that in future they would act as residents advocates and ensure that residents with pressure sores received the care and attention they needed. Residents told us that they felt safe in the home. Care Homes for Older People Page 18 of 29 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. Residents benefit from a safe and clean environment. Evidence: Residents rooms were generally well personalised to their individual tastes and preferences. The home had two shared rooms and seven single rooms. Three single rooms and the two shared rooms had an en-suite bath or shower and the remaining single rooms had an en-suite toilet and basin. The home had one communal assisted bath. The home had a lounge with a dining area and a separate small room with an armchair and table. This room was occasionally used as a quiet room for residents who wished to be away from the noise of the television. It was also used for meetings with relatives and visiting professionals. Alarms were fitted last year on doors leading to the fire escape to alert staff if residents left the home. The garden was improved last year with new paving and a water feature in the centre. There was also a sensory area with herbs and plants with particularly good scents that residents could touch and smell. The exit from the home was level to assist residents with mobility problems and was wheelchair accessible. On the day of inspection the home was clean and there were no unpleasant odours apart from a strong smell of urine in one residents bedroom. The managers said that they would be taking action to address this following the inspection. Residents and Care Homes for Older People Page 19 of 29 Evidence: relatives told us that the home was generally kept very fresh and clean. Residents told us that the laundry service was very good. One resident said Staff always put my clothes away tidily. The home did not have a washing machine with a sluice cycle but the managers said that staff handled soiled linen in the appropriate red bags and washed on a high setting when necessary. The clinical waste bin was overflowing with bags on the ground when we arrived at the home. The managers said that they would contact the waste disposal company to discuss whether a more frequent collection or a larger bin was required. Care Homes for Older People Page 20 of 29 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. Residents are supported by an adequate number of staff but their safety and wellbeing is potentially put at risk by a lack of staff training. Evidence: The home was full, with eleven residents at the time of inspection. The managers told us that currently none of the residents required more than one member of staff to assist them and only one resident had very occasional challenging behaviour. The home had increased the staffing levels since the last inspection so that there were three members of staff on in the morning including a manager. The managers said that they were planning to work from 09.00 to 17.00 so that there would be an additional member of staff on duty during the day. This would enable the third member of staff to take residents on more outings and trips out of the home. The majority of residents and relatives we spoke with and who responded to our survey told us that staff were always or usually available when they needed them only one relative who responded to our survey felt that staff were only sometimes available when residents needed them. Staff considered that there were sufficient staff in the home to meet residents individual needs. Residents we spoke with told us Carers keep coming up to see that Im alright (when they remained in their room). When I ring the bell they come straight away. They showed us their mobile call bell and said this reassured them that they could call staff if they fell anywhere in their room. Care Homes for Older People Page 21 of 29 Evidence: We looked at three staff records and these demonstrated that staff had been recruited appropriately. Staff had a criminal records bureau check and references were taken up prior to them taking up employment. They also made a health declaration and a declaration about any previous criminal convictions. Staff told us that they had full employment checks before they started at the home. One of the application forms had gaps in employment history and previous qualifications and training. However, there was no record that these had been explored at interview. There were systems for supervising staff and for an annual appraisal and there was documentary evidence of this. The supervision included one to one sessions with staff, as well as monitoring care practice and sessions monitoring staff competence when administering medicines. The majority of staff who responded to our survey told us that their induction covered everything they needed to know, a few considered that the induction mostly covered what they needed to know. One member of staff had completed national vocational qualification (NVQ) at level 2 and one had completed NVQ level 3. Three members of staff were undertaking NVQs and one was starting the course in the near future. Two of the care staff had an overseas nursing qualification. At the last inspection in May 2009 two residents had pressure sores and a requirement was made for staff to receive training in the prevention and management of pressure sores. The training was not given until December 2009 despite the fact that three residents had developed grade four pressure sores during the past year. Seven staff including the managers received the training in December 2009 and five staff still needed the training. The managers said that additional training in the prevention and management of pressures sores was due to be booked. A relative who responded to our survey told us The care assistants need more training in how to care for and improve the daily life of the dementia clients. The majority of staff had received an introductory session for dementia but more in depth training in dementia care was needed as the home was registered to provide dementia care. One of the managers had received training in the Mental Capacity Act but none of other staff had received this training or training in deprivation of liberty safeguards. The majority of staff still needed infection control, fire safety and health and safety training but the managers said that some of the training sessions had been cancelled during the spell of bad weather. Training in infection control and fire safety was due to be given following the inspection. The majority of staff told us that they received training that was relevant to their role, helped them to understand and meet residents individual needs and kept them up to date with new ways of working. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers are not proactive in assessing and managing potential risks to residents. Evidence: The home had two registered managers, one of whom was also one of the registered providers. They shared the management responsibilities and worked alongside care staff on a daily basis. One of the managers had completed the registered managers award and the national vocational qualification at level 4. The other manager had completed the assessors award. Staff considered that they had regular support from the managers and felt that staff worked well as a team. Two members of staff described the home as well run. The staffing levels were increased prior to the inspection and this had enabled the managers to spend more time keeping the paperwork up to date. The AQAA completed by the managers demonstrated that they did not have a good understanding of quality assurance. Information in the AQAA was not sufficiently Care Homes for Older People Page 23 of 29 Evidence: linked to the national minimum standards and did not always provide us with information on how the managers were auditing and maintaining standards. They needed to develop a range of audits to monitor standards within the home. The managers told us that they had a catering audit that they were planning to use. They showed us risk assessments of the environment but these needed to be developed into a more systematic tool and not be combined with risk assessments for individual residents. Accident records we looked at were well completed but there was no evidence that staff monitored residents after accidents, particularly head injuries. The managers had only been sending Regulation 37 notices to CQC regarding deaths of residents and not for any serious incidents, illness, accident or injury to residents, for example severe pressure sores. The home held a small amount of money for residents day to day needs. The managers held receipts for all transactions and a double signature system was used for transactions. We checked the balance for two residents monies and both were correct. The home had systems in place for servicing and maintenance of equipment. Water temperatures at outlets used by residents were monitored every month to ensure that they were safe for residents. The home had a fire risk assessment. There was evidence of fire drills and of emergency lighting and alarms being tested. A fire officer visited the home in August 2009. Action had been taken to install fire door seals on six fire doors. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The managers must ensure that the care plans are updated when residents condition changes. In order to provide staff with up to date guidance on the care residents need and to encourage consistency of staff practice. 01/09/2009 2 30 18 The managers must ensure 01/12/2009 that staff receive training and updates in food hygiene, infection control, first aid, dementia care and the prevention and management of pressure sores. In order that staff are given the knowledge, skills and understanding to enable them to meet residents needs. 3 33 24 The managers must develop a quality assurance system for the home. In order to identify areas where improvements to care and services for residents are needed. 01/12/2009 Care Homes for Older People Page 25 of 29 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 15 Staff must ensure that care 10/05/2010 plans cover all residents needs and are updated when their condition or needs change. In order to ensure that residents needs and preferences are met. 2 8 12 The managers must ensure that all staff are aware of the actions to take to prevent and treat pressure sores when residents are identified at high risk. In order to minimise the risks of residents developing pressure sores. 10/05/2010 3 9 13 Staff must ensure that medicines with a limited shelf life on opening are dated on first use. 10/05/2010 Care Homes for Older People Page 26 of 29 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 In order that they are not given to residents when they are beyond the time when they are fit to be used. 4 18 13 The managers must ensure that all staff receive training in safeguarding vulnerable adults. In order to protect vulnerable residents in the home. 5 29 19 The managers must ensure that gaps in employment history and previous qualifications and training are explored at interview. In order to ensure that suitable staff are recruited and to protect residents in the home. 6 30 18 The managers must ensure 04/10/2010 that all staff receive training in the Mental Capacity Act, Deprivation of Liberty Safeguards, in depth training in dementia care, prevention and management of pressure sores and health and safety. In order to ensure that staff are given the knowledge, skills and understanding to meet residents needs. 10/05/2010 05/07/2010 Care Homes for Older People Page 27 of 29 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 7 31 37 The managers must send notifications to CQC in line with Regulation 37. In order that CQC can monitor any adverse incidents, illnesses, accidents or injuries relating to residents. 10/05/2010 8 33 24 The managers must develop a quality assurance system for the home. In order to identify ares where improvements to care and services for residents are needed. 05/07/2010 9 38 12 The managers must ensure that residents who have an fall are monitored following the accident. In order to ensure that they do not suffer from delayed symptoms following the accident. 10/05/2010 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 16 Staff should record verbal concerns as part of good quality assurance and to assist communication within ht home. The managers should ensure that all relatives are made aware of how to raise a complaint or concern. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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