Inspection on 18/03/10 for Abbegale Lodge

This inspection was carried out on 18th March 2010.

CQC found this care home to be providing an Poor 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbegale Lodge 02/06/10

Abbegale Lodge 06/10/09

Abbegale Lodge 17/06/08

Abbegale Lodge 15/05/07

Abbegale Lodge 07/02/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Abbegale Lodge 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG     The quality rating for this care home is:   zero star poor 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: Michael Perry     Date: 1 9 0 3 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 41 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Abbegale Lodge 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG 01519223124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: brenda.bailey@blueyonder.co.uk Mr Ramesh Chander Parkash Sabberwal care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named out of category service user in the category of Learning Disabilities. This variation applies to the named service user only. Should they leave the home, the variation will cease to apply. One named service user under pensionable age Ramp access to be provided to the home within six months of registration. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Abbegale Lodge is an established privately owned care home that is registered to provide residential care for 41 older persons. Mr Ramesh Chander Parkash Sabberwal is the registered provider. The registered manager is Miss Brenda Bailey. The service is situated on a busy road close to bus services and a train station. It is within easy Care Homes for Older People Page 4 of 41 Over 65 41 0 0 6 1 0 2 0 0 9 Brief description of the care home distance of local amenities. The service is set out as two converted Victorian villas with a two storey modern extension. There is lift access to the main building with a stair lift in place to the other villa and extension. A ramp access is provided to number 11. The service has a call bell facility in residents rooms and public areas. The service provides upper and ground floor accommodation with lounges and dining rooms in each ground floor area. A large rear garden and off street parking is available to the front of the premises. Weekly fees are £383. Care Homes for Older People Page 5 of 41 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: zero star poor 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 inspection was a key [main] inspection for the service and covered the core standards the home is expected to achieve. We visited the home unannounced and the inspection took place over two days. This inspection follows a previous key inspection in October 2009 when the home was rated as poor in terms of overall outcomes for people. We met and spoke with a number of residents and visiting relatives. We also spoke with members of care staff on a one to one basis and the registered manager and the provider who was also in attendance [for feedback at the end of the inspection]. Resident survey forms [comment cards] were also issued prior to the inspection and some of these were returned and comments have assisted in the inspection process. A tour of the premises was carried out and this covered all areas of the home including peoples bedrooms. Records were examined and these included three of the residents Care Homes for Older People Page 6 of 41 care plans, staff files, staff training records and health and safety records. Prior to the inspection the provider [owner] completed a pre inspection self assessment form [AQAA] which detailed some information about the home and gave some up to date information. A pharmacy inspector was also present on the first day of the site visit and findings and any requirements and recommendations are included under the Health and Personal Care section of the report. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: We have not listed all of the requirements and recommendations in this summary and we would refer you to the main body of the report and the full requirements listed at the end of the report. We have concentrated here on the main or key findings that we feel the service needs to address. We looked at care plans for one resident who is diabetic and there was a lack of information as to how care needs are to be addressed. This is especially important in respect of conditions such as diabetes, as this condition must be monitored to ensure a persons good health and welfare. Care Homes for Older People Page 8 of 41 We were concerned when reviewing other care records as although they had been updated by the staff the information was not accurate in respect of their current health needs. This was noted for a resident who had fallen recently, a resident who had a break to their skin and also a resident who needed monitoring with regard to their nutritional intake. There was a lack of detail as to how the staff were to provide the necessary care and support to keep the residents in good health. We noted that a number of residents had needed prescribed medications for medical conditions, for example, a chest infection and at that time there was no plan of care for staff to follow to provide the necessary care and support. The AQAA reported, health care professional advice is sought regularly for our service users (residents). This was found not to be the case. No medical referral had been made for a resident who had suffered a number of falls or for the resident who had lost weight. Specific risks had been recorded in respect of the residents health but again the information was lacking or not accurate and this has the potential to place people at risk. These points were discussed with the manager who seemed generally unaware of how the residents health was being monitored. We have advised the manager that the health and care needs of the residents must be monitored effectively to ensure their well being. Current practices are placing people at risk. We looked at how personal care is carried out and were concerned that medical examinations and also the emptying of commodes were not conducted so that peoples privacy and dignity are maintained. This must be addressed. Some people had chosen to self-administer some medicines. As seen at our previous visit there was no written information within their care plans to show how safe selfadministration was supported by care staff. Again we saw that staff authorized to handle medication were only normally on duty between 08:00 in the morning and 21:00 at night. This does not allow for much flexibility in the times that medicines are administered and medicines cannot normally be given at night. This has been an outstanding issue over a number of inspections. We looked at how information within peoples care plans supported the safe handling of medication. As previously seen we found a lack of information about the use of medicines prescribed when required and about the use of prescribed external preparations e.g. creams and lotions. We saw that one person had several lotions and creams but their care plan had no information about how and when they should be used. The manager carries out audits of medicines handling but although improvement was seen in some areas these have not been fully effective in identifying and addressing weaknesses in the homes procedures for handling medication. We have made further requirements and recommendations. At the time of the inspection we had a serious concern as to how a residents money was being managed. There was a lack of evidence to support the persons financial interests and the practice we saw did not protect them and was open to abuse. We issued an immediate requirement notice telling the manager to stop any further financial transactions and we reported this through the appropriate channel for a safeguarding investigation. Care Homes for Older People Page 9 of 41 We toured the environment of the home and we have continued concerns around the general maintenance and management including infection control issues, health and safety hazards and general upkeep and monitoring. These are listed in detail and we have made specific requirements. Overall there is a lack of clear planning and management of the environmental standards in the home and there is an absence of routine maintenance which puts people [residents and staff] at risk. We have made another requirement that the provider and manager of the home liaise effectively to produce a development plan which includes named responsibilities and specific deadlines and that this is consistently reviewed. The home is divided into 3 separate units and we found issues in all of the units that suggest the home is not adequately staffed. For example in the main building there were two staff on duty for fifteen [15] residents. There is no laundry staff and care staff are also expected to help out in the kitchen on occasions [we observed this over lunch periods]. There were periods where we found it difficult to locate staff and residents were left unsupervised for lengthy periods. Some personal care was left unattended [e.g commode emptying] Staff spoken with confirmed that because of a lack of ancillary staff cover care staff are expected to help out with these extra tasks. This means that there is not clear boundaries to peoples duties and direct care may be affected. A review of staffing numbers is required to ensure enough staff to carry out care needs are regularly on duty. Although training has generally improved in the home we also found some ongoing anomalies such as the medication training issue. We also found that the cook is in need of an update in food hygiene and that this had been recommended by environmental health in early December 2009. We would recommend that training needs are formally analyzed by the manager so that priorities can be assessed and planned appropriately. There was a previous requirement to ensure staff are appropriately recruited and that all necessary checks are in place to ensure they are fit to work with vulnerable people. Again we found anomalies in staff recruitment records indicating that required checks needed prior to employment are not being met. These checks are important to ensure staff are properly recruited and are suitable to work with vulnerable people. Over all we are concerned that key issues such as deployment of staff and staff recruitment processes are not managed in the best interests of people living in the home. We spoke at length to the manager, Brenda Bailey, about our concerns regarding the ongoing failings in management of the home. Brenda had poor knowledge about some of the issues we asked about and a poor overall concept as to the running of many of the management systems in the home. Another example of this includes a lack of action and knowledge around the health and safety risk assessment carried out by an independent consultant and presented to the home some 6 weeks prior to our visit. The manager was unsure or didnt know or had not actioned any progress with regard to key issues identified in the report such as overall health and safety policy and who the responsible people are. Other idendified areas were risk assessments needed for people on top floor regarding fire exits, risk assessments for pregnant members of staff, an identified need to stop residents entering the basement area [to many hazards], recording of fridge temperatures and covering of radiators to ensure people Care Homes for Older People Page 10 of 41 are protected from burns. None of these had been actioned. This is of major concern as although issues have been identified there has been little management action to ensure these are addressed. We use this as an example of the overall lack of control and adequate planning to ensure objectives are prioritorise and met. Many of the systems in the home remain fractured or incomplete and there does not seem to to be any overall management plan [or development plan] to set key objectives and prioritorise and this needs to be a main aim of the manager. Some practices such as the policies and procedures for safe handling of monies on behalf of the residents must be improved to ensure their ongoing protection. We have previously made comments about the many maintenance and compliance issues around health and safety in the home which has meant we have had to issue five immediate requirements to ensure essential standards are met. This shows poor monitoring and management of this area. Overall the management of the home has failed to ensure essential standards. 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 11 of 41 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 12 of 41 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. Residents do not have sufficient information about the home to enable them to make a decision whether the home is right for them. This includes terms and conditions of accommodation, so their best interests may not be protected. Evidence: We asked to see written information regarding Abbegale Lodge, as surveys received from residents indicated they had insufficient information about the home. There was no evidence of a Service User Guide. This is the document we require care homes to have and it must provide detailed information regarding the home. For example, details of the facilities, terms and conditions of occupancy and a brief description of the service. People thinking of moving into a care home must have sufficient information to help them to decide whether the home is right for them. The Statement of Purpose was generic in style and had not been personalised with the homes details. The manager said she was reviewing this document, however we saw no evidence of this. We were also advised that there were information leaflets about the home, Care Homes for Older People Page 13 of 41 Evidence: though these still had the previous owners names printed on them. As did an external noticeboard. The staff provide care and support for residents who are privately funded and also those who are funded by the local authority. We asked to look at residents contracts and terms and conditions of residency. Of the four files seen, only one person had a contract. All residents must receive a statement of terms and conditions of their accommodation, so that they are aware of their rights of occupancy and what they expect to receive for the fee paid. This helps to protect their best interests. Prior to coming in to a care home, people must have their care needs assessed. This helps to ensure the staff can provide them with the right level of care and support. The manager said that there had been no new admissions for long term care since the last key inspection in October 2009. Two residents had been admitted for respite (short term) care and they had a care needs assessment. The assessments included information in respect of daily living, medical background and prescribed medicines. Staff had sufficient information to enable them to plan the care the residents needed. The manager is in the process of introducing a different format for the assessments and this includes individual quotes from the residents about their needs and expectations. This helps to make the assessment more person centered. The AQAA reported that potential new service users (residents) are encouraged to come in for a meal and have a look round for themselves to see if they like us and to ensure they feel comfortable. This helps them to get a feel for the home and what it has to offer. We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessments. The home does not provide intermediate care and this standard was therefore not assessed. Care Homes for Older People Page 14 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs including medications are not well managed to ensure they receive the care and attention they need. Evidence: We looked at the care file for 6 residents with varying care needs. Each person had a care file with a plan of care and supporting care documents. We noted that some care files contained more information than others and this seemed to be linked to which staff member had completed them. The manager is introducing a new format for the care plans and this, like the the initial assessment, includes quotes from the residents about their care and what they would like staff to do for them. We looked at these new care plans for one resident and there was a lack of information as to how this support will be provided by the staff. This is especially important in respect of conditions such as diabetes, as this condition must be monitored to ensure a persons good health and welfare. The old style care plans which the other residents had, included information in respect of daily living, for example, mobility, personal hygiene, communication and Care Homes for Older People Page 15 of 41 Evidence: nutrition. We were concerned, as although they had been updated by the staff, the information was not accurate in respect of their current health needs. This was noted for a resident who had fallen recently, a resident who had a break to their skin and also a resident who needed monitoring with regard to their nutritional intake. There was a lack of detail as to how the staff were to provide the necessary care and support to keep the residents in good health. We noted that a number of residents had needed prescribed medications for medical conditions, for example, a chest infection and at that time there was no plan of care for staff to follow to provide the necessary care and support. The AQAA reported, health care professional advice is sought regularly for our service users (residents). This was found not to be the case. No medical referral had been made for a resident who had suffered a number of falls or for the resident who had lost weight. Specific risks had been recorded in respect of the residents health but again the information was lacking or not accurate and this has the potential to place people at risk. Instructions to staff to weigh a resident weekly had not taken place and staff were unsure as to the persons current state of health in respect of their intake. All these points were discussed with the manager who seemed generally unaware of how the residents health was being effectively monitored. Other information in the care files included the residents daily care records. These again were completed to different standards by the staff and not always reflected the care and support given each day. At times the record was a statement rather than a summary of the care given during a shift. We have advised the manager that the health and care needs of the residents must be monitored effectively to ensure their well being. Current practices are placing people at risk. When assessing how staff ensure good standards of privacy and dignity towards the residents the following was observed. An optician was visiting at the time of the inspection and we saw optical examinations being conducted in a residents bedroom. We were not given any information to support the fact that the resident had given permission for this to take place in their room. Staff also had not provided any opportunity for the appointments to be carried out in private for each resident as their examinations took place. We also noted that a bedroom had a commode with faecal matter, which was not emptied for a long period of time (approximately 4 hrs) and this was only done when we brought this to the attention of the staff. This shows a lack of respect towards the residents and also poses a risk from an infection control perspective. Care Homes for Older People Page 16 of 41 Evidence: We looked at how medicines were administered. Some people had chosen to selfadminister some medicines. People spoken with were happy with the arrangements in place, but as seen at our previous visit there was no written information within their care plans to show how safe self-administration was supported by care staff. In some cases signed declarations were in place stating that they wished care staff to administer their medication. Again we saw that staff authorised to handle medication were only normally on duty between 08:00 in the morning and 21:00 at night. This does not allow for much flexibility in the times that medicines are administered and medicines cannot normally be given at night. The manager explained that this would be addressed once the booked certificated training had been completed. We looked at how information within peoples care plans supported the safe handling of medication. As previously seen we found a lack of information about the use of medicines prescribed when required and about the use of prescribed external preparations e.g. creams and lotions. We saw that one person had several lotions and creams but their care plan had no information about how and when they should be used. Three of the external preparations had no label and were not listed on their current medication administration record. Records of application were not made, so it was not possible to tell whether they were being used correctly as prescribed. Where records were made to show the use of prescribed external preparations they were not always completed by the person who actually applied them. To help ensure records are accurately maintained they should normally be completed by the person who actually applies the external preparation. We compared a sample of internal (e.g. tablets and liquids) medicines stock and records and found with the exception of an occasional discrepancy we could account for medicines handling in the home. Medicines stock control had generally improved but we were concerned to see that someone had missed three doses of a recently prescribed medicine because the remaining supply had been mistakenly sent for disposal before a new supply was received into the home. A second person was no longer having a prescribed laxative, there were none left in the home although the manager told us they will still need them, at least sometimes. We looked at how medicines were stored and found that all medicines including controlled drugs were safely locked away. However, we were concerned that keys to the medicines trolley were not always securely handled, they should be kept under the control of staff authorized to handle medication. The manager carries out audits of medicines handling but although improvement was seen in some areas these have not been fully effective in identifying and addressing weaknesses in the homes procedures for handling medication. Care Homes for Older People Page 17 of 41 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. Residents should be offered activities and meals to suit individual need, so that there is daily variations and interests for them. Evidence: We spent time in various parts of the home observing the care and support given to the residents. There was a relaxed atmosphere in the flats and also the smaller house N0 11. Staff were seen to have time to sit and talk with the residents and they were being encouraged to join in with a discussion about the daily news. The main house N0 9 is accommodated by more residents and the staff seemed rushed and had little time to sit with the residents. The lack of staff was particularly noted at lunch time when only one staff member was serving the meal. It as also difficult to locate the staff at this time. This is discussed further under Outcome Area 6 [staffing]. There are two lounges in the main house both have TVs, one of which is wide screen. We noted that both televisions were on from the time we arrived to the time we left. Residents were not asked whether they would like to join in any form of social activity at this time. The smaller lounge is adjacent to the smoking lounge and the smell of smoke permeates both rooms. This does not provide a pleasant atmosphere for people to sit in, meet with visitors and for staff to work in. Care Homes for Older People Page 18 of 41 Evidence: There is no structured programme of activities for the residents and residents spoken with in the main house N0 9 said they would like more going on in the home. One resident said, I am bored, likewise another reported, I would like some music and would like to go out more. We were advised by the manager that an activities organsier is soon to be employed for eight hours a week. For the size of the home these hours would not provide sufficient time to organise and implement a meaningfull programme based on what the residents would like to take part in. We advised the manager to reconsider the hours allocated for this purpose. In light of the comments received from the residents, social arrangements need to be improved with urgency. The residents need to be consulted regarding what they would like to take part in, so that their wishes, lifestyle, preferences and expectations are respected. This will help them to enjoy their day. The new assessments detail this information and the AQAA reported that the homes plans are to reassess all service users (residents) to ensure that their lifestyle choices are full encompassed. Residents said they can see a hairdresser and chiropodist at the home and at the time of the inspection an optician was conducting optical examinations. This has previously been discussed under Outcome Area 2 [health and personal care]. Services such as these help the residents to remain independent with respect to their chosen daily lifestyle. The dining room tables in the house No 9 were laid for lunch and the majority of residents were seen to sit together. We discussed the menu with the residents and they said there was no choice at lunch time; the following comments were made, Food is ok, but no choice, if you dont like what is on the menu you go without, Am not sure what you do if you dont like the lunch, I dont think there is any choice, no one has told me and It could be much better. We looked at the menu and this only showed one hot meal at lunch time, we were also advised that frozen vegetables are cooked six days a week. Residents should be assured of a varied diet, so they receive meals of their choice and liking. The manager and cook agreed that the menu needed attention and that a new one would be devised following consultation with the residents. Prior to lunch a number of staff were seen helping with kitchen duties and they said this is the norm, as well as caring for the residents. This is discussed further under Outcome Area 6 [staffing]. Discussion with the cook confirmed that she needs to undertake a certificate in food hygiene. This was also recommended following an inspection by an environmental health officer in December 2009. This will ensure she has the skills and knowledge to handle food safely. Care Homes for Older People Page 19 of 41 Evidence: Visitors were seen at various times of the day and they could meet their family member in the lounges or in their private room if preferred. A visitor to the flats commented that they liked the atmosphere and that staff were interested and attentive to the residents. Community based activities or clubs were not being accessed and this should be included in the development of the activities, as a number of residents are independent. Care Homes for Older People Page 20 of 41 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. Policies and procedures in place are not adhered to and this has the potential to place people at risk. Evidence: The last inspection report had three requirements listed. These were: Failure to ensure complaints are logged and investigated, failure to ensure records are stored appropriately and failure to ensure training for staff in safeguarding [awareness of abuse]. The preinspection information completed by the manager [AQAA] states: We have made sure that the complaints procedure is more accessible to the service users and their relatives and friends by ensuring it is on the main notice boards of each house. Also we have made sure that each house has complaint forms in the general information files by the front door. The investigation procedure has been redesigned to indicate the methodology of the investigation, findings and a summary of the outcomes followed by an action plan should one be required. We have obtained new filing cabinets to ensure that data protection of our service users is maintained. Copies of no secrets and multi-agency framework for safeguarding are readily accessible. The AQAA also stated that there had been 12 complaints over the past year. We looked at the complaints policy and procedure and a copy of the complaint Care Homes for Older People Page 21 of 41 Evidence: procedure was displayed in the home for residents and their family members/representatives to view. Residents interviewed said they had no complaints however, negative comments were received about the food and activities, which we have recorded under Outcome Area 3 [daily life and social activities]. We looked at the complaint log and this recorded three complaints received and the investigations undertaken. One was received from a resident and this has been resolved to the satisfaction of all parties. We asked to view the home safeguarding policy to protect people and this had to be downloaded from the computer. It was not available in the policy folder and therefore not easily accessible for the staff. There was a copy of Sefton and Liverpools Guide to the Protection of Vulnerable Adults and staff interviewed were aware of the correct local procedure to follow should they need to report an alleged incident. Staff also said they carry an alters card which has the contact details for the relevant agencies. The AQAA reported that there had been two safeguarding referrals, as residents were placed at risk. We were aware of these and the subsequent investigations undertaken. At the time of the inspection we had a serious concern as to how a residents money was being managed. There was a lack of evidence to support the persons financial interests and the practice were saw did not protect them and was open to abuse. We issued an immediate requirement notice telling the manager to stop any further financial transactions for this resident and we reported this through the appropriate channel for a safeguarding investigation. This is stated also under Outcome Area 7 [management and administration]. We spoke about current good practice around assessing mental capacity [under the Mental Capacity Act] and also the Deprivation of Liberty safeguards [DOLs]. It is important for the manager and staff to become aware of this legislation as it affects the way people are assessed and how the home provides for choice in all daily activities and decision making. We would strongly recommend that the manager and staff are updated around these issues. Care Homes for Older People Page 22 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home requires better management to ensure comfortable and safe surroundings for people to live in. Evidence: At the last inspection in October 2009 we made two requirements. One of these was specific concerning the provision of bed and furnishings for a resident and the other was more generalized around the need for planned upgrade of the environment generally. We toured the home and observed some improvements to the Flat and number 11 [the home is divided into three separate areas] which has made these areas more comfortable for people. Overall however we were concerned at the lack of progress in many areas and also the lack of effective planning and ongoing routine maintenance which has meant that residents have been left at potential risk. We issued some immediate requirements to address the more serious issues and we have issued specific requirements in this report to address other areas of need. These concerns are: * The hot water from the bath outlet in the flats measured at 60c. This puts people at risk of scalds. There were no bath thermometers in situ to test for safe bath temperatures. The manager advised us that hot water temperatures are recorded on Care Homes for Older People Page 23 of 41 Evidence: chart in the bathroom bu the chart was blank The bath door was open and the room was freely accessible. This was discussed with the manager and we issued an immediate requirement to get measures in place to control water temperatures safely. *One bedroom on the Flat was observed to have a broken window which did not open. Staff were unable to tell us how long this had been broken. The other window in the room likewise did not open so there was no ventilation to this bedroom. We have made a requirement that this is addressed so that the person can ventilate the room. * The laundry in the basement of the main building is currently being upgraded. We saw staff doing laundry and found that there is no designated laundry worker and all staff fill in as needed. This increases the risk of cross infection as care workers are performing a multitude of tasks involving personal care and also [we observed] spending time in the kitchen. We would strongly recommend a laundry worker is employed and meanwhile that designated staff are rotared in on a daily basis so that the care staff involvement is limited. We saw that the hand wash facility is separated currently and obviously not used. We issued an immediate requirement to address this. We also observed the immediate environment around the laundry to be not clean. There was an old disused ironing machine which was dirty and the nearby door leading out was open exposing stairs which were dirty and full of cigarette ends and cardboard boxes and other debris. There was a hole in the wall exposing flaking masonry . Shelving was dirty and needed cleaning. We asked the manager how long it will take to complete the laundry work but she had no time scale for this and did not know. We are concerned that while the laundry is being upgraded the lack of effective planning means that infection control standards may be exposing people to risk. *The laundry in No11 [basement] was seen. Staff reported this is used. This area was very dirty and consisted of a washing machine set amongst debris and rubbish and stored items. There was no hand wash or any other facilities you would expect to see in a laundry. An immediate requirement was issued to stop using this facility as it is both dangerous and unhygienic. *We observed some shared rooms. There was no screening available in one room and in another the screens [mobile screens] were broken. These screens are also ineffective as they cannot be moved by frail elderly people who may therefore lack the choice of being able to maintain their privacy. We would require that effective screening is put in place in all shared rooms. Care Homes for Older People Page 24 of 41 Evidence: *The bed in one room was placed up against an unguarded radiator which places the person at risk of burns. We issued an immediate requirement to address this. Other radiators are uncovered and the need to cover these is identified in the homes own risk assessment. Again when we spoke to the manager about plans to do this work she was not sure. *The stairs leading to the basement in the main building was dangerous in that a step was loose [mentioned on previous inspection 6 months ago] and the covering on the stairs was loose causing a trip hazard. The manager reported she had fallen on these steps some time ago. We issued an immediate requirement to make these stairs safe. *Care staff were observed to be entering the kitchen at times throughout the day without protective clothing. This is particularly relevant in relation to other comments around infection control [above]. Again the risk of cross infection is increased by staff not carrying out / understanding their role in infection control. * The home smelled strongly of smoke [from cigarettes] in the main building. The smoking room has an extractor but this was observed not to be turned on. We strongly recommend that this is wired up so that it is turned on automatically when the door is opened and the room is in use. * One room smelled strongly of urine. This was discussed with the manager and needs effective cleaning to protect the residents dignity. The bed head was also broken in this room and is an example of numerous snagging jobs that we saw on the inspection. *The decor in the main building remains poor. Examples are bedrooms with stained walls, flacking paint, ripped wallpaper, curtains hanging off rails. There is a need to invest in this building so that general improvements can be made and the environment can be made more comfortable for people to live in. we have made a strong recommendation that a specific and time projected decorating plan is made and actioned. Overall there is a lack of clear planning and management of the environmental standards in the home and there is an absence of routine maintenance which puts people [residents and staff] at risk. We have made a requirement that the provider and manager of the home liaise effectively to produce a development plan which includes named responsibilities and specific deadlines and that this is consistently reviewed. Care Homes for Older People Page 25 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing standards remain inconsistent, which is affecting the way people are cared for. Evidence: During the site visit we spoke with staff and looked at duty rotas and observed the staff interacting with people living in the home. The home is divided into 3 separate units and we found issues in all of the units that suggest the home is not adequately staffed. For example in the main building there were two staff on duty for fifteen [15] residents. There are no laundry staff and care staff are also expected to help out in the kitchen on occasions [we observed this over lunch periods]. There were periods where we found it difficult to locate staff and residents were left unsupervised for lengthy periods [particularly over staff breaks]. Some personal care was left unattended [such as the failure to empty a commode in one instance]. Staff spoken with confirmed that because of a lack of ancillary staff cover care staff are expected to help out with these extra tasks. This means that there is not clear boundaries to peoples duties and direct care may be affected as evidenced in other sections of this report [infection control, maintenance]. We spoke about this to the manager who has some awareness and has agreed with the owners to employ a person to organise activities, for example. We feel that the proposed eight hours for this may need to be reviewed along with a review of staffing Care Homes for Older People Page 26 of 41 Evidence: numbers to ensure enough staff to carry out care needs are regularly on duty. We spoke with care staff and looked at records regarding training of staff and qualifications. Some previous requirements and recommendations have been met. Staff said that they are trained in all basic care issues and that they feel supported to be able to do their job through supervision sessions [for example]. We still found some outstanding issues however, such as the lack of training around medication for staff which means that medication management at night time is compromised. This despite previous recommendations. We also found that the cook is in need of an update in food hygiene and that this had been recommended by environmental health in early December 2009. We would recommend that training needs are formally analysed by the manager so that priorities can be assessed and planned appropriately. There was a previous requirement to ensure staff are appropriately recruited and that all necessary checks are in place to ensure they are fit to work with vulnerable people. We were only able to check one staff file as this had been the only recruit since the previous visit. We found that the staff member had started working in the home a week prior to a criminal record declaration had been obtained. There had been no initial check made to ensure this person was not the register to ensure they were not excluded to work [ISA register] and the manager was unsure as to any initial supervision for this person. The staff file was also deficient in supportive documentation such as proof of identity and photograph. The application form did not list any references. All of these checks are important to ensure staff are properly recruited and are suitable to work with vulnerable people. Over all we are concerned that key issues such as deployment of staff and staff recruitment processes are not managed in the best interests of people living in the home. Care Homes for Older People Page 27 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has failed to ensure essential standards are maintained, which may effect the way people are cared for. Evidence: We spoke at length to the manager, Brenda Bailey, about our concerns regarding the ongoing failings in management of the home. Brenda had poor knowledge about some of the issues we asked about and a poor overall concept as to the running of many of the management systems in the home. Examples of this are listed below but also include a lack of action and knowledge around the health and safety risk assessment carried out by an independent consultant and presented to the home some 6 weeks prior to our visit. The manager was unsure or didnt know or had not actioned any progress with regard to key issues identified in the report. These include overall health and safety policy and who the responsible people are, identified risk assessments needed for people on the top floor regarding fire exits, risk assessments for pregnant members of staff, an identified need to stop people coming to the basement due to too many hazards, recording of fridge temperatures and covering of radiators to Care Homes for Older People Page 28 of 41 Evidence: ensure people are protected from burns. This is of major concern as although issues have been identified there has been little management action to ensure these are addressed. We use this as an example of the overall lack of control and adequate planning to ensure objectives are prioritised and met. The provider has employed the input of a management consultant who has completed some auditing of the home [see above]. Many of the systems in the home remain fractured or incomplete however and there does not seem to to be any overall management plan [or development plan] to set key objectives and prioritise. This needs to be a main aim of the manager. As stated under Outcome Area 4 [complaints and protection] we had serious concerns as to the handling of a residents monies. The management of this was poor in respect of the practice undertaken by the staff for this resident and this had the backing of the manager who seemed unaware of the significant risks involved. We also looked at other financial records held on behalf of 7 residents. A spot check of a number of balances was found to be correct, however we do strongly recommend that two signatures are recorded for all transactions made. This should include the resident where possible. There were no individual receipts for expenditures, such as hairdressing and therefore records seen were difficult to follow. Policies and procedures for safe handling of monies on behalf of the residents must be improved to ensure their ongoing protection. Staff complete accident reports for incidents that affect a residents safety. We looked at accident records in respect of a resident whose care file we examined, as part of monitoring her ongoing care and welfare. This is stated under Outcome Area 2 [health and personal care]. This shows that, although some monitoring is going on, the manager is failing to ensure that issues are followed up. The AQAA gave us details of ongoing contracts for equipment and services to the home. We carried out a spot check for the gas, electric, fire prevention equipment and lift certificates. The eclectic certificate needed renewal and we had to ask the owners to confirm a date of this work to be undertaken prior to us leaving. This date was provided. The other certificates were all satisfactory. We have previously made comments about the many maintenance and compliance issues around health and safety in the home which has meant we have had to issue five immediate requirements to ensure essential standards are met. This shows poor monitoring and management of this area. Care Homes for Older People Page 29 of 41 Evidence: Overall the management of the home has failed to ensure essential standards are maintained. Care Homes for Older People Page 30 of 41 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that residents care plans evidence the management of their individual care needs to include confusion, urine infections, infected toe, weight loss and disturbed nights. This will ensure residents care is not compromised. 20/11/2009 2 8 13 Where people choose to self- 16/11/2009 administer medicines assessments must be completed To help ensure they receive any help they may need to do so safely. 3 8 13 The registered person must ensure that residents who are at risk of falls are fully assessed with risk assessments in place and management of this risk documented. This will ensure that staff are aware of residents who are at risk and give staff the recorded management instructions on how to manage this risk. 19/11/2009 4 9 13 Arrangements must be made 16/11/2009 Page 31 of 41 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action made to ensure that medicines can be safely administered during the night To help ensure medicines can be safely administered a prescribed. 5 9 13 Complete, clear and accurate 16/11/2009 records of all medicines received and administered must be completed (including for external preparations) To support and evidence the safe handling of medication 6 19 23 The environmental standards 12/12/2009 in the home must be improved to show that all residents bedrooms and public areas are decorated and refurbished to a higher standard. This will ensure that all of the people in the home are living in comfortable surroundings. 7 29 19 The registered person must ensure that robust pre employment checks are in place for all employees. This will help to ensure that residents health and welfare is not compromised. 8 38 13 The provider must ensure 30/11/2009 that routine risk assessments are undertaken which 27/11/2009 Care Homes for Older People Page 32 of 41 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 identify all obvious hazards and risks and that a plan of systematic maintenance supports this process. This will help ensure that people working and living in the home are protected and kept safe. Care Homes for Older People Page 33 of 41 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 1 19 13 The stairs leading down to the basement in the main building must be made safe for use. This will reduce the risks of accidents occurring. 22/03/2010 2 25 13 The radiator in bedroom 17 must be assessed for risk and made safe. This will help ensure that the person nearby will be protected form burns. 22/03/2010 3 25 13 Thermostatic valves must be 22/03/2010 fitted to the hot water outlet in the bath in the flat. This will help to ensure safe water temperatures for people. 4 26 16 The laundry area at No11 must not be used. The facility is totally unsuitable and presents as a health and safety risk. 22/03/2010 5 26 16 The main laundry area must 22/03/2010 have hand wash facilities and be maintained in a clean and hygienic state. This helps ensure that the risk of infections are controlled. Care Homes for Older People Page 34 of 41 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 A Service User Guide is required for the home. This is to ensure residents and their families/representatives have information about the service to help them to decide whether the home is right for them. 01/06/2010 2 2 4 Residents must receive terms and conditions in respect of accommodation. This is to help ensure they are aware of their rights of occupancy to help protect their best interests. Residents care plans must record their current health care need. This will help to ensure the staff can provide the necessary care and support they need to mee their individual needs. 01/06/2010 3 7 15 01/05/2010 4 8 13 Residents risk assessments must record accurately the extent of the risk and how it is to be managed. This will help ensure the safety the residents to keep their in good health. 01/05/2010 Care Homes for Older People Page 35 of 41 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 10 12 Residentss health 01/05/2010 appointments must be conducted in a manner which respects their privacy. This help to ensure they are treated with respect. 6 10 12 Residents commodes must be emptied in a timely manner This will help to ensure the residents dignity is maintained. 01/05/2010 7 12 16 Social activities must be arranged for the residents following consultation with them. This is to help ensure their wishes, lifestyle, preferences and expectation are respected. This will help them to enjoy their day. 01/06/2010 8 15 16 Residents must be offered a choice of varied meals. This is to ensure they receive well balanced meals, which they enjoy. 01/06/2010 9 24 23 Room 12 is in a poor state of decor and maintenance and must be upgraded with attention being paid to the broken overhead light. 01/06/2010 Care Homes for Older People Page 36 of 41 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 This is for the comfort of the person living there. 10 24 12 Appropriate screens must be 01/06/2010 made available in all shared rooms. This will help ensure a degree of privacy. 11 24 16 The bed head in room 7 is broken and needs repair. This is for the comfort of the person living there. 12 25 23 One room in the flats does not have any windows that open. These must be repaired. This will ensure that the room can be properly ventilated. 13 26 23 One bedroom in the main building has a strong smell of urine and must be cleaned and maintained appropriately. This to ensure good hygiene standards and uphold the dignity of the person living there. 14 26 16 The laundry must be upgraded to ensure clean and hygienic conditions. 01/06/2010 01/06/2010 01/06/2010 01/06/2010 Care Homes for Older People Page 37 of 41 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 This will provide a clean and hygienic service. 15 26 13 A policy of care staff not 01/06/2010 entering the kitchen must be reinforced. Any staff that do enter the kitchen must wear protective aprons. This will reinforce good standards of hygiene and reduce any risk of infection. 16 27 18 The provider and manager 01/06/2010 must review the overall staffing in the home and ensure that there is sufficient numbers of both care and ancillary staff cover on duty. This is to provide a consistent level of care. 17 31 10 The manager must ensure that she has an overall knowledge and view of the systems in the home and that she manages the care home with sufficient care, competence and skill. This will ensure that the home is run in the best interests of people living their. 18 33 24 The manager in conjunction with the provider must produce a prioritized and 01/06/2010 01/06/2010 Care Homes for Older People Page 38 of 41 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 clearly targeted development plan for the home which includes the issues raised in this report. This will help ensure that the homes meets its objectives and the home is run in the best interests of residents. 19 35 17 The records with respect to peoples personal allowance must include details of all transactions. This will help ensure that peoples personal allowances are monitored safely. 20 38 13 The manager must ensure that all health and safety issues identified in the homes risk assessment are actioned. This will help ensure safe standards for people. 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 01/06/2010 01/06/2010 1 3 The need for to assess peoples mental capacity at the point of admission to the home should be incorporated in the admission and ongoing assessment process. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. Page 39 of 41 Care Homes for Older People 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 into the admission and ongoing assessments. 2 12 An activities programme should be introduced based on on the wishes, preferences and expectations of the residents. An activities organiser should be employed and allocated sufficient hours to ensure the activities programme is well managed. Residents should be offered a menu which offers a daily choice of meals, so that residents receive meals they enjoy. The manager and all staff need to be updated regarding the mental capacity act 2005 and the Deprivation of Liberty safeguards and incorporate assessments into current documentation. 3 4 15 18 5 6 19 19 The extractor fan in the smoke room should be set so that it is working when people are in there. An action plan of maintenance and upgrading of the home should be produced with appropriate timescales and individual named responsibilities to ensure consistent management and development. We would recommend that training needs are formally analyzed by the manager so that priorities can be assessed and planned appropriately. Financial transactions made on behalf of residents should include two signatures and where possible the signature of the resident. Receipts should also be kept for services, such as hairdressing. This will help to protect the residents financial interests. 7 30 8 35 Care Homes for Older People Page 40 of 41 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 41 of 41 - 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!