Inspection on 21/06/10 for Portland House

This is the latest available inspection report for this service, carried out on 21st June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Portland House 31/07/07

Portland House 03/07/06

Portland House 17/11/05

Portland House 11/05/05

Portland House 02/12/04

Portland House 23/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Portland House 11 Portland Road Hove East Sussex BN3 5DR     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: Gwyneth Bryant     Date: 2 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Portland House 11 Portland Road Hove East Sussex BN3 5DR 01273325705 01273738260 manager.portland@vigcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Beant Kaur Vig,Mr Joginder Singh Vig Name of registered manager (if applicable) Sunjay Sungkur Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category/ies of service only: Care home with nursing - 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 - OP Date of last inspection Brief description of the care home Portland House is a care home registered for forty (40) places for people of either gender, aged sixty-five (65) years or over on admission. Nursing care is provided at this service. The home is located in a quiet residential area in Hove. The registered providers own Care Homes for Older People Page 4 of 29 Over 65 40 0 2 9 0 7 2 0 0 9 Brief description of the care home several care homes throughout the South of England, predominantly older people services. The home is a large detached home that provides accommodation over two floors. There is a lounge area on both floors of the home and a communal room in the basement that can be used if needed. There is a passenger shaft lift at the home to assist residents accessing all areas of the home. There are ramps or chair lifts in other areas for those unable to mobilise on steps. There are seven rooms for shared occupancy, of which three are provided with en suite facilities and twenty-two rooms for single occupancy, of which ten are provided with en suite facilities. The home generally accommodates only thirty-six people. There are suitable communal toilet facilities. There are two assisted baths and a wheel in shower on the ground floor and an assisted bath on the first floor. Four of the en suites have baths provided, however these are not assisted and are currently not suitable for use by the residents residing in these rooms. Weekly fees range from £314 to £600 per week. There are additional fees; hairdressing, chiropody and newspapers/magazines. This information was provided to us on the 22 April 2009. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Portland House will be referred to as residents. This unannounced site visit took place over seven and a half hours on the 21 June 2010. Evidence obtained at this site visit, previous information regarding this service and information that we have received since the last key inspection in July 2009 forms this key inspection report. There were twenty-five people in residence on the day of the site visit. Two people living in the home were spoken with in addition to discussion with the Registered Manager, both registered nurses, the laundry person and the cook. The purpose of the inspection was to check compliance with the requirements made during the last inspection and to inspect other standards. A range of documentation was viewed including service users care plans, personnel files and medication records. A tour of the Care Homes for Older People Page 6 of 29 premises was also carried out during which seventeen bedrooms, two communal bathrooms and the communal lounges were visited. The registered provider completed an Annual Quality Assurance Assessment (AQAA) in April 2009 as required. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report where it remains relevant. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people returning to the home following a stay in hospital need to be reassessed to ensure the home is still able to meet their needs. Evidence: Two resident contracts were viewed and although the terms and conditions were clear, it was not specified who is responsible for payment and nor was it clear whether the fees stated included state funding for the nursing element of care. This needs to be addressed to ensure residents and their families are clear on how much they need to pay. One of the registered nurses confirmed that there had not been any recent admissions to the home but existing pre admission assessments were satisfactory. The registered manager confirmed that he did not reassess residents following a stay in hospital. It is important that there is a re assessment process following a stay in hospital in order to demonstrate that the home is able to meet assessed needs. Care Homes for Older People Page 10 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All aspects of service users health, welfare and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care. The handling, storage and recording of medication is good. Evidence: Four care plans were viewed in full and a further two in order to cross reference with other documents such as medication administration records (MAR) and daily notes. All of the plans consisted of numbered individual sheets which related to a particular care need and an attempt to personalise the plans was evident as where residents had additional needs, additional sheets were used. However, the content of the care plans were often generic with the same wording used for different residents. In addition, the plans were inconsistent in parts as some sheets indicated that the individual did not have capacity but other parts stated that they had consented to treatment. The parts of the care plan relating to advance care have been signed by relatives but unless there is a lasting power of attorney in place, this decision needs to be taken after consultation with healthcare professionals and after an independent capacity Care Homes for Older People Page 11 of 29 Evidence: assessment has been carried out. In the main care plans identified care needs but lacked detail in respect of what staff need to do to meet those needs. Discussion with staff found that they are familiar with the individual care needs of residents but this system relies on good memory and communication, therefore needs may not be met consistently. Written handover notes are not used at the start/end of shifts although one nurse said she kept her own notes but destroyed them at the end of the shift. Good practice suggests that written handover notes be maintained to ensure staff starting a shift have an overview of events that affect residents. None of the care plans viewed included detailed information on chiropody, dentists, opticians and hairdressing but there was a folder in the office which included this information. Good practice is that this information be included in individual care plans in order to ensure they are person centred. Daily notes were poor and gave little information on how individuals spent their day and for the most part consisted of phrases such as safety maintained and care given with consent. Discussion with the activity co-ordinator and in the care plans found that she visits some residents in their rooms and provides a range of activities but this is not reflected in the daily notes. It is important to ensure daily notes contain sufficient details to facilitate the monthly care plan reviews and provide a clear record of how people spend their day and to show that care was delivered in line with the care plan. One person had returned to the home following a stay in hospital and although an extra sheet had been added to the care plan folder, other relevant parts of the care plan had not been updated. Such a situation may cause confusion as staff will not be clear about which part of the plan to follow. Discussion with the manager found that care plans are updated monthly but good practice indicates that care plans need to be updated according to changes in need. This indicates that although care plans are reviewed this is done to an inflexible monthly timetable regardless of changes in need. Reviews of care plans are also limited with comments such as monitor her condition and check regularly but there are no explanations as to the form the checks and monitoring should take and nor is there evidence in daily notes or other documents to demonstrate that they have been carried out. One residents daily notes as at 19:00 stated that they had been given medication and paracetamol with good effect but the MAR chart showed these medications had been administered in the morning. Therefore is it not clear if staff write up notes at the end of the day or if medication is signed as administered in the morning but not actually given until later in the day. Care Homes for Older People Page 12 of 29 Evidence: Two care plans indicated that the individuals no longer have baths or showers but are washed in bed. The other plans viewed did not stipulate whether or not the individuals have baths, nor was there records in the daily notes to indicate when residents were bathed. When residents are no longer able to use the bath or shower, good reasons need to be given as the home is well equipped with hoists and assisted baths so it is not clear why some residents can only be washed in bed. The residents spoken with said that they were happy in the home and one nurse was singled out by one resident as being particularly kind and the comment was (name) is always kind and helpful to me. Although environmental risk assessments had been carried out for those at risk of falls, they were inadequate as they did not clearly identify the hazards nor include sufficient detail for the management of these risks and this was the case even for those people identified as being at high risk. Risk assessments must be expanded to provide staff with clear direction on the management of the risk. All of the care plans viewed showed that the individual had bed rails but this appears to be a blanket policy as no reason was given as to why they were needed. For two residents their family had signed to agree to this form of restraint but this is not acceptable as it is for the manager to use appropriate legislation to determine whether or not the use of bed rails is justified. The reviews of the risk assessments for bed rails indicated a task orientated approach as all reviews stated the bed rails are in good working order. When bed rails are used, reviews need to be focused on the person, their capabilities and whether or not the use of bed rails remains in the best interest of the resident. Weight charts for five residents were viewed and three showed that residents had lost weight but care plans had not been updated with the action staff needed to take to address the weight loss. One persons plan showed they had gained over 4Kg within a four week period. This was discussed with both the registered manager and the general manager who believed that staff are misreading the scales when residents are weighed with the hoist scales. This needs to be addressed as unless weights are accurate staff are unable to take appropriate action to address weight loss/gain. The pharmacist from CQC assessed the medicine management system in the home.The Service has good facilities to keep medicines safe. The home uses medication dosage system [MDS] and the day of the inspection was the first day of the 28 day cycle for the MDS. We checked all the previous cycles Medication administration record [MAR] charts. We looked at a few care plans to check healthcare professional input and records relating to care. Care Homes for Older People Page 13 of 29 Evidence: We watched 8 people being given their medicines and noted that creams were signed for by the registered nurse before being applied by the carers. The nurse was asked how she could be sure that these creams were applied and she replied because the carers would ask for more supplies when they run out of the creams. However the nurse cannot be sure that the creams had been applied at each time when in fact she had signed for them as applied. In the main a good manner was used by the nurse when giving medicines and it was observed that nurses washed hands several times while giving medicines. Each persons medicine was given individually. One person refused their medicines and a record was made to indicate this. The medicines refused were place in the disposal container and a record was made in a book. It was noted that this book contained records of disposal of medicine that were discontinued and medicines disposed off which belonged to deceased residents. It had no previous records of medicine refused. On checking the MAR charts medicines had been refused by residents on occasions. This means the record of disposal of medicines are kept but are incomplete as not all medicine that are disposed are recorded. Medicines that need special attention due to needing blood monitoring were handled well. Records are available of blood test and resulting action. We saw that for medicines that were due three monthly the records were clear for the next due date. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience by people living in the home does not always match their expectations, choice or preferences. Evidence: Discussion with the chef found that menus are nutritious and well balanced with alternatives offered at each meal time. The chef is given a sheet by nursing staff in respect of special diets. The chef said that about twelve residents currently have a cooked breakfast and there is also porridge and a range of cereals available which is in addition to toast or sandwiches. The lunchtime meal appeared plentiful and was attractively presented and there was evidence that residents are offered fruit and soft drinks. However, fruit offered was whole and given the frailty of some residents it would be good practice to offer cut up fruit as finger foods which enable residents to feed themselves. At the start of the site visit a nurse was asked about morning routines and said that breakfast is served at 8.30 and that not all residents are offered a drink on waking as it depended on whether or not they work near breakfast time. One resident was clearly heard asking both nursing and care staff for a cup of tea over a period of twenty minutes and it was only provided when the inspector intervened and requested that it was provided. Care Homes for Older People Page 15 of 29 Evidence: These practices indicate that the homes routines are paramount rather than users needs. Good practice is that all residents be offered a drink of their choice on waking and breakfast provided at a time of residents choosing. Two care plans stated that the individuals needed 5-6 glasses of water a day and 4-5 glasses a day but they did not state the size of the glass nor when it should be offered. Where fluid charts are maintained these did indicate how much fluid the individual had consumed but maintaining fluid intake was not reflected in the daily notes nor in the care plan reviews. For those residents who need their food intake monitored, food charts were inadequate as they lacked sufficient detail to determine how much had been consumed. Given the high dependency of residents it is crucial for detailed records to be kept in respect of both food and fluid intake. The pharmacist inspector noted that a number of residents were on food supplements and this needs to be addressed to ensure residents get adequate nutrition wherever possible including fortifying foods as soon as weight loss is noted. Records relating to the daily routines of individuals included preferred times for getting up and going to bed. Preferred leisure activities were also identified, however those identified at the time of admission had not been carried over to the current care plan sheet for activities, therefore there is a danger that they will not be enabled and encouraged to continue with past hobbies. The AQAA indicated that visitors are welcome at all reasonable times and visitors were noted to be in the home on the day. The activity co-ordinator explained that she provides a range of communal activities including board games, sing-a-longs and musical bingo. This is in addition to organising outings and one-to-one visits in residents rooms. Discussion with the activity co-ordinator found that she also assists with some care tasks such as assisting with meals and manual handling. Training records indicate that she has training to enable her to carry out care tasks but it is important that providing care does not detract from the tasks outlined in her job description. Although care plans include preferences in respect of getting up and going to bed they lack crucial information on other preferences such as food likes/dislikes, clothes, daily routines and meal times. The fixed breakfast times, monthly care plan reviews and equipment orientated reviews indicate that the home may not be run in the best interests of residents. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon, improvements need to be made to the adult protection systems to ensure residents are protected from abuse. Evidence: Information in the AQAA indicated that there are detailed policies and procedures on both complaints and Safeguarding Vulnerable Adults. The complaints log was viewed and there have been three complaints during 2010 each of which had been recorded and included actions taken and outcomes. Since the inspection in 2009 there have been six safeguarding adult alerts made and these are currently being investigated by the local authorities who have responsibility for such investigations. The allegations focus mainly on the lack of good quality care which leaves vulnerable residents at risk of neglect. In addition there was evidence that the home is run to suit staff routines rather than in the best interests of those using the service. The placing authority have suspended placements in the home until the safeguarding adult investigations are complete. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is satisfactory but improvements need to be made to infection control practice. Evidence: A tour of the premises was carried out with the laundry, seventeen bedrooms, three lounges and two communal bathrooms being inspected. Overall, bedrooms were well maintained, clean, tidy and free from offensive odours. Communal lounges were also well maintained and the one in the basement was currently being redecorated. There is also a training room, nurses station and a staff room. One bedroom was found to have a pot of cream in the en-suite that was not prescribed for the occupant, however discussion with the manager found that it was prescribed for the occupants wife who died recently. This was clearly an oversight therefore no requirement was made. Part of the laundry floor is not impermeable and this needs to be addressed to ensure risk of contamination is minimised. Both nursing and care staff were seen to be wearing aprons in communal areas and on one occasion a nurse also entered a residents bedroom wearing an apron and was still wearing it when she came out. A cleaner was seen to be wearing gloves in a communal area and this is not good practice. Staff must follow good practice of disposing of gloves and aprons in the room in which they were used in order to reduce the risk of cross infection. There are dispensers of hand wash gel throughout the home for use by staff and Care Homes for Older People Page 18 of 29 Evidence: visitors. Care Homes for Older People Page 19 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff deployed who have the skills to meet the needs of those people living in the home and the recruitment practice sufficiently robust to safeguard those living in the home. Evidence: On the day of the site visit there were two registered nurses on duty of which one was there to do paperwork but she had to assist with the medication round for part of her shift. In addition there were two care staff on each of the two floors and an additional carer who assisted on both floors as necessary. The registered manager confirmed that the information given in the AQAA in 2009 remains accurate in that at least 50 of care staff either have or are working towards gaining National Vocational Qualifications at level 2. The staff rota showed that some nurses work particularly long hours with one regularly working in excess of 50 hours a week. The registered manager needs to ensure that staff have sufficient time off to ensure they do not become too tired, particularly as most of the residents are very dependent. The recruitment records for the last three people to be employed were viewed and they were satisfactory with all providing the required documentation of Criminal Bureau records checks, two written references and a safeguarding adult check. Care Homes for Older People Page 20 of 29 Evidence: One person is here on a student visa and the letter from their college states they may work 15 hours per week as a work placement and a further 20 hours. The staff rota showed that this person had regularly worked in excess of 35 hours per week. The registered manager checked again with the college and then agreed to ensure this person no longer worked more than 35 hours in term time, therefore no requirement was made. One of the induction and foundation training workbooks were viewed and this showed that most of the work had been completed in three weeks. Good practice suggests that the foundation programme is spread over six weeks to ensure new staff have a solid understanding of care practice and the homes procedures. Care Homes for Older People Page 21 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality monitoring systems are satisfactory but improvements need to be made to the fire safety precautions and the overall management of the home. Evidence: The registered manager has managed the home for a number of years and is a registered nurse. In discussion with the manager and looking at documents it is evident that he lacks a solid understanding of the Mental Capacity Act and the accompanying legislation in respect of Deprivation of Liberty Safeguards and Best Interest Assessments. He confirmed that he and his staff have all received training in the Mental Capacity Act but information in the care plans indicated that it is not used appropriately to ensure residents independence is protected and promoted. There are quality monitoring processes in place including annual surveys for residents and their families and the responses to the 2010 surveys were viewed and found to be positive. The last nurses and general staff meetings were held in March 2010 and this showed that staff are consulted on how the home is run. Minutes of residents Care Homes for Older People Page 22 of 29 Evidence: meetings were also viewed and found to be basic but satisfactory. Discussion with one registered nurse found that they felt supported by the manager and that they received regular supervision. When asked the registered manager initially stated that he held monies for just one person but further discussion found that he holds monies for six residents. All monies held are kept in a locked drawer or cupboard and records maintained and receipts provided. Accident records were viewed and found to be compiled in line with the latest legislation and the registered manager collates these records each month as part of the quality monitoring process. In the last eleven months there have been nineteen expected deaths and five unexpected deaths and although nothing untoward has been found it would be good practice for the registered manager to include death rates in the quality monitoring process. Each resident had a personal emergency evacuation plan in the event of fire, however they had not been regularly reviewed and were not consistent with current needs. For example, two of these plans indicated that the resident needed two carers but the care plans showed that they currently needed three carers for all transfers and the use of hoists and slings. When visiting the basement it was noted that the laundry room door and the door to the maintenance persons room were both wedged open. This practice must cease as it puts both residents and staff at risk in the event of fire. Information in the AQAA completed in 2009 indicated that there is an on-going programme of maintenance for all parts of the home and on the day the maintenance person was in the home. Care Homes for Older People Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 That contracts clearly outline 21/08/2010 the required payments. To ensure it is clear how much residents need to pay. 2 3 14 That reassessments be carried out as required. To demonstrate the home can meet assessed needs 21/08/2010 3 7 13 That all risk assessments include the management of the risk and be regularly reviewed. To ensure service users are not at risk. 21/08/2010 4 7 13 That the use of bed rails be 21/08/2010 justified and only used when all other methods have been tried. To ensure service users are not unnecessarily restrained. Care Homes for Older People Page 25 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 7 15 That plans of care are person centred, consistent and include personal preferences. To ensure staff are clearly directed in the delivery of care in a manner preferred by the service user. 21/08/2010 6 8 16 Tha food intake records be more detailed. To ensure service users maintain nutritional intake. 21/08/2010 7 9 13 That daily notes correspond with information in medication administration records. To ensure it is clear when medication has been administered. 31/07/2010 8 9 13 To ensure staff sign for 31/07/2010 creams and ointment applied after they have been used. so that records are true and accurate. 9 9 13 To have complete and accurate records of all medicines that are disposed of when no longer required. So that an audit is possible if necessary 31/07/2010 Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 10 12 16 That service users are encouraged to continue with past leisure pursuits. To ensure they are able to continue with a past lifestyle. 21/08/2010 11 14 12 That service users preferred 21/08/2010 daily routines and personal preferences be recorded and adhered to. To enable service users to maintain control and choice over their daily lives. 12 18 33 That the registered manager 21/08/2010 ensures service users recieve good quality care. To ensure they are not at risk of abuse. 13 26 16 That all staff are trained in 21/08/2010 infection control and follow it in practice. To ensure the risk of cross infection is reduced. 14 31 18 That the registered manager 21/09/2010 be trained in the use of the Mental Capacity Act and the accompanying legislation. To ensure he has a good understanding of when and how to apply this legislation to good effect. Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 15 38 23 That advice is sought from 21/08/2010 the local fire service in respect of wedging open fire doors and reviewing personal emergency evacuation plans. To ensure staff and service users are not at risk in the event of fire. 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 7 That written handover notes are used at the start/end of shifts. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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