Inspection on 04/08/09 for Albany House

This inspection was carried out on 4th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Albany House 19/01/10

Albany House 19/11/09

Albany House 24/07/07

Albany House 08/08/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 24/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Albany House The Square Tisbury Salisbury Wiltshire SP3 6JP     The quality rating for this care home is:   one star adequate 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: Sally Walker     Date: 0 4 0 8 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 37 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 37 Information about the care home Name of care home: Address: Albany House The Square Tisbury Salisbury Wiltshire SP3 6JP 01747870313 F/P01747870313 albanyhouse@bmcare.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BM Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 21 Number of places (if applicable): Under 65 Over 65 1 21 dementia old age, not falling within any other category Additional conditions: 0 0 Albany House can accommodate one named service user with Dementia however, the registered person must notify CSCI if the service user is no longer accommodated. This condition will then be removed. Date of last inspection Brief description of the care home Albany House is an older detached building, which is situated in the village of Tisbury, Wiltshire. The home benefits from a good location within the centre of the village, within walking distance of the local amenities. A main line station from Waterloo to the west country is also located in Tisbury and again within walking distance of Albany House. Accommodation is provided on 2 floors of the home with the majority of the bedrooms provided being single. The home provides two communal areas and a large conservatory, which leads to a pleasant patio area and garden. Albany House is Care Homes for Older People Page 4 of 37 Brief description of the care home registered to provide personal care for 21 older people. The home was purchased by BM Care Limited in Jan 2006. Currently there is no registered manager. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 4th August 2009 between 9.20am and 6.30pm. Mrs Veronica Ingram, acting manager, was present during the inspection. We spoke with Dr Mahendran, of BM Care Limited, about our findings, the day after the inspection. The registered manager resigned at the end of March 2009 after a period of long term sickness. Dr Mahendran of BM Care Limited had advertised the manager post. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. Care Homes for Older People Page 6 of 37 We spoke with four people who use the service and two staff. We looked round the building. We looked at care files, staff training and recruitment files, complaints, rotas, menus and medication. Before this inspection we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. We looked at the information we had gained since the last inspection so that we could decide on which areas to focus on during the inspection. The last Key inspection was on 24th July 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? A new recording system for care planning is being introduced. A new cupboard has been installed for controlled medication. Staff know that controlled drugs are now recognisable by the mark CD on the containers. Care Homes for Older People Page 8 of 37 People benefit from the appointment of a part time activities co-ordinator. Hand washing facilities for staff have been provided in peoples bedrooms, to reduce the risk of cross infection. A handy person has been employed to attend to day to day maintenance and repairs. One person who smokes has been provided with a patio area outside their bedroom. What they could do better: A manager needs to be appointed who meets the requirements for registration. This will mean that the service can be developed. Care plans must identify guidance to staff on how peoples care and support needs are to be met and monitored. Risk assessment outcomes must be clearly identified in peoples care plans. There must be information about how any identified risks are managed and monitored. The nutritional risk assessment should relate to the pressure damage risk assessment. So that peoples nutritional status can inform the pressure damage risk assessment. The pressure damage risk assessment should state whether people have a history of pressure sores or not. Records must be kept of any wounds or pressure damage. This should include location, size, colour and whether the skin is broken. A record must also be kept of progress in healing. If people have pressure relieving equipment is in place, this should be recorded in their care plan. The home must keep their own records of healing and not rely on those kept by the district nurse. People must have risk assessments for bathing. If people like to take a bath without staff support, their care plan must identify how long they are to be left alone and where the staff are, when the person is in the bathroom. If other people are assessed as never to be left alone in the bath, their care plan must identify this. If people need to have their fluid intake monitored, the fluid charts should record how much they should achieve each day so that staff can see that they are drinking sufficient fluids. All documents should be signed and dated for monitoring purposes. Staff must record observations, conversations or interventions in the daily reports, rather than judgemental or unclear comments about people who use the service. Call alarms must be turned off where the person is rather than in the dining room. This is so that staff can see whether the call is an emergency. Care Homes for Older People Page 9 of 37 Risk assessments must be carried out with people who may wish to look after their medication. Peoples safety in taking their own medication must be regularly monitored. All medication must be accounted for, so that there is no risk of it being given to anyone inappropriately. Medication must always be given in accordance with the prescribers instructions. When staff record handwritten entries in the medication administration record, the prescribers instructions must be clearly transcribed. This is so that people have their medication at the proper time. Handwritten entries in the medication administration record should be witnessed signed and dated by two staff. If people cannot be given medication at the time that it is prescribed, for example, if they have to be woken up, this must be discussed with their GP as to whether they still need it. Care plans must identify when people should take medication that is prescribed to be taken only when needed. If people are on two different pain relief medications, their care plan must identify when each one should be given. Care plans should identify the different sites that medication patches are applied to. Peoples medication must always be given to them directly from the container that the pharmacist has made up. Medication must never be put in pots, then left to be given at a later time. This is to reduce the risk of people being given the wrong medication. Although staff knew that they must report any safeguarding issues to management, they should be more aware of the local safeguarding reporting procedure. Consideration should be given to a better system to delivering peoples laundry, so that it is not hung on radiators around the home waiting to go into their bedrooms. The undersides of toilet surrounds and raised toilet seat should be regularly cleaned. To reduce any risk of cross infection. Consideration should be given to how staff are deployed, so that staff do not work too many day and night duties without reasonable time of in between. Decisions about why staff who may have convictions, cautions or police information have been employed, must be recorded. To protect people from staff who may be unsuitable to work with vulnerable people. 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. Care Homes for Older People Page 10 of 37 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move in so that they can know whether the home is suitable for them. Evidence: People had an assessment of their care and support needs carried out before they moved in. Information was gathered from the person, their family or anyone else in their support network. In the AQAA the providers told us we admit residents only after a comprehensive assessment of their needs by our trained staff. We inform our potential service users and their families of the services we provided, of their identified needs and how we could meet their needs. We could not establish who had carried out the assessments that we looked at because they were not signed or dated. Care Homes for Older People Page 13 of 37 Evidence: One person told us they had been unable to visit the home before moving in because they had lived some distance away. They said my son found the place and took pictures so I could see what it was like. Care Homes for Older People Page 14 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not always up to date with details about how peoples needs are to be met. There is however, a personal focus on what people prefer to do for themselves. People are not protected by good risk assessment. Daily reports are sometimes judgemental and do not always show how people are properly supported. People are not protected by safe medication systems. People feel that staff consider their privacy and treat them with respect. Evidence: Some action had been taken to address the requirement we made that care plans are fully completed and reviewed monthly or when care needs change. New pre-printed paperwork had been introduced and information was gradually being transferred across. Mrs Ingram told us that the three senior carers wrote the care plans. She went on to say that people who use the service were consulted about their care plans each month and senior staff wrote a review of their care. Mrs Ingram told us that changes were made immediately. In the AQAA the providers told us that they were encouraging people who use the service to be more involved in their care plans. Care Homes for Older People Page 15 of 37 Evidence: As well as the care plan, peoples files had a list of morning and evening care routines at the front. We could not establish whether they were current care needs as they were not dated. The list showed that people had been consulted about how they wanted their intimate personal care to be carried out. There was a focus on what people preferred to do for themselves to maintain their independence, how they liked to be addressed and details of what support they needed with their own routines. Risk assessments were in the form of a tick list and numbering format. Assessments were carried out with regard to moving and handling, falls and pressure damage. There was no information about what action should be taken if the outcome score was medium or high risk. We looked at the care plans and found little information about how to manage and monitor the identified risks. One care plan stated weakness to left side, one carer to help with mobility. The pressure damage and nutritional assessments did not relate to each other. The pressure damage risk assessment did not identify the persons history of pressure damage as a risk. One persons care records stated ulcer on heels came back again, seen by district nurse. There was no record of the location of the wound, size, colour, whether the skin was broken or monitoring of healing. We were told that this would be in the district nursing notes. Another person had been identified as having a high risk of pressure damage. The care plan stated moisturise skin. Pressure relieving equipment was available if needed but this was not always recorded in the care plans. Staff told us that those people who had been diagnosed with diabetes followed special diets. They said that the district nurse would test blood glucose levels and administer insulin injections if needed. Some of the daily records had unclear statements such as all care given, no problems, hysterical, has only rung bell twice and seems a little down. Some of these statements were repeated for a number of days and nights. There were other judgemental comments about people, for example, doesnt want to do anything for herself and making allegations and getting staff into trouble. We talked with one of the senior staff about recording only what was said or witnessed, or support that was given. It was clear from talking with people and staff, that some people had complex care needs, but this was not evident from the care plans or daily records. Two peoples care plans stated depression. There was no record of how this affected the people or how they were to be supported, save for one care plan which stated that the person should be encouraged downstairs. Care Homes for Older People Page 16 of 37 Evidence: Care plans showed good information of peoples social history and family relationships. We saw that those people who were spending time in their bedrooms had their call bells within easy reach. One person showed us the call alarm pendent that they wore. They said Mrs Mahendran gave it to me after I fell, so that I can call staff to help me. I have to have someone with me when I get about. We saw one member of staff turn off the call alarm from the point in the dining room, rather than go to the person and see why they were calling. Mrs Ingram told us that the alarm would ring again if it was not cancelled in the room. One person told us Its lovely here, we are well looked after. People had jugs of juice or water which was replenished by staff during the day. One person told us staff tell me I dont drink enough. I have lots of juice and special drinks. We looked at their care plan. There was no detail about how much fluid the person should achieve each day or any fluid chart. Another persons care plan stated needs some assistance with fluid intake. There was no clear guidance as to what this meant. People were weighed when they moved in and every month thereafter. Significant weight loss was reported to the persons GP and some people had food supplements. We saw that one person had a kettle in their bedroom to make hot drinks. When we looked at the persons care plan there was no evidence that a risk assessment had been carried out as to safety issues in using the kettle. Staff told us that people could take a bath without staff support. There was no assessment of any risks to their safety when bathing alone. There were no records of whether anyone must never be left to bath alone. One care plan stated carers assistance with having a bath. Mrs Ingram told us that people received good support from the district nursing service who regularly visited to give treatments and advice. People we spoke with told us that they could see their GP whenever they wanted and that staff would make appointments for them. We saw that staff accompanied people when they needed to go to hospital appointments. We looked at the arrangements for medication. Action had been taken to address the requirement we made at the last inspection that all medication is stored safely. A new controlled drugs cupboard had been installed. There was a trolley secured to the wall Care Homes for Older People Page 17 of 37 Evidence: to hold the monitored dosage system. Staff told us that they had received training in medication. One of the people we spoke with showed us their prescribed creams and ventilators that they administered themselves. They showed us where they kept the prescribed medication out of other peoples reach. There were no risk assessments on file for those people who were administering their own medication. We found three Diazepam tablets without a packet in the controlled drugs cupboard which could not be accounted for either in the controlled drug records, or medicines disposal log. We said that all medication must be accounted for so that it is not given or taken by anyone else. Mrs Ingram immediately made a record of the medication and returned it to the pharmacy. We saw that some handwritten entries in the medication administration record was not the same information as on the prescription labels. One person was prescribed Amitriptyline to be taken at night. The medication administration record had a handwritten entry to be taken at 17:00pm. Mrs Ingram said that she had written the main part of the medication administration record but another staff had put in the time. There was no record of whether the GP had authorised the change of time in the persons care plan. Another person was prescribed medication to be administered via an adhesive patch. We saw that the hand written entry on the medication administration record stated it was to be given on a Saturday but the label stated change Thursdays. There was nothing in the care plan about where the patch should be applied, that it should be put on alternate sites or why the administration day was different to the prescribed day. Another person was prescribed two different pain relieving medications to be taken only when needed. The handwritten entry in the medication administration record stated times for regular administration throughout the day, which were all signed for. The persons care plan did not give details of why these were taken or when to give each one. We said that the medication and times of administration may need to be reviewed with the GP if people were being woken up to be given night time medication. We said that medication must always be given in accordance with the prescribers instructions. We also said that handwritten entries should be witnessed by another member of staff, signed and dated to make sure it is an accurate record. We saw some named pots in the medicines room. We asked what they were for. We were told that staff were putting peoples medication from the monitored dosage system or the original packs into the pots, about half an hour before given the medication. There was no reason for doing this, given that the medication trolley was stored in a room by the dining room where medication was given at meal times. We said that medication must be given to people straight from the blister packs put up by the pharmacist, otherwise people may be at risk of not receiving the proper Care Homes for Older People Page 18 of 37 Evidence: medication. We identified another risk as the pots were left on the side in an unlocked room. We said that there was good guidance to care homes about medication on our website for care professionals. Mrs Ingram told us she would go through all the medication administration records and make sure that the prescribing instructions were correctly written. Action had been taken to address the good practice recommendation we made that advice should be sought from the supplying pharmacist regarding which medication is a controlled drug if staff are unsure. We identified the POM and CD identifying marks on the packs of the controlled medication. Some of the prescribing labels had been put over these marks. Care Homes for Older People Page 19 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have benefited from having an activities co-ordinator who provides lots of different things for people to do. People benefit from the home being in a good position for them to go into the village and use the facilities. People enjoy a range of freshly cooked nutritious meals. Evidence: An activities co-ordinator had been employed since the last inspection. They provided activities on three afternoons. In addition an outside creative arts person was employed to spend a full day every week with people who use the service. There was a range of activities including sessions in house and trips out. Mrs Ingram told us about hiring a local bus which could accommodate a wheelchair. There had been a recent trip to see the lions at Longleat, with a picnic lunch and cream tea. Other trips were advertised: a local garden centre and to the gardens in a country house. In the AQAA the providers told us they intend to provide more excursions. On the day we visited there was a quiz and singing in the morning and watercolour painting during the afternoon. One person told us they enjoyed the art classes. We saw paintings and embroidery displayed around the home. The activities co-ordinator Care Homes for Older People Page 20 of 37 Evidence: gave awards for different activities. We saw that one person had displayed their award for skittles in their bedroom. Mrs Ingram told us that someone comes in every six weeks to provide a music therapy session. They bring a range of musical and percussion instruments for people to play. Different religious organisations come to the home regularly to provide services. One person goes to a local church. Some people have communion privately in their bedrooms. One of the people we met with told us I lay the tables. I like to keep busy. Another person, when we asked they about things they liked to do said I go up the road and Ive got lots of knitting. One person told us I go out to the hairdresser in the village. A hairdresser comes here but my son told me it would be better for me to get out and about in the village. Staff take me over and the hairdresser brings me back. Another person told us they stopped me going out today because I have to have someone with me. We asked them why and they said that they had been told that there were not enough staff. There were good stocks of food in the stores, including snacks, treats and alcohol. One of the people we spoke with told us we always have a glass of wine or sherry with Sunday Lunch. I like a glass of sherry. Another person said I go down to lunch but have all my other meals in my room. We asked them what was for lunch they said they did not know. They said they tell us whats for the evening meal; its soup, main course and sweet. The cook knows what I dont like. I can have vegetable pate because I dont like liver or kidneys. Mrs Mahendran has given me these drinks [a food supplement]. Another person told us Im fussy about my food, Ive been used to a bland diet. There is a good variety of meals. Another person told us that a cake was baked when people had a birthday. Mrs Ingram told us that people had their birthday card, cake and present at lunch time because this was when most people came to the dining room. We looked at the menus. The staff member who had taken over the cooking from Mrs Ingram, told us that Mrs Mahendran wrote the menus after speaking with people about what they like to eat. They told us the menus were changed throughout the year. We saw that any changes to the menus were recorded. The staff told us about their previous experience running a restaurant. We saw that all the meals were cooked from fresh ingredients. The cook told us that all the cakes were made in house. We saw that each weeks menu had instructions to serve the meals starting with a different table Care Homes for Older People Page 21 of 37 Evidence: each week, so that the same people did not always have their meal first. The lunch meal was ham and parsley sauce with three vegetables and mashed potatoes. Meals were served according to peoples appetites. The meal was well presented and looked appetising. The menus identified when ingredients were cooked from frozen, for example, frozen peas. In a survey form one of the relatives wrote the residents are always beautifully clean and well turned out. The home is always clean and fresh and the food is freshly prepared daily. Menu varied and fresh cakes cooked daily. I sometimes feel the residents could do with more stimulation. Care Homes for Older People Page 22 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their families are told about the complaints procedure. Staff should be more aware of the local safeguarding reporting procedure even if they only have limited responsibility for reporting any issues. Evidence: The home had a complaints procedure which was made available to people who use the service and their families. We asked people what they would do if there was anything they were not happy with or wanted to make a complaint. One person said I would tell Helen [a senior staff]. There was a complaints log in the managers office. It contained a letter of complaint dated February 2008. There was no record of whether the complaint was investigated and the outcome made known to the complainant. We asked Dr Mahendran whether that information would be kept elsewhere. He told us that he would have responded to the complainant at the time. Since the last inspection Dr Mahendran had carried out a full investigation into an allegation. He provided us with his very detailed report and action plan, following his investigations. We asked staff about referring any allegations or concerns to the local safeguarding procedure. They were not familiar with the process and could not locate the information needed to make a referral. However they were aware that they needed to Care Homes for Older People Page 23 of 37 Evidence: let us know of any safeguarding issues in line with regulation 37 and that there was a booklet available. We saw that staff had received training. Dr Mahendran told us that the booklet entitled No Secrets in Swindon and Wiltshire was available to staff and visitors with information by the front entrance. Care Homes for Older People Page 24 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a home that is well maintained, clean, bright and homely. Evidence: Peoples bedrooms are on the ground and first floors. The floors are accessed by a passenger lift or stairs. Staff told us that some people used the lift unaided. Two of the bedrooms are doubles and sixteen have ensuite facilities. Those bedrooms without ensuite facilities have toilets and a bathroom nearby. People had been asked about whether they wanted to have a key to their bedrooms and their choice was recorded in their care plan. Peoples bedrooms were personalised. People told us that they had been able to bring small items from home to furnish their bedrooms. We saw that staff respected peoples private space by always knocking on doors before being invited in. We saw one staff turn off the call alarm from the point in the dining room rather than go to the person and see why they were calling. Mrs Ingram told us that the alarm would ring again if it was not cancelled in the room. There was an ongoing plan to improve the environment for people. A new carpet was due to be fitted in the dining room. In the AQAA the providers told us they planned to change the front door and the entrance to make it more welcoming and homely. To improve the appearance of the exterior of the building and to landscape the gardens. Care Homes for Older People Page 25 of 37 Evidence: There was a large flat screen television in the sitting room that could be seen and heard by everyone in the room. Action had been taken to address the requirement we made that hand washing facilities for staff are provided in each bedroom to reduce the risk of cross infection. Action had been taken to address the good practice recommendation we made that the home should consider recruiting a handy person. Mrs Ingram told us that her husband, who was an electrician, dealt with some maintenance and repairs as they were reported and tended the garden. One person who smoked had been provided with a patio area outside their bedroom. Staff who smoked did so in the garden. Housekeeping staffed work from 9.00am to 1.00pm Monday to Friday. Mrs Ingram told us that at the weekends care staff cleaned the toilets, emptied the bins and dealt with any emergency cleaning. We saw that generally the home was cleaned to a good standard and there were no unpleasant odours at any time during the inspection. We saw that the undersides of some of the toilet surrounds and raised toilet seats had dried yellow drip marks and not been cleaned when the toilet was cleaned. Mrs Ingram told us she would discuss this with the housekeepers. Staff had received training in infection control. Disposable gloves and aprons were available to staff. The local Environmental Health department had recently done an inspection of the kitchen and given the home five stars. We asked people what they thought about the laundry service. Every one we spoke with said they were pleased with the service. We looked at the laundry. It was clean, tidy and well organised. There was guidance to staff on how to organise different types of laundry. There were systems to deal with soiled or infected laundry, separate from regular laundry. We saw that night staff did not return laundry directly to people but hung it either on radiators or handrails outside their bedrooms for day staff to put away. Care Homes for Older People Page 26 of 37 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. Staffing levels mean that people do not always have staff when they need them. Some staff work day and night shifts, often without much break in between. The recruitment process does not always evidence why decisions have been made about employing staff and their suitability to work with vulnerable people. Staff have good access to NVQs and training. Evidence: When we visited there were four care staff, one of whom took over the lunch preparation from Mrs Ingram, who was covering for the cook who was on sick leave. Two housekeepers were working during the morning. During the afternoon and evening there were three care staff working; one of whom was working in the kitchen preparing and cooking the evening meal. We asked about staffing levels and staff told us that people could not have their baths at night but would be offered a bath in the morning as there were more staff. The rota showed two waking night staff. There was a volunteer who regularly came to help with activities. We saw that some staff were working split shifts and days shifts as well as night shifts. One staff worked nine days without a day off which included three waking nights. One of the senior staff who worked from 8.00am until 1.00pm that day and was due to work the night shift, told us that they had always worked days and Care Homes for Older People Page 27 of 37 Evidence: nights. Dr Mahendran told us that none of the staff were working more than forty eight contracted hours a week. One of the staff held NVQ Level 4. Another staff was undertaking NVQ Level 4 and another staff was undertaking NVQ Level 3. In the AQAA the providers told us that about 75 of staff have qualified in NVQ 2 or above or are in training. We hope that in the near future all our care staff will achieve at least NVQ 2 standard. One of the more recently employed staff told us that they had received a six week induction and that the records of this would be in the office. They said they had shadowed a more experienced member of staff and that Dr Mahendran had explained different aspects of the work. They told us they had completed training in moving and handling, safeguarding people, infection control and had nearly finished NVQ Level 2. Mrs Ingram told us that staff were due to receive training in emergency first aid. Staff had certificates for care planning training dated January 2009. There was a list of which training staff had undertaken in the last year which included: diabetes, first aid, food hygiene, dementia, medication, care planning, moving and handling and fire safety. In the AQAA the providers told us that they planned to provide further training courses for our staff and to enhance the supervision of our staff in their work as carers. Staff training certificates were displayed in the main entrance. Staff told us there were regular staff meetings. We saw copies of staff meeting minutes in the office. We looked at the staff recruitment files. Most of the information we require by regulation was on staff files. Criminal Records Bureau certificates had been received showing staffs suitability to work with vulnerable people. The providers had told us about long delays in receiving Criminal Records Bureau certificates which had delayed staff appointments. We saw that there were no records of discussions or decisions on employing staff when any convictions, cautions or police information were shown on the certificate, particularly if staff had stated that they had no criminal record on the application form. All of the people we spoke with made very positive comments about the staff. One person told us about their keyworker and how they supported them with bathing. They told us they liked a bath once a week. One person told us they are short of staff, there has been a lot of sickness. Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Ingram is making sure that the day to day running of the home goes on. She understands the needs of the people who use the service very well. However the home needs a manager who meets the requirements for registration, in order that the service can be further developed. Staff have regular supervision. Improvements have been made following a quality audit by the providers. Environmental risk management is contracted out. Evidence: The providers took over the running of the home in January 2006. The previous manager resigned at the end of March 2009 after a long period of sick leave. Mrs Ingram, the deputy manager, had taken on the role of acting manager. She worked part time. When we visited, Mrs Ingram was working in the kitchen, as the cook was on sick leave. Dr Mahendran has told us that the managers post has been advertised. In a survey form one of the staff wrote the last year proved difficult as the manager Care Homes for Older People Page 29 of 37 Evidence: was on long term sick leave, putting a lot more pressure on staff to cover more duties. However changes were made, the deputy manager stood in to help with day to day running which relieved some of the added pressure and saw a vast improvement. The manager has since resigned and the post advertised so hopefully a new manager should be in situ shortly. Dr Mahendran told us that he and Mrs Mahendran visited the home every few weeks. They said that they regularly spoke with them about any issues that needed to be discussed. Dr Mahendran has kept us up to date with developments in the home by sending us a report on his monthly unannounced visits. He has also regularly telephoned us to tell us of any event that we should know about. In the AQAA the providers told us we have allocated a designated time for the acting manager to spend in supervision of front line services. We asked staff whether they had regular supervision. They told us they had appraisals with Dr Mahendran. We saw that records of staff supervision were kept in staff personnel files. The home recently sent questionnaires to people who use the service, relatives and staff for them to comment on the quality of the service. The forms had been collated. There was no action plan showing measures to improve the service from this or previous years. In the AQAA the providers told us we strive to respond to individual and collective views of residents, for example on type and range of menus, interior decor, health and safety issues, environment and outings. Risk assessments on the environment had been contracted out. An action plan had been drawn up. The fire risk assessment had also been contracted out. The providers told us in the AQAA that they had implemented the recommendations of the assessment. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person will 15/09/2007 ensure that care plans are fully completed and reviewed monthly or when the care needs of the service users change. Care Homes for Older People Page 31 of 37 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 7 17 The home must keep their own notes and not rely on those kept by the district nursing service. So that records are kept of monitoring and healing. 30/09/2009 2 7 13 Risk assessment outcomes must be clearly identified in peoples care plans. There must be information about how any identified risks are managed and monitored. For peoples safety 30/09/2009 3 7 13 The home must record size and colour of any wounds, together with details of whether the skin is broken. For peoples safety 30/09/2009 4 7 15 Care plans must identify guidance to staff on how peoples care and support needs are to be met and monitored. 30/09/2009 Care Homes for Older People Page 32 of 37 So that peoples current care and support needs are met. 5 7 13 Bathing risk assessments must identify whether people need staff with them in the bathroom or not. To reduce the risk of drowning or scalding. 6 9 13 Risk assessments must be carried out with people who may wish to manage their own medication. For peoples wellbeing. 7 9 13 If people are prescribed two 30/09/2009 different pain killers only when required, the care plan must record when and why each one is to be given. So that people recieve the right medication. 8 9 13 Care plans must identify 30/09/2009 when people should take medication that is prescribed to be taken only when needed. So that people only have medication when they need it. 9 9 13 Staff must not put the medication in containers, left to be administered at another time. To reduce the risk of people receiving the wrong medication. 30/09/2009 30/09/2009 30/09/2009 Care Homes for Older People Page 33 of 37 10 9 13 Unwanted or discontinued 30/09/2009 medication must be kept in its original pack, recorded in the log and returned to the Pharmacy. So that all medication held can be accounted for. 11 9 13 Handwritten entries in the medication administration record must accurately record the prescribing instructions. So that people have their medication at the right time. 30/09/2009 12 22 13 Call alarms must be turned off where the person is, rather than in the dining room. So that staff can see whether the call is an emergency. 30/09/2009 13 26 19 Decisions about why staff who may have convictions, cautions or police information have been employed, must be recorded. To ensure there is a robust recruitment procedure which protects people from staff who may be unsuitable to work with vulnerable people. 30/09/2009 14 31 8 A manager must be appointed who meets the requirements for registration. 30/10/2009 Care Homes for Older People Page 34 of 37 So that all aspects of management can be developed. 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 2 3 4 7 7 8 9 Unclear and judgemental statements should be avoided in daily reports. Body maps may improve the recording of any wounds or marks. Fluid charts should identify how much people should drink each day. The nutritional risk assessment should relate to the pressure damage risk assessment and should state whether people have a history of pressure sores or not. If people cannot be given medication at the time that it is prescribed, for example, if they have to be woken up, this must be discussed with their GP as to whether they still need it. Handwritten entries in the medication administration record should be witnessed by another member of staff, signed and dated. To ensure they are correct. Care plans should identify the different sites that medication patches are applied to. Staff should be more aware of the local safeguarding reporting procedure, even if it is not their direct responsibility to report any issues. The undersides of toilet surrounds and raised toilet seat should be cleaned. To reduce any risk of cross infection. Consideration should be given to deployment of staff, so that they do not cover day and night duties without a reasonable break. Consideration should be given to a better system to delivering peoples laundry, so that it is not hung on radiators around the home waiting to go into their bedrooms. All documents should be signed and dated for monitoring Page 35 of 37 5 9 6 9 7 8 9 18 9 10 26 26 11 26 12 37 Care Homes for Older People purposes. Care Homes for Older People Page 36 of 37 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 37 of 37 - 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!