Inspection on 20/05/09 for Abbey Grange

This inspection was carried out on 20th May 2009.

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

Other inspections for this house

Abbey Grange 16/11/09

Abbey Grange 14/10/09

Abbey Grange 06/08/09

Abbey Grange 24/02/09

Abbey Grange 02/10/08

Abbey Grange 11/03/08

Abbey Grange 10/10/07

Abbey Grange 23/10/06

Abbey Grange 18/10/05

Abbey Grange 21/06/05

Abbey Grange 15/10/04

Abbey Grange 23/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Reynolds     Date: 2 0 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 43 Information about the care home Name of care home: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT 01432271519 01432271519 ubheedave@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Aileen Ubhee,Mr Bissessur Ubhee care home 29 Number of places (if applicable): Under 65 Over 65 29 29 29 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 29 29 0 29 All residents must be at least 50 years of age on admission. That Mr Ubhee works a minimum of 30 hours a week at Abbey Grange in order to fulfil his responsibilities as the Care Manager. Date of last inspection Brief description of the care home Abbey Grange is situated in a residential area on the outskirts of Hereford city. There is a parking area at the front of the home and local buses pass within easy reach. The original part of the premises has been adapted for its current use. It carries a listed building status. This places some restriction for making desired alterations. The original building has been extended to provide additional, purpose-built accommodation. The home is registered to provide care to 29 people who are over 50 years of age and who Care Homes for Older People Page 4 of 43 0 2 1 0 2 0 0 8 Brief description of the care home have needs arising from old age, dementia or mental disorder. Information about the service is displayed in the main entrance hall of the home. A copy of the most recent inspection report is also displayed. A schedule of fees is available from the home. Additional charges are made for hairdressing, transport, escort, chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 43 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: We spent a day at the home observing daily life, talking to the people who use the service and the staff. We looked at the records which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service and records about staff recruitment and training. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We also received completed survey forms from people who use the service, their Care Homes for Older People Page 6 of 43 relatives and health and social care professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. We also took into account information from random inspections that we did in February and March 2009 and from discussions with local health and social care professionals under multi-agency safeguarding adults arrangements. We have referred in this report to a complaint we received shortly after our site visit. This was about medication arrangements and fire safety. We referred these matters to Mr Ubhee and to Hereford and Worcester Fire and Rescue Service. We have included information about their responses in the relevant sections of this report. At this inspection we were following up requirements from inspections in October 2008, February 2009 and March 2009. We were also checking compliance with statutory requirement notices served after the February and March inspections. We served these because requirements relating to recruitment and medication had not been met. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to provide up to date and accurate information for people about the service that the home is able to provide. The owners should be giving careful consideration to the homes ability to offer accommodation to people with dementia related care needs. They need to take significant steps to develop this aspect of the service. The home needs to consider ways (including staffing levels) to improve the attention and support they give to people living at the home including at meal times. Staffing levels at the home should be based on the needs of individual people living there, the overall combined needs of the population of the home and the layout and design of the premises. The owners should be able to demonstrate how they have arrived at the staffing levels provided. Further improvements are needed to the way medication is managed to make sure that people always receive the medication prescribed for them. This is the third occasion we have raised this and we are now considering further enforcement action. Whilst in recent months more activities have been arranged these are based on a limited list of things and not enough has been done to find out what individual people Care Homes for Older People Page 8 of 43 might like to spend their time doing. Similarly, people living at the home need to be given more opportunities to influence the range of meals provided. The communal rooms are currently too crowded and improvements are needed to the premises to provide more space and choice for people. Facilities for private discussions, health appointments and phone calls about people living at the home need to be improved to ensure that peoples privacy and dignity are upheld and confidentiality maintained. If the owners intend to continue accommodating people with dementia the environment of the home needs to be developed in line with nationally recognised good practice in dementia care. Improvements are also needed to make sure the home is safe in respect of fire safety. Specialist advice needs to be taken about the sluice and laundry facilities. Staff recruitment arrangements are inadequate and these must be improved to minimise the risk of unsuitable staff being employed. This is the third occasion we have raised this and are now considering further enforcement action. Some aspects of how staff training is organised and recorded need to be improved. Induction training provided to staff must be based on nationally recognised induction standards. More staff need to be trained in essential health and safety related subjects such as first aid. The way that the home is managed needs to be improved. We are not satisfied that Mr Ubhee only being at the home for three days a week is an effective way to manage the home and consider that the home lacks effective leadership. We consider that he should review his working pattern so that he fulfills the requirement to be in full time day to day charge of the care home. We have acknowledged in this report that the surveys we received from people who live at the home and from relatives gave a positive view of the home and that some did not agree with the 0 star rating we gave the home in October 2008. We also acknowledge that staff at the home want to do whatever they can to improve things. Having said this, our inspections in February, March and May have confirmed to us that there are shortcomings in the service provided at Abbey Grange which the owners must attend to. Some of the concerns relate to issues not necessarily evident to visitors but all have an impact on the health, safety and well being of people who live at the home, some of whom are not in a position for their voices to be heard. 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 set out 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 43 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 43 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. People considering moving to the home cannot be confident that the service has the skills and resources needed to provide them with the care they need, particularly if they have a dementia type illness. Evidence: There was no one at the home on the day of our inspection who had recently moved in. We therefore did not have the chance to speak with anyone about how this had been dealt with. In surveys people indicated that they had enough information when they moved in and one person had visited the home first. In their AQAA the owners told us that they obtain full information from people and those close to them so they can decide if Abbey Grange can provide them with the service they need. They also told us that they allow people to visit but that sometimes relatives have to do this for them depending on circumstances. They also Care Homes for Older People Page 11 of 43 Evidence: told us that in certain circumstances someone goes to visit prospective residents as part of the assessment process. We would expect the process of deciding if the home is right for someone to always include a visit to the person either in their own home or in hospital and for a visit to Abbey Grange to be actively encouraged rather than just allowed. The admission policy we were given to read following the inspection does indicate a more positive approach to visits. The owners have since told us that they actively encourage people to visit. In the AQAA the owners told us that they record information about a range of areas for each and every person thinking of coming to the home. This has not been our experience of the reality at the home and it is positive that the owners go on to say they need to write service user plans in more details (sic). They have also told us they plan to elaborate on our admission procedure to ensure that any care plan and any other assessment are well implemented. We are concerned about the services ability to look after the needs of people who have dementia properly. This is because at present few staff have completed training in this topic (although most staff have started a distance learning course) and because the facilities at the home have not been adapted to the specific needs of people with dementia in line with recognised good practice. We have observed examples of staff finding the needs of people difficult to deal with and are aware that Herefordshire Council, having re-assessed some people at the home have arranged for them to move because their needs were not being met. Concerns about the services ability to meet the needs of people with dementia have been raised by health and social care professionals at local multi-agency safeguarding meetings and in response to surveys we sent to them. During the inspection we asked Mr Ubhee for copies of the service user guide and statement of purpose. He told us he is upgrading these and that they were not currently available. In view of the concerns regarding the homes ability to look after people with dementia we advised that the updated documents must clearly identify the level of needs that the home is able to cater for. Since our last inspection a clear emergency admission procedure has been written. No relevant admissions had taken place so we could not check how this procedure had been used in practice. Care Homes for Older People Page 12 of 43 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. People living at the home cannot be confident that they can rely on their health and personal care needs being met and may not always be afforded the privacy they have a right to expect. Arrangements for medication, though improved do not ensure that people always receive the medication prescribed for them. Evidence: In planning this key inspection we had conflicting information about the standard of care provided at the home. In the surveys we received from people living there and from relatives we were given some very positive comments about peoples experiences, for example I am very happy at Abbey Grange I like living here, its my home The doctor has been called out when necessary and I have had my eyes tested Care Homes for Older People Page 13 of 43 Evidence: This is a very caring home - the staff are very kind and genuinely caring and patient In their AQAA the owners told us that they maintain peoples independence wherever possible and facilitate good health by involving other agencies. During our inspection we spoke to a number of people who live in the home and they expressed satisfaction with their care. A large proportion of people at the home have dementia and are not all able to express their views. Our experience, and that of other professionals in recent months has given a different picture whereby some people have not had their needs met and there have been concerns about peoples welfare dealt with under local safeguarding arrangements. At previous inspections in the last year we found examples of poor care records that provided staff with no guidance about the correct way to care for people at the home. This included situations where guidance was missing or contradictory about essential aspects of some peoples care. Social care staff had also identified this as a concern. For example, at one of their reviews they found a record that said the spouse of a person also lived at the home although they had died two years before. This changed the nature of the surviving spouces care but the records had not been updated accordingly. Because we had previously made a requirement about care records in October 2008 we issued a statutory requirement notice. During this inspection we found that sufficient progress had been made in improving the care plans that the notice had been complied with. However, we expect more to be done in future to directly involve the people concerned in the content of their care records as we found little evidence that the recent work done had taken their contributions into account. We also saw some records which still did not contain enough guidance to staff, for example about how to deal with occasional aggressive behaviour by one person, about the nutritional supplements for a person whose weight was a concern and for another with a health need which would need staff to provide first aid from time to time. We are concerned that some of the work to improve the care records was done by staff in their own time, on occasions late into the evening after working all day. However some staff we spoke to said they had done this willingly to help improve things at the home. This commitment is commendable but is an indicator that Mr Ubhee is overly reliant on the good will and hard work of the staff team. We say more about this in the management section of this report. During our random inspections in February and March 2009 we observed incidents Care Homes for Older People Page 14 of 43 Evidence: where staff were trying hard but struggling to cope with the needs of some people at the home; particularly those with dementia. For example, we saw distressed residents becoming increasingly agitated and disturbing other people at the home and staff finding it hard to reassure them and give them the time needed to sooth them. Health and social care professionals visiting the home have had similar experiences. During the key inspection we again saw examples of lack of staff time having an effect on the quality of peoples lives. For example during a mealtime we saw the following scenario A person was taken to the table twice but each time they left and went and sat in the lounge, where they would again get up and start moving around. We noticed they smelled strongly of urine. The persons lunch was taken to them in the lounge and put on to a small table in front of them. The table was placed too far away for the person to be able to feed themselves which is what they seemed to want to do. A member of staff sat with the person for less than 5 minutes during which time she cut the persons food into smaller pieces and helped them put some into their mouth. The person was not very receptive so the staff member left them unattended. A little later we found the person standing and pushing the table which was in the process of collapsing. Their drink fell on the floor and we alerted staff to the need for them to give assistance. Sometime later we found that this person had been given a change of clothes. A member of staff told us that the person had been wet so needed changing. We asked how staff knew whether people had been taken to toilet or had incontinence materials changed but she did not know and gave no indication of a system in place for staff to make sure each person was attended to. When we told the manager about this situation he said that the resident concerned was reluctant to go to the toilet and staff might have had problems with her. We also saw a person passing anothers discarded pudding to a third person after eating some of it themselves. No staff were at hand to support these people in managing their meals in a dignified way. In our surveys four people who live at the home said they always get the care they need whilst three said this is usually so. The same proportion of people said that staff are always or usually available when needed. The situations we observed affected people unable to express their views about these issues due to dementia. We are concerned that peoples right to have their privacy and dignity upheld is not always adhered to. There is a lack of private space for people to meet with social care professionals or be seen by health professionals. We have observed meetings (such as Care Homes for Older People Page 15 of 43 Evidence: care reviews) and examinations by health service staff that should be carried out in private taking place in the sitting and dining rooms. Some health and social care professionals have told us of their concerns about this. One health professional told us they have tried to overcome the problem by telling the home in advance what time they will arrive so that staff can help a person to their room; they had done this on the day of our inspection but when they arrived the person was still in the sitting room and was examined there. We saw an overall improvement in the security and storage of medication. The area used to store medication had been tidied with increased space provided for the desk and medicine trolley. The medicine trolley was securely chained to a solid wall. We saw that the manager held the medicine keys. This means that medication was safe and secure which protects the people who use the service from harm. We saw improved documentation in the care plans and also in the medication administration folder stating the reason why medication was prescribed and in particular there was better documentation for any medication prescribed on a when required basis. We saw typed information about the medication people were prescribed including what it was prescribed for, an action plan and what side effects the medication may cause. For example, one person had been prescribed medication for agitation. We saw staff guidelines on when to administer the medication with a four point action plan. This helped to ensure that staff were better informed about what medication was prescribed for and also to ensure that the health and wellbeing of people who use the service were protected. The medication records had improved with increased checking and counting of medication. We saw records documenting weekly counts of medication, which helped to ensure that medication was being administered as prescribed. We saw records for the receipt and administration of medication. When medication administration record (MAR) charts were changed or a new medication started then two members of staff checked the records for accuracy. This helped to ensure that accurate medication records were available. One area of concern during our inspection in October 2008 was the security of medication and we did a random inspection in March 2009 which focused on medication arrangements. We found that the previous requirement about safe storage was not met and served a statutory requirement notice. During this inspection we acknowledged that the service had changed and improved medication management systems to ensure the safe administration of medication. However we found that one person had not received their prescribed medication for a three week period. The prescribed medication was to be administered once a week on a Wednesday morning. Care Homes for Older People Page 16 of 43 Evidence: The records documented that the medication had been received into the service. We saw that the MAR chart had not been signed for administration for three weeks (including the day of the inspection which was on a Wednesday). We checked the medicine trolley for the medication and it was not available. The manager could not find the medication in the medicine trolley or in any of the medicine store cupboards and could not offer an explanation for this even though he had been the person administering the medication that morning. There were no weekly checks recorded for the availability of this medicine. It therefore appeared that the checking system had failed to ensure that prescribed medication was available to administer at the right time to the right person. This finding did cause concern for the health and wellbeing of the person. We also noted that another person, prescribed the same weekly medication had not been given it that morning either although in that case, stock was available. Because of these failings we concluded that the statutory requirement notice had not been met and are taking further action about this. We read information in some care records about the use of certain creams (Aqueous and E45) where the records said they should be applied sparingly because they make the skin thin. This information is incorrect in respect of these products. Shortly after the inspection we received a complaint that Mr Ubhee had initiated a new arrangement for taking medication to people. The arrangement described (putting pots of tablets on trays) is poor practice and not acceptable. Mr Ubhee has written to us to refute the allegation and confirmed that this is not happening. Care Homes for Older People Page 17 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Abbey Grange may not have their needs met in respect of day to day life, provision of a nutritious diet and autonomy and choice; this is because insufficient attention is paid to the specific needs of people in the home (including those with dementia) and how they can be supported as individuals. Evidence: A positive aspect of the service provided at the home is the friendly welcome visitors receive from the staff and this was commented on by many of the relatives who returned surveys to us. This view is shared by staff from Herefordshire Council who have been visiting and this has also been our experience. When we did our inspection in October 2008 we found indications that people at the home were bored and that requests for more choice about activities had not been acted on. We made a requirement about the provision of opportunities for activities. When we did our random inspection in February we found that Mr Ubhee had initiated a programme of activities and people had been asked which of these they wanted to take part in. This was not the outcome we had been intending which was for people at the home to be consulted about what sorts of activities they would like to be offered, Care Homes for Older People Page 18 of 43 Evidence: either as individuals or in groups rather than being presented with a limited range choice of things decided on by staff. Whilst we acknowledged that the requirement had been met we wanted to see more done to focus on the preferences of each person and made a recommendation about this. In the AQAA the owner told us that people who live at Abbey Grange are enabled to take part in as many activities as they can and that we would find evidence of this in the records at the home. The AQAA also included the information that people are encouraged to plan their own activities. In the AQAA the owners informed us that they were looking into which people would enjoy watching childrens television programmes. This concerns us as we are not aware of practice guidance to evidence that this is of benefit to or enjoyed by older people. Mr Ubhee also said in the AQAA that they could encourage a toy of comfort to service users. This is a strategy that is beneficial for some people who have dementia but needs to be part of a planned person centred approach to meeting their individual needs. We would have explored both these issues with Mr Ubhee to ask what his reasoning was for these suggestions and what reference he had made to good practice guidelines for dementia care. Due to his limited availability during the inspection we were unable to do so. Subsequently, Mr Ubhee has informed us that he has consulted guidance regarding these approaches to care although he has not told us what sources he has used. In replies to our surveys one person said there are always activities for them to take part in, two said this is usually the case and five that this is sometimes the case. During our inspection we looked at the activity records. These showed little evidence of individual activities or that reference had been made to best practice guidelines for dementia care. The main activity recently had been bingo and we looked at the record for one person which showed they had taken part in this four times in seven days but had not done anything else. There was a bingo session arranged on the day of the inspection. A weekly plan in the activity folder showed that activities provided were bingo, baking, puzzles, cards, writing and colouring but the records did not reflect that this range of activities had happened. The staff rota includes shows that time is allocated to a memeber of staff to do activities five days a week. No evidence was available to show that staff have been trained for this role. We found no evidence to show that thought had been given to what individual people might prefer to spend their time doing. Our findings were supported by the findings of a monitoring visit by Herefordshire Council - There is still no major input of choice from the residents that can be identified, there is major dependence upon bingo and colouring but they appear to be happening daily. A social care professional had told us they observed staff changing the channel on the television (from horse racing to a childrens programme) without first asking people Care Homes for Older People Page 19 of 43 Evidence: sitting in the room if this was what they wanted. We were told that a person trained to do music and movement now visits the home for exercise sessions. Some of the responses we received from relatives indicated that they had noticed an increase in the level of activities being provided - definitely a huge improvement although some said they think there is room for further improvement. One person commented that there should be better provision for people to get outside for some exercise. One person commented that they thought the home would be pretty awful for someone in need of more mental or physical stimulation. One social care professional had been told by some people living at the home that they disliked it when activities take place in the room they are sitting in because they dont necessarily want to join in. The issues relating to the space available in the home are covered in more detail in the environment section of this report. Some staff commented on wishing they had more time to provide activities but felt this was limited due to their other duties. One staff survey highlighted the importance of training for staff in providing activities and indicated a good understanding of the value of identifying suitable activities to suit individual people. People at the home and their relatives expressed general satisfaction with the quality of the food provided although one relative told us that her relation is not keen on some of the meals. On the day of the inspection the person cooking had done a midweek roast dinner. We noted that there was no meat left over if anyone had wanted a second helping. The cook told us that left over vegetables are used to make soup for tea. We observed the amount left on the day of our inspection was small and was used with stock cubes to make soup. People spoken with told us they enjoyed their food and that they have sufficient. 50 of the surveys we received from people who live at the home said they always like the meals, 50 said they sometimes like them. During the day we saw that people were offered regular hot and cold drinks. As we were leaving the home we noted that tea was being served to people in their armchairs in the sitting room. We only saw them being given sandwiches and wondered how they would manage the soup we understood to be on the menu. We do not know if this is the routine arrangement but hope that people who might prefer to sit at the table would be supported to do so. Neither of the cooks has had formal catering training although one of them said she is doing a course about nutrition. There was no evidence that people who live at the home are consulted for their views about the choice of meals provided. The cook on duty showed us records kept of the food each person has had. She has been delegated responsibility for keeping these records up to date. We were concerned that this Care Homes for Older People Page 20 of 43 Evidence: includes retrospectively recording food from the previous days tea, although she would not have been there to see what people had. These records should be made by staff who are present when the meal is taken and who have first hand knowledge of what people had eaten. Care Homes for Older People Page 21 of 43 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. Recent improvements mean that people living at Abbey Grange should have their concerns taken seriously and be kept better informed about the action being taken. Similar improvements have begun in providing safeguards in the event of a person being abused or neglected. Evidence: In their AQAA the owners acknowledged that they need to improve the way they deal with complaints and that they are doing so. They told us they are now being more open in listening to people and will take action accordingly. They told us that we would find evidence of this in their monthly complaints record. When we looked at these records during the inspection there was limited information because only one concern had arisen. This matter had been referred to be investigated under local multi-agency safeguarding arrangements. This showed a recognition by the owners that they have to work in co-operation with outside agencies to protect people living at the home. The surveys we received showed that most people said they knew who to speak to if there was a concern they needed to raise although one person wrote - It is a bit hit and miss although communication has improved as I have got to know various members of staff. One person who lives at the home wrote - They (the staff) listen but occasionally do not act on what I say. One relative told us that on one occasion staff did not pass a message to her relation. The staff who sent surveys back said they Care Homes for Older People Page 22 of 43 Evidence: knew what to do if someone wishes to make a complaint. People we spoke to during our visit were unsure about the complaints procedure but we saw that there was a copy of this displayed on a notice board in the home. When we did our previous key inspection in October 2008 we were concerned that very few staff had done training about the right action to take if they are concerned that a person is being neglected or abused. Most staff have now done this training and those we spoke to on the day told us they would report any concerns to Mr Ubhee or to the authorities. The issue referred to above had come to light because a member of staff had been concerned about a person not being given the care they needed and had reported this to Mr Ubhee. This is a reassuring indication that staff are now more aware of their responsibilities. We noted that staff did their training in Swansea and would recommend that in future they do it in Hereford; this is because local training would provide them with knowledge about the Herefordshire safeguarding procedures which may differ from those in Swansea. During a meeting between Herefordshire Council, ourselves and Mr Ubhee about this referral he showed concerns about steps taken by the Council to get the views of the resident concerned. This indicated gaps in his awareness of safeguarding procedures and the importance of putting the person involved at the heart of any investigation. The staff training information we were given by Mr Ubhee shows that he has not done recent safeguarding training himself; something it is essential that he does. We recommend that he also does this training in Herefordshire rather than in Swansea. The recruitment procedures at Abbey Grange are not sufficiently robust to make sure that unsuitable staff are not employed. This means that people at the home may be put at risk. This is explained in detail in the Staffing section of this report. We are taking formal action about this. Care Homes for Older People Page 23 of 43 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. People living at Abbey Grange do not benefit from an environment equipped to meet their individual and specialist care needs and cannot be confident that all aspects of their safety are adequately catered for. Evidence: In the AQAA the owners told us that the homes maintenance problems are rectified quickly and the grounds kept tidy for people who wish to go outside. They referred to the limitations posed for them due to Abbey Grange being a listed building. The AQAA refers to the new extension providing wheelchair access due to having wide doorways. In reality the benefits of this are limited because these rooms can only be reached by walking down a flight of stairs or using a stair lift. Access to all floors above or below the ground floor is by stair lift; the building does not have a passenger lift. It is our understanding from what the owners had said over the years that this is because planning applications for a lift have been turned down. The house has a welcoming feel and people have been encouraged to personalise their rooms with their own belongings. We saw one room where the person needs equipment for moving and handing and found it was well arranged to meet these needs and she was very happy with it. Just over half of the residents who sent surveys back told us the home is always clean and fresh, the rest said this is usually the case. Care Homes for Older People Page 24 of 43 Evidence: No reference is made in the AQAA to how the owners make sure the needs of people with dementia are met within the environment. We noted that apart from external doors being alarmed to alert staff if someone goes outside there are no other design features to help people with limited memory or understanding due to dementia. Good practice would include using clear signs to help people locate bathrooms, toilets, their own room etc; but signs for these were limited to room numbers or nothing at all. This is an area which must be improved using nationally recognised good practice guidance for dementia care homes if the owners continue to accomodate people with dementia. During our random inspection in February and March and during this inspection we observed a level of overcrowding in the two main sitting rooms. This was also commented on in a survey from a relative - There should be a room to receive visitors - it is rather crammed at present - perhaps too many residents and too many rooms crammed on the site. We have already commented on the lack of space for private meetings or health appointments earlier in this report; this is made more difficult due to the lack of lift which means it takes some time for people to be helped back to their own rooms. We noted that conversations and telephone calls conducted at the staff workstation could be overheard in the nearby dining room. This means that peoples privacy and confidentiality are not being upheld. During this inspection we saw that most of the armchairs in the quiet room and the TV room were occupied most of the time. One person told us she would like to go into the other room to watch TV but, when she went to check she found there were no free chairs. She therefore returned to the quiet room. Chairs in both rooms are arranged very close together and, in the TV room some face the back of a row of chairs in front. When a new extension was built to provide more bedrooms a small sitting room was included in this. The room is only large enough for two or three people to use and on the day we inspected was furnished with a small portable tv and hard office type chairs, not armchairs. This means it would not be a comfortable place for someone to spend their time. The lack of communal space is a particular concern in a service which is putting itself forward as able to cater for people with dementia because of the impact on other people when someone becomes restless or agitated. During our inspections in February and March we observed the effect this had and the upset it caused to other residents. During this inspection we saw a confrontation between two people narrowly avoided due to a staff member intervening just in time. Mr Ubhee has told us that he is trying to get planning and listed building consent for an extra communal room leading off the quiet room. This would improve the situation as there would be more space for people and more choice about where to sit. Mr Ubhee told us that his applications keep being turned down but that a person with Care Homes for Older People Page 25 of 43 Evidence: planning experience who is the appointee for a resident is now trying to help him put forward acceptable plans. When we inspected in October and February we were concerned by a number of infection control issues and issued a statutory requirement notice about these. The issue include lack of staff training in infection control and shortcomings in toilets and bathrooms such as open waste bins and lack of toilet roll holders, liquid soap or paper towels. We also had concerns about precautions relating to a person with MRSA. During this inspection we noted a number of improvements. A plumber was at the home replacing two wash basins which had been out of use when we were at the home in February and there were new pedal bins, paper towels and hand wash in bathrooms and toilets. We saw that some toilet rolls were still propped on skirting boards rather than being on holders. Six more staff had been enrolled on infection control training and the information about precautions for infection control relating to MRSA had been addressed. Generally we found that staff were more aware than before. We therefore considered that the requirements of the notice had been met. We found some cleaning products which were not safely stored; these were containers of bleach, Milton and washing powder all of which were easily accessible to residents. This carries the risk of them being swallowed by someone with limited understanding due to dementia. We made an immediate requirement for cleaning products to be stored safely and Mr Ubhee wrote to us to confirm he had put this right. We went back and checked the work done and found that items were no longer in unlocked cupboards and that a lock had been fitted to the laundry door. This requirement was therefore met. On the lower ground floor a small sluice room has been created. We saw that this contains a butler style sink and a flushable toilet pan. There was no wash hand basin or hand cleansing gel in this room. This does not appear to be an adequate facility because staff who are emptying commodes and washing them need to be able to wash their hands before doing something else. The floor of the sluice is unsealed concrete which would prevent effective cleaning of spillages. We are making a requirement that guidance is sought regarding facilities required in a sluice room. We would suggest that the owners approach the Health Protection Agency regarding this. Very soon after the inspection we received a complaint that many staff are unaware of the fire procedures. In the light of this and other matters described in the staffing and management sections of this report, we made a referral to Hereford and Worcester Fire and Rescue Service. They did their own inspection and this highlighted shortcomings including a number of fire doors being inadequate due to missing smoke and heat resistant seals. We say more about this in the management section of this Care Homes for Older People Page 26 of 43 Evidence: report. Care Homes for Older People Page 27 of 43 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. People at Abbey Grange are cared for by hard working and caring staff but are not supported by effective management and leadership or by well planned training arrangements. People are not adequately protected from the risk of unsuitable people being employed due to inadequate recruitment procedures. Evidence: We consistently receive positive feedback about the staff who work at Abbey Grange. People who live there and their families speak highly of them and find them caring and friendly. In our recent surveys people said things such as - They are very helpful and friendly and keen to help at all times, Very kind and caring staff, The staff are very kind, warm and genuinely caring and patient, in often difficult circumstances. Staffing arrangements on the day we inspected were affected by a number of staff going on a training course in Swansea. When we arrived the manager was on duty with two care staff and a cook. He told us that the cleaner and some of the care staff who would have worked that day had gone on the training. He told us he was expecting another member of staff but she had not arrived yet. When this person arrived at 10:15am we found that it was not a member of staff employed at Abbey Grange but the manager of another care home owned by a company of which Mr Ubhee is a director. The rota was not accurate because it showed the names of some Care Homes for Older People Page 28 of 43 Evidence: staff who were on this training as working on shift at the home. Whilst it was positive that an extra person was brought in this raises a concern about how Mr Ubhee plans training to make sure the home remains adequately staffed. Our observations during the meal at lunch time led us to conclude that staffing levels were not sufficient to give people at the home enough support and assistance with eating their meal. When we spoke to Mr Ubhee about staffing levels he indicated that there were problems at present due to one person in particular needing a lot of time. He said he has told the persons relatives that she may need to move or that they will need to pay a higher fee so he can provide more staff. This is another indicator that the home is not equipped to provide a service for people who have care needs related to dementia. Our concerns about staffing levels are added to because there is no designated laundry worker so care staff have to fit in doing the laundry around their other duties. We are aware that on occasions care staff also do cleaning and catering duties during their shift. When we spoke to Mr Ubhee about the statement in the AQAA that staffing levels are determined by resident need he was unable to show us how he arrives at the staffing levels needed. The induction training being provided at the home is not based on the national standards set out by Skills for Care although Mr Ubhee told us that the NVQ training staff are doing is provided by Herefordshire PCT. One of the staff we spoke to was fairly new; she had not done structured induction training and was unaware that there are national induction standards for carer workers. We had some difficulty in reconciling the staff training matrix (which shows the topics staff have been trained in) with the certificates in their staff files. For example, one person was shown on the matrix as having done induction, infection control and dementia but there were no certificates for these in the file. The same person told us she had not had medication training although this was also shown on the matrix. One problem we encountered was that some staff were shown on the matrix as having done medication training but the certificates for the corresponding date were for Introduction to care. Mr Ubhee told us he was sure the training on this date was medication. We have since contacted the training provider and they confirmed that they issued the wrong certificates to the home. This is something Mr Ubhee should have identified and followed up himself when the certificates arrived. We are aware that Mr Ubhee has been arranging more staff training since we did our inspection in October 2008 and during this site visit we took note of information on the noticeboards about forthcoming training. However, it was difficult to get a Care Homes for Older People Page 29 of 43 Evidence: comprehensive picture of staff training due to the contradictory information and Mr Ubhees lack of availability on the day. Overall we remain concerned that the home does not have effective arrangements for monitoring staff training needs and keeping track of when updates are needed. We also found it hard to establish who the various training courses are provided by. We spoke to Swansea local authority to check the authenticity of some of the training certificates we saw at the home. We did this because the course title was handwritten by the staff who did the training. They said this is how they provide certificates for large training sessions but expressed concern that Hereford staff had attended. They said the training they provide is aimed at staff who work in care services in the Swansea area and are often oversubscribed. They said they would not knowingly give places to staff from another area. We have had particular concerns about dementia care training for staff at the home. When we inspected in February we were given a staff matrix showing that two staff were doing dementia training (on a distance learning course) and that two others had also done dementia training. We made a requirement for training to be arranged for other staff and during this site visit saw that ten staff started a course in March. Two relatives who sent surveys to us made comments about the need for dementia training for staff. Some staff also highlighted the need for training in respect of activities for people at the home, for example one wrote - Although the care staff are doing their best to do this, it would still make a difference to have a qualified activity co-coordinator as he/she can fully assess what sort of activities is suitable for the residents. The training matrix shows there are still some significant gaps in essential staff training. For example, in the week we did our site visit there were four night shifts when none of the staff from 8pm to 8am had done first aid training; three of the four staff who work nights have not done infection control training; nine staff had not done fire safety training and five staff had not done moving and handling training. We say more about management of safety in the home in the management section of this report. When we inspected in October 2008 we were concerned that the home had inadequate staff recruitment arrangements and made a requirement for them to improve these; in particular we told them they must do the checks required by law to make sure people are suitable to be employed as care workers. When we checked this again in February we found that some essential checks had still not been done. We therefore issued a statutory requirement notice. During this site visit we found that some staff files were still incomplete and that essential checks that the law requires such as criminal records checks and references were not available. This meant that the statutory requirement Care Homes for Older People Page 30 of 43 Evidence: notice had not been complied with. Due to the homes continued failure to comply with Regulations and the possible risks to people who reside at Abbey Grange further enforcement action is being considered by CQC. Care Homes for Older People Page 31 of 43 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. People who live at Abbey Grange do not benefit from a well managed service with effective leadership to staff. The manager is at the home for less than half the week which means that staff do not have the expected support and guidance to provide the best possible service. Evidence: Mr Ubhee is the joint owner (with his wife) of Abbey Grange and is the person who manages the home. The legal requirement is for a person to be in day to day charge of a care home. If they are not or do not intend to be, the law says they must appoint a manager. Mr Ubhee chooses to work his hours over three long days and is therefore absent for four days a week. We have had information from a range of different sources that he has been at Abbey Grange less than that although is now spending more time there. In view of the concerns identified in this and previous reports we are unconvinced that the current arrangement is satisfactory and have made a recommendation that Mr Ubhee reviews this working pattern. Care Homes for Older People Page 32 of 43 Evidence: We have concerns about the level of ability of staff given the responsibility of being in charge when the manager is not there. Some of the information we received from staff echoed our views about the the lack of adequate management. Some of the comments included - There should be a deputy manager who can oversee the needs of the home if ever the manager is not there, I think Abbey Grange could do better if there is a deputy manager who would take the place and responsibilities in the absence of the registered manager. Mr Ubhee told us he is intending to appoint a deputy manager and is also considering recruiting someone as a new manager so that he would only have his responsibilities as owner to fulfill. We were concerned that the person Mr Ubhee was considering as deputy has limited care experience but he assured us that she is undertaking a comprehensive training programme first. Mr Ubhee is shown on the staff training matrix but there are no entries against his name for any training topics other than an infection control course in 2007 and his enrollment on an infection control distance learning course in February 2009. There is no date shown against his name for dementia training. It is a legal requirement for owners of care services to undertaken training to ensure they have the knowledge and skills required for their role. We did not have the opportunity to discuss this with Mr Ubhee during the inspection but have made a recommendation for information about the training he has done to be available for inspection at the home. We have had information from several unconnected sources that people are concerned about the manner in which Mr Ubhee treats staff who work at the home. We have been told that he looses his temper with them and bullies them. Mr Ubhee has denied this allegation. We have not witnessed this first hand but have found him unhelpful on occasions. For example, during our site visit he frequently left the room in the middle of us discussing things with him and on several occasions we needed to go and find him when we were expecting him to return quickly. This meant the inspection took longer than it needed to and that we were unable to discuss many issues with Mr Ubhee. Staff from Herefordshire Council have had similar experiences during meetings about peoples care. There are no structured quality assurance measures in place at the home. In the AQAA the owners told us they have meetings with relatives every three months but when we asked to see information about these Mr Ubhee told us these are informal social events with no records kept. We looked at a folder containing thank you cards and letters. These showed that many people had been pleased with the care that they or their relatives had received. A number of the surveys we had from relatives gave a positive view of the home and some specifically said they did not feel that the report on our previous key inspection in October gave a picture of the home as they see it. We Care Homes for Older People Page 33 of 43 Evidence: believe that the explanation for this may be that for some people care at the home does meet their needs but this is not the case for all. In addition, some of the issues we have identified would not be visible to people visiting. For example, they would be unaware of the issues regarding staff recruitment procedures and fire safety. We checked the records and storage of spending money for people the home keeps small amounts for. With the exception of one minor error the amounts held reconciled correctly with the records. Mr Ubhee told us he was in the process of making arrangements to make sure this money would be available on request for people when he is not there with the key. We had made a recommendation about this in October. Mr Ubhee has introduced a system of staff supervision and is keeping records of this. This is a positive step which should help to build the effectiveness of the staff team. We have spoken about the improvements in the records relating to individual peoples care and we also found improvements in the way staff files were organised. However, the level of organisation in Mr Ubhees office and in the two staff workstations needs to be improved. This would benefit the overall efficiency and effectiveness of how the home is run. For example, in Mr Ubhees office there were piles of files and papers on surfaces, on a sofa and on the floor. This level of disorganisation carries the risk of information being being lost. Mr Ubhee needs to address a number of areas related to the safety of the accommodation and the training of staff in health and safety topics. The report done by the fire service highlighted that as well as some fire doors providing inadequate protection the fire risk assessment for the home was also inadequate. They found that it was inadequate, out of date and had not been reviewed or updated since 2006. They also identified that staff fire training was inadequate. The fire service are returning to the home in September to check that the requirements they made have been met. We have taken note of Mr Ubhees response to the complaint we received about staff not knowing fire safety procedures. This said that some staff would be doing training on 23rd June and others as soon as this could be arranged. The information in his letter about staff who did training in August 2008 was different from the information on the training matrix given to us at the inspection. During our site visit we found unsecured cleaning materials and unlocked doors to the boiler room and linen store, both of which had signs to say they should be locked. The staff matrix shows that there are numbers of staff who still need training in topics such as first aid, fire safety, food hygiene and moving and handling. More positively, the home received a 3 star good food hygiene rating from Herefordshire Council Environmental Health Department. Care Homes for Older People Page 34 of 43 Care Homes for Older People Page 35 of 43 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 9 13 The service must make 30/04/2009 arrangements to ensure that medication administration records are accurately maintained. This is to prevent a medication error that may cause harm to a resident. 2 9 13 The service must make 30/04/2009 arrangements to ensure that there are records for medicines documenting what medication is stored and available within the service, including receipt, administration and disposal records. This is in order to ensure that the residents medication needs are being safeguraded. 3 29 19 You must ensure that all the information specified in this Regulation is secured to determine the fitness of employees working at the home. This will help to prevent unsuitable staff being employed. 31/12/2008 4 29 19 You must ensure that in respect of all people 27/03/2009 Care Homes for Older People Page 36 of 43 employed at the care home all relevant information and documents as required by Regulation 19 of the Care Homes Regulations 2001 is sought and available for inspection. To help protect people living in the home from unsuitable staff being employed. We have issued a statutory notice about this. 5 29 19 Where people are employed 27/03/2009 to work at the home with a POVA 1st check ensure that appropriate arrangements are put in place to ensure that they work in accordance with Regulation 19(11) of the Care Homes Regulations 2001. To help protect people living in the home from unsuitable staff being employed. We have issued a statutory notice about this. Care Homes for Older People Page 37 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 Regulation 4(1) 31/07/2009 There must be an up to date statement of purpose and service user guide available in the home at all times. These documents must reflect the type and level of care that the home is set up to be able to provide. This is to ensure that the home has clear and realistic aims for the needs that can be properly catered for at the home and so people thinking of living there know what they can expect. 2 8 12 Regulation 12(1) You must have reliable arrangements in place for providing the personal care needed by each person living in the home. This is to ensure that each person has their individual care needs noticed and dealt with promptly and in the 31/07/2009 Care Homes for Older People Page 38 of 43 way best suited to them as identified in their assessment and care plan. 3 9 13 Regulation 13(2)You must ensure that effective arrangements are in place for the stock control of medication and for ensuring that people reliably receive the medication prescribed for them. This is to make sure that you do not run out of peoples medication and so that people can be confident that you will give them the medication prescribed fro them by their general practitioner or other health professionals. 4 10 12 Regulation 12(4) You must make facilities available for private discussions, reviews, health consultations etc. This is to make sure that people living at the home have their dignity and right to privacy upheld. 5 12 12 Regulation 12(3) 31/07/2009 In addition to your set list of activities you must take steps to find out what peoples individual preferences are for how they would like to spend their time. This is to give people chance to spend time doing things that they enjoy. 31/07/2009 31/07/2009 Care Homes for Older People Page 39 of 43 6 15 12 Regulation 12(1) 31/07/2009 You must ensure that people are provided with the staff time and attention they need at meal times. This is to make sure that each person is given the support they need to eat their meals so that their nutritional needs are met. 7 15 12 Regulation 12(2) You must provide people who live at Abbey Grange with opportunities for influencing the range of meals provided. This is to give people a say over this important aspect of their lives and to improve the choice available to them. 31/07/2009 8 18 13 Regulation 13(6) 31/08/2009 Mr Ubhee must do up to date safeguarding training and we strongly recommend that he does this in Herefordshire. This is to make sure that the manager is fully conversant with local multi agency safeguarding procedures; this will help him to make sure people living at Abbey Grange are properly safeguarded. 9 19 12 Regulation 12 (4) You must provide facilities for conversations (including phone calls) about people living in the home to be in private. 31/07/2009 Care Homes for Older People Page 40 of 43 This is to make sure that peoples privacy and confidentiality is upheld. 10 38 13 Regulation 13(4) 30/09/2009 There must be at least one person trained in 1st aid in the home at all times. This will make sure that people who use services receive appropriate attention in an accident. You must make 30/09/2009 arrangements to ensure that all staff receive training in health and safety related topics relevent to the work they do. This will ensure that the staff team has the necessary knowledge to provide safe care for people at the home. 12 38 24A You must comply with the requirements of the recent inspection report by Hereford and Worcester Fire and Rescue Service To ensure that fire safety arrangements at the home will protect people living there in the even of a fire. 30/09/2009 11 38 18 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 4 If you wish to continue to be registered as a service which provides care for people with dementia related needs the Page 41 of 43 Care Homes for Older People service provided at the home needs to be developed in line with nationally recognised good practice in dementia care. 2 19 If you wish to continue to be registered as a service which provides care for people with dementia related needs the environment of the home needs to be developed in line with nationally recognised good practice in dementia care. In addition to your planning application for an additional communal room you should review whether, in the short term other areas of the home could be used to alleviate the overcrowding in the two sitting rooms; this may in the short term mean considering reducing the number of people you accomodate at the home. You should seek appropriate guidance and advice regaridng infection control arrnagements at the home and in particular the sluice and laundry facilities. We would suggest approaching the Health Protection Agency. Mr Ubhee should have information available at the home which shows the training he has undertaken and what qualifications he has. Mr Ubhee should review his working pattern so that he fulfills the requirement to be in full time day to day charge of the care home. A concerted effort to organise and store all the homes records in a more orderly way would contribute to the home being managed more efficiently. 3 19 4 26 5 31 6 31 7 37 Care Homes for Older People Page 42 of 43 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 43 of 43 - 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!