Inspection on 28/04/09 for Alexander Care Centre

This inspection was carried out on 28th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexander Care Centre 29/04/08

Alexander Care Centre 01/05/07

Alexander Care Centre 08/06/06

Alexander Care Centre 15/12/05

Alexander Care Centre 19/08/05

Alexander Care Centre 14/09/04

Alexander Care Centre 05/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report Care homes for older people Name: Address: Alexander Care Centre 21 Rushey Mead Lewisham London SE4 1JJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Owen     Date: 2 8 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Alexander Care Centre 21 Rushey Mead Lewisham London SE4 1JJ 02083145600 02086906100 alexandercare@mchealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 78 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 20 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male) 28 residents, elderly persons and persons aged 55 years and above with physical dependency Date of last inspection Brief description of the care home The Alexander Care Centre is a modern, purpose built care home for Older People: Southern Cross Healthcare Services Ltd is the registered provider. The home provides for a maximum of 78 people with dementia care needs, residential care needs, and nursing care needs. The home has 68 single rooms and five shared rooms, each with en-suite facilities. Care Homes for Older People Page 4 of 35 Over 65 0 78 0 78 0 78 Brief description of the care home Adequate communal space and bathing facilities are provided. The home is situated in its own grounds in a cul-de-sac in a residential estate. It is close to local shops and public transport. There is car parking at the front of the building and two gardens to the side and the rear. Care Homes for Older People Page 5 of 35 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 visit to the home was undertaken as a part of the inspection process for the year 2009/2010. Two inspectors visited the home on the 28th April. In writing the report, consideration has been given to information received throughout the year such as reports of incidents and complaints. Some of the residents were spoken to and they commented positively on the care they are receiving. Completed surveys were also received from people using the service, relatives and staff. Once again comments were generally positive. A tour of the building was also carried out. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA). It is a self-assessment that the provider owner must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is included in the report. Care Homes for Older People Page 6 of 35 As part of this inspection one of the inspectors undertook a structured observation on the dementia unit to determine the quality of care provided. The findings are commented on in this report. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Homely remedy medicines are now more organised with a list agreed by the GP. The repairs required to the toilet pans and bathroom tiles have been addressed and the hairdressing room flooring has been repaired and the room repainted. The fridge in the Care Homes for Older People Page 8 of 35 dementia nursing unit kitchenette has now been replaced. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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 are admitted to the home based on the outcome of a pre-admission assessment and therefore they cna expect their needs are met. Information is provided but not always made available to people living there. Evidence: A Statement of Purpose and Service Users Guide (SUG) have been developed and are in the process of being reviewed with up to date information. These are both produced in a written format, although more general Southern Cross Provider information can be provided in the form of a DVD. Discussions with the manager showed that the Guide has not been made available to people living there. Whilst we understand that a number of people may not be able to read or understand the information others are very much able to do so and could do, if they made the information available in different formats such as pictorial, audio large print etc. Pre-admission needs assessments were seen on the care files of three residents caseCare Homes for Older People Page 11 of 35 Evidence: tracked. All had been completed by the home manager, dated and signed. Key areas of need were identified, although with a stronger focus on health needs rather than social or psychological ones. For one of the residents, there was also a health needs assessment by the care manager and, in another, a dementia assessmentcompleted once the person arived in the home was completed. On touring the home and observing people on the nursing unit we found a person sitting in the lounge with other residents. This individual was very confused, agitated and causing some amount of disruption to others seated there. We were told that a reassessment was being arranged. This does need to be reviewed as soon as possible to ensure all people are receiving the support and care required for their diagnosis. A number of Local Authorities arrange for people to be admitted to the home and there are also a number of privately arranged placements. Not all of the files viewed for newly admitted individuals had contracts in place due to the delay with the authorities. Privately placed individuals are also provided with contracts in place and those funded by the Local Authority are also provided with the homes contract. We viewed two of these to ensure people have the full information that they need. On viewing the contracts we found comprehensive information. We also noted that the fees are for personal care and accommodation and, where applicable, paid for by the Local Authority or by the individual. It states that the element of nursing care paid directly to the company by the Health Authority Agency will be retained by the company. However the fees quoted exclude this. It does not say how much these are even where the form allows for its input. If this element is not relevant in the individuals circumstances then the contract should make this clear or it should be recorded. Care Homes for Older People Page 12 of 35 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 were prepared to show how needs were to be met, although were not always fully reflective of the individuals full needs. Satisfactory arrangements were in place to ensure peoples healthcare needs were met, although some improvements are needed to medicine management to ensure peoples health is not placed at risk. Evidence: As part of the inspection one inspector sat for two hours observing some of the people living on the dementia unit to determine the quality of care provided. The observations indicated this care setting was generally supportive, with residents showing mostly positive or passive mood states. The findings also suggested residents mood states were more positive while they were on the unit compared to the time they spent in the dining room. Completed surveys sent to us were very positive about the care and support provided. One relative survey said residents health needs are monitored and liason with family is quite good. Care Homes for Older People Page 13 of 35 Evidence: Another said x is treated with dignity ... One resident wrote Staff are good and nice. ...staff are very support (ive). I am very happy with everything. The care records of five people were sampled for inspection, one on the nursing unit and one on the dementia unit and three on the residential unit to determine the quality of the care planning and supporting documentation. Care plans had been drawn up from the assessments of the residents needs, showing how these were to be addressed. The plans had been reviewed regularly, reflecting changes to the individuals needs. The care plan reviews for the resident on the nursing unit were more detailed and evaluative of the care given than those for the resident on the dementia unit. For one person, who has both vision and hearing impairment, there was some good personalized information about the individuals needs. There were some gaps in some of those viewed. One gap was a discrepancy between the assessment and care plan, particularly regarding the lack of food supplements required and the record of the persons disposition as being cheerful, but in fact, suffers with depression. However, the care plan showed the up to date information and was signed and dated by the person agreeing the support provided. The care plan detailed the pressure care support required by the District Nurse and the care staff. This was satisfactory, although the use of sudocream and checking continence need to be more clearly recorded. We did note that there was no record of a shower or bath since admission on 14th April 2009. There were good records of GP and District Nurse visits, as well as a visit by the Community deaf team arranged in a very short space of time. In the second one viewed there were clear records of the need to use infection control procedures in respect of MRSA. In a third file viewed there was once again some good information and risk assessments updated to reflect the current situation. The care plan was personalized to reflect the individuals choice of care staff. However, there was a significant gap in these records relating to the individuals diabetes and the support required by the District Nurse. We observed the District Nurse visiting to administer insulin before lunch but none of the records showed this aspect of care, except the medication record. There was no information regarding the dietary needs required in this area either. Care Homes for Older People Page 14 of 35 Evidence: Carers spoken with said they read care plans but it was not always evident plans were being implemented as intended. For example, the care plan for a resident on the dementia unit addressed her hearing impairment. The plan stated her right ear is fairly good and that staff should make sure they address her from the right side. However, at lunchtime she was seated with her right side against a wall, so she could only be spoken to from her left side. The nutrition care plan for the same resident stated she likes bananas. She did not eat her food at lunch despite assistance from staff but was not offered a banana as an alternative to the meal served. It is positive that they are promoting the dignity of others by appointing Dignity champions with some staff going through training that day. In particular,the maintenance is one of those chosen and is positive about this, beleiving he will be able to observe practice and encourage staff to promote dignity and respect thoughout the home. All residents case-tracked were registered with a GP and had been supported by the homes staff to receive the health care input they needed, such as dental or optical care. It was evident from discussions and from documentation seen that the residents had ready access to health care support, such as from the tissue viability nurse, physiotherapist, podiatrist and dietician. All of the surveys completed by people living there felt their health needs were being met. The wound care of a resident on the nursing unit was examined as part of casetracking. The resident has a gangrenous wound to one of his feet. He told the inspector he gets pain in his foot and did not think it was getting better. He said that staff change the dressing every other day, which was also noted to be the interval set out in his care plan. He said he is not able to walk on the leg so uses a propelled wheelchair to get around the home. It was evident from documentation seen that the wound had formed part of the home managers pre-admission assessment of the resident. The progress of the wound since admission to the home had been recorded well, including the use of photographs and an on going wound assessment form that had recorded wound dimensions, wound bed, exudates, wound margin, pain, and any actions taken or referrals made. A specialist nurse who visits the home regularly offered very positive comments about the standard of wound care on the nursing unit. She said the home is one of those she recommends to the local PCT when they are looking for a placement for a person with wound care needs. Risk assessments were generally up to date. The pain assessment tool for a resident on the nursing unit had not been used correctly, as raw scores had been added up Care Homes for Older People Page 15 of 35 Evidence: without being converted first in the way the tool requires. This gave much higher numerical totals than should have been recorded but there was no evidence of any detrimental effect on the persons care. This error was drawn to the managers attention as a likely training need for staff. Moving and handling practices seen on the dementia unit were satisfactory. These included two care workers assisting two residents to transfer from armchair to wheelchair using a hoist, in accordance with the care plans and risk assessments. Carers made sure wheelchair footplates were used. However, a carer was seen giving minimal assistance to a resident from armchair to a standing position at his walking frame by use of an underarm lift on one side. The resident used his other hand on the arm of his chair. The manager agreed to ensure staff are reminded about appropriate lifting practice. We were informed that the home had recently changed to the Boots medication system and this was the first week. There had been a few hiccoughs but otherwise had gone generally smoothly. One of the inspectors observed the member of staff administering the lunch-time medication to those on the residential unit. The practice was safe. Records were generally completed well and, on auditing the numbers, we found them to be correct. This would not have been difficult as this was only the second day of the new system being in place. However, two prescribed medications for one person had been handwritten with only one person signing the accuracy of the transcription and no record of its receipt or carried forward amount. This was also the same for another individuals records. Medications are generally stored in a locked trolley and these are kept in the medication cupboard. However, when undertaking a tour of the home during the morning we observed eye drops and a gel had been left on top of the medication trolley which was left unattended on the nursing unit. The team leader and Nurse on duty administer medications, although the care staff administer creams. There are some issues that need to be addressed with this practice. Firstly care staff administering the cream must sign the medication record (this could be left in the persons room for ease) the staff must be trained to do so and the creams and any other prescribed medications must be kept securely rather than on display in peoples rooms. The care plans should also detail any interventions required. We informed the manager about the information and guidance they require in this area from the CQC website. The last inspection highlighted the need for a homely remedy procedure and a record Care Homes for Older People Page 16 of 35 Evidence: of homely remedies used. This has now been complied, although further improvements would make the system more robust. A record of any medication purchased for homely remedies must be made. Records were also viewed regarding medication being disposed. These were adequate with a licensed contractor system in place as part of the dual registration. Some of the people living there have controlled drugs (CDs) supplied. These are kept secure in a CD cupboard within the medication room and are recorded in a CD register. The register was viewed during this inspection. Recently the records had been transferred from one book to another. Auditing these was not as simple as it should have been due to a number of reasons, including lack of legibility of the person doing the transcript, lack of clear signposting and misinformation. The misinformation related to a medication signed with a record of the date and amount as being returned to the pharmacist. This medication was still in the cupboard. Records must be accurate and, in this case, could have lead to questions about the reasons for recording the medication as being disposed of. One liquid medication of morphine sulphate did not have a date of opening recorded on it to ensure it was used within timescales. A resident on the nursing unit was on anti-coagulation medication. The nurse in charge of the unit explained the process by which it is ensured the resident receives the correct dosage. The home sends regular blood specimens to a hospital laboratory for testing, which then advises the home in writing (in the yellow book) of the dose to be given. This is satisfactory practice. Care Homes for Older People Page 17 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements were generally in place to provide people with social activities and a stimulating environment. Menus seen showed a balanced, nutritious and varied diet was provided. People should be given more choice and independence promoted whenever possbile. Evidence: The structured observation of a group of residents on the dementia unit showed provision of planned activities for residents during the observation period was good, consisting of a variety of activities that were appropriate for the capabilities and interests of individual residents. A resident on the nursing unit said that staff make sure he is able to practice his religion, and that the local minister visits him at the home. Surveys received were generally positive about the actvities, although some relatives and some service users felt this is an area that could be improved. The observation of a group of residents was continued during lunch, which was served in the ground floor dining room used by residents on the dementia unit. Some residents were asked what they wanted to eat from the choice of two main meals, Care Homes for Older People Page 18 of 35 Evidence: whereas others were not. It was not clear whether this was because they had already chosen a particular meal. The tables were laid with plastic covers, and paper napkins were provided, as well as bibs for each resident. Staff wore blue aprons while serving the meal. There were no condiments on the tables and none were offered during the meal. Gravy was put on plates directly from the hot trolley and people were not asked whether they wished to have gravy or how much they would like. The gravy was poured on the quiche option as well as on the roast chicken meal. Chicken was served on the bone, which clearly presented difficulty for some residents even after staff had given some assistance with separating the meat from the bone. The second inspector observed the serving of the lunchtime meal in the ground floor dining room. The observations were very much the same as the first inspectors and these people were able to interact more and tell staff if they wished gravy and how much etc. The company has adopted the Nutmeg system of menu planning to ensure adequate balance and nutritional content, each menu can be assessed individually for the nutritional content. Additional menus are also in place to ensure there is sufficient choice to cater for individual and cuitural preferences. There are fruit baskets in each unit for people to help themselves or to be offered by staff. The completed surveys stated that the food was generally good. Care Homes for Older People Page 19 of 35 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. Satisfactory arrangements were in place to ensure people are protected and that they are listened to so that their care needs are met. Recruitment procedures are not robust enought to fully prtoect peole living in the home. Evidence: A complaints policy and procedure was provided and a system in place to record complaints made about the service. Since the last inspection two complaints had been made to management. Neither were relating to the quality of care provided and records seen were satisfactory and showed how complaints had been managed. Residents and relatives spoken with said they knew how to make a complaint and feedback received in Commission surveys supported this comment. A policy and procedure was provided in relation to safeguarding adults. Two staff members interviewed separately were asked about their roles with regard to safeguarding the residents in their care. A carer said she had completed relevant training both in a previous employment and since working at this home. She said, I would blow the whistle if she saw or suspected any abuse of a resident by reporting itimmediately to a senior colleague. She would, at the same time, help to give the resident any support they need. A team leader told the inspector about his responsibility to raise staff members awareness of safeguarding, and monitor and support them to carry out their responsibilities in this respect. Care Homes for Older People Page 20 of 35 Evidence: The AQAA states that within the home they want to work within the Mental Capacity Act to ensure all those needing an independent mental capacity advisor will receive such support. They are currently working to ensure this is put into practice. Recruitment checks are completed on those staff new to the home, although are not as robust as they could be. This is commented on in the relevant outcome group. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are areas of the home that must be improved to ensure people are provided with a comfortable, safe and well-maintained environment. Procedures and systems are in place to minimise the risk of infection. However, people are placed at risk by the continued use of equipment that is not cleaned regularly. Evidence: The inspectors toured the premises with the registered manager. Potential hazards to residents health and safety were identified quite eearly on in the tour in the nursing unit day room. There was a hot kettle on a side table, near a resident who was mobile and showing signs of confusion and agitation. There was a COSHH product in an unlocked kitchenette cupboard, and medications were seen left on the top of the medicines trolley without anyone in attendance. Potential hazards to residents health and safety were also identified in the dementia unit. There was a hot kettle on a kitchenette worktop, and a green liquid said to be dishwashing liquid in a plastic Coke bottle in an unlocked kitchenette cupboard. Our previous requirement to replace the fridge and repair the kitchenette worktop in the dementia unit had been met, as has a previous requirement about improvements to the hairdressing room. Care Homes for Older People Page 22 of 35 Evidence: Orientation aids were seen on the dementia unit included colour coding of doors and installation of front door knockers. In the lounge there was an orientation board showing day, date and weather, and a clock with large face showing the correct time. It is clear that they are trying to provide people with as much help and guidance as possible to fnd their way around the unit. A carer interviewed by one of the inspectors was asked about ensuring effective control of infection. She said, The most important thing is hand-washing and said each wash hand basin always has liquid soap and paper towels. She said that other important measures were the appropriate use of protective clothing, such as aprons and gloves, and the proper disposal of clinical waste. This was confirmed by appropriate hand-washing facilities in place around the home and, in the case of someone with an infection, appropriate equipment in place within their room. Walking through the home we noted bedrooms were personalised and looked comfortable as did some of the lounges. However, some areas were quite bare or stark in the way they were furnished. The AQAA told us that there had been some improvements such as replacement of carpet on the first floor, new curtains and throws in the bedrooms on the dementia unit and redecoration of the lounge on the nursing unit. It also told us that they are planning to continue redecoration of the nursing unit and then the residential unit. There are ten bathrooms and two shower rooms located throughout the home but three were not working and, according to the water temperature records, these have not been working since December 2008 at least. There were no out of use signs to stop people entering. This also limits the number of operational bathrooms on each unit. We also saw a number of trolleys which were not only very marked (possible burns/scorch marks) but very, very dirty with stale food crumbs and liquids in gaps between the table and frame. Infection control is severely compromised with this standard of cleanliness. Equipment viewed, including hoists had appropriate service records in place. Lifts and ramps were in place to allow accessibility for people. We observed throughout the ground floor a number of the ceiling tiles in the hallways looked very water marked and a number of these were missing. This does not make a very comfortable and homely environment to live in. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels ensure people receive the support they require. The team have the skills and training to meet individual needs, although interactions could be improved to ensure peoples overall well-being is improved. Recruitment practices are generally atisfactory although a more robust approach would safeguard people from being cared for by unsuitale staff. Evidence: The structured observation of a group of residents on the dementia unit included staff interaction with residents. The observation data suggested that whenever there was some interaction by a member of staff this usually had a positive outcome for the individual resident. Staff interacted more with some residents than with the others, with residents who appeared better able to communicate receiving more interaction from staff. Staff members were prompt in responding to the group of residents being observed and appeared to have enough time to meet their needs. Key findings were shared with the manager, to assist in evaluation and development of practice. These included the poor staff interactions observed. For example, a carer was seen to wake a resident in order to take her to the dining room by tapping her arm several times and saying loudly, Oi, oi, wake up. Another carer then came over and spoke kindly to the resident, who was still drowsy, and waited for her to wake Care Homes for Older People Page 24 of 35 Evidence: fully. During lunch, carers were seen on two occasions to put food in front of a resident without speaking to the person or even looking at them. A carer assisted a resident with feeding without any verbal interaction with the person. While, as noted above, the majority of staff interactions seen were positive, these examples showed that improvements are still needed to ensure a person-centred approach to residents care is always used. We received three completed staff surveys and all felt that the quality of training is good. One staff wrote The training we receive is very interesting and informative and cover a wide range of subjects... Two staff members interviewed separately spoke about training provision. A carer said she had completed a two-day induction programme on taking up her post at the home. She said she had completed training in first aid, fire safety, medication, safeguarding and end of life care. A team leader said he had completed mandatory health and safety training, medication administration, and further training in dementia care. He referred to this latter training as YTT (Yesterday, Today and Tomorrow), and explained about this person-centred approach to dementia care. Records viewed confirmed that staff are provided with induction and core training. We viewed the records of four members of staff recently recruited. The manager was unable to show us the Criminal Records Bureau checks due a malfunction with the computer and e-mail system. We were therefore only able to view the POVAfirst checks. It appears from the files that the home recruits, as a matter of course, once a POVAfirst check has been completed. We informed the manager that this practice should be used in exceptional circumstances rather than as the norm. We were told that all staff with a POVA1st has supervisory arrangements in place, although there was no actual records or written evidence of this. On one file we noted that the reference from the last employer had not been requested, nor was there any checks completed on one other previous care employer to determine the reasons for leaving that particular employment.However, there were two references in place. A health declaration for each person had been obtained as required at the last inspection and proof of identity was also in place. We found from completed staff surveys received that induction is provided when they first commence employment. We were later provided confirmation that Criminal Records Bureau (CRB) checks had been completed for all but one person. We viewed copies of the staff roster and this appeared appropriate with adequate levels of nursing, care and ancillary staff. It is also positive to note that the dementia unit has a trained mental health nurse on duty. Care Homes for Older People Page 25 of 35 Evidence: The AQAA stated that there are over 70 of care staff with NVQ2 or above. Care Homes for Older People Page 26 of 35 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. The home is managed effectively with systems in place to continuously improve the quality of care to people. Satisfactory systems were in place to manage residents personal finances. Whilst there are systems in place to safeguard people livng there some of the practices mean they are placed at risk of harm. Evidence: The manager is registered with the Commission and has a nursing qualification and an NVQ level 4 in Care and Management. She is very keen to ensure to ensure that people receive a good quality of care and that any requirements made by the Commission are complied with. The home has systems in place to monitor and improve the standard of care provided. This included monthly visits and reports as required under Regulation 26, monthly Care Homes for Older People Page 27 of 35 Evidence: audits and three-monthly visits by the senior managers. Regular resident and relatives meetings and satisfaction surveys also take place. Results from audits were collated and where necessary an action plan was devised to address any shortfalls. The area manager visits the home regularly and speaks with staff and residents to assess the service. The results from a recent satisfaction survey were displayed in the reception area. Throughout the report we have commented on the gaps in record keeping that show they can be improved. We sampled a number of service contracts and agreements to determine if the equipment and services used ensure peoples safety. The Environmental Health Office Scores on the Doors rated the home four stars in July 2008; a lift service had taken place in January 2009 and gas in May 2009. We also found an appropriate fixed wiring certificate. Adequate fire safety arrangements are in place with a fire service during January 2009; regular checking of the emergency lighting; weekly fire checks taking place and fire drills taking place over the last few months. We also viewed the regular checks made on the hot and cold water system to ensure peoples safety. One member of staff is an accredited moving and handling trainer and provides training to staff on a rolling basis. However, the last inspection identified issues with the moving and handling practice and it has been commented in previous sections the observation by one of the inspectors of an illegal underarm lift still being used. This tells us that whilst people are being trained there is a lack of monitoring of practices. The previous inspection reported that the administrator was able to store some personal money for residents and locked cabinets were provided for money and valuables in each bedroom. A receipt was provided for any money received by staff for safekeeping and also kept for money spent such as hairdressing and chiropody fees. Due to the lack of computer facilities this aspect could not be audited on the day of the inspection. We have no information to doubt the continued safe recording and security of peoples monies. The manager and the operations manager carry out random checks to ensure that staff were following company procedures in relation to management of residents personal allowances. Two staff members interviewed separately spoke about supervision arrangements Care Homes for Older People Page 28 of 35 Evidence: within the home. A carer said we have supervision once in a while, and that this might include how she carries out a particular responsibility such as using a hoist. She said the person supervising will ask about her knowledge and might observe her carrying out a task, for example, making sure she uses the right hoist and slings for the right person. She said that a senior carer or team leader carries out supervision, and that I can ask what questions I like. A team leader said he arranges one-to-one supervision for his staff once a month, and uses the sessions to look at the persons strengths and limitations. He said he invites the person to identify these and then they discuss them. He said if a training need is identified, he ensures this is addressed. Specific health and safety issues are noted in Environment section above and give us some concerns about peoples safety. This also shows that there should be more monitoring by senior staff regarding practices and ensuring the safety of people living there. Two staff interviewed separately confirmed they had completed mandatory training, which is kept up to date. These two staff also outlined their responsibilities if an accident takes place within the home. Both responses were satisfactory and show appropriate action would be taken. A certificate of registration and Employers Liability insurance were in place, although we had to remind the manager to replace the out of date certificate with an up to date one. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 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 5A People must have the full information about the fees with a breakdown of who is responsible for paying all or part of the fees. People will have clear information about who is responsible for paying the fees. 12/06/2009 2 1 4 People living in the home must be provided with information about the service provided. People will then have the information they need. 12/06/2009 3 7 15 Care plans must detail all aspects of personal, social, physical and emotional needs identified. People can be assured that their needs will be met. 10/07/2009 4 8 13 Risk assessments must be completed accurately. 12/06/2009 Care Homes for Older People Page 31 of 35 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 Potential risks to be peoples health will be reduced. 5 8 13 Medication records must be accurate, up to date and legible. People can be assured that they will have the medication that they require. 6 9 13 All medication must be stored securely. Potential risks to peoples health will be reduced. 7 9 13 Creams must be stored securely and when administered signed by the staff administering the medication. People will have their medication adminsitered safely and at the right time. 8 19 23 The missing and stained ceiling tiles must be replaced. People need a safe and wellmaintained environment to live. 9 21 22 There must be sufficient 12/06/2009 bathrooms in good working order available on each unit. 12/06/2009 12/06/2009 29/05/2009 29/05/2009 Care Homes for Older People Page 32 of 35 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 People need to have access to bathrooms that are in good working order within a reasonable distance. 10 22 23 The dining area on the dementia unit must be redecorated and furnished. People must have a comfortable and homely environment to live in. 11 22 23 The walking aids must be thoroughly cleaned or replaced. People must have equipment that is safe and clean to use. 12 29 17 There must be evidence of the supervisory arrangements in place for those that commence employment with a POVA1st. People can be assured that they are being cared for by staff who are safe to work with them. 13 29 17 People working inthe home 12/06/2009 msut have appropriate checks completed prior tp commencing work in the home. Spcifically references from the last employer must be requested and confirmed. 12/06/2009 26/06/2009 01/09/2009 Care Homes for Older People Page 33 of 35 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 People will be protected from the employment of unsuitable staff. 14 36 17 Records must be accurate, legible and up to date. This will ensure that people have the right information to ensure peoples health, safety and well-being. 15 38 23 The environment must be free from potential hazards. People are protected from risks to their safety. 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 12/06/2009 22/05/2009 1 2 3 9 All aspects of the individuals needs should be assessed fully. Records should show when homely remedies are purchased for use inthe home to enable medications adminsitered to people to be audited. Staff should be provided with training on how to interact and communicate with people. People should be offered alternatives during mealtimes and should be given a choice on how they wish their food to be served. There should be monitoring of the home by senior staff to ensure practices do not put people living there at risk. 3 4 12 15 5 33 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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!