Inspection on 19/01/10 for Whittington Village

This is the latest available inspection report for this service, carried out on 19th January 2010.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whittington Village 22/10/08

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF     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: Rose Moffatt     Date: 1 9 0 1 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 31 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 31 Information about the care home Name of care home: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF 01246455000 01246453018 bridgethodgkinson@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Whittington Village Ltd care home 18 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: 18 The registered provider may provide the following category of service only:- Care Home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons Code OP Date of last inspection Brief description of the care home Whittington Village provides personal care for up to 18 older people. It is situated on the main road in New Whittington, on the outskirts of Chesterfield. The home is a detached house that has been extended. The majority of the bedrooms are single with en-suite facilities. The home is set back from the road and has a patio/garden area at the rear. Local amenities, including a post office, shop and pub are located nearby. Fees at the home range from £344.82 to £426.38 per week. This information was provided by the acting manager on 19th January 2010. Care Homes for Older People Page 4 of 31 Over 65 18 0 0 2 0 9 2 0 0 9 Brief description of the care home Information about the home, including CSCI/CQC inspection reports, is available from the acting manager. Care Homes for Older People Page 5 of 31 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 quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other Care Homes for Older People Page 6 of 31 people have told us about the service. The home went into administration on 11th August 2009. The administrators are involved in the day to day management of the home and are providing support to the acting manager and staff. At the last key inspection in September 2009 the overall rating for the home was poor and so the home was included in the CQC improvement strategy. A management review was held with the inspector and regulation manager, and then a meeting with the administrators of the service. The administrators were required to produce an improvement plan detailing how they were going to make the necessary changes to comply with the regulations and improve outcomes for people living in the home. The improvement plan was produced in the required timescale and further updates provided to show progress made to meet requirements. We carried out an unannounced inspection visit by 2 inspectors that took place over 5 hours on 19/01/2010. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home but did not receive any responses. The acting manager told us they had not received the surveys at the home. There were 8 people accommodated in the home on the day of the inspection visit. People who live in the home and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 2 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that the Statement of Purpose and Service User Guide for the home is available to all people in the home and their representatives, in appropriate formats. This will give people better access to information about the home. Always record all medication received into the home. This will help to ensure a robust system for the safe-handling of medication. Develop the range of activities and employ an activities coordinator. This would ensure that all people in the home are offered opportunities to be involved in appropriate activities in and out of the home. Provide people living at the home with meals that offer variety, choice and reflect individual preferences and needs. This is so that a person centred approach to care is supported and nutritional wants and needs are met in imaginative ways. Ensure that staff are not be employed at the home without all the required checks and references in place. This is to protect people in the home and so that the homes managers can be sure that only the right people for the job work at the home. Provide training for all staff working at the home that helps them do their jobs more effectively and professionally. This is so that the health, welfare and safety of people living at the home is maintained. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. The Statement of Purpose and Service User Guide were not available to people living there, (or their representatives), so they did not have sufficient information about the home. There were gaps in staff training and a lack of structured activities so that the needs of people in the home were not fully met. Evidence: The Statement of Purpose and Service User Guide were not available in the home as they were in the process of being amended and updated. There had been no admissions to the home since the previous inspection in September 2009. We looked at the care records for 2 people in the home. For 1 of these people there was a new format for the assessment of needs and care planning. This included details of all their assessed needs and personal preferences regarding their daily Care Homes for Older People Page 11 of 31 Evidence: routine. There was also a separate assessment of their needs from their social services care manager. The other persons record was the only one in the home that had not been updated to the new format. No changes had been made in this record since the last inspection and so there was insufficient detail about their needs. We found from observation, discussion with the acting manager, and looking at records that this persons needs were not fully met at the home. We found that staff had not had all the training necessary to ensure they could understand and meet peoples needs. The new format for the care records included space to record if the person had made any advance directive about their care. There was also a mini mental examination looking at the persons mental abilities. There was no specific assessment of the persons mental capacity to make decisions. Standard 6 did not apply as there were no people in the home receiving intermediate care. Care Homes for Older People Page 12 of 31 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. Although improvements had been made, there were still some inconsistencies in care plans and reviews so that peoples needs were not always fully met. Evidence: Since the previous inspection in September 2009, new care plans had been introduced and were in place for all except one of the people in the home. The new care plan we looked at for one person covered nearly all of their assessed needs. This person had been assessed as at risk of developing pressure sores but there was no care plan in place about pressure area care. The care plans in place had sufficient details of the action required by staff to meet the persons needs. The care plans were written in October 2009 and had been signed by the persons relative to indicate their agreement and involvement. There were no recorded reviews of the care plan. The acting manager told us that care plans should be reviewed monthly and we saw evidence of this in 2 other care records. One person did not have a new care plan in place. Their existing care plan had not been reviewed or added to since the previous inspection and so still lacked sufficient Care Homes for Older People Page 13 of 31 Evidence: detail of their needs and of the action required by staff to meet those needs. We found evidence in daily records that this persons needs had changed and although the acting manager was able to verbally update us about action taken in response, there was nothing recorded in the care plan. The new care plans included nutritional screening, an assessment of the risk of developing pressure sores, an assessment of the risk of the person having falls, and an assessment of the persons mental health status. These were all completed in October 2009 for one person but had not been reviewed since then. There were similar assessments in place for the other person whose records we looked at. None of their assessments had been reviewed since June 2009. We found that people were referred appropriately to the GP when required. GP visits, and visits from other healthcare professionals, were noted in the persons daily records. There was no separate record to provide quick and easy access to this information. The new care plans included prompts for staff about maintaining the persons privacy and dignity and encouraging their independence. The preferred name and daily routine was included in one of the care records we looked at. We observed that staff generally had a friendly and appropriate approach to people. For one person, we observed that staff sometimes appeared to lack understanding of the persons needs. Medication was stored securely in the home. There were satisfactory records of the administration and disposal of medicines. Medicines received into the home were not always recorded. The care plans seen lacked detail of medicines prescribed as required. Staff who administered medication had received appropriate training. As noted at the previous inspection, there were no assessments of staff competence in the safe-handling and administration of medicines. Care Homes for Older People Page 14 of 31 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. There was an unstructured approach to planning activities and meals so that people lacked choice and their needs were not fully met. Evidence: One of the care records we looked at had details of the persons life history, family, previous interests, and preferred daily routine. The other care record did not have these details. People told us they liked living in the home - Im happy here. We observed that people who were physically able to could move freely around the home and could use the different lounges if they wanted to. Peoples bedrooms were personalised with their own possessions. Meetings were advertised for people in the home and their relatives/ representatives. However, the acting manager said these meetings had not taken place as there had been no interest from peoples relatives. People were asked their opinions about life in the home at the monthly visits of the area manager, monthly audits by the acting manager, and through annual surveys. We found the range of activities offered had not changed since the previous inspection. There was little evidence of a structured approach to providing meaningful Care Homes for Older People Page 15 of 31 Evidence: activities for people, particularly for 2 people with learning disabilities. During the inspection visit we observed people watching television and playing dominoes. The acting manager told us that staff sometimes took people out to local shops, and that they had visiting entertainers. There was no regular church service at the home and none of the people there went out to church. The acting manager said that a visitor from the local church had stopping coming to the home due to retirement. The acting manager said that no-one in the home had expressed a wish to go to church or to have a church visitor, but if they did this could be arranged. As found at previous inspections, there was no cook employed at the home and so care staff were responsible for planning and preparing meals. A brief visit was made to the kitchen and the member of care staff who was responsible for cooking lunch described current arrangements. She described how the menu was developed on a daily basis, usually the previous day, and depending on what was available in the cold storage. The deputy manager was responsible for regular shopping trips to local suppliers and for keeping the meat supply and freezers stocked up. We looked at the menu record for the last month and noted, from the sample of meals that had been served, that there had been a selection of traditional style meals on offer and that all of the eight residents had opted for the main choice. There was no indication that any other option had been available, although the member of staff indicated that they knew peoples preferences and would be able to offer something else if they wished. There was some variety served during the past month but we noted that roast pork nearly always featured on Sundays and egg and chips was always served at least once during each week. Arrangements for purchase, storage and stock control of food supplies were satisfactory, with a good supply of fresh vegetables and cakes in the refrigerators and freezers. At the time of the inspection we were told that there was nobody at the home who had any special dietary needs. We observed lunch being served and, where people needed help, staff were seen to individually sit with them with them to offer the assistance they needed. Each person had a drink of their choice and where people asked for something different this was provided to them. Each person had different portion sizes and used cutlery appropriate to their skills to eat independently where possible. People told us they always enjoyed the meals provided, although they said they never knew what was on the menu for the day. Care Homes for Older People Page 16 of 31 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. Appropriate action was taken to address complaints, ensuring that peoples concerns were taken seriously. There were gaps in staff training so that people were not fully protected. Evidence: The complaints book was kept in the main entrance area and still had the previous name of the home on the front cover. There were 2 complaints recorded since the last inspection with details of the action taken and the outcome. As the complaints records included personal information, we advised that the complaints book should be kept more confidentially and the acting manager moved it into the office. The complaints procedure had not been updated as recommended at the last inspection and so still had incorrect contact details for CQC. We had not received any complaints about the home since the last inspection. We had received information from Derbyshire County Council adult social care services in January 2010. They informed us of their concerns about the heating system in the home as they found it was not adequate for people living there. They told us they were satisfied with the action taken by the acting manager in response to these concerns. There were satisfactory policies and procedures in place regarding the safeguarding of Care Homes for Older People Page 17 of 31 Evidence: vulnerable adults. Staff had not received any training updates concerning their responsibilities to identify and report any suspicions of abuse since May 2008. Staff spoken to had a satisfactory understanding and told us that they would make the situation safe, inform the acting manager or, in her absence, tell Social Services, theyre the key people. Care Homes for Older People Page 18 of 31 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. Standards of maintenance, decoration and physical comfort of the home had been reestablished after problems identified at the last inspection, although items of maintenance, repairs and health and safety activity could still put people at risk. Evidence: During this inspection we carried out a tour of the building, including communal and bedroom areas and noted improvements that had been made since the last inspection as well as a number of items that still need attending to. Overall we noted that the majority of the work required had been completed. We found that: the skirting board in room 5 had been repaired and replaced, the window in bedroom 4 had been repaired, the large cupboard and medication trolley had been removed from the main lounge and placed in the managers office, the arrangements for the small lounge where residents smoked was in compliance with smoke-free legislation, all the items in the food refrigerator were labeled and properly managed, liquid soap had been placed in all toilets, the kitchen extractor fan had been cleaned and there were records of a cleaning schedule in the kitchen, the sluicing programme in the laundry was being properly operated, the lift shaft had been serviced and a certificate of worthiness obtained. We found that the following was still outstanding: work to replace double glazing in Care Homes for Older People Page 19 of 31 Evidence: two bedrooms, floor covering in the lower ground floor bedroom en-suite bathroom was cracked, although this room was unoccupied, hand washing sinks in the kitchen and toilets did not contain any paper towels, the inspection by the Environmental Health Officer made in November 2009 made three requirements that had not been attended to, one item in relation to manual handling equipment remains from the last inspection, as noted in the Management and Administration section of this report. In general, we noted that there had been no decorating carried out since the last inspection and the home continued to be in need of attention, both inside and out. The home was warm and comfortable during the inspection, but the acting manager described difficulties during the recent extremely cold weather when they had been unable to get a balance between the temperatures of the upstairs and downstairs of the home. This had been the subject of recent visits by officers of the adult social care department of the Derbyshire County Council. Each persons bedroom that we viewed had personal possessions in them to make them homely and all had been fitted with modern furniture. Residents were seen to have the run of the ground floor in safety and there were no areas that they needed access to that were locked, other than general storage areas, the kitchen and laundry. We saw some specialist manual handling equipment around the home but staff told us that this was not in use for any of the people living at the home at present. None of them required any other equipment such as bed-rails or nursing beds. From our tour of the building we found the home to be very clean apart from one toilet which had a strong odour. We noted that a number of bottles and other items of cleaning materials were stored in unlocked cabinets in bathrooms and staff removed these to the general storage area at our request. The laundry was equipped with a good range of equipment and we were told by staff that all of the laundry was completed each day. We saw that there was sufficient bed linen and towels in the general storage area and that all the people living in the home were seen wearing clean and well presented clothing at the time of the inspection. As noted at the last inspection, although staff had received training in infection control, there were no records of this. The acting manager told us this was due to difficulty in getting certificates from the training provider. Care Homes for Older People Page 20 of 31 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. The home has adequate numbers of staff to carry out the physical care needs of the people living there but there have been failures in the recruitment and training systems that help staff to do their jobs properly, safely and in a professional way. Evidence: During the inspection we spoke to all of the staff on duty during the day, and noted that the manager was operating in an acting capacity. They told us that there had been few changes in staff at the home over the past two years, with two staff being appointed to night duty during 2009. They felt that the staff group offered stability and consistent care to the people living at the home because of this, and the written records confirmed that only one new member of staff had been employed since the last inspection. All of the staff spoken to expressed high levels of satisfaction with their work, in spite of being worried about the future of the home, and they were aware of all the difficulties that had been occurring with the homes ownership during 2009. We examined individual staff files and the record of the training for staff during the past five years and found that there had been no training activities since the last inspection and the findings described in the last report remain the same. For the two recently appointed night care staff this meant that they had received no formal training in that period, apart from one appointed in August 2009 who had been given Care Homes for Older People Page 21 of 31 Evidence: a three day induction which covered care at the home in a very basic way. For example, staff had not received any updates concerning their responsibilities to identify and report any suspicions of abuse since May 2008 and in respect of safe moving and handling since July 2007. The staff we spoke to confirmed this and additionally told us that we need to have training updates in order to sure we are working safely and moving and handling training is important as the updates tell us about any changes; it always seems to be changing and we need to be safe. We found that all of the established staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 and the acting manager said that a number had enrolled for level 3, which is to be commended. We looked at the personnel files of the two night carers who were appointed in 2009, and although one contained evidence of the proper checks and references being made, the most recent did not contain or details of any employment history or written references from previous employment. The acting manager told us that there had been difficulties with this because the person concerned did not have any previous paid employment to refer back to, and that she had been trying to obtain two character references as a minimum compliance. We wrote to the administrators following the inspection, requiring them to take urgent action to comply with the requirement made about ensuring all the required documents and information are in place when new staff are employed. Examination of the duty roster and discussion with staff indicated levels of staff on duty that were satisfactory, with the target of two care staff throughout the day (for currently eight residents) being achieved. The acting manager was supernumerary to these numbers for five days a week. Staff told us that the impact of this was for a workload that we can manage OK and that there is more time to sit and be with the residents in the lounge area. We saw the latter occurring throughout the inspection. Additionally the staff spoken to were positive about working at the home; they told us that: We all work well together, its a stable group. In spite of the uncertainties I love working here, its like a home from home here. Well all carry on regardless; its our job to make sure people are safe and happy. The small size of this home is the best thing; its homely and we work hard to keep people as independent as possible. Care Homes for Older People Page 22 of 31 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. Improvements had been made so that the health, safety and welfare of people in the home was better promoted. However, there were still gaps in staff training, staff records, and some environmental issues that may put people at risk. Evidence: The acting manager had been in post for over a year, having previously worked in the home as a senior care assistant. She had not made an application to be registered with us and told us she did not intend to do this as she did not wish to continue in the role. The acting manager had support from the administrators to manage the home and said she felt positive progress had been made since the last inspection. The administrators had produced an action/improvement plan after the last inspection in September 2009 and had provided an update of this in November 2009 showing the progress made. The acting manager showed us a new system of internal quality assurance audits Care Homes for Older People Page 23 of 31 Evidence: recently introduced by the administrators. When the system was fully operating there would be monthly audits of all aspects of the home, such as health and safety, staff training, and accidents. So far, the acting manager had completed an audit of the system for the safe-handling and administration of medication in the home. The acting manager told us that quality assurance surveys had been sent out to the relatives/representatives of people in the home in December 2009, though none had been returned yet. The acting manager said that surveys would be given out to people in the home later in the year. The acting manager told us that the annual quality assurance assessment (AQAA) for the home had been completed and returned to us in October 2009. However, we had not received this as it had been sent to an out of date address for CQC. As the acting manager did not keep a copy, we have requested another AQAA to be completed. A representative of the administrators visited the home every month and produced a report as required under regulation 26. At the last inspection the systems in place for looking after the personal money of people in the home were found to be unsatisfactory. At this inspection the acting manager described how these had been changed so that the two people whom they support with personal spending money now have individual systems in place and cash floats available within the home. We did note that the record sheets did not contain two signatures of the staff involved in transactions. The acting manager told us about standards of health and safety activity at the home and we found that all the requirements relating to this that were made at the last inspection had been dealt with. We examined records which supported this. Additionally observations made around the building and examination of fire safety and equipment records indicate that the home was hazard free at the time of the inspection, although we noted that the testing of portable electrical equipment had not been carried out since 2008; the manager informed us that quotations for this work had been obtained and the matter was in hand. There was an outstanding requirement from our inspection in 2008 that had not been fully met. The passenger lift in the home had been recently serviced as required, however, the equipment used for manual handling had not been serviced and maintained. The bath hoist was in regular use, the lifting hoist was not required by any of the people currently in the home. The acting manager told us that she had recently reminded the administrators of this requirement but no further action had Care Homes for Older People Page 24 of 31 Evidence: been taken. There was another outstanding requirement from our inspection in 2008 regarding staff records that had been partly met. As noted in the Staffing section of this report, the records for one member of staff had been updated to include all the required information and documents, but one newly recruited member of staff did not have two written references in place as required. Also as noted in the Staffing section of this report, a requirement to provide fire safety training for all staff had not been fully met. Following the inspection, we wrote to the administrators about our concerns regarding the outstanding requirements, (as above re manual handling equipment, staff records and fire safety training), not being fully met. We required them to take urgent action by 26th February 2010. Care Homes for Older People Page 25 of 31 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 29 19 Staff records must include all 26/02/2010 the required information and documents, specifically, a full employment history and two written references. This will ensure people are better protected by a more robust recruitment system. Previous timescale was 30 October 2009. This has been partly met as some improvements had been made. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. 2 30 23 All staff at the home must have training in fire prevention. This will help to protect people living in the home. Previous timescale was 30 October 2009. This has been partly met as all except 2 staff had received training. Therefore, a time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. 26/02/2010 Care Homes for Older People Page 26 of 31 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 3 30 13 All staff in the home must have up to date training in manual handling from a suitably qualified and experienced person. This will ensure that the health and safety of people in the home is promoted. Previous timescale of 31st December 2009 has not been met. A time extension has been allowed. If this extended timescale is not met, enforcement action will be taken. 31/03/2010 4 38 23 All equipment used for the 26/02/2010 manual handling of people in the home must be regularly maintained and serviced. This will ensure compliance with relevant health and safety legislation and promote the safety of people in the home. Previous timescale was 30 October 2009. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. Care Homes for Older People Page 27 of 31 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 1 5 The Statement of Purpose and Service User Guide for the home must be made available to all people in the home and their representatives. This will ensure that people have access to information about the home. 26/02/2010 2 7 15 There must be a care plan in 26/02/2010 place for the identified person that details their health and personal care needs and how these are to be met. This will help to ensure their care needs are fully met. 3 9 13 There must be records of all medication received into the home. This will help to ensure a robust system for the safehandling of medication. 26/02/2010 Care Homes for Older People Page 28 of 31 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 4 19 23 The windows in the 31/07/2010 identified bedrooms must be replaced. This will improve the environment of people living in the home. 5 26 13 Disposable towels must be provided in all communal toilets and bathrooms, and in all areas used by staff. This will help with the control of infection in the home. 26/02/2010 6 30 18 All staff working at the home 31/03/2010 must receive training that helps them do their jobs more effectively and professionally. This is so that the health, welfare and safety of people living at the home is maintained. 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 1 The Statement of Purpose and Service User Guide should be available in suitable formats to meet the needs of people in the home, for example, in large print. The admission processes should include: recording whether the person has made an advance decision on receiving medical treatment, and if they have a 2 3 Care Homes for Older People Page 29 of 31 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 Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative; consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are safeguarded and their rights are promoted. 3 7 Care plans and assessments should be reviewed at least every month to ensure that peoples changing needs are known and met. There should be annual assessments of staff competency in the safe-handling and administration of medication, carried out by am appropriately trained and experienced person. This will ensure a more robust system that protects people in the home. The range of activities should be further developed and an activities coordinator should be employed. This would ensure that all people in the home are offered opportunities to be involved in appropriate activities in and out of the home. People living at the home should be provided with meals that offer variety, choice and reflect individual preferences and needs. This is so that a person centred approach to care is supported and nutritional wants and needs are met in imaginative ways. The floor covering in the en-suite bathroom to the ground floor bedroom should be replaced to ensure a pleasant and safe environment for any person living in this room. An annual report should be produced from the analysis of quality assurance measures taken in the home, giving details of the action taken to meet issues raised. The report should be made available to people in the home and their representatives. This will help to ensure the home is run in the best interests of people living there. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. 4 9 5 12 6 15 7 19 8 33 9 33 Care Homes for Older People Page 30 of 31 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. 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