Random inspection report
Care homes for older people
Name: Address: Loose Court Rushmead Drive Maidstone Kent ME15 9UD zero star poor service 19/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Montgomery Date: 2 3 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Loose Court Rushmead Drive Maidstone Kent ME15 9UD 01622747406 01622749948 managerloosecourt@regalcarehomes.com www.regalcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Regal Care Homes (Maidstone) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 46 Number of places (if applicable): Under 65 Over 65 0 46 dementia old age, not falling within any other category Conditions of registration: 46 0 The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection 2 6 0 4 2 0 1 0 Care Homes for Older People Page 2 of 16 Brief description of the care home Loose Court was a domestic house until 1982, when it changed to a care home for the elderly. The house has had purpose built extensions. The accommodation comprises of three lounges and integral conservatory, and two dining areas. There are 35 bedrooms of which 4 are double rooms, 16 single rooms, and 15 single en-suite rooms. There is a lift to access the (15) first floor bedrooms, as well as stairs for those more ambulant. Some internal/external doors have keypad locks for the security and safety of residents. The home has a small-enclosed garden. The care home is currently registered as a residential care home for 46 older people (over 65 years) with a diagnosis of dementia. At present there are 26 service users living in the home. Following the inspection in November 2009, the registered person agreed to cease admitting new service users. Loose Court is approximately 50 yards from the main Loose Road where local bus services are available to the town centre of Maidstone approximately 4 miles away, where there are two main line railway stations. Please contact the home for information regarding current fees. A copy of the most recent inspection report can be seen in the main hallway of the home. Care Homes for Older People Page 3 of 16 What we found:
This random inspection was conducted by Compliance Inspectors Sarah Montgomery and Andrea Leverett on the 23rd of July 2010, who were in the home from 9.45am until 5pm. During the inspection they spoke with representatives from Regal Care Homes. This included the responsible individual, the home manager, the operations manager, and care staff. Time was also spent speaking with service users, and with a relative. We looked at records from three key outcome groups: Health and Personal Care, Complaints and Protection, and Management and Administration. These records included care plans, risk assessments, incident and accident forms, staff records, and complaints. Information gathered at the inspection was cross referenced with; the improvement plan the registered person sent us following our random inspection of the service on April 26th 2010; requirements made at the inspection on April 26th 2010; and outstanding requirements made following two previous inspections undertaken in November 2009 and February 2010. A summary of our findings is as follows: Health and Personal Care The improvement plan stated that requirements in relation to care planning were now met although the new manager informed us that only one service user in the home had had their care plans and risk assessments transferred onto the new format and updated accordingly. We assessed care plans and risk assessments of three service users. We also looked at information regarding appointments and visits with health professionals, and cross referenced this to assess if (when necessary ) care plans and risk assessments had been updated. We found evidence on all files assessed that care plans and risk assessments had not been updated following changes in support needs of service users. Some examples of this were: On the 7th and 12th of June 2010 a service user had a visit from a district nurse. On both occasions the nurse recorded action that staff should take to support the service user with skin care. Following both visits there was no evidence to show that those instructions had been transferred to the service users care plan. On the 14th June 2010 a GP visited a service user who was experiencing abdominal pain and diagnosed a urinary track infection. There was no evidence that this information had been transferred to the persons care plan and there was no guidance for staff in relation to pain management, changes to medication or potential changes in physical and mental health due to having a urinary tract infection. We saw evidence of an update to a memory and orientation care plan on the14th June
Care Homes for Older People Page 4 of 16 2010 which stated another resident pushed me into the wall We could not find any evidence to show that a risk assessment had been put in place following this. Incident forms inspected showed that service user risk assessments and care plan reviews continue not to be undertaken following service user falls. Previous inspections had shown that staff at the home were making poor judgments about service users who were unwell or had experienced an accident. There were instances where service users had received delayed or no medical treatment when unwell or injured. Evidence seen at this inspection shows further incidences where delays in accessing medical treatment are still occurring and in several cases appropriate medical treatment continues not to be sort at all. Medication Medication storage in the dedicated medication room complies with Regulations. The controlled drugs cupboard was secured to the wall and stored inside the metal medication cupboard which is also securely fitted to the wall. The member of staff was able to open the controlled drugs cabinet, demonstrating that keys had been located. The home had also ensured the mobile medication trolley, when stored in the medication room was fixed to the wall. When assessing a care plan we saw information which showed that a service user did not begin a course of medication until six days after it was prescribed by their GP. At the time of the inspection many of the service users rooms did not have appropriate medication storage in place although the services improvement plan stated that all breaches of regulation in regard to medication had been complied with. Nutrition Some progress had been made with updating care plans in regard to service users nutritional needs, and there are better systems in place for recording the weight and fluid intake of service users. However, staff do not consistently record what people actually eat rather than simply what they were given. Complaints and protection The services record of complaints was inspected. The home has had two complaints since the last inspection. Records evidenced that one complaint regarding offensive odour was followed up and appropriate action taken to resolve the issue. The second compliant referred to an allegation that an acting deputy manager had falsified signatures on medication administration records. Although records showed that an internal investigation substantiated the allegation this was not reported to the Care Quality Commission as required by regulations or reported to Kent County Council under safe guarding protocols. At the inspection in April 2010 we witnessed abusive practice towards service users at the home by a member of staff. This was reported to the operations director immediately, and also recorded in the inspection report. Evidence at this inspection showed that this
Care Homes for Older People Page 5 of 16 incident was not followed up and consequently no action was taken. Management and administration It was evidenced at this inspection that the registered provider has strengthened the senior management team at Regal Care. In addition to recruiting a home manager, there is an operations director and a head of quality assurance. The home also employs a social care consultant to work in the home for two days a week. The consultant has over 20 years management experience in care for older people. Prior to this inspection the home has received significant support from Kent Adult Social Services, who provided key staff to work at the home alongside the management team, for a period of two months. The home manager was present throughout the inspection. She had been in post twenty three days and was still in her induction period. We looked at the recruitment records in respect of this manager and these showed that although two references were in place there was no reference from the previous employer. The organization had a POVA check for this person in place but did not have an up to date Criminal Records Check. Although the responsible individual told us that the manager was supervised at all times a risk assessment was not in place to show how this is being achieved. Interview records also stated that the manager would need Dementia Training. The manager told us that she had no prior experience with older people or older people with dementia, but had management experience in homes for adults with learning disabilities. In discussion the manager demonstrated a good understanding of Deprivation of Liberty Issues but was unable to answer questions about recognized practices of caring for older people with dementia. What the care home does well:
Some progress was noted when observing practice and assessing records: We spent some time in the main lounge, the quiet lounge and dining room. The atmosphere was relaxed, and interactions between staff and service users were good. Staff were observed speaking with service users with respect and courtesy. When drinks were offered, service users were given a choice, and were assisted to drink if this was required. We saw that some service users were engaged in craft activities with staff, and other service users were listening to music and chatting with each other. Picture signage around the building had changed, and photographs now reflect the actual rooms in the home. Medication storage in the dedicated medication room complies with Regulation. The
Care Homes for Older People Page 6 of 16 controlled drugs cupboard was secured to the wall and stored inside the metal medication cupboard which is also securely fitted to the wall. The member of staff was able to open the controlled drugs cabinet, demonstrating that keys had been located. The home had also ensured the mobile medication trolley, when stored in the medication room was fixed to the wall. We spoke with a relative who told usthis place is lovely, the girls are fantastic, and everyones welcoming. I have no concerns. Not withstanding the comments about nutritional needs set out in the following section, what the home could do better, progress had been made with updating care plans, and there are better systems in place for recording the weight and fluid intake of service users. 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 set out on page 2. Care Homes for Older People Page 7 of 16 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must produce a statement of purpose and service user guide which tells service users and their representatives about the home. The registered person must ensure that prospective residents and their representatives have correct information about all services and facilities at the home. 22/01/2010 2 3 14 In order to meet individuals 31/12/2009 particular support needs, the registered person must ensure that prospective service users are competently and thoroughly assessed prior to admission to the home. This includes demonstrating appropriate consultation with the service user and their representative has taken place. Prospective service users are currently not competently assessed prior to being offered a place at the home; therefore support needs are not being met. 3 7 13 The registered person must 08/01/2010
Page 8 of 16 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action develop robust risk assessments that support people to have a safe but fulfilling life. 4 7 12 The registered person must develop comprehensive care plans which detail support needs of individuals. The home must demonstrate they have consulted with service users, and have taken into account their wishes and feeling. Current care plans are inadequate and do not contain support needs of individuals. The home has not consulted with service users or their representatives regarding care plans. 29/01/2010 5 8 12 The registered person must 31/12/2009 ensure that the health needs of service users are met and keep and maintain accurate health care and nutrition records. The registered person must ensure that they respond, without delay, to health concerns, and that service users are given access to health care professionals for medical treatment. This includes seeking advice from specialist continence nurses and nutritional specialists to make sure the right support is given and that specialist Care Homes for Older People Page 9 of 16 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action advice is sought and followed when conditions change. Current systems do not promote or maintain proper provision for the health and welfare of service users. 6 9 13 The registered person must ensure all medicines at the home are stored so that it complies with current Regulation and Legislation. To ensure medicines are stored correctly. 7 15 16 The registered person must 02/07/2010 ensure that they have a system in place that monitors service users nutritional status and that appropriate action is taken when changes occur. Where needed, service user dietary intake is monitored and recorded, in relation to what was eaten not what was offered. This must include ensuring service users receive a suitable nutritious diet in adequate quantities, and that all service users who require assistance to eat their meals are provided with appropriate support whilst maintaining their dignity. This includes making sure that meal times are not rushed and food is not removed before service users have finished eating. To ensure the health, safety and welfare of service users.
Care Homes for Older People Page 10 of 16 02/07/2010 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 8 16 22 The registered person must 29/01/2010 develop a complaints procedure which is accessible and suitable for service users with dementia. To ensure service users are able to communicate concerns and complaints. 9 18 13 The registered person must 29/01/2010 ensure that all staff receive accredited sufficient and effective training in adult protection (recognising and responding to signs of abuse) and that they are competent to use this knowledge. To ensure the health, safety and welfare of service users is met. 10 24 13 The registered person must 02/07/2010 have systems in place that ensure all potential environmental hazards are assessed and action taken to reduce or eliminate the risk. This includes the portable heaters and radiators situated in service users bedrooms. To ensure the safety of service users is met. 11 24 23 The registered person must 02/07/2010 have a system in place that ensures broken equipment in the home is removed and replaced. This includes items such as headboard covers. Care Homes for Older People Page 11 of 16 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action To ensure service users are comfortable and safe. 12 27 18 The registered person must ensure that the home employs staff who are competent to carry out their duties Staff must be skilled, qualified and competent. This includes achieving 50 of the staff team being NVQ qualified, and includes all staff receiving suitable training. The registered person must supply to the Commission a rolling programme of training which demonstrates accredited training has been organised and booked in a timely fashion. Furthermore, all staff must have an individual training profile. 13 33 26 The registered person must 02/07/2010 ensure there are effective quality assurance and quality monitoring systems in place at the home. This includes monthly Regulation 26 visits. to ensure the health, welfare and safety of service users. 14 36 18 Staff working at the care home must be appropriately supervised. The registered person must ensure that all staff receive regular supervision which is carried out by senior staff
Care Homes for Older People Page 12 of 16 29/01/2010 29/01/2010 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action who have received Have the necessary skills, training and experience appropriate to this role. 15 37 17 The home must keep and maintain appropriate records. The registered person must ensure that records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 29/01/2010 Care Homes for Older People Page 13 of 16 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, 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 The registered person must 20/08/2010 ensure that care plans and risk assessments are updated without delay when changes in support needs are identified. To ensure the health, safety and welfare of service users are met. 2 8 12 The registered person must 20/08/2010 ensure that outcomes and actions for service users generated from a medical appointment are recorded on care plans and risk assessments. To ensure the support needs of service users are met. 3 9 12 The registered person must 20/08/2010 ensure that medication prescribed to service users is obtained and administered to the service user without delay. To ensure the health, safety and welfare of service users Care Homes for Older People Page 14 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action is met. 4 18 37 The registered person must 20/08/2010 ensure that the Commission are notified of any allegation of misconduct by any person who works at the care home. To ensure the health, safety and welfare of service users is met. 5 29 9 The registered person must 20/08/2010 ensure that appropriate references are obtained prior to appointment. To ensure service users are supported and protected from harm and abuse. 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 Care Homes for Older People Page 15 of 16 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 16 of 16 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
