Inspection on 25/06/09 for Meyer House

This is the latest available inspection report for this service, carried out on 25th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meyer House 28 Meyer Road Erith Kent DA8 3SJ     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Owen     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Meyer House 28 Meyer Road Erith Kent DA8 3SJ 01322338329 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nellsar Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The Registered Person may provide the following categories 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 category - Code OP Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Meyer House was registered with the Commission in November 2006. Since that time the registration has changed to include nursing and mental health clients. It offers accommodation for 34 residents. Care Homes for Older People Page 4 of 32 Over 65 0 34 34 0 Brief description of the care home Private accommodation is offered in single rooms, with the exception of six double rooms for those wishing to share. All bedrooms have en-suite facilities. Communal areas comprise of lounge, dining room, conservatory, cinema room, activities room and hairdressing room. Currently all double rooms are being used as single rooms. The home has also seen a change of Provider to Nellsar Ltd in February 2008. Meyer House is located in a quiet residential area with local shops a short bus ride away and the main town centre also a short ride away in the opposite direction. Public transport is easily accessible with numerous buses running along the main route and a railway station in Erith. The home provides information to prospective residents through a brochure and Statement of Purpose. On admission residents are provided with a Service Users? Guide. Residents are provided with terms and conditions of residency with fees ranging from #423-#682. The fees do not include items such as hairdresser, private chiropodist, toiletries, individual TV licences, private telephone charges and newspapers etc. Care Homes for Older People Page 5 of 32 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: The last key inspection took place on 24th June 2008. This inspection included a visit to the home over one and a half days on 25th June 2009 and 8th July 2009 with one inspector undertaking the inspection. As part of the inspection we spoke to people about the service including visitors, staff and management and we also obtained written feedback in the form of surveys. During our visit we observed practices, looked at records and toured the home. We also looked at information we had received during the year inlcuding the Annual Quality Assurance assessment. This is information services are required to send us about the service and how they providing care to meet the quality standards. Care Homes for Older People Page 6 of 32 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 set out on page 4. Care Homes for Older People Page 7 of 32 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 32 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 32 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. There are sound procedures and practices in place that ensure people wishing to live in the home have all the information they need to make a decision and to ensure staff working in the home have the information they need to ensure they can meet individuals needs. Evidence: A Statement of Purpose and Service Users Guide have been developed along with a brochure about the home. These documents give people the information they need to make a decision on whether the service is right for them. They are in the written format and available in larger format, if required. We are informed that they are looking to develop these documents in an audio format also. This would be a positive step. We also suggest that the information makes better use of pictures which may aid some of the readers. Care Homes for Older People Page 10 of 32 Evidence: We were informed that each person is provided with a contract which gives people information about fees; what is included; how they are paid and rights and obligations of both parties. Each person who wishes to live at Meyer House is assessed by the manager or nurse prior to any decisions being made and people are also encouraged to visit the home. Whilst we were carrying out the inspection one person along with their relative were visiting the home. We spoke to them and they told us that they had already visited the home and that the prospective resident was making a short stay over lunch to find out what it is like living and to see if it suited them. The relatives were impressed with the way they had been treated and the openness staff displayed. They also told us that they had received a brochure, although not the Guide. We looked at the files of three people living in the home and found them to contain an assessment completed prior to admission. Some of these were completed in more detail than others but gave staff information they needed to ensure they were able to meet the persons needs. Where people are admitted in an emergency and a full assessment cannot be undertaken, information is obtained from the Local Authority prior to the persons admission so staff are aware of their needs. One relative wrote I feel I made the right choice for x .whilst another said I am so glad I found Meyer House for my mum as she is very happy. Care Homes for Older People Page 11 of 32 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. People receive a good standard of care from staff who understand their needs. Care plans are developed to record peoples identified needs. However, the lack of full and accurate written information on care for staff means that individual needs may be left unmet. The medication practices and records have improved since the last inspection, although further improvements are needed to ensure peoples health is not placed at risk. Evidence: During the visit we observed the staff practice whilst working in the morning and during lunchtime. One of our observations included two staff moving a resident with a hoist. This activity was carried out with sensitivity consideration and importantly, they were safe. During our observations we saw people looking well-groomed and well-presented. Care Homes for Older People Page 12 of 32 Evidence: There were also good signs of well-being with people involved in tasks such as reading, talking or making decisions about where they wished to go and were generally alert to what was going on around them. Staff interacted well and were generally sensitive to peoples needs. Feedback from people living there and their relatives was positive. Some of the comments we received were dont think they could do any better. Very supportive and caring. The carers are very friendly and polite. I am happy with the staff. The place is kept clean. Staff are friendly and homely atmosphere. We looked at the care plans and supporting information relating to three individuals living there. These varied in their content and completeness. They consisted of the assessment and risk assessment, from which the care plan is developed, along with a model care summary. Within this there are also signs of well being chart, night care plan and social choices assessment. All of these documents form the care plan and are expected to be completed by staff. In the first one viewed the assessment had been completed, together with risk assessments relating to nutrition, moving and handling, infection, bell cord and wheelchair assessment. There was, however, only one care plan entry about an individuals hesitant gait. No information arising from the risk assessment or assessment had been used to formulate the care plan. We noted that there had been a number of health care visits including the GP and DN, with one such recent visit stating the persons legs should be elevated during the day and raised at night. We observed that this action was not being followed during our visit. If there is a reason for this treatment not being followed this should be documented. It is clear that there are a number of different needs, including pressure care, communication, vision, personal care and health care etc that must be included as part of the care plan to ensure all staff are aware of the way in which the individual should be cared for and supported. The second care plan viewed contained more information on the care plan about the persons needs, although, once again there were a number of gaps on the forms completed. If there are gaps this makes unsure as to whether the information has been collected and not needed or they have missed some information. The care plan included personal care, continence, catheter care, nutrition and pressure sores. There continues to be a number of gaps from the information on the assessment, including confusion, depression, vision and communication. If the assessment contains information that is not current this should be made clear. It is also apparrent from the records that there are health care needs that should be recorded, such as the need for Care Homes for Older People Page 13 of 32 Evidence: nursing staff to carry out treatment such as blood tests and injections. Such information must be included as part of the individuals holistic needs. Risk assessments were in place which showed risks in nutrition but this information was not included in the care plan. This individual has a pressure sore and we found a pressure sore care plan and wound care information in place to provide treatment and heal the wound. In the third case there were a number of care plan entries but, once again, areas identified in the assessment and risk assessment had not been included as part of the persons needs. Overall the system in use for planning an inviduals care was variable and therefore we could not be assured the persons needs would be met. We found that there was access to healthcare for people including optician, GP and DN services and that weight is recorded regularly. One person had also received physiotherapy due to a fracture. In the written feedback people told us that they are well care for and that staff understand their needs and receive the medical attention they need. The GP commented that the home was doing fairly well at the moment. We were told by the quality assurance manager that the Providers are developing new care plans to make them more person-centred and more user friendly. They are also looking to implement end of life care plans. This is a positive step. The AQAA also told us that they are looking to nominate staff as dignity champions to ensure people are treated with dignity and respect. On arrival at the home the senior staff was adminsitering medication which we observed for a little while. We found the handling of medicines to have minor deficiencies which could impact on the health and welfare of the residents if not addressed. The records had improved since the last inspection with information about the individual, including allergies completion of medication administration records (MAR)) and as required protocols. We also noted self-administration risk assessments in place. Care Homes for Older People Page 14 of 32 Evidence: A PRN protocol for co-codomol was also in place but the medication record showed this to have clear administration guidelines and not PRN. Other records showed administration guidelines but in reality the medication was given on an as required basis. The manager should revisit this with the GP to ensure medication is being administered in line with the prescription. We found that where adminsitration involved variable doses these were generally recorded with the number of tablets given, although there was still an inconsistency in this practice. It is clear that this area has improved and some good systems now put in place. They should now consider how consistency could be improved. However, there are issues about the administration of creams, whereby the member of staff administering medication signs that these have been given by them, even where the care staff administer it. We discussed how this could be improved. We also noticed that some people had directions for applying cream, for example: diprobase but it was not on the MAR as a prescribed medication. Another person had PRN protocol for sudocream but the sudocream did not have a label nor did the persons diprobase cream. We were told this was due to family bringing these into the home and therefore not prescribed medications. Another MAR had cavilon cream as being received but none administered and the RGN could not tell us why that was. Prescribed medication is stored in two locked trolleys for both units and, these in turn, are then stored, when not in use, in the medical room. The room also contains a fridge and the controlled drugs cupboard and we noted two bottles of calogen in the fridge with no label attached. Controlled drugs (CDs) are stored in a suitable cupboard with a CD book to record the receipt and administration. Only two people are currently prescribed controlled drugs. We viewed these and found that on auditing the records corresponded to what was in stock. However, the CD book was, in one case, not being used in the way that it should be to show receipt of medication and balances. This should be reviewed. Staff who administer medication include the RGN for the nursing care residents and senior staff for residential care. They are provided with training through the Boots accredited training system. Staff are also assessed on their competency prior to staff administering medication. Care Homes for Older People Page 15 of 32 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. The home provides a relaxed and friendly environment with flexible routines. Improvements have been made in the provision of activities so that people are more stimulated and active. Food provided is of a good quality sufficient in quantity and varied providing, people with a healthy and nutritious diet Evidence: We observed the practices and routines throughout our visit. After breakfast some people went to the lounge to sit whilst some made the most of the good weather and sat outside in sunshine under parasols. People were seen reading newspapers and magazines with the TV also on. An activity co-ordinator is employed and arranges activities within the home, as well as supporting people on appointments. The first day of the inspection she took a resident to a hospital appointment and on our return on the second day was absent. Therefore we did not have the opportunity to discuss the role with her. We saw on display a schedule of what is planned over the next month, as far as entertainment is concerned. Care Homes for Older People Page 16 of 32 Evidence: Written feedback showed people to be generally satisfied with the activities provided, although a few relatives commented that this was an area that could be improved. We noted staff interacting well with residents chatting and laughing with them. They responded positively to this and we found there to be overall positive signs of wellbeing througout our visit. The cinema and activity room are not well used and are still currrently used to store items such as wheelchairs. Visitors are made very welcome in the home and encouraged to visit be part of the persons care. We saw a number of visitors throughout the visit enjoying time with their relative and interacting well with staff, giving a very warm and friendly feel to the home. The manager should consider the use of one of the rooms currently not in use, to be used as a visitors room to give people some privacy, particularly where there may be a number visitors and bedrooms cannot comfortably accommodate them. There are four-weekly menus with choices available at the main meal times. We received good feedback about the meals provided and our observations showed that a number of people take them in the dining room. Tables were pleasantly laid and the breakfast and lunch-time meal were taken at a relaxed pace. At the last inspection were concerned that those on the first floor were having meals which were not hot, due to the delay in their serving and, particularly, for those that needed assistance this was delayed even further. They have addressed this through staggering the serving times and taking meals to the first floor in a hot trolley. Staff can then concentrate on serving and assisting, as required. Alternatives are on offer at meal times and home baked cakes served daily. We noticed that a person who was going for a hospital appointment was provided with a picnic lunch to take way with them, as they would be out at lunch-time. Refreshments are served regularly with choices of hot or cold drinks. People appeared able to tell staff if they wished for anything other than the choices on the day and staff assisting those that needed it, did so in a sensitive manner. There is information available in the home about advocacy agencies and support and people are encouraged to contact them for advice. People are also encouraged to maintain their finances for as long as they wish to. We would recommend that this information is included as part of their care plan and have commented further on this Care Homes for Older People Page 17 of 32 Evidence: in the management standards. On touring the home we noted that peoples rooms were adequately furnished with many containing personal possessions and mementoes, making them homely and giving some continuity in their lives. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are managed well and people feel listened to and that their concerns acted upon to improve the service for them. People are protected though sound adult protection procedures and training for staff. Monitoring of training and guidance provided would ensure new staff are able to recognise abuse and ensure they understand their role further protecting people living there. Evidence: The AQAA showed there to be four complaints in the last twelve months. These were resolved but the AQAA did not show how many of these were substantiated. The manager is reminded to complete information in full. The last inspection showed that complaints were not being formally recorded and the complaints procedure was not that of the new provider. At this inspection we found this had been updated the service with a new complaints procedure in place relevant to the provider and complaints now recorded. The record showed seven complaints, although none of these were about care. All of those recorded had been addressed and resolved. The majority of people who provided written feedback told us they knew how to raise a concern or make a complaint. Some comments received were they Always puts problems right. A staff member wrote, They take complaints and comments very seriously. Care Homes for Older People Page 19 of 32 Evidence: Adult protection procedures are in place and staff spoken to had a reasonable understanding of their role in ensuring people are protected. However, there is a need to ensure new staff have their understanding of safeguarding checked following training to ensure that they have understood the training and are alert to possible issues, what they should do and that all staff are clear about reporting on all incidents. The staffing outcome group comments on the recruitment practices and how they protect people from the employment of unsuitable staff. Our main concern was the lack of checks on the agency staff used by the home. The manager has acted quickly to address this issue and ensure the checks are completed with evidence of this now in place. Care Homes for Older People Page 20 of 32 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. Meyer House provides a warm comfortable safe and generally well-maintained place for people to live. Evidence: On touring the home we found it to be comfortable and homely. The residents were having breakfast in the dining room in a very relaxed manner with tables laid with tablecloths, flowers etc. The cinema room looked less comfortable with a number of wheelchairs being stored there and limiting access, possibly causing a safety problem if someone with mobility problems walked into the room. We were informed in the AQAA that the providers are working on a full refurbishment plan and looking to paint internal areas. We were also told of the purchase of various furniture and equipment, as well as purchasing new conservatory furniture. After breakfast some people went to the lounge to sit, whilst some made the most of the good weather and sat outside in the sitting area with parasols. There are some individuals who have infections and procedures are in place to minimise this risk of spreading. Staff spoken to generally had a good understanding of their role in ensuring infection is controlled within the home and that they, and others, are safe. Care Homes for Older People Page 21 of 32 Evidence: People who provided feedback told us that the home was of a good standard of cleanliness. It is smell free as a result of hard work of staff and manager wrote one person. We were aware on the day of the visit that there were issues with the boiler and the lack of hot water running in some residents rooms. The problem had occurred at the weekend and was still an issue on the second day of the inspection. We were informed that this was in hand and the part required ordered. There was hot water in some places and staff were having to make use of this for the time being to ensure people were able to continue with their personal care. This issue was later resolved with hot water running throughout the building. The openness of the reception area means a lack of privacy when taking handover, speaking on the telephone and having discussions. We spoke to the quality assurance manager about this who told us that the providers have also identified this and have plans to make changes that would ensure the confidentiality and privacy. This work has now been completed making the area a little more private and ensuring confidentiality. One relative also commented on the lack of security at the entrance, whereby the door is always left open, allowing people to enter and residents to exit at their choosing. We found that people living in the home are able to make decisions about where they would like to sit and the ease of exit enables them to go and sit outside when they wish. However, it also presents a risk to unwanted guests. We were told that staff are generally in the vicinity to observe and monitor the area, although at evening and night the door is locked and people have to ring the bell. We were told that a digilock is on order for the front door which will provide more security. We hope this will not affect the independence of the people living there. It is positive that the home has employed a maintenance person to undertake many of the day to day repair and servicing tasks that arise in the home. Care Homes for Older People Page 22 of 32 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. Staff provide a good standard of care, are safe and trained. Recruitment procedures for permanent staff have improved since the last inspection and are more robust and safe ensuring the employment of people suitable to provide care. Evidence: On arrival in the home on the first day we found the home staffed by one RGN, two senior members of staff and three carers. The lead nurse and manager were both on training that day. Ancillary staff were also on duty and included a domestic, laundry person, kitchen staff and activity coordinator. At the last inspection there were major issues with the recruitment of staff in the home with lack of required checks being completed. An immediate requirement was made and we were told that this had been addressed. During this inspection we looked at the records of three staff who had been employed since the last inspection. No RGNs had been recruited and so we looked at the files of two carers and the maintenance person. Improvement had been made as required at the last inspection in that criminal records bureau checks, (CRBs) and proof of identity had been completed. Care Homes for Older People Page 23 of 32 Evidence: There were some areas that could be improved easily. The forms used to record the checks undertaken should be completed in full so that information is available. The verification of previous employment in care must be made consulting previous employers and not the applicant applying for the job, application forms must be checked to ensure they are completed in full with a good record of employment and education and that references are completed by the management of the home, agency or someone else with responsibility and not administrative staff or a friend or colleague etc. It is positive that the manager is now checking the legitimacy and accuracy of the references. We also found that, where possible, the applicants provided certificates of qualifications and training. However, we were concerned that one staff member provided a certificate from a care provider that they had not put on their application form nor was there any verification of reasons why they left that employment. Supervisory arrangements are in place where the applicant commences employment with a POVA First prior to the full criminal records check being received. It is positive that there is a record kept of the new employee and who is responsible for them on each shift. We were also aware of the use of agency staff but noted that there was no evidence of the checks being undertaken by the agency. We were told that, in some cases, agency staff did not wear name badges and that information about checks and qualifications were not available. We were told that a contract had been completed between the Provider and the agency but were then told that they were using a different agency. The manager was not aware of any contract with this agency and whilst the Provider may have a contract this was not available for viewing at the time. There is some reasonable expectation that the agency will carry out the checks it states in its contract, however it is also reasonable to expect the management to carry out random checks to assure themselves of the suitability of staff and the agency it uses. The manager has since confirmed and sent evidence that the checks are being completed and they will ensure this information is maintained by them. We have, however, made a requirement on this aspect due to the findings on the day. The manager also informed us of the use of school college/students undertaking work experience in the home. Whilst the manager told us that the college is responsible for the CRBs no checks, information or risk assessments had been completed by the home. We would expect there to be some monitoring and risk assessment in place to ensure the student and people living there are safe. Care Homes for Older People Page 24 of 32 Evidence: We spoke to two staff who told us about the induction training provided and the need to complete their induction booklets. The induction includes a buddy system, voluntary shifts and a first day basic home induction. They both felt that they had the required training support and guidance during this time. The time allotted for this varies due to the experiences and skills of the member of staff. One of the future improvements detailed in the AQAA is the improvement of the induction process. One member of staff spoken to was the acting clinical lead. She had good knowledge of what to do in the event of an accident occurring in the home and of infection control. She had undertaken a number of different training courses related to her job role, although she felt she would benefit from further training, such as catheter care and tissue viability. It is also positive that she has been trained with the manager to be a moving and handling trainer. This will enable the staff to be updated when it is needed and for new staff to receive training in a timely fashion. The second member of staff had been working in the home for approximately three months. Much of her training was received previously in their former care employment. It is only now that she is receiving training from this organisation which includes POVA and First Aid. Whilst there have been issues with the provision of POVA training due to cancellations, it is something they should be mindful of. Discussions with both staff showed they felt they had received good support from their peers and management. The training matrix supplied to us shows core training taking place with some specific training also. The matrix also showed a number of 18 staff with NVQ 2 or above and therefore with the skills and competency to provide the care and support required. Comments made by staff the manageress is really good. A relative said about the home, Makes all relatives feel included. A member of staff wrote they (staff) believe they work well as a team. Another relative said of that agency staff are sometimes abrupt or rough but Meyer House own staff are angels. Care Homes for Older People Page 25 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed with systems in place for ensuring continuous improvement in care. Evidence: The manager is qualified and experienced to manage the home along with the lead nurse who is responsible for clinical decisions. The clinical lead is also undertaking the new management award to develop her skills further to enable her to take her responsibility as part of the management team. We were a little concerned that on the first day neither the manager or acting clinical lead were on duty and there appeared to be no clear lines of authority in the home. This aspect of the management should be looked at, so that in future all staff are clear as to who is responsible for making decisions in the home. Care Homes for Older People Page 26 of 32 Evidence: The manager is also expected to undertake care shifts as part of her role. Whilst we agree it is good practice to have time with residents there may be confusion about the managers role, if they are then providing personal care on a regular basis. It may also lead to issues where problems may arise in their practice and who can people then go to to raise the concern. There is also an issue about having the time to monitor the systems, particularly record keeping. Staff spoken to and written feedback showed there to be good support from the Area Manager, quality assurance manager and the home manager. One comment recieved was the home manager is great and (we) could not ask for more. We were provided with recent copies of the regulation 26 reports on visits completed by the provider to monitor the quality of care. The monitoring visit and subsequent reports had been completed either by the area manager of the quality assurance manager. These provided information about the service, including areas for improvement, as well as what the service is doing well. There is a quality assurance system which includes audits in areas such as medication, infection control, accident reporting and health and safety. The organisation also consults with staff and people living there through surveys. Once collated a report on the outcome is produced and made available to interested parties. The AQAA also tells us that there are regular meetings with residents and relatives, although this was not sampled at this inspection but it shows the managements approach to involving people in their care. Staff supervision is taking place for all staff. The supervision record allows staff to make comments about their employment etc. This is good practice, although it is limited in its format. We recommend that the supervision format is reviewed and changed to ensure all areas are included as part of the discussion and that there is space to record areas discussed. We undertook a brief audit of the management of service users monies. Each person has a cash bag with a record of money spent with receipts of expenditure and signatures where money is brought in by relatives. Not all people have their monies managed by the home and therefore locked facilities Care Homes for Older People Page 27 of 32 Evidence: are available if people are independent in this. We were made aware that the facility is not often used and relfects peoples independence in this area. We would suggest some dislcaimer be used and the care plan identifies the way in which each persons monies is managed. We noted that there is Employers Liability is in place with appropriate cover, is in date and that the certificate of registration was also in place. We are receiving notifications of events as required under Regulation 37, although we had not been notified about the current problem with the boiler and therefore lack of hot water in a number of rooms. Whilst this is not an aspect that affects all of the home it is goodpractice that we are alerted to these issues. The training matrix shows staff are receiving core training such as moving and handling, infection control, fire and 1st Aid. We noted that the required checks are being completed on the fire system and equipment and that many staff have been involved in fire drills. However, a new member of staff who has been employed for three months has yet to be involved in a drill, although knew the meeting point if a fire broke out. Inclusions in fire drills would ensure staff are prepared in an emergency situation and respond accordingly. Care Homes for Older People Page 28 of 32 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 14 Care plans must reflect the 01/08/2008 personal, health, social, emotional and spiritual needs of the individuals to ensure people receive the care and support they require. Care Homes for Older People Page 29 of 32 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 Care plans must be written detailing how the persons needs in rspect of his health and welfare are to be met. So that staff have the informationt hey need to ensure the persons needs are being fully met. 18/09/2009 2 9 13 There must be adequate 04/09/2009 arrangements for the safe keeping, recording, handling, safe administration and safe disposal of medication. Specifically, the practices in relation to the recording and administration of creams must be improved People must be assured that their health needs are being met. Care Homes for Older People Page 30 of 32 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 3 29 19 There be robust and safe systems in place for the recruitment of staff, the use of agency staff and the use of volunteers in the home. To ensure people living in the home are protected from the use of unsuitable staff providing care to them. 03/09/2009 4 31 18 There must be a review of the management arrangements in the home. To ensure there are clear lines of responsibility at all times. 02/10/2009 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 18 Staff understanding of the safeguarding training and guidance should be moniored to ensure they are clear about their role in protecting people. The manager should consider using one of the rooms available as a visitors room. We recommend there are clear lines of staff responsibility recorded when the manager and deputy manager are not working. The supervision format should include areas detailed in the standards to ensure staff are able to discuss opportunities and personal development. 2 3 19 27 4 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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