Inspection on 08/12/09 for The Conifers Nursing Home

This is the latest available inspection report for this service, carried out on 8th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Conifers Nursing Home 14/03/08

The Conifers Nursing Home 02/11/06

The Conifers Nursing Home 03/11/05

The Conifers Nursing Home 31/05/05

The Conifers Nursing Home 15/03/05

The Conifers Nursing Home 05/10/04

The Conifers Nursing Home 23/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Conifers Nursing Home Brampton Road Wombwell Barnsley South Yorkshire S73 0SS     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: Marina Warwicker     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Conifers Nursing Home Brampton Road Wombwell Barnsley South Yorkshire S73 0SS 01226751007 F/P01226751007 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Dominic Manfredi,Mr Anthony Constantine Manfredi,Mr Anthony John Manfredi,Mr Ian Hyde care home 33 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons accommodated shall be aged 60 years and above. Two specified service users under the age of 60 may live at the home. Date of last inspection Brief description of the care home The Conifers is a purpose built care home for older people requiring nursing or personal care. The facilities are on two floors. The communal areas for the residents are on the ground floor. The first floor is serviced by a passenger lift and stairs. The provider informed us that the fees ranged from £356 to £502 (in December 2009) per week depending on the needs of the individuals. Additional charges apply for hairdressing and chiropody. Care Homes for Older People Page 4 of 30 Over 65 33 0 0 3 0 2 2 0 0 9 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key unannounced inspection was on 3rd February 2009. The quality rating for this service remains 1 star. This means that the people who use this service experience adequate quality outcomes. An inspection of this care home was carried out on Tuesday 8th December 2009 between 9am and 4pm. The staff, the management, the people using the service or the visitors were not informed of our visit and therefore it was unexpected. Care Homes for Older People Page 5 of 30 Thirteen people who use the service and five visitors were consulted on the day. We also spoke with eight staff that were on duty. A further 10 people using the service, 10 staff and five professionals who came into contact with the people were contacted by post and telephone to obtain their views on the service. Comments received from the surveys have been included in the body of the report. Time was also spent observing and chatting with staff and the people using the service. The registered manager and a relative of the provider who was also a manager were on duty at the time of our visit. We informed them of our findings throughout the day, which helped both parties to verify and start taking action when it was required. The premise was inspected, which included bedrooms of people using the service and communal areas. Private areas i.e. bedrooms, were accessed with the permission of the people and/or the staff at the home so that we respected the peoples wishes. Samples of records such as the care plans, staff recruitment and training files were checked. We would like to thank the people who live at Conifers, their relatives, the staff who took part and the management for their contribution toward this process. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We have made the following requirements to improve the service and promote good practice at Conifers. The registered manager must ensure that accurate records are kept of all the medicines leaving the home for disposal. This is to ensure that there is no mishandling of medicines. The care staff must receive training on Palliative care, practical assistance and advice. This will ensure people are not in pain and discomfort. Also the staff will be competent in seeking the necessary community support and delivering End of Life Care to those at the home. The registered manager must ensure that residents are consulted and organise a programme of activities on behalf of the residents. The activities need to be in relation to recreation, fitness, religious and social activities. This will make sure that the residents are able to keep in contact with people and also kept occupied to avoid boredom. One of the managers must ensure that there are enough chairs for the use of the staff and the visitors. The staff must be able to sit comfortably by the side of the residents when they help them at meal times. This will avoid residents getting distracted and stop accidents at mealtimes. The relatives must have access to portable chairs when they wish to sit beside the residents. This will prevent people sitting on wheelchairs and tables. Thereby preventing incidents. The carpets identified as worn, stained and not fit for purpose must be replaced without delay. This will pevent accidents and promote peoples safety. The staffing numbers must reflect the dependency levels of the residents. This will ensure that residents are able to receive the identified care. Care Homes for Older People Page 7 of 30 To protect and promote the health, safety and welfare of the residents at the home and to ensure all staff are trained and competent to carry out their duties; the management must make arrangements without delay for staff training on moving & handling, health & safety, fire safety, food hygiene, and infection control. Proof of identity of the workers at the home must include individuals recent photographs. This is to protect the people living and working at the home from strangers. The daily involvement from one of the relatives of the providers has a contradictory impact on the day to day running of the home and questions the accountability and the responsibility of the registered manager. Therefore there needs to be a clear line of accountability within the home. This is to make sure that the registered manager is able to execute her authority and work towards fulfilling Conifers aims and objectives. The registered manager must ensure that all the staff working at the home receive regular supervision to ensure that the staff are competent, confident and fit for the job. Thereby the registered manager is able to promote residents safety and welbeing. An unannounced visit to monitor the service provided by the home must be carried out each month by the responsible individual for the home. The visit needs to include with consent interviewing residents, visitors and staff, a tour of the premise to monitor safety and any improvement needs. The information gathered during the visit would help the provider findout whether the home is providing the appropriate care to the individual and the people who live and work at the home are safe. Through effective quality assurance the management must develop annual maintenance and refurbishment plans for the home based on systematic planning and review. Forward planning will help organise the residents and the staff so that there is minimum disruption for those who are living and working in the home. The management must ensure that the environment within the home is kept safe by providing storage areas. The present arrangement compromises the health, safety and the welfare of the service users. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the service are able to access the information they need to make an informed decision about the home. Residents and their relatives are confident that staff are able to meet their care needs. Evidence: We spoke to three visitors and two staff to find out the process for admitting people into the home. We also checked three peoples needs assessments, which had been completed by the placing authorities. One resident, two staff and one relative said that the manager visited the people before admission to see whether they were able to meet the identified needs of the people. The residents and the care staff said that people were given the opportunity to say whether they wanted to stay at the home and felt settled in. One resident said if they were not happy they were able to tell their relatives and move elsewhere. We observed the residents to be contented and comfortable. Care Homes for Older People Page 10 of 30 Evidence: Two residents said that they had been at the home for a very long time and that they feel they made the best decision moving into Conifers. One of the residents said, The staff really care and that is what matters. If I need information about the home I would ask the staff. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff and monitored by the management of the home. Evidence: We observed the residents during our visit, checked three care plans, consulted with two visiting relatives and interviewed four staff on duty. The care plans had been prepared from the individual assessments. These had been amended according to the changing needs of the people. During interviews the staff seemed confident that they were meeting the needs of the people they were caring for. We witnessed that the staff had a good rapport with the relatives and they interacted with the residents well. We saw staff consulting with the residents as to what they wanted to do. One relative said, I come visiting almost everyday and I see what happens here. The girls are smashing, they are helpful and friendly. I cant ask for more. Care Homes for Older People Page 12 of 30 Evidence: During our visit we saw one of the GPs visiting the home to see a resident. The manager said that the GPs visited the home at their request. We have received positive feedback from one of the GPs about the staff at the home and their commitment to giving good care to the vulnerable people. The staff told us that they looked after peoples pressure areas by helping them to move and walk about. They said that those who needed help with changing position were turned regularly. We were informed that one person had pressure sores and that the staff were in contact with the community tissue viability nurse regarding the management of pressure sores. This was evident in the care plan of the resident. We were informed by the staff that the residents who were prone to developing pressure sores were turned regularly especially at night times. Those residents we chatted with were clean and smartly dressed. Some of the residents were sitting in the lounge, watching TV or chatting to staff/visitors. The residents were offered drinks during the day by the care staff. Some residents who were reluctant to take fluids were encouraged by the care staff to promote hydration. Although there were snacks on the drinks trolleys when drinks were served staff did not offer people snacks. This resulted in three people saying that they had plenty of teas and coffees and were not offered any snacks. The manager was made aware of this on the day of the visit. We observed the nurse administering medication to residents in the dining area. We noted that the nurse made sure the person had taken the medicine before moving on to the next resident. We checked three MAR (medication administration record) sheets. There were no gaps and when medicine was not administered, the nurses had recorded this on the MAR sheets. Most of the time the nurses had written the reason for the residents not having the medication. This is good practice. The manager informed us that recently the local PCT staff had been in the home and had carried out medication reviews of the residents and that they were awaiting the result/report. The medicines were supplied by the local pharmacist but there were no records of their audits on the management and disposal of the medicines at the home. Our checks revealed that the system for the disposal of medicine needed to be revised. We highlighted the areas which needed improvement to the registered manager and the provider during our visit. They included improving the recording of medication which was to be returned to the pharmacy and the use of the appropriate book for the purpose. For example, the name of resident was not always written Care Homes for Older People Page 13 of 30 Evidence: against the medicines, the number of tablets or the measurement of liquid-medicine was not recorded accurately. However these had been signed and accepted by the supplying pharmacy. We observed staff discreetly toileting service users before meals. The staff addressed the residents in a polite and friendly manner. We were informed that there had been deaths in the last few months and the staff took care of the residents and supported the relatives. The care staff have not had any formal training on end of life care and they would welcome some training on this subject. One relative said, I have seen the staff running around the residents and their family when they are really poorly. I have known the staff for several years and I am more than confident that they will look after X when the time comes. Care Homes for Older People Page 14 of 30 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. People who live in Conifers are able to make choices about their lifestyle, and are on the whole supported to maintain their life skills. Arrangements for social, cultural and recreational activities need to reflect the expectations of the people living at the home to alleviate boredom. Evidence: On the day of our visit the residents said that the activities person worked only on Thursdays and they enjoyed playing Bingo with her. We saw residents in the two lounges. They looked bored and were very happy to chat with us. When staff spoke with them they came alive and started chatting. Some residents were happy to sit alone and observe the others. These were some of the comments we received with regards to activities. I am happy to sit around. Not bothered about going out. We enjoy bingo. Otherwise we just sit and watch. The staff are too busy to entertain us. At the meetings we have asked for more activities, especially when the weather gets better. Not enough staff to take us out. Some residents are trigger happy because they are bored. To get attention they keep ringing the buzzer. One person said if the relatives did not visit they would feel very lonely. The provider said that they carry out manicures and sometimes get Care Homes for Older People Page 15 of 30 Evidence: residents together and have a discussion. This was productive and that residents joined in on the discussions and enjoyed it. We saw relatives visiting during the day. They were made welcome by the staff at the home. The visitors told us that they could speak to the residents in private in their individual bedrooms. The relatives were very positive about the staff and the manager and praised them for their support and care. We saw lunch being served to residents. Meals were brought to the dining area by the kitchen staff. The cook was familiar with the peoples likes and dislikes and portion sizes. We observed the care staff, who took the meals up to the residents and gave them assistance. In order to sit beside the residents the care staff had to use wheelchairs or kneel on the floor. This was due to the lack of chairs. We highlighted this to both managers and urged them to purchaser chairs without delay. One of the managers assured us that it was to be put right within a fortnight. (A requirement has been made under outcome area Environment.) The food was hot and well presented. The cook knew the special diets and we saw people receiving the correct meals. Three residents said that they enjoyed their meals and that the food was wonderful. Three visitors confirmed that the meals served at the home were varied and of good quality. We were informed that a special birthday party was celebrated by a resident and the cook and the staff organised the celebration and everybody enjoyed the party which included the families. During our tour of the home we noticed that people had some of their personal possessions in their bedroom and the bedrooms were individualised. One of the managers informed us that apart from two residents the others either managed their own finance or the relatives helped them with it. The same manager was appointee for two residents and therefore she continued to assist them with their finances. Care Homes for Older People Page 16 of 30 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. The people using the service and the staff working at the home are protected from abuse and their rights are protected by the management style and the systems in place. Evidence: We spoke with two residents, two visitors and two staff on duty to find out how the management handled formal complaints. People were a little confused about the person they need to go to since the managers were present at the home most days. The resident and relatives were generally happy with the way staff handled any concerns. One person said, I have no complaints. Staff are marvelous here and if people have got something to say they should say it to their face . One relative said that the manager (the person referred to as manager was the relative of the provider) was around most of the time and helped them discuss any problems. We have commented on this under the outcome area Management and administration. Three staff training records were checked and there was evidence that the staff have received training on Protection Of Vulnerable Adults. The staff were able to tell us what actions they would take if they were to witness any type of abuse at the home. Care Homes for Older People Page 17 of 30 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 physical design and layout of the home enables people who use the service to be independent. Due to the lack of storage space parts of the home are unsafe and unaccessible. Evidence: We measured this outcome area by speaking to the residents, the visitors and the staff. We also took on board what we saw on the day. The outdoor area was tidy and kept safe allowing access for the people using the service. There was building work taking place and this has resulted in some unavoidable upheaval. We made the following observations. When we entered the home at around 9am the care staff were busy delivering personal care and the domestic worker was busy cleaning the communal areas. During the tour of the premise later that day we found the home clean. However, we observed the following. One of the upstairs bathrooms was used as a store room and not in use as a bathroom. Two other bathrooms and the shower room were also used to store items such as a table, large boxes, hairdressers equipments, an easy chair--- etc. Therefore cluttering the rooms and making it difficult to use the facilities. A section of the downstairs corridor was used to house the wheelchairs which were not Care Homes for Older People Page 18 of 30 Evidence: in use. This area was also used to recharge the electric wheelchair and the hoist. We discussed with one of the managers the lack of storage and questioned why the wheelchairs were kept in the corridor. She said that the wheelchairs were used as pool chairs and that only those who had special chairs had their own. Residents requiring wheelchairs need to be assessed by their GP and according to their financial situation either the resident or the placing authority should purchase the wheelchairs. Therefore wheelchairs should not be used as an easy mode of transport for residents. However, it would be acceptable for the home to keep a wheelchair to use in an emergency. In some parts of the home the carpets were not fit for purpose and needed replacement. The carpets were dirty, stained and worn in places. A rug was used to cover a large stain and this was causing a trip hazard to the peopel. One of the managers said that due to a dispute with the carpet manufacturers they were unable to replace them. We found out that this dispute had been over the past two years. Bedrooms of residents were kept personalised and tidy. The rooms were centrally heated and had natural lighting. Laundry facilities were sited away from the food preparation area. The laundry assistant was on duty during our visit. S/he explained to us the system in place for laundering residents clothes and replacing them in their bedrooms. Care Homes for Older People Page 19 of 30 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. There is a lack of ongoing training and development for the staff. The staff competence and skills are not formally monitored by the systems at the home, but the staff say that they are supported by the nurses. The staffing levels are maintained at the minimum level. Evidence: The staff rotas were completed in advance. On the day of our visit there were two students taking part in non-personal care activities. We noted that the contribution from the students helped the staff with their workload. Domiciliary staff were employed in sufficient numbers to deal with cleaning, cooking and house keeping. The care staff were given the opportunity to take part in (NVQ Level2) National Vocational Qualifications in care and this had been taken up by most care workers. Some care staff were in the process of completing NVQ level3. We checked three staff training records, spoke to two staff about the training they receive at the home and took on board the feedback from our surveys. The records we checked were not up to date. There were several gaps in the training. The managers assured us that they were in the process of organising training. These were some of the comments. I have not attended any training here, apart from Adult Safeguarding. Difficult to go on training. But not keen on in house training. The Care Homes for Older People Page 20 of 30 Evidence: manager is good at helping. She shows us and gives us support if we are not sure.! Have attended Fire drills but have not had training on Fire safety here. We checked three staff recruitment files. There was evidence that the checks had been carried out and they were correct. However, none of the three files had a recent photograph of the staff. Not all of the staff had received a copy of their contract and none of them had signed to agree the terms and conditions. One of the managers said that she was working on this. There was further confusion as to who was responsible, whether the registered manager or the relative of the provider for the staff recruitment training and retention. Care Homes for Older People Page 21 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect to those who use the service and those who work at the home. Working practices and the day to day management lack clear line of accountability. The home is managed by two individuals; the registered manager and a relative of the provider who is also known as manager. The management have developed quality assurance systems. However, these have not been tested by the staff. Evidence: The registered manager is an experienced first level nurse. She is registered with the Care Quality Commission CQC. The senior staff were familiar with the disease and conditions associated with old age. We noticed that there wasnt a clear line of accountability within the home. This is due to two people managing the service. The comments we have received confirmed that the care staff received supervisions and support from the senior but they were not taking part in regular formal Care Homes for Older People Page 22 of 30 Evidence: supervisions. Following a conversation with the staff and the management we ascertained that the manager did not have the resources, autonomy or the necessary training to organise and carry out supervision of her senior staff and promote and monitor other staff supervisions within the home. The registered manager had records of accidents, injuries and incidents and these events have been notified to the care quality commission under regulation 37. The staff training records showed that there were several gaps and that the present arrangement did not provide staff with the necessary training. The comments we received highlighted the the training was in-house and videos & questionnaires were used. There was a lack of outside/independent training. We have discussed this issue under staff training and have made requirements. The gaps in training were on health & safety, moving & handling, fire safety, food hygiene and Infection control. These are essential to maintain the health and wellbeing of the people living and working at the home. One of the managers confirmed that all service certificates (such as lift checks, electrical circuit, portable appliance checks etc.) were up to date and that regular maintenance checks had been carried through. The registered manager confirmed that recently employed staff have had induction training and worked alongside experienced staff before they were allowed to work on their own. The records were not accessible for our verification since the manager was unable to locate them. However, the staff we spoke with confirmed that they had received induction training and told us what was included in the induction. There was also confusion about the need for regulation 26 visits and reports since the relative of the provider said that she was in the home most days. We explained what was expected of the provider to comply with regulation 26. We referred to the document where it is outlined that one of the partners or the responsible individual is required to visit the home unannounced atleast once a month and interview with consent, residents, visitors and staff working at the home to find out the standard of care provided at the home. They need to inspect the premise and records including complaints and produce a report to the manager each month. This is an ongoing process where the responsible individual for the home is able to put into action improvements and monitor the running of the home. On our tour of the premise we visited some bedrooms where we found pillows used by the residents to be lumpy and not fit for purpose. The registered manager was Care Homes for Older People Page 23 of 30 Evidence: present. Some bedroom doors were held open with wedges even when residents were not in their rooms. Although the home was compartmentalised for the purpose of fire safety it is necessary for bedroom doors to be kept shut to contain any fires. Care Homes for Older People Page 24 of 30 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 25 of 30 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 9 13 The manager must ensure that accurate records are kept of all the medicines leaving the home for disposal. This is to ensure that there is no mishandling of medicines. 13/01/2010 2 12 16 The registered manager 13/01/2010 must ensure that residents are consulted and organise a programme of activities on behalf of the residents. The activities need to be in relation to recreation, fitness, religious and social activities. So that the residents are able to keep in contact with people and also kept occupied to avoid boredom. 3 19 23 The provider must ensure that the home has storage facilities. 13/01/2010 Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that bathrooms and empty bedroom are not used as store rooms. 4 19 23 The carpets identified as worn, stained and not fit for purpose must be replaced without delay. So that peoples health and safety are not compromised. 5 27 18 The staffing numbers must reflect the dependency levels of the residents. So that residents are able to receive the identified care. 6 29 19 Proof of identity of the workers at the home must include individuals recent photograph. So that people living and working at the home are protected from strangers entering the home. 7 30 18 To protect and promote the 18/01/2010 health, safety and welfare of the residents at the home the management must make arrangements without delay training for staff on moving & handling, health & safety, fire safety, food hygiene, and infection control. 18/01/2010 18/01/2010 13/01/2010 Care Homes for Older People Page 27 of 30 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 To ensure all staff are trained and competent to carry out their duties. 8 31 8 The day to day management 18/01/2010 involvement of both the registered manager and the second manager puts into question the accountability and the responsibility of the registered manager. There must be clear lines of accountability within the home. So that the registered manager is able to execute her authority and work towards fulfilling the Conifers aims and objectives. 9 33 26 An unannounced monitoring 18/01/2010 of the service provided by the home must be carried out each month by the responsible individual for the home. The visit needs to include with consent interviewing residents, visitors and staff, a tour of the premise to monitor safety and any improvement needs. So that the provider is confident that the home is providing the appropriate Care Homes for Older People Page 28 of 30 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 care to the individual and the people are safe. 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 11 The care staff must receive training on Palliative care, practical assistance and advice.So that the staff will be competent in delivering End of Life Care to those at the home The provider must ensure that there are enough chairs for the use of the staff and the visitors. The staff must be able to sit comfortably by the side of the residents when they help them at meal times. The relatives must have access to chairs when they wish to sit beside the residents. Through effective quality assurance the management must develop annual plans for the home based on systematic planning, improvement and review. So that the structural development and improvement could provide good outcomes for people living and working in the home. The registered manager must ensure that all the staff working at the home receive regular supervision which needs to cover- care practice, philosophy of care and the individuals career development. So that the staff are competent and fit for the job. Therefore not compromising the needs and safety of the residents at the home. The management must ensure that the environment within the home is kept safe by providing storage areas. So that the health, safety and the welfare of the service users are promoted and protected. 2 19 3 33 4 36 5 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!