Inspection on 10/10/08 for Allambie Court

This inspection was carried out on 10th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Allambie Court 29/01/09

Allambie Court 07/01/08

Allambie Court 21/09/07

Allambie Court 29/11/06

Allambie Court 19/04/06

Allambie Court 22/11/05

Allambie Court 06/07/05

Allambie Court 15/02/05

Allambie Court 23/04/04

Similar services:

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle McCarthy     Date: 1 6 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG 02476383501 Telephone number: Fax number: Email address: Provider web address: allambiect@btinternet.com Name of registered provider(s): Name of registered manager (if applicable) ADL Plc Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Allambie Court Nursing Home is situated in Nuneaton approximately 1 mile from the town centre, and is easily reached by a local bus service. The home is an Edwardian building converted into a nursing home and has had an extension built to accommodate 30 people who have a diagnosis of dementia and mental health problems. There is a small secure garden to the rear of the property and sufficient parking to the front. The home has a mixture of single and shared occupancy and all bedrooms are fitted with a hand washbasin. Written information about the current scale of charges for the home was not available on the day of this inspection visit. 0 30 Over 65 30 0 Care Homes for Older People Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the inspection, we looked at all the information we have about this service, such as information about concerns, complaints or allegations, incidents and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. We made two visits to the home. Our first visit was on Friday 10th October 2008 between 4.30pm and 10pm. Our second visit to the home was on Thursday 16th Ocotber between 12.30pm and 8.20pm. 27 people were living in the home on the day of our visit. It was the assessment of the home manager that the majority people living Care Homes for Older People Page 5 of 33 in the home had medium to high dependency dementia nursing care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We observed the way staff behaved towards residents and looked at their working practices. We talked to people who use the service and looked at the way staff interact with them. We We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. We sent surveys to people who use the service. The relatives of three residents returned survey forms to us. Their comments are included in this report. We talked to several staff. This included the manager, deputy manager, two night nurses, four care assistants, the housekeeper and activities support worker. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. At the end of the visit we discussed our preliminary findings with the home manager. What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 33 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 8 of 33 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 who are considering moving into the home benefit from having their care needs assessed so they can be sure the home can meet their needs. Evidence: We examined the records of three people admitted to the home since the last inspection. The manager said that it was usual for him or a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Each of the files examined contained information gathered during a pre-admission assessment that identified all of the persons needs. Care Homes for Older People Page 9 of 33 Evidence: For example, one person was identified as having good cognitive ability and would require extra support to meet their social needs. Care plans and daily records documented one to one support from staff escorting the resident on shopping trips and visits to day centres to maintain their interests and recreational preferences. Care Homes for Older People Page 10 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated respectfully and their personal care needs are met. Systems for the management of medicines are not sufficiently robust to safeguard residents. Evidence: The manager told us that the majority of people living in the home have medium or high dementia care nursing needs. Several people also have high physical needs. For example, 13 residents have limited mobility and are assisted to move using a hoist. It was evident from our observations that the personal care needs of people are met. Residents looked cared for; their skin, hair and nails were clean and they wore appropriate clothing. The relative of one resident told us, Im delighted with the service. Its clean, efficient and my relative is well looked after. My relative was in another care home before coming here, but I was not confident they were meeting his needs. I feel he is much better cared for here. We looked at the records of three people identified for case tracking. Care Homes for Older People Page 11 of 33 Evidence: Care plans were available for the identified needs of residents and kept under review. Care plans are develped for new or short term needs. For example, a care plan was developed for the treatment of one persons surgical wound. The review of care included a referral to the GP when staff observed signs of infection and antibiotics were prescribed. Records document wound dressings were renewed as planned. The service uses risk assessment tools to monitor residents risks of poor nutrition, increased falls and developing pressure sores. Care plans are developed and implemented when increased risks are identified. For example, one person was identified as having a high risk of developing pressure sores. A care plan was developed and implemented to minimise the risk. This included the use of a specialist pressure relieving mattress which we observed in use. The care planned and given to this person resulted in a good outcome as they have not developed pressure sores. Records demonstrate that residents have access to other healthcare professionals including GP, optician and chiropodist and community nurses. One relative commented, My husband has improved and is much better since his stay at Allambie Court. Records show that people are weighed every month to monitor their general health and well being. Two records we looked at showed people had sustained or gained weight. Records for a third person documented their weight had been recorded once since their admission to the home several months previously. This person was identified as having a high risk of poor nutrition but often refuses to be weighed because of challenging behaviour needs. The manager should consider alternative methods of assessing peoples nutritional well being where it is not appropriate to use weighing scales because of their physical or pyschological condition. A care plan for one person who has diabetes controlled with tablets recorded that the person should have a sugar free diet. There was no reference to monitoring their blood sugar levels. When we examined the medication for this person we observed that the prescription for their diabetes medicine had changed. Arrangements should be made to monitor the blood sugar levels of people who have diabetes to detect changes in their condition. Several residents are identified as having some verbal and physical challenging behaviour needs which could make them resistive to intervention. We talked to several staff members how they would manage a resident who became challenging when they undertook caring tasks, such as washing and dressing. Staff told us they would use verbal reassurance but if residents continued to refuse care they would leave them to Care Homes for Older People Page 12 of 33 Evidence: calm down and return to them after some time when the residents mood had changed. Evidence was available that care plans are developed and implemented for peoples challenging behaviour needs. During our inspection visits we observed several incidents when residents became verbally or physically challenging. Staff used calm and sensitive attitudes and techniques to divert the behaviours, which should minimise the agitation and distress for people using the service. Our examination of management of medicines evidenced shortfalls. The service uses a monitored dosage (blister packed) system. Medicines are secured in locked trolleys and stored in locked rooms. A medicines fridge is available and daily records are maintained to demonstrate the temperature is within recommended limits. Daily room temperature records are maintained for the clinical room demonstrating that medicines are stored withing recommended limits to retain their stability. The arrangements for storing controlled drugs comply with legislation. The medicine contents of the controlled drug cupboard corresponded with the numbers recorded in the controlled drugs register. We looked at medicine administration records for one person prescribed a fentanyl patch (strong painkiller) every 72 hours. Records show this was administered regularly as prescribed. Care staff told us that when they are involved in witnessing the administration of controlled drugs, the controlled register is signed before the medicines are given. This practice does not safeguard people from the risk of medicine misuse. Staff must be aware of the correct procedures for recording the administration of controlled drugs and have an understanding of their role and responsibilities. We examined the medicines for three people involved in case tracking. We audited some of their medication by comparing the number of tablets signed as administered on the Medicine Administration Records (MAR) against the number of tablets received and those currently remaining in stock. Medicine Administration Records (MAR) were accurately maintained for one person and an audit showed their medicines had been given as prescribed. Staff identified that another resident often refuses their medication. The MAR chart for this person reflected that they often decline medicines. We noticed that on occasion, the person will accept some medicines but not others; for example, they will accept a blood pressure tablet but not a water tablet. There was no record to show whether the persons non compliance with medication had been discussed with the GP or action taken to monitor the effect of their non-compliance on their general health by, for Care Homes for Older People Page 13 of 33 Evidence: example, regular monitoring of their blood pressure. The same person was prescribed dihydrocodeine tablets, which they took regularly. During our audit it was found that 28 dihydrocodeine tablets could not be accounted for. This leaves people at risk of harm from misuse of medicines. When we examined the third persons medication we found anomalies between the medication prescribed between August and September 2008. For example, the dose of levothyroxine (thyroxine hormone) was reduced from 100mcg to 75mcg between August and September 2008. This persons diabetes controlling medication had also changed; glicazide had been discontinued but metformin was still prescribed. There were no entries documented in the daily records or GP visit sections to indicate why these changes were made. The manager was unable to tell us the reason for the changes. This means staff cannot be certain whether these medication changes have been made by the GP or in error. We looked at the equipment available for monitoring blood sugar levels for residents who have diabetes. Two blood sugar monitors and blood letting devices were available in the home. The manager told us that one belonged to a recently admitted resident but the other was for the shared use of residents with diabetes. The use of shared blood letting devices is not safe practice because of the risk of cross infection. Arrangements must be made for each person to have a blood letting device and monitor for their individual use only. Insulin was stored in the fridge for a resident who had been admitted to hospital. These were pen type devices that need to be set to deliver the correct dose of insulin. We asked the manager to demonstrate how to use one of the devices, but he was unable to. He told us he did not know how to use the device as this particular one was administered by the night staff. We observed staff treating people with respect; addressing them by their preferred names and giving personal care in private. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities for residents to participate in the creative and meaningful activities provided are limited. Visitors are made welcome which supports people to maintain enduring relationships. Meals are not served in a manner that promotes peoples independence or enjoyment. Evidence: A support worker is employed for 16 hours each week to support the recreational needs of residents. A weekly programme of activities is planned and displayed in the reception area of the home. Activities include aromatherapy, trips out (both in groups and individuals), art therapy and music. The support worker told us she has established a group of regular entertainers who take it in turn to provide a weekly performance for residents. This has proved succesful because performers and residents have become familiar with each other. We looked at photo albums displayed in reception showing residents participating in activities, along with displays of paintings and pottery produced by residents. The support worker told us she has recently attended a music therapy workshop and plans to implement her learning in the home. Care Homes for Older People Page 15 of 33 Evidence: We discussed with the manager and support worker the limitations of supporting peoples recreational needs in the home as care staff are busy undertaking personal care and the support worker has time limited resources. Some residents are offered one to one assistance to meet their needs to participate or escorts for trips out. The support worker has developed and maintained lifestyle diaries recording peoples past employment, hobbies and important relationships. This should mean that staff have access to information about peoples preferences. The support worker maintains detailed records of peoples participation their reaction to the activities provided which should mean that the planned activity programme reflects peoples preferences. The home has an open visiting policy which means reisdents can recieve visitors when they want. We observed late supper on the first day of our inspection and an evening meal during our second visit. These were both served to people as they were seated in the lounge. Staff told us that the dining rooms are used for breakfast and lunchtime meal service. During our first visit the evening meal was finised and cleared away by the time we visited both communal lounges at 5.30pm. A care worker told us the evening meal is usually served about 4.30pm. At 8.30pm night staff brought a trolley of hot milky drinks (kept warm in a large vacuum flask), sandwiches and biscuits to the lounge where residents were served. About half of the residents were still in the lounges at this time. During our second visit we observed the evening meal service in the ground floor lounge. The evening meal consisted of sandwiches and crisps followed by a mousse dessert. People were offered a choice of tea and coffee. Some residents had access to small, side tables to place their meal on, but several more were served in lap trays. One residents meal was placed on an adjacent window cill. This made it difficult for some residents to eat their meal. We observed one person eat their sandwiches then tip the tray on to the floor. A carer replaced the lap tray then served the persons dessert. The person again tipped the tray on to the floor when they had finished. We discussed with the manager that the absence of suitable tables for serving food to residents did not enhance their enjoyment of the meal, made it difficult for some people to eat and did not uphold the personhood of people with dementia care needs. The manager told us that he had recently received an order of tables which had proved to be unfit for purpose because they were unstable. Care Homes for Older People Page 16 of 33 Evidence: We observed a bowl of brown liquidised food and we asked a carer what it was. We were told it was a liquidised meal for an identified resident. The carer was unable to tell us what the meal was. This bowl of warm food was brought from the kitchen uncovered and was not kept in a warm trolley before it was taken to the resident. This means we cannot be certain the food was still warm when given to the resident. The carer would not have been able to explain to the resident, with limited cognitive ability, what they were being served. Each part of a liquidised meal should be served individually so that people can enjoy the taste of each part of the meal. When we shared this information with the manager, we were told the meal was lamb stew. The midday meal service on this day was a choice of pork or lamb. We did not establish the choice of midday meal given to this resident so we cannot be certain whether they had the same meal choice for both lunch and dinner. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident their concerns will be listened to and acted upon. Senior staff are not familiar with police and social services guidelines for responding to suspicion or allegation of abuse, which could result in delayed appropriate action to safeguard people using the service. Evidence: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. Two residents told us they would tell the boss if they had any concerns, hed sort it out. The home maintains a record of complaints and their response. They have recorded one complaint since the last inspection regarding a visit from social services and the primary care trust in response to an allegation of abuse. The managers records tell us they are awaiting the outcome and recommendations. There has been no other information shared with us since the last key inspection that Care Homes for Older People Page 18 of 33 Evidence: raised any concerns about this service. Abuse awareness is discussed with new staff. We examined an induction sheet for one recently recruited care assistant. Abuse summary and whistleblowing and bullying were indicated as complete on the induction tick list. When we talked to the new staff member about what constitutes abuse, they were able to identify physical and verbal abuse and understood their responibility to report incidents to a senior member of staff, but did not demonstrate an awareness of acts of neglect or ommission. This staff member has not yet had the opportunity to attend the annual abuse awareness training provided by the organisation. Abuse awareness training sessions are provided annually by the organisations in house trainer. The annual updates for mandatory training, including abuse awareness, were currently underway in the home. Arrangements must be made to make sure staff have an awareness of the symptoms and types of abuse when they start working in the home. The manager told us that staff raising concerns (whistleblowing) would be treated as a complaint. He said no concerns had been raised by staff since about two years ago when a staff member raised concerns about a colleague, which he referred to a social worker. When we talked to the manager, he was knowledgeable about types of abuse. For example, in January 2008 the manager suspected the appointee of a resident was withholding personal monies and the manager contacted the residents social worker to make arrangements to resolve this. It was evident through discussion that the manager was not familiar with updated local social service safeguarding guidelines for responding to allegations or suspicion of abuse. We recommend a copy of the current guidelines is obtained and made available in the home for reference. All senior staff must be aware of their role and responsibilities in responding to suspicion or allegations of abuse to safeguard people using the service. Care Homes for Older People Page 19 of 33 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. People living in the home are provided with comfortable surroundings to live in. There is insufficient appropriate furniture to support people who eat their meals in the communal lounges. Unpleasant odours in parts of the home do not uphold the dignity of the people living there. Evidence: Communal areas are traditionally and comfortably decorated; they were warm, bright and clean. Communal areas were tidy but looked quite sparse. A table in the reception area held a range of activity resources such as games and jigsaws along with a bookcase full of books. We did not see any residents use the resources. New carpet has been fitted to the reception area since the last inspection. The offensive odour evident in the reception area during our last inspection persists. The manager showed us the homes plan of refurbishment developed earlier in the year. It was not clear which parts of the refurbishment plan had been achieved because the plan had not been reviewed against the original objectives set. The manager and housekeeper told us about some improvements to the environment since the last inspection. Care Homes for Older People Page 20 of 33 Evidence: We looked at several bedrooms, including those belonging to the people involved in case tracking. All the rooms we looked at smelt fresh and were clean, homely and personalised with some of the resident’s own possessions so it looked like it ‘belonged’ to them. The quality of the furnishings and fittings in residents’ rooms varied. Some rooms have hard vinyl flooring as an alternative to fitted carpet. Some rooms have new, matching wardrobes and chests of drawers while other rooms have worn, mismatched furniture. Staff have continued with improving individual rooms, evidenced during the last inspection, by the addition of cushions, throws and wall art. The handbasin vanity units in each of the rooms we looked at were chipped and worn. In one room, shared by a married couple, staff had created a sitting area and supported the couple to choose and purchase an appropriate double bed. This means the couple could choose to share private time together. Privacy curtains were available in other shared rooms viewed. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattresses is available for people who have an identified need for them. A bottle of bath foam found in one communal bathroom was marked bathroom which suggested this was for shared use of residents. This does not uphold the personhood and individuality of residents. People should have their own toiletries. Dining areas look sparse and functional. Evidence in the Daily life and social activities section of this report shows there is insufficient equipment to support people choosing to eat in the communal lounge areas. The home has systems in place for the management of dirty laundry and the disposal of waste. Residents personal clothing is washed in the homes own laundry and an outside contractor is used for bedlinen and towels. Systems are in place to manage the control of infection, for example, we saw staff using plastic aprons and gloves and there are handwashing facilities in public areas. Care Homes for Older People Page 21 of 33 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. There are sufficient competent staff on duty to meet the physical needs of people using the service. Residents are safeguarded by robust recruitment procedures. Evidence: The manager told us that the current staff complement for the home is: One registered nurse and four or five care staff on duty during the day (between 8am and 8pm). One registered nurse and three care staff on duty during the night (between 8pm and 8am). The examination of three weeks of duty rota between 1st September and 12th October 2008 confirmed that this staffing complement is mostly achieved. The manager relies on staff working overtime to cover any absence and maintain the staff complement. The manager told us that he chooses not to use use agency staff because they are not familiar with the needs of residents. This means that people living in the home benefit from a continuity of care given by staff who are familiar with their needs but there is no other contingency to maintain the staff complement if staff are not available for overtime. Care Homes for Older People Page 22 of 33 Evidence: The duty rota showed that on 12th September 2008 there was one nurse and one care assistant on duty between 8pm and 8am. When we asked the manager about this he was not aware of it. He checked the staff time sheets which recorded a third staff member had worked in the home from 11pm until 8am. We talked to several members of the night nursing and care staff who told us there are always three staff on duty on the night shift as any less would not be safe. Staff cover each others absence and have a system of ringing round each other to cover, particularly if there is short notice of staff absence. During our inspection visits it was evident that the numbers of staff on duty were sufficient to meet the physical personal care needs of people living in the home. We observed that there are short periods of time when residents are left unsupervised in communal areas because care staff are attending to the needs of people in their rooms who require the assistance of two carers. It was evident from our observations and talking to staff that care staff are busy meeting the personal care needs of people so their social and recreational needs have to be met by the activities support worker who works 16 hours each week. We spoke to several members of day and night staff who told us that they manage to get everything done and felt the safety of residents was not compromised. Staff commented that new residents take some time to settle in and need extra support for a while until they become familiar with us, and us with them and some times are busier than others, especially if a resident is poorly or very agitated. Comments made in the survey forms returned to us included, The staff are always very polite and helpful and The staff are very good. Theyre kind and helpful. The home does not have a system or tool to decide the number of staff required to meet the identified needs of residents in the home; this is monitored informally by the manager. It was not clear from examination of the duty rota or discussion with the manager how it is decided whether 4 or 5 care staff are needed to meet the needs of residents on particular days. The manager said he distributed the staff hours available across the week which meant sometimes there are 4 and sometimes there are 5 staff on duty. Training records show that eight out of the 18 care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 44 , is just below the National Minimum Standard for 50 of staff to be qualified. However, a further four staff members are working towards the award which should mean that people living in the home are cared for by competent staff. Care Homes for Older People Page 23 of 33 Evidence: Several staff have undertaken an accredited dementia care course at level 2 which should enhance their understanding of caring for people with dementia care needs. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as references, Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) are obtained before new staff start working in the home. We sampled staff records to check if nursing staff have current registrations with the Nursing and Midwifery Council (NMC). The records held in the home were out of date, but the manager used the NMC website during our visit to confirm that nursing staff had current registrations. The staff training matrix shows that staff have access to mandatory training in fire safety, moving and handling and abuse awareness. The training is available annually and was underway at the time of our inspection visits. Each staff member had an individual record showing a programme of development identifying the training they needed for their role. The induction for new staff consists of a tick list of subjects to be discussed. There is no evidence that the knowledge skills and competency of new staff is checked further as there was little evidence of formal supervision for staff, other than for moving and handling. New staff receive further training when they are enrolled on the NVQ programme and access the annual mandatory training provided. Care Homes for Older People Page 24 of 33 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 way the home is managed does not consistently sustain improved outcomes for people living in the home. Evidence: The manager is a Registered Mental Nurse (RMN) with experience of caring for older people with dementia and has attained the Registered Managers Award (RMA NVQ Level 4). He was reappointed to the post in August 2006 after resigning from the position in December 2005. The manager has not applied to us for registration. The manager has a variable amount of supernumerary time each week to enable him to fulfill his managerial responsibilities. He works the floor as a nurse for at least 3 shifts each week. Available evidence indicates the manager is not fully effective in monitoring and directing staff. For example, medicine management in the home is poor indicating ineffective medicine audits and monitoring of staff competency, formal staff supervision is not regularly done and the manager is not always aware of adverse Care Homes for Older People Page 25 of 33 Evidence: incidents in the home (he was not aware of the staff shortage on the night shift on 12th September). An improvement plan was developed and returned to us to address the requirements we made at our last inspection in January 2008. The service has complied with the requirements we made. We found evidence of poor medicines management during our inspection of this service in September 2007. The service complied with requirements made by us and medicine management had improved when we inspected again in January 2008. The service has failed to sustain the improvements made as we have assessed the medicines management as poor during this inspection. There was evidence of audits in the homes quality file related to medicines and accidents but there is no evidence that the information collected from the audits is analysed or used to develop plans for improvement. Staff files have been audited since the last inspection and improved recruitment procedures were evident during this inspection. Service user satisfaction surveys were distributed by the manager in August 2008 and nine were returned. Regualtion 26 vists have been made by a representative of the provider organisation, but have not been consistently regular every month. Records show the last regulation 26 visit to the home was made in August 2008. The home does not hold personal monies for residents. Residents are invoiced for any expenditure such as chiropody, toiletries or newspapers. We looked at the plan for staff supervision which showed that staff have not had regular supervision. Most of the supervision sessions that had occured were undertaken by the moving and handling trainer in the home to update and check staff competency. The file of one of the nurses reorded a detailed supervision session We looked at the homes accident records. Individual sheets are completed and filed in residents care plans folowing accidents, such as falls. The information is also recorded on a monthly accident summary. We recommend the monthly accident summary records the outcome of the accident and any action taken. For example, any injury sustained or whether a person required medical treatment. This should enable the manager to assess the severity of outcomes and whether appropriate action is taken. Care Homes for Older People Page 26 of 33 Evidence: We sampled records that demonstrate the home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. For example, annual tests of portable electrical appliances were made in April 2008, hot water temperature temperatures are recorded monthly and were within recommended limits, weekly fire alarm tests are recorded and hoists were serviced in May 2008. Care Homes for Older People Page 27 of 33 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 28 of 33 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 8 12 Arrangements must be made for people who need their blood sugar levels monitored to have a blood letting device and monitor for their individual use only. This is to minimise the risk of cross infection. 15/11/2008 2 9 13 Staff must be familiar with any device used to administer medicines prescribed for residents. This includes pen type devices for the administration of insulin. This is to make sure residents receive the correct dosage of medicines. 30/11/2008 3 9 13 Changes to residents prescribed medication must be recorded accurately. This is to make sure residents receive their prescribed medication at the correct dose and frequency 30/11/2008 Care Homes for Older People Page 29 of 33 to promote their health and well being and minimise the risk of medication errors. 4 9 13 Records relating to the 30/11/2008 receipt, storage, administration and disposal of medicines prescribed for residents must be accurately maintained. Staff must be able to account for medicines recieved into the care home. This is to make sure an accurate audit trail of medicines can be maintained so staff can demonstrate medicines are administered as prescribed and residents are protected from the risk of medicine misuse. 5 9 13 Arrangements must be made to make sure that staff are aware of their responsibilities when witnessing the administration of controlled drugs. This is to minimise the risk of medicine misuse and comply with legislation. 6 15 12 Arrangements must be 30/11/2008 made for meals to be served in a way that promotes the independence of residents. This is to make sure residents have the opportunity to enjoy their meals and retain their skills to promote their 30/11/2008 Care Homes for Older People Page 30 of 33 independence and uphold their personhood and dignity. 7 18 13 Arrangements must be made to make sure staff have an awareness of the symptoms and types of abuse when they start working in the home This is to safeguard people using the service. 8 18 13 Senior staff must be aware 30/11/2008 of their roles and responsibilities in responding to suspicion or allegation of abuse. A copy of the current social services safeguarding guidelines must be available in the home for reference. This is to safeguard people using the service. 9 30 18 New staff must receive 31/12/2008 induction training that meets the Skills for Care Common Induction Standards withing 12 weeks of starting work in the care home. This is to make sure staff develop the knowledge and skills required to care for people using the service. 30/11/2008 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 8 The manager should consider alternative methods of assessing peoples nutritional well being where it is not appropriate to use weighing scales because of their physical Care Homes for Older People Page 31 of 33 or pyschological condition. 2 12 The provider should make arrangements to increase the opportunities for people to participate in meaningful activities to enhance their quality of life, with consideration for the level of their physical and pyschological abilities. The manager and provider should consider providing appropriate tables for residents who choose not to use the dining table for meals. This should promote the independence and dignity of residents. Food groups should be liquidised separately and served separately so that people can enjoy the taste of individual foods. The home should be free from offensive odours to uphold the dignity of people. The numbers and skill mix of staff should be kept under review at all times to meet the changing health, welfare and social needs of people living in the home. The manager should be able to demonstrate that the current needs of residents are considered when deciding the staff complement. This should make sure there are sufficient competent staff on duty to meet the changing needs of people living in the home. Arrangements should be made to make sure the manager appointed to run the home is registered with us. This should make sure the home is managed by a person who is fit to be in charge. Staff should receive formal supervision at least six times a year to monitor their development. We recommend the monthly accident summary records the outcome of the accident and any action taken. For example, any injury sustained or whether a person required medical treatment. This should enable the manager to assess the severity of outcomes and whether appropriate action is taken. 3 15 4 15 5 6 26 27 7 31 8 9 36 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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. 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