Inspection on 23/06/09 for Leeming Garth

This is the latest available inspection report for this service, carried out on 23rd June 2009.

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

The inspector found 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leeming Garth 02/07/07

Leeming Garth 04/07/06

Leeming Garth 22/11/05

Leeming Garth 08/06/05

Leeming Garth 30/12/04

Leeming Garth 01/07/04

Leeming Garth 02/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Leeming Garth Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT     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: Janet Lamb     Date: 2 3 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Leeming Garth Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT 01677424014 01677425121 leeminggarth@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited care home 55 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 55 The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categoru OP, Physical disability PD. Date of last inspection Brief description of the care home Leeming Garth Care Centre provides general nursing care and residential social care for up to 53 older people and for two people with physical disabilities, giving a maximum number of 55. The home is situated in the village of Leeming Bar with close access to the A1. The accommodation is spread over two floors and there is stair lift and a passenger lift, Care Homes for Older People Page 4 of 33 Over 65 53 0 0 3 Brief description of the care home giving access to the upper floor. There are two areas of the home, known as the Manor and the Court. The home is set in extensive grounds and there is ample car parking facilities for visitors and staff. Southern Cross Home Properties Limited owns the home. Fees range between £350.00 and £700.00 per week, per person. Information is available regarding the service through inspection reports, statement of purpose and service user guide on request from the manager. Care Homes for Older People Page 5 of 33 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: An annual quality assurance assessment (AQAA) document was requested from the home on 09/04/09 and this should have been returned to us by 07/05/09. This had not been received by the time the site visit was carried out and a copy was obtained from the manager on the day. Surveys were sent to the home to give out to people living there and thirteen were returned. Surveys were also sent to relatives, staff and health care professionals. Three were returned from each of these groups. Information sent to us in notifications, in complaints received and in the surveys was then used to determine what it must be like living in Leeming Garth. Then on 23/06/09 Janet Lamb carried out a site visit to check if the views of the Commission about living in the home were true. Several people living there, the manager, staff, activities coordinator and the cook were interviewed, some files, records, documents and certificates etc., were viewed Care Homes for Older People Page 6 of 33 with permission of the people they relate to, and some of the building was inspected. Finally some interactions between people and between people and staff were observed. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The service still needs to make sure staff administering medicines have received training to do so and are competence checked annually. Staff should be retrained every three years as a guide. Staff must only sign the medication administration record sheets after giving medicine to a person. The service should make sure all staff are trained in safeguarding adults policies, procedures, awareness and referring of information. Also that staff are annually competence checked in these issues. All training and competence assessing must be recorded. The service must make sure the local area adult protection committee multi-agency adult protection policy and procedure manual it uses is current and relevant. The service could make sure the kitchen is fully modernised, refurbished and refitted to make sure it is safe, efficient and hygienic to work in. Gas and electrical requirements set by the environmental health department must be met as quickly as possible. The service could also consider rebuilding the rear concrete ramp to make sure it is safe for use by meeting a 1 in 12 gradient or less. The service must also repair or replace the central heating and domestic hot water systems so that both can be used independently of each other, thereby being able to turn off the heating when it is not needed. Care Homes for Older People Page 8 of 33 All trained and care staff should complete infection control training and have periodic updates. Staff should also complete NVQ or equivalent qualifications so that a minimum of 50 are qualified. Staff should also complete mandatory training on a regular basis and have all training recorded. Individual staff training and development plans and records are useful tools. The service should determine whether or not the current manager is to remain permanently in her post and if so submit an application for her to become the registered manager of the service. Finally the service should make sure a legionella bacteria test is carried out on the hot water storage and retain the certificate results as evidence of the check. 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 33 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 33 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. People have their diverse and specific needs well assessed with the use of comprehensive assessment tools that are accompanied by detailed risk assessment documents so they know if the home is the right place for them and can meet their needs. They receive written confirmation needs can be met. Evidence: Discussion with people in the home, the manager and staff and viewing of files and documents with permission from the people they concern reveals there are good assessment systems in place for determining peoples needs before they move in to the home and afterwards. Southern Cross has devised its own assessment documentation in the form of a preassessment and a general assessment form. Forms include the assessing of physical and social needs listed from 1 to 12. These are safe environment, communication, breathing, eating and drinking, elimination, washing and dressing, body temperature, Care Homes for Older People Page 11 of 33 Evidence: mobility, work and play, sexuality, sleeping and dying. There are other needs for dependency listed from A to L, these being mobility, dressing, hygiene, feeding, eyes, hearing, pressure sores, continence of urine, continence of faeces, communication, social dependency, and behaviour. Two files seen had assessments dated from September 2007 initially to January 2009 for one and from April 2007 to May 2009 for the other. Assessments also come in the form of other documents for assessing specific risks. Risk assessment documents are in place for such as moving and handling, pressure sores, nutrition, bowels and falls. Assessments and risk assessments are carried out as they begin to become a need to people so dates of documents are numerous ranging over two years at least. There is poor representation from councils in the form of community care assessment documents, as only one from three people sampled had an assessment of needs. The manager confirms that any emergency admission, or fast response admission, is usually preceded by information via the telephone from councils or the primary care trust. Of the people spoken to two cannot remember having had assessments of need carried out, though they do recall signing a care plan, and a third says My assessment is somewhere, but I dont know where it is, it could be in the drawer in my yellow file. No one really remembered clearly about the assessments undertaken on them. Intermediate care is not provided in the home so this standard is not applicable. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good care and health care plans in place that reflect their needs and inform staff how to meet them well. The systems for regualraly reviewing and amending them with changes in need are also good. Privacy and dignity are well upheld and people are well protected by the policy and procedure and practice for handling medication. Evidence: Discussion with people in the home, the manager and staff and viewing of some of the homes records and documentation and files with permission from the people they concern shows there are satisfactory health and personal care and medication systems in operation. Care plans and health care plans are in place in the form of Southern Cross documentation and there are 28 areas that may be applicable to people. Only those that are identified as a clear need however are covered and listed in the care plan. For example one file seen had personal hygiene, moving and handling, sleeping, catheter care, constipation, skin integrity, pain following surgery, a specific medication Care Homes for Older People Page 13 of 33 Evidence: injection, pressure care, social activities, wound care and nutrition that actuallly apply. This person clearly has many health care needs and has medical intervention under the homes category to provide nursing care. Another file seen had maintaining a safe environment, sleeping, understanding and acceptance of the future, hygiene, social isolation, grieving and mourning, and social activities as the areas that needed to be listed to enable staff to assist the person in their care. This person is clearly more able with regard to personal care and is selfcaring. There is also an assessment of needs devised by Roper, Logan and Tierney called activities of living that is used. There is evidence that care plans and health care plans are reviewed twice yearly in the form of recorded review dates. There are individual recording documents for each area of need all coded with a number and a letter that show how and when intervention occurs to assist people in meeting that need, and then there are evaluation sheets that correspond to each of these care need records. There are also records of such as GP and health care professional visits, weight, relative visits and comments, personal hygiene etc. There is a medication policy and procedure in place for staff to follow, the Boots Chemist monitored dosage system is in use, and the practice for administering drugs is satisfactory. Medicines are the responsibility of trained nursing staff only and are booked into the home, recorded as administered and recorded as disposed of, returned or refused etc. on the medication administration record sheets supplied. These looked to be satisfactorily completed. Practice of administering drugs was observed and also considered appropriate, with the only exception being that staff removed tablets from the cardex to a pot and then signed the record as administered before tablets were actually taken to the person they were intended for. This information was passed to the manager for discussing with all staff to ensure procedures are properly followed. A recommendation is made in this report to ensure staff administer drugs before signing to say they have been taken. Staff administering medicines are trained and competence checked and undertake a Safe Handling of Medicines course at Middlesborough College, though the training matrix for this year shows only five staff have done the training in November 2008. Those giving out medicines need to be competence checked on a yearly basis and re trained at least three yearly and all of this should be recorded as evidence. A recommendation is made in this report to make sure staff administering drugs are Care Homes for Older People Page 14 of 33 Evidence: competence checked yearly and trained three yearly. Privacy and dignity are well maintained in the home generally and observation of people being assisted to move and transfer from their wheelchairs showed staff are discreet and caring. One person spoken to says, I get help with personal care and the girls are very good. Another says, The staff are very kind, but you can get some clever devils. The person did not wish to elaborate on this when asked. Some surveys returned to us were completed by relatives of the people they were given to and their comments include, The staff are very helpful and caring, and Certainly there is compassion and willingness. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good opportunities to engage with their community, friends and relatives, to decide for themselves what they wish to do and when, to be in control of their finances and to eat reasonably well. Evidence: Discussion with people in the home, the manager and staff and viewing of some of the records and files with permission of the people they concern shows there are satisfactory systems in place for enabling people to lead lives of their choosing. There is an activities coordinator employed in the home and an activity plan is in place and generally followed. People were observed enjoying the heat wave in the garden, sitting in the shade and joining in with a quiz. Others were in their room or the lounges watching television, listening to radio and playing dominoes. Some people had some one-to-one time with the coordinator and therapeutically coloured in pictures for making bookmarks or sat chatting to her. Two people wandered a fair bit during the morning and were later seen following the tennis on the television with great interest. A small group of people were sitting in the foyer area of the home listening to classical music on the radio. Care Homes for Older People Page 16 of 33 Evidence: One person spoken to says she is not always allowed to go out alone and would very much like to take a walk around the village. She says this is not possible without a carer or a relative. She says she often walks around the garden and that it is boring watching television all day. Another person says her brother visits every two weeks and her sister visits every Tuesday night, and there is nothing else she would like to do. She says she enjoys a sing-a-long and playing dominoes with her three friends. Another person says no one ever goes to church as far as she knows but there is a service in the home now and then. It is more of an informal chat, singing hymns and sharing of a pot of tea though. A fourth person told of plans to hold another garden fete this year, as one took place last year. Also that there has been the odd trip out to such as the Braemore Ice-cream parlour, but there is no designated transport now. She also told of a cream tea and raffle day planned for July. Her opinion is that the activities that take place at ten in the morning are not at a good time. The afternoon is a better time but this is allocated to one-to-one time spent with the coordinator. She also thinks people with rooms on the upper floor are often left out of the activities. Daily diary notes and the coordinators activity evaluations record peoples pastimes and activities and the success or failure of them. People spoken to also talked about being able to make their own decisions where possible about their daily routine and handling their finances etc. Some say they have family members or solicitors that handle money for them and others say they hold amounts on them and only have to ask sons or daughters and money will be brought in for them. Some people have money held in the companys safe keeping facility, which is somewhat complicated to follow as it involves all computer accounting of one account containing all money held. People receive monthly statements of their current balance and there is information detailing how and when money is taken or spent, but auditors are unable to check the individual amounts of people without completely auditing everyone else as well. People did not think the system was unreasonable and no one complained about not being able to access their funds. One person did express a dissatisfaction with the loss of some money and details were passed to the manager for her to look into and to talk to the person concerned. There is a planned four weekly menu that changes seasonally and there is opportunity Care Homes for Older People Page 17 of 33 Evidence: to make special requests if budgets allow. People spoken to say there is a reasonable choice of hot or cold foods on offer, but that no one asks them what they might want to have on the menu or what they want each day. They also say they just eat what is brought out to them and staff do not go out of their way to find anything different for any one not liking the food on offer. Though they also say they have never gone hungry. One person says the jacket potatoes are always too hard and under cooked, and while another says the food is terrible yet another says they always enjoy the food. Views are very conflicting about food. Care Homes for Older People Page 18 of 33 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 are well protected by the homes systems for making complaints, but not for referring allegations, because not sufficient staff are trained or competence assessed in safeguarding awareness, handling allegations or following procedures. Evidence: Discussion with people in the home, the manager and staff, and viewing of some records and documents, and observation of relationships between people and between people and staff shows there are some shortfalls in the meeting of these two standards. There is a company complaint policy and proedure in place that is also written in the statment of purpose and people say they are aware of what to do if they have a complaint. Of the people spoken to one person says they are happy in the home, have no complaints and would go to the office and speak to whomever is there if they did, though there has never been a cause to, and they are pretty tolerant of things anyway. Also there is no reason for anything to change or to be done any better. Another two say there is nothing to grumble about and they have no qualms about anything, as they are too easy going. There is a complaint register in place which is evidenced as having been reviewed Care Homes for Older People Page 19 of 33 Evidence: twice in the last twelve months, by the home manager and the operations manager. This register refers to complaints received and how they have been handled, though there is no current information to view as none have been received. There is a City of York and North Yorkshire Adult Protection Committee multi-agency adult protection policy and procedure in place, which may be out of date. A recommendation is made in this report for the manager to make sure the named local authorities are still using this policy and procedure for the making of referrals, and to obtain the current ones if not. Of the people spoken to one says, On the whole the place is not bad. We could do worse. Staff are very kind, but you can get some clever devils. Another says, I dont complain, as Im easy going, but Im not sure if someone is not being nice to me. A third person says, I need my teeth attending to as some are loose, it is taking months to get something sorted out, no one cares. There is clearly something in the culture of the home or something coming from isolated staff that makes people feel they are not always being treated well or having their needs satisfactorily met. The manager has been informed of this and asked to discuss approach and attitude with the staff. According to the staff training matrix seen, seven staff have completed some safeguarding adults training between the start of 2008 and the start of 2009. As there are some 45 staff named on the matrix this is not a good enough representation of the overall numbers of staff suitably trained in handling safeguarding issues. The manager informs us there are another ten staff currently doing a protection of vulnerable adults course purchased from an external training company. This is still not a sufficient number to ensure people are protected from the risk of harm or abuse. A requirement is made in this report to make sure all nurse trained staff and care staff periodically complete an externally sourced safeguarding adults course, and that all staff are annually competence assessed in safeguarding awareness and referrals. All of this must be recorded as evidence. Care Homes for Older People Page 20 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from a well maintained, comfortable and safe environment, though the standards of cleanliness are good and the house is homely and personalised. Evidence: Discussion with people in the home, the manager, staff and the cook, and observations made throughout the day, as well as viewing some of the premises and especially the kitchen, shows there are some major shortfalls in meeting of the standards in this section. Leeming Garth is a large old hall with a history and has been a care home providing nursing care since registration in 2002. The house is suitable for providing care and accommodation to older people. The house is not entirely ideal for providing the same to people with a physical disability, as the main wheelchair access to the rear, a concrete slope, does not have the correct gradient of 1 in 12. It is therefore only negotiable with assistance from staff. Access for people in wheelchairs is not impossible, just unsafe if they are not assisted. A recommendation is made in this report to check the gradient of the external rear ramp and consider replacing it with one of a suitable gradient, if and when any garden landscaping and designing is done. Care Homes for Older People Page 21 of 33 Evidence: The grounds to the home are tidy to the front and rear but the rear garden is very large, unused and almost wasted, except it provides a viewing area where rabbits and birds can be seen. The manager informs us there are plans to develop the rear garden to possibly include a vegetable patch, raised flower beds, a central fountain and pathways. The pebbles immediately outside the back of the house are to be removed and replaced with paving stones, to provide a more suitable surface for people with mobility aids. The kitchen is in great need of refurbishment and modernisation. Interview with the cook and kitchen assistant reveals there is major work to carry out in the kitchen, isolation valves to be fitted on gas pipes and new electrical box to be installed. The fridges and freezers are old and inefficient, one freezer was leaking on the day of the site visit, waste bins had no lids to them, the heated serving trolleys are also inefficient, and the wall and floor surfaces require replacement as they are old and damaged in parts. The wall boarding only covers half the surface and ought to cover the whole surface. The servery area of the kitchen needs reorganising, fitting with new equipment and keeping clean. The cook explains that new equipment needed throughout the kitchen includes a washing up sink, dishwasher, larger oven, larger mixer and larger deep fat fryer, as well as the freezers, fridges, waste bins, serving trolleys etc., mentioned already. Because of the heating situation, mentioned under standard 25, the kitchen is extremely hot and uncomfortable to work in and clearly needs improved extraction or air conditioning. A requirement to refurbish and equip the kitchen is made in this report. Observation on the day of the site visit show there is clearly a major problem with the central heating as although it was an exceptionally hot day for the time of year the heating was still on in the home, because there can be no domestic hot water from the system unless the heating is also working. This is a poor situation to have in a care and nursing home setting, and people were looking extremely tired and lethargic due to the uncomfortably hot environment. A requirement is made in this report to make sure the central heating and domestic hot water systems are separated from each other, new tanks, boilers supplied, whatever is required to remedy the situation. Temporary air conditioning units may be needed if the weather outside becomes unusually hot again this year. There is an infection control policy in the home and some staff have completed infection control training, as according to the training matrix three staff competed this in April 2008. The manager informs us there is to be infection control training for all trained and care staff within the next few months. Staff were observed using personal Care Homes for Older People Page 22 of 33 Evidence: protective equipment in preparation of assisting people with personal care. There is a recommendation made in this report to make sure all staff complete periodic infection control training and that records are kept as evidence. The laundry and sluicing facilities were not inspected during the site visit. Care Homes for Older People Page 23 of 33 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. People are cared for and supported by appropriately recruited staff in sufficient numbers to meet their needs, but the staff may not be sufficiently well trained or qualified. Evidence: Discussion with people in the home, the manager and staff, and viewing of records and staff files with permission shows there are satisfactory systems for recruiting staff and supporting people, but that there could be some improvement in ensuring staff are qualified and trained. The home keeps a staff roster and there is usually ten staff on duty within the whole of the building in the morning and seven on duty in the afternoon. Night staffing levels were not assessed. There appears to be sufficient numbers of staff on duty to meet peoples physical needs and to provide the support they require. Of the people spoken to the majority of them say they receive sufficient care and attention to feel their needs are being met. Only one person felt people did not really care about his requirements, though he did say there was nothing he would change, as his room is good, he can go to bed when he wishes, and there is nothing really to grumble about. Of the staff employed in the home there is only a small number, eight, with NVQ level 2 according to the AQAA received on the day of the site visit. The AQAA shows there Care Homes for Older People Page 24 of 33 Evidence: are sixteen trained nursing staff and forty one care staff, a total of fifty seven. However the training matrix seen on the day of the site visit shows there are forty five staff working in the home. Consistency of staffing numbers needs to be established and an accurate record maintained. There is no clear information to determine whether or not there are enough staff with the relevant training qualifications. A recommendation is made in this report to make sure a minimum of 50 of the staff have NVQ level 2 or equivalent qualifications. Efforts to achieve this must continue. Recruitment policies and practice were assessed on this site visit as being satisfactory. The requirement made at the last inspection to make sure all trained staff have a current and up to date Personal Identification Number with the National Midwifery Council, is being met as two trained staff files viewed with permission, show the PIN checks to be valid. Care and trained staff files seen show application forms, written references, full security checks, and initial security checks. Files also contain job descriptions, staff handbook receipt forms, medical reports, contracts of employment, employment details, identification information, and such as supervision records, grievance and disciplinary information, and signed declarations for receiving information or upholding health and safety responsibilities, etc. There are also new starter forms and sickness absence forms. As far as can be determined recruitment systems are satisfactorily followed in line with the requirements of regulations 18 and 19 and schedule 2. Staff training information is held on a staff training matrix and in individual staff files. Courses covered include health & safety, fire safety, food awareness, medication administration, assisting people to move, infection control, food hygiene, cleaning products use, first aid, safeguarding adults, mental capacity act, use of bed rails, challenging behaviour and multiple sclerosis awareness. There are so many different dates of completion of these courses that it is very difficult to determine whether or not staff training is up to date, without going into every staff file to check dates of every course people have ever done. The manager should monitor all training and ensure staff training is kept up to date. Generally it appears that most staff have done and do complete training but safeguarding adults, medication administration, assisting people to move and use of hoists, and fire safety must be very clearly identified as required, provided, recorded and competence checked on an annual basis. A recommendation is made in this report to make sure all training is monitored and delivered where identified as being needed/updated. Care Homes for Older People Page 25 of 33 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. People benefit from having an experienced registered manager (though not for this service), that runs the home in their best interests, protects them financially, and promotes their health safety and welfare. Evidence: Discussion with the manager, administrator and staff, and viewing of some documents, certificates, records and maintenance checks show the home is being run by another company manager and in the best interests of people living there. Their health, safety and welfare are being appropriately protected and promoted. The registered manager for Leeming Garth has recently exchanged positions with a manager from another registered care service within the Southern Cross company, on instruction from senior management and on secondment. Therefore the current manager has only been managing Leeming Garth for approximately one month. There is a requirement for Southern Cross to inform the Commission formally of this temporary exchange of managers in writing, and for them to check the Commission Care Homes for Older People Page 26 of 33 Evidence: internet site to establish if a new registration application is needed, should the manager exchange become permanent. The current manager is a qualified registered nurse to level one and maintains her personal identification number. There is a management structure within Southern Cross and the manager is accountable to the area manager and then the responsible individual for the company. There is a quality assurance system operated in the home that is devised and overseen by the company and involves the surveying of people and stakeholders and auditing parts of the service provision, but this was not assessed during this inspection. Finances of people living in the home are generally not handled by the homes staff. Where possible people handle their own money or their family or solicitor do so for them. What does take place is the handling of money held in safe keeping, which is only carried out by the homes manager and administrator. There is a detailed computer finance handling programme, which provides individual printouts of balances and how money has been spent. It also provides an accounting system detailing money in and out, and all receipts on transactions are maintained. The whole system is balanced each week. The only drawback is that peoples individual money balance can only be checked on computer against the total balance held in the bank or in petty cash, and not in actual money held, as the petty cash is a combined amount held for use by all people with money in safe keeping. There is an audit carried out by the company area manager as and when required. There is a health and safety file maintained in the home, which contains details of monthly health and safety inspection checks on areas covering administration: training, lifting equipment, RIDDOR, hazards etc., catering: stores, compliance with agreements, fire blanket in the kitchen, cleaning materials and COSHH, safety of knives, cold storage and temperatures etc., and housekeeping: cleanliness of store room, use of approved cleaning products only, flammable materials, correct disposal of waste etc., and also on general maintenance within the home. Health and safety meetings are held every three months and recorded. There is an extensive six monthly inspection audit carried out. There are also risk assessment documents on use of display screens, power failure, heating, nurse call system, use of stairs, electrical drills, possibility of burglary, stress to staff, bathing and assisting people to move. Areas sampled for an indication of overall safety standards are fire safety, water Care Homes for Older People Page 27 of 33 Evidence: storage and temperatures and legionella, use of hoists, bath hoist and passenger lift, gas and electrical maintenance and portable appliance testing. There are company fire audits with WMS carried out on the fire system and on the extinguishers. There are weekly checks carried out on the fire system and doors by the maintenance person, monthly checks on the emergency lighting and door closers, and two monthly fire safety drills, the record of which shows date, number of staff present and all staff signatures. All of these checks are recorded. There are weekly water temperature checks on outlets and monthly window restrictor checks, again recorded. Hoists, slings and the bath hoist are all maintained by Saluss, while the passenger lift maintenance is carried out by Ascendent Lifts and checked for insurance purposes by Allianze. Caterware Ltd did the last gas check and Amtec produced the last electrical wiring certificate. Hawskworth did the last portable appliance test and MSM produced a chlorination check. All of these checks have been carried out within the last twelve months or in the case of gas and electric within three and five years. There is no clear evidence of a legionella water test certificate so this should be investigated by the company and is a recommendation of this report. Care Homes for Older People Page 28 of 33 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 9 13 Staff who administer medication must receive training with regard to safe practice to promote the safety and well being of service users. 01/09/2008 Care Homes for Older People Page 29 of 33 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 18 13 The registered person must make sure all trained and care staff periodically complete safeguarding adults training, and are annually competence assessed in safeguarding awareness, procedures and referring of allegations. So people are protected from being harmed or suffering abuse or being placed at risk of harm or abuse. 28/10/2009 2 19 23 The registered person must undertake a refurbishment of the kitchen and servery and equip it as necessary to enable staff to provide an efficient and hygienic catering service to people in the home. 26/03/2010 Care Homes for Older People Page 30 of 33 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 So people are confident their food is provided from a safe, efficient and hygienic facility. 3 25 23 The registered person must 28/01/2010 make sure the central heating and domestic hot water systems can function independently so that the heating may be turned off on very hot days without the loss of hot water. So people are living in a comfortable and healthy environment at all times and are able to use the hot water on demand. 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 9 The registered person should make sure all staff administering medication are competence checked annually and retrained every three years, and that this is recorded as evidence, so people are confident they are being given medicines safely and they are protected from harm. The registered person should make sure staff administering medication sign on the medication administration record sheet after tablets etc. have been administered to the person they are intended for and not before, so people are confident they are being given medicines safely. The registered person should check with relevant local authorities that the multi-agency adult protection policy and procedure being used are the current ones for referring Page 31 of 33 2 9 3 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations safeguarding issues, so people are confident their allegations are being effectively handled and referred. 4 22 The registered person should check the gradient of the external rear ramp and consider replacing it with one of a more gentle and approved gradient if the grounds are to be landscaped and developed, so people are able to safely leave and enter the home independently. The registered person should make sure all trained and care staff complete infection control training periodically and that records are kept as evidence, so people are confident they are protected from the risk of infection. The registered person should make sure there are at least 50 of staff with NVQ level 2 or equivalent, so people are confident they are cared for and supported by skilled staff. The registered person should make sure staff undertake regular mandatory training and other training required to skill them in their roles, keep a clear record of this and monitor any shortfalls, so people are confident they are being cared for and supported by competent, skilled staff. Individual staff training and development plans and records are efficient tools for monitoring training needs and competence etc. The registered person should make sure that the manager becomes the registered manager for this service by submitting an application, if this proves necessary and she remains the permanent manager of the service, so people are confident the home is being managed in their best interest by a registered manager. The registered person should make sure a legionella water test has been carried out on the hot water storage system and retain the result as evidence, so people are confident they are protected from the risk of harm from bacteria. 5 26 6 28 7 30 8 31 9 38 Care Homes for Older People Page 32 of 33 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. 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