Inspection on 06/10/09 for Abbegale Lodge

This inspection was carried out on 6th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 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 18/03/10

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 15/02/2010.

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: Margaret VanSchaick     Date: 0 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 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 36 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 36 Over 65 41 0 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 36 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: A site visit took place as part of the unannounced key inspection. It was conducted over one day for the duration of 8.5 hours. 35 residents were accommodated at this time. A pharmacy inspector and an additional regulatory inspector were present during the inspection. As part of the inspection process many areas of the service were viewed including residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and a visiting health professional. The inspection was conducted with Brenda Bailey (registered manager) Ramesh Sabberwal (registered provider) and his business partner Keiran Patel. During the inspection 4 residents were case tracked (their files were examined and their views of the service obtained). Two other residents had their care documentation looked at also. All of the key standards were assessed and requirements and Care Homes for Older People Page 6 of 36 recommendations from the previous inspection in June 2008 were discussed. The two requirements were met. Satisfaction forms Have your say about....were distributed to a number of residents and a relative on the day of the visit. A number of comments included in this report are taken from surveys and from interviews. An AQAA (annual quality assurance assessment) was completed by the registered manager and registered provider prior to the visit. The AQAA comprises of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The manager must ensure that assessments are made which clearly identify peoples care needs and how these are to be met by the home so that admissions are suitable and meet registration requirements. We are concerned that the manager is not ensuring that prospective residents are properly assessed. Two of the residents had no pre admission assessments in place. Residents health could be compromised because of weaknesses in the arrangements for handling medication and because care plans and other care documentation is either not in place or does not evidence the ongoing health and personal care of the individual residents. One of the residents had no care documentation in place except for the medication record. Another resident had no daily care record in place. Residents health and welfare will be compromised because of the lack of care documentation. Several requirements have been made including an immediate requirement in respect of care plan documentation. There is a relaxed and homely atmosphere but people would benefit from more structured activity on a daily basis to enhance their quality of life. Residents could be at risk because staff were not fully aware of the reporting processes for safeguarding. Although staff have attended safeguarding training in the past year staff spoken with were not clear of the processes. The service need to ensure an up to date copy of the local adult protection procedure is in place. Contact details of the agencies involved need to be available for staff to refer to. Staff need to be confident in how to report an alleged incident. There needs to be better assessment and planning of routine maintenance so that Care Homes for Older People Page 8 of 36 environmental standards are met with more consistency. Many areas of the service were in need of refurbishing and repair. This will make it a better and more comfortable environment for residents to live in. Residents may be at risk through staff not being sufficiently trained to meet the needs of the residents. Some of the residents who are being cared for have quite complex needs including Dementia, mental health problems and alcohol ause. Staff also need training with regard to completing care documentation. Some of the care documentation was missing. Some of the other care documentation was poorly written including care plans, daily reports and medication records. There are key areas of management of the service that need to be tightened up so that the home can be run in the best interests of the people living there. We were advised that the owners do not have any formal training in health and safety. There were risk assessments evident in many areas and general safety certificates such as electrical and gas safety were up to date but the risk assessments were sporadic and some key areas of environmental safety are not audited routinely. For example we observed people being moved around the home in wheelchairs without foot rests which may cause injury and wheelchairs were stored in fire exits. We would recommend that regular walk around risk assessments are made and formally recorded on a routine basis. Another example of the fractured nature of the auditing process is the lack of completion of monthly audit visits by the owners. These are called Regulation 26 visits and are another legal requirement. The Provider [owner] looks at various quality issues in the home and also talks to staff and people living in the home to get an idea of the quality of care and raise any issue with the manager. A report is made and left with the manager. This is important so that the manager can get feedback and plan any continued improvements. We found that these are not completed on a routine basis. As serious concerns have been raised in this report, the Regulation 26 reports must be forwarded to the Commission so that we can establish improvements to the management thus helping to protect the people in the service. 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 36 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 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager must ensure that assessments are made which clearly identify peoples care needs and how these are to be met by the home so that admissions are suitable and meet registration requirements. Evidence: We looked at care for people who had been admitted to the home to see if they had been assessed previously so that the home could get a good idea of the care needs and whether the home could meet those needs. We reviewed two people on unit 9a and the care records did not contain any pre admission assessments by the home. Two people were spoken with and said that they had been seen by a staff member prior to coming into the home and this was also confirmed verbally by staff members. It is a concern that these records seem to have been misplaced or lost. Care Homes for Older People Page 11 of 36 Evidence: We asked to look at some recent assessments that were on file.We were given an assessment for a recent admission to the home. The person had been assessed looking at how they carry out activities of daily living and it included a dependency assessment. There was a score for this but staff were not able to tell us what the score meant as there was no scale to convert or understand the score. We discussed the need to include the conversion scale for the assessment to be relevant. The assessment said that the person has paranoid thoughts and confusion. The social worker assessment also said the person has a mental health issues which included aggressive and dangerous behavior and that this needed monitoring. The assessments did not clearly identify any general care needs that the home are registered to meet. We are concerned that this resident has primarily mental health needs according to the assessment and as such may not meet the homes registration category. The persons needs may not be met as the home have no staff trained around mental health issues [confirmed by the manager and staff training records]. We spoke to the manager regarding the current resident group with reference to recent discussions concerning admissions of people with mental health needs such as those with a medical diagnosis of Korsacoffs dementia. The manager advised us that some of these people are admitted from a mental health unit. We discussed one resident who has mental health issues who was admitted as an emergency. This means that the home did not even previously assess this person to see if they could meet their needs. We are concerned that the manager is not ensuring that people are properly assessed prior to coming into the home. This means that peoples care needs may not be met and they may be at risk. Care Homes for Older People Page 12 of 36 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. Residents health is compromised because of weaknesses in the arrangements for handling medication and because care plans and other care documentation is either not in place or does not evidence the ongoing health and personal care of the individual residents. Evidence: Four residents were case tracked and other residents care documentation was also viewed in relation to medication and care plans. Care plans were in place for the four residents who were case tracked but not for one resident who was admitted to the service approximately two weeks previously. The care plans viewed were in some areas not reflective of residents assessed needs. Staff need to be provided with training on how to set up a care plan that reflects the residents assessed needs and individual changing needs whilst being cared for. Many areas have not been addressed in care plans including, Dementia, confusion, oral care, colostomy management, urine infections, incontinence, foot infection, pain Care Homes for Older People Page 13 of 36 Evidence: and weight loss. One of the residents is having disturbed nights as recorded on the daily records but no care plan is in place to manage this. One resident whose condition is deteriorating has been referred to a specialist and this is documented. Residents interviewed told us they were happy with their care. Residents interviewed stated, We see the Dr if you want to, My legs have been bad, I couldnt have had more attention and I would not go anywhere else, I wouldnt for the world change it. A visiting health professional told us that the service is generally responsive to any instructions left regarding care. A resident has been admitted who has no daily records in place at all. Examination of the records demonstrate that one resident had no daily records in place at all. Other residents records were incomplete with no daily records being made. In some cases no entries had been made in residents records for up to three days. In addition one residents daily record was written on scraps of paper for some dates, which is not acceptable. One resident has been admitted and has no care documentation in place except medication records. They have no pre admission record, no care plan, no falls management or risk assessment documentation, no risk assessment re self medication nor record of Gp visits. Staff informed us that the resident had been seen by their Gp on several occasions since admission. It is of great concern to us that a resident who is insulin dependent and on strong pain relief has no care documentation. This residents health care is compromised and they are at risk. An immediate requirement has been made with regard to ensuring residents have full care documentation. Some of the residents were interviewed and asked if they had signed and agreed their care plans. One of the residents told us he had but the other residents do not remember. Care plans were currently being reviewed three monthly. It is strongly recommended that care plans should be reviewed on a much more frequent basis to ensure that they continue to reflect the care required to meet the residents assessed needs. We looked at how medicines were administered. Some people had chosen to selfadminister some medicines but there was no written information within their care plans to show how this was supported by care staff. In several cases signed declarations were in place stating that they wished care staff to administer their medicines. Staff authorised to handle medication are 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 needs to be addressed, as medicines cannot normally be given at night. We saw that several photographs were missing from the administration records, the manager said they would be developed and put in Care Homes for Older People Page 14 of 36 Evidence: place. We looked at record keeping. Most medication administration records were preprinted by the pharmacy these were generally clearly completed, and also showed the receipt of medicines into the home. But, it was of concern that where handwritten administration records were used some were very poorly completed and so did not support and evidence the safe administration of medication. It was of concern that records were not made to show the application of prescribed creams making it impossible to tell whether these were being applied as needed. We saw two examples where creams had been prescribed following a doctors visit where there was no record of the cream ever being received into the home or applied. We found a lack of information about the use of when required medicines. It is important that any advice about the use of when required medicines is clearly recorded to help ensure they are correctly used, when needed. We compared a sample of medicines stock and records. We found that medicines in the monitored dosage system were generally given correctly. We checked a sample of medicines contained in packets and bottles and found the occasional discrepancy where records showed more tablets had been given than had gone from stock. We were concerned to find that where medicines needed re-ordering outside the normal monthly ordering cycle, people were at risk of missing doses of medication because there were none left. We saw two examples were people had run out of medicines the previous month and on the visit day, one person had not had any of their morning medicines because there were none left. We looked at how medicines were stored and found that all medicines were safely locked away but controlled drugs were not kept in a controlled drugs cupboard. It was of concern that one controlled drug was being administered from a bottle with no dispensing label and that entries in the controlled drugs register were not always clearly made. This needs to be addressed to reduce the risk of mis-handling. The manager carries out audits of medicines handling but these need to be broader to help ensure that where there are weaknesses in the homes arrangements for handling medicines, these are identified and promptly addressed. It would benefit the service if the manager attended further training so that she could be more aware and knowledgeable when carrying out medication audits. Some of the residents were observed being transferred around the service in wheelchairs without footrests therefore this needs to stop to prevent residents sustaining an injury. Some of the male residents looked unshaven and there was evidence of institutional practice of residents being shaved on certain days of the week. This needs addressing to promote the dignity of residents. If residents choose to shave irregularly then this should be recorded on their care plan. Care Homes for Older People Page 15 of 36 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 is a relaxed and homely atmosphere but people would benefit from more structured activity on a daily basis to enhance their quality of life. Evidence: We spent time observing the care and speaking to people who live in the home. The atmosphere was very relaxed and people said that they generally enjoyed living in the home. They said that staff spent time talking and socialising although the pace of life could be a little slow and they would like to be a bit more active. Residents told us that visitors were made welcome and stated, They can visit any time of the day. One relative canvassed for their views commented, It is lovely, I have never seen my mum so contented as she has in the years she has been here. The residents all look happy every time I am in here. We asked staff about activity for people and although there are special occasions celebrated and occasionally entertainers there is a lack of planned activity on a daily basis. Some comments were that there was not enough staff available for things like regular outings. This was confirmed by staff interviews. One person living in the home said: Care Homes for Older People Page 16 of 36 Evidence: I would like to go out more but there is not enough staff to take me. We discussed this with the manager and would recommend somebody is designated to organise activity in the home as this would enhance the quality of life for people. We observed the staff and how they interact with people living in the home and saw that they were positive and enhanced peoples feelings of well being. People spoken with said that staff were very kind and helpful. One said: The staff are great - they keep me sane! They always talk to me. Although the social care was generally unstructured we were concerned that some aspects of the daily life was institutional rather than centered around peoples daily needs as individuals. For example people reported that they get up very early: We get up at 6.30am. Its the routine. I actually prefer getting up early but it is a long day. Staff did not have any particular reason for such an early start. The person quoted above had his preferred rising time recorded as 7.30am. We also got told that people are shaved on only certain days of the week. This was confirmed by staff and also by a notice in the unit office saying shaves to be completed on Monday, Wednesday and Friday. We would recommend that this is reviewed and care is constructed around a more person centred approach looking at the individual needs of people. We observed the dinner time meal and this was well paced and sociable. Staff were seen assisting some residents to eat. People spoken with said that the food was good and there was a choice available. We saw that there was no menu available and people said they would like this as they could be made aware of forthcoming meals. People interviewed stated, The food is very good, We cant grumble about the food, the food is always nice and We dont know what we are getting for lunch until we have got it, not a clue as to what we are having for tea, its usually soup and sandwiches. Local clergy visit the service on a regular basis. Care Homes for Older People Page 17 of 36 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. Residents could be at risk because staff were not fully aware of the reporting processes for safeguarding. Evidence: A complaints procedure is in use and this needs to be displayed in all three buildings to ensure residents and their families have access to it. There have been no complaints recorded in the complaints log since last July. The manager told us that she deals with any concerns as they occur. The service need to ensure that the complaints log evidences complaints raised. The full investigation of the complaint has to be logged and outcomes for the complainant recorded. This way we will know that residents and their families are being listened to. Residents interviewed stated, I have no complaints at all and We know how to make a complaint but we have no need to. Residents care documentation was lying around in the dining room and sitting room. This is not acceptable. Care records have to be stored securely when not in use. Residents confidentiality was not being maintained. We spoke to staff about their understanding and knowledge around abuse and how to keep people safe in the home. Staff spoken with said that they had attended training and this was confirmed by the manager and the training records seen. We asked staff Care Homes for Older People Page 18 of 36 Evidence: about how they would report any concerns and, although all said they would report to the manager there was a general lack of awareness around the wider reporting processes and the role of statutory bodies such as social services and the Care Quality Commission. Staff were not aware of the whereabouts of the homes policy documents and there were none on the individual units. We spoke with the Manager and was concerned that she was not able to find a copy of the local procedures and was not aware of the local safeguarding contact number. This potentially puts people at risk as any serious allegation may not be reported through appropriately and peoples rights may not be enforced. During the inspection we had a serious cause for concern as one of the people living in the home had no care records available including a care plan. This puts the individual at risk because there is no plan or communication process to carryout and review the care for the person. We have reported these concerns through the social service safeguarding team for a separate investigation to ensure the person concerned is safe. We also issued an immediate notice telling the manager to organise a care plan [see health and personal care section of the report]. Care Homes for Older People Page 19 of 36 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. There needs to be better assessment and planning of routine maintenance so that environmental standards are met with more consistency. Evidence: We toured all of the day areas and many [but not all] of the bedrooms of people living in the home. We found the general standards of maintenance to be varied and lacking consistency. For example there was a maintenance/decorating schedule seen and this addresses some of the environmental needs in the home. Also many of the bedrooms were comfortable and personalised. We were concerned however that one bedroom smelled strongly of urine and the bed was badly stained as well as the carpet. Although we were advised that a bed and flooring has been ordered we were concerned that the timing of this had been delayed and standards had not been maintained. It was explained that the reason for the delay was that the resident concerned was funding this. We advised the Manager and Provider [owners] that the funding for necessary furnishings was their responsibility and not the resident concerned. Other areas of general maintenance such as the garden area, replacement of toilet lights, broken window restrictor, broken lock on one bedroom door evidenced that the maintenance programme is not keeping up with general snagging issues in the home [many of these come under health and safety and are dealt with in the management Care Homes for Older People Page 20 of 36 Evidence: section of the report]. We were advised that the home does not have a person employed as responsible for maintenance issues on a daily basis and that such jobs are contracted in. We would strongly advise that this is reviewed so that the manager can access routine maintenance on a daily basis. We found most areas clean and odour free [the above bedroom apart] and staff said that the have attended training in infection control. We spoke with one senior staff who was able to display a good understanding of infection control processes and understood the need to report and get advice for any infectious outbreak. Care Homes for Older People Page 21 of 36 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. Residents may be at risk through staff not being sufficiently trained to meet the needs of the residents. Evidence: The duty rota evidenced staff on duty. Staff interviewed stated, We have enough staff sometimes. Five carers are employed each day to provide care for 35 residents in three separate buildings therefore this needs close supervision to ensure residents needs are not compromised. The staffing levels need to be monitored to ensure sufficient staff are on duty to meet the needs of the residents. In particular providing staff to promote activities with residents. Additional catering and housekeeping staff are also employed. Residents interviewed were happy with how staff care for them. Residents interviewed stated, Staff are very good and are nice to other residents as well, Staff are kind and patient and the night staff are nice. A relative canvassed for their views commented, Staff are all very caring and attentive. Many of the staff have an NVQ Level 2 qualification in care with senior carers qualified to Level 3. Care Homes for Older People Page 22 of 36 Evidence: The manager told us that no new staff has been employed for some years. We chose three staff files to look at. The staff files evidenced that three references were not dated. One reference was dated 6 years following commencement of employment. One application form was very brief and one induction commenced three months after starting work. All of these staff have been employed in the service for several years. The manager was advised to ensure that all future employees pre employment checks are in place prior to commencing work. The manager was advised to audit staff files to ensure all information and documents are in place for all staff employed in the service. Dates of commencement of work and references obtained need to be recorded also. Police checks were in place for all three staff. A training programme is in place for staff and this covers areas such as health and safety, infection control, food hygiene, fire and manual handling. Safeguarding training was provided last year although as discussed earlier in this report staff were not familiar with the processes. Not all of the mandatory training has been addressed nor up to date. The service needs to audit individual staff training needs and clearly identify where each member of staff needs further training. It would benefit the service if they had a clearer picture of the training needs of the service as this will ensure that the training provided will meet the needs of the residents. Staff files need to include an individual training and development programme for each member of staff. Staff files also need to evidence any training attended including an up to date record of training and a full structured induction. Further training needs to be provided for staff so that they can manage the needs of residents who have Dementia. The service needs to ensure that they provide well trained staff who can meet the residents needs with all aspects of their care otherwise their care may be compromised. Equality and Diversity training needs to be implemented to ensure that staff promote the health and wellbeing of all residents in their care. Training also needs to be provided for care staff to ensure they know how to commence a care plan and record entries in other care documentation. There were many areas that were not documented correctly. Care Homes for Older People Page 23 of 36 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. There are key areas of management that need to be tightened up so that the home can be run in the best interests of the people living there. Evidence: We spoke with the manager and owners of the home during the inspection. We discussed some concerns around key areas of management of the home not being addressed systematically. This has meant that failure in areas like care planning and assessing peoples needs may expose some people to the risk of care needs not being met. We found other areas to be lacking in detail and the communication between the manager and the owners a little disjointed. An example of this is the way some auditing of the systems such as health and safety are carried out. The manager leaves this aspect to the owner and has no immediate or overall view of health and safety in the home. She needs this overview as she is in day to day control of the running of the home. Care Homes for Older People Page 24 of 36 Evidence: We were advised that the owners do not have any formal training in health and safety. There are risk assessments evident in many areas and general safety certificates such as electrical and gas safety were up to date but the risk assessments were sporadic and some key areas of environmental safety are not audited routinely. For example we observed people being moved around the home in wheelchairs without foot rests which may cause injury. Wheelchairs were also stored obstructing fire exit routes. One window above ground floor level had a broken restrictor which may place people at risk of falls. Hot water temperatures in baths are not routinely audited and staff are not testing water temperatures with thermometers which may expose people to risks of scalds. There was no light in one toilet which had not been noted and with a lack of routine maintenance staff there was no immediate date for replacement. The stairs down to the basement were very steep and one of the steps is loose exposing staff to risk. Again there was no sign of any routine auditing picking this up and action to reduce the risk. These are individual observations which we made on a simple tour of the home but none of these are monitored by the manager or owner with any routine auditing. We would recommend that regular walk around risk assessments are made and formally recorded on a routine basis. We looked at the Health and Safety policy but this does not specify who is responsible for health and safety in the home. Another example of the fractured nature of the auditing process is the lack of completion of monthly audit visits by the owners. These are called regulation 26 visits and are another legal requirement. The Provider [owner] looks at various quality issues in the home such as complaints and also talks to staff and people living in the home to get an idea of the quality of care and raise any issue with the manager. A report is made and left with the manager. This is important so that the manager can get feedback and plan any continued improvements. We found that these are not completed on a routine basis. We looked at the way peoples personal allowances are maintained in the home. The manager showed us the records maintained for six residents whose money is managed. We looked at one person in detail and found that we were able to audit the amount of expenditure and the balance was checked as correct. We saw some receipts for expenditure but these were not easy to reference and we discussed how this could be made easier. We also saw that all entries have only one signature and we would strongly recommend that two signatures are recorded for all transactions and if Care Homes for Older People Page 25 of 36 Evidence: possible one of these should be the resident concerned. There is no external auditing evident and we would also recommend that the owner conduct routine auditing of personal allowances as part of the Regulation 26 audits [see above]. This will help ensure an open and accountable system. Care Homes for Older People Page 26 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 36 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 7 15 That the registered person must ensure that a resident had a pre admission assessment, care plan, risk assessments and daily records in place. To ensure that the residents care needs are not compromised. 07/10/2009 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 3 14 The manager must ensure 12/11/2009 that all of the people admitted to the home are suitably assessed and that assessments clearly identify appropriate care needs to meet the homes registration category. This is so that people admitted are sure that they can have their care needs met. 2 7 15 The registered person must ensure that residents care plans evidence the management of their individual care needs to include confusion, urine 20/11/2009 Care Homes for Older People Page 28 of 36 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 infections, infected toe, weight loss and disturbed nights. This will ensure residents care is not compromised. 3 7 15 The registered person must ensure that all residents have a care plan in place on admission to the service. This will ensure individual residents care needs have been identified and agreed. Staff will then know how to manage their needs. 4 8 13 Where people choose to self-administer medicines assessments must be completed To help ensure they receive any help they may need to do so safely. 5 8 12 The registered person must 20/11/2009 ensure that all residents admitted to the service have full documentation in place that ensures all of their care needs are being addressed. This will ensure that residents care needs are not compromised. 6 8 13 The registered person must ensure that residents who are at risk of falls are fully 19/11/2009 16/11/2009 19/11/2009 Care Homes for Older People Page 29 of 36 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 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. 7 9 13 Sufficient stocks of medicines must be maintained And, arrangements made to ensure that medicines can be administered during the night To help ensure medicines can be safely administered a prescribed. 8 9 13 Controlled Drugs must be kept in a locked Controlled Drugs cupboard To meet with current law. 9 9 13 Complete, clear and accurate records of all medicines received and administered must be completed (including for external preparations) To support and evidence the safe handling of medication 16/11/2009 11/01/2010 16/11/2009 Care Homes for Older People Page 30 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 10 16 22 The registered person must 20/11/2009 ensure that all complaints are logged, fully investigated and outcomes recorded. This will show that residents and their families are listened to. 11 18 13 The registered person must ensure that all staff attend safeguarding training. This will help staff to understand the reporting sytems and therefore protect residents. 14/01/2010 12 18 17 The registered person must ensure that all records relating to residents care must be stored securely when not in use. This will ensure residents confidentiality is promoted and maintained. 20/11/2009 13 19 23 The environmental 12/12/2009 standards 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. Care Homes for Older People Page 31 of 36 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 14 24 23 The provider must ensure that the bed and carpet / flooring in the bedroom identified on the inspection is replaced. This will ensure that the resident concerned has a comfortable bedroom to live in. 02/11/2009 15 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. 27/11/2009 16 30 18 The registered person must ensure that all staff are up to date with mandatory training and that staff files and training records evidence this. This will ensure that residents are being cared for by well trained staff 12/01/2010 17 33 26 The provider must conduct monthly unannounced visits to the home for purpose of completing a regulation 26 audit and make a report available. This is to provide for a quality audit that can be fed 30/11/2009 Care Homes for Older People Page 32 of 36 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 back to the manager so that the home can continue to be run in the interests of the people living there. 18 38 13 All wheelchairs must have foot rests fitted when moving people. This will ensure that the equipment is used properly and that people are free from risk of injury. 19 38 13 The provider must ensure 30/11/2009 that routine risk assessments are undertaken which 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. 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 02/11/2009 1 2 3 3 7 8 We would recommend that the dependency assessment should include a reference to the scoring criteria. It is recommended that all residents care plans should be reviewed monthly with their input were possible. It is recommended that specific information should be recorded with regard to oral care so that staff know what Page 33 of 36 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 support residents may need in this area. 4 8 It is recommended that detailed information should be recorded with regard to residents eyesight, hearing and foot care so that staff know how to support residents in these areas. It is recommended that male residents should have a shave daily unless it is recorded in their care plan that they choose not to. This will promote their dignity. We would recommend that a designated person organises a planned activity programme for people in the home. We would recommend that some of the daily routines such as rising times and routines of personal care is reviewed and care is constructed around a more person centred approach looking at the individual needs of people. We would recommend that a menu is made available on a daily basis for people. It is recommended that a copy of the complaints procedure should be displayed in all three buildings. It is recommended that the staffing levels should be kept under review to ensure resident care is not compromised. It is recommended that all staff should have training in regard to Equality and Diversity so that they promote the health and welfare of residents. It is recommended that all pre employment checks carried out should be dated and application forms are fully complete with work history included. It is recommended that all staff should have a training and development file that identifies their training needs and evidences training attended. It is recommended that all new staff should have a full structured induction with dates recorded and evidenced in staff files. It is recommended that all staff have training with regards to Dementia care so that staff can better understand the individual needs of the resident. It is recommended that care staff have training to ensure they are competent at setting up care plans and at 5 10 6 7 12 14 8 9 10 11 15 16 27 29 12 29 13 30 14 30 15 30 16 30 Care Homes for Older People Page 34 of 36 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 recording in care documentation correctly. This will ensure residents care needs are not compromised. 17 31 The manager should be aware of all of the systems in the home so that the home can be run effectively on a daily basis. We would recommend that the good practice guidance in the report around the monitoring and auditing of peoples personal allowance is followed by the manager. There are key areas that we would recommend as part of the routine risk assessments / audits to be carried out. These would include monitoring of hot water temperatures, limited opening of windows above ground floor level and risk of burns form radiators. Other hazards observed and reported on the day of the inspection should be addressed as part of the above monitoring. 18 35 19 38 Care Homes for Older People Page 35 of 36 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). 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