Inspection on 21/01/09 for Allington Court

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Adequate 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

Allington Court 01/10/09

Allington Court 04/10/07

Allington Court 16/10/06

Allington Court 05/10/05

Allington Court 03/02/05

Allington Court 31/08/04

Allington Court 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia House     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN 01923894542 01923894544 sylvestj@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (BNH) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 44 Number of places (if applicable): Under 65 Over 65 44 dementia Additional conditions: Date of last inspection Brief description of the care home 10 Allington Court is registered to provide accommodation and nursing care to 44 older people with dementia, 10 of whom may be below 65 years of age. It is owned and operated by BUPA Care Homes Limited and is situated in extensive grounds, adjacent to another BUPA care home, in a semi-rural location in the village of Bricket Wood, within easy access of the M25 and M1 motorways. There is ample parking space provided at the front of the building. The home was purpose built for this service user group and is in the form of a hexagon with two internal courtyards, which, together with the attractive and secure grounds provide ample additional communal space where service users can walk and exercise, or simply sit and enjoy the gardens and views. Care Homes for Older People Page 4 of 33 Brief description of the care home All service users are accommodated in single rooms and there are four lounges, an activity room and dining room. There is an information folder/Service Users Guide in the reception area of the home, which includes contact details of the Commission for Social Care Inspection, (CSCI), and information about charges for the home. The last CSCI inspection report and the homes Statement of Purpose are displayed in the homes reception area and copies are also available on request. Current weekly fees start at £895 and are calculated according to need. Additional charges apply for hairdressing, personal toiletries and newspapers and for any chiropody, dentistry and optician services where these are subject to charge. Care Homes for Older People Page 5 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: 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: The last key inspection of this service was completed on 4th October 2007 . As a result of concerns raised by some relatives about the home, Hertfordshire County Council Adult Care Services called a Serious Concerns meeting under the joint agency safeguarding vulnerable adults procedures to consider the findings. This inspection took place subsequent to that meeting. We have also reviewed any other information we have received about this service between inspections. The information in this report is based on an unannounced inspection of the home, Care Homes for Older People Page 6 of 33 which took place over one day by two regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager was not on duty during the inspection and has since left the home. A registered manager from a sister home is currently the acting manager. This acting manager was not present in the home at the start of the inspection but arrived during the morning. We spoke with residents and staff and observed their interaction throughout the day. We also spoke with visitors to the home and checked a variety of records. We visited all areas of the home during the inspection. Since the Serious Concerns meeting took place senior BUPA managers have completed an Action Plan which shows time scales for implementing improvements in the home. We have been provided with a copy of the Action Plan and of the latest review showing where actions have already been completed. Information from the Action Plan is referred to in this report summary. What the care home does well: What has improved since the last inspection? What they could do better: Allington Court is a home specialising in care for people with dementia. It was therefore worrying that we saw no examples of good dementia care provided by staff. Some care staff and nurses appeared to have no understanding of how to interact with confused people or how to provide comfort and stimulation. There was no specialist adaptations to the environment as recommended in current guidelines for dementia care and the home was generally not well maintained. We did not see activities provided on the day and one relative told us that staff said they were too busy to provide one-to one support even though at least one care plan, in the area concerning daily stimulation, stated this should be provided. Care Homes for Older People Page 8 of 33 We saw the mid-day meal served and this was quite a chaotic event and did not provided a relaxed time which was the highlight of the day for the residents, where they were encouraged to eat well and maintain good health. As noted at the last inspection, quite a few bathrooms and toilets were being kept locked and this means that residents could not access these facilities independently if they wished. This must add to peoples confusion when those who are still mobile need a toilet. Several of the bathrooms which were unlocked were full of equipment and peoples toiletries and clothes. Some of the items left accessible could present a hazard to vulnerable people and it shows a lack of respect to have to use a toilet where someones clothes and personal posessions are being stored. A recommendation has been made in two previous inspection reports that procedures followed for storage in the home should be reviewed. There appeared to be a general lack of domestic staff in the home and parts were quite dirty. The deployment of care and nursing staff also needs reviewing as the poor outcomes for some residents, shown later in this report, suggest there are either not enough staff on duty or that staff are not properly deployed or supervised. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 3 and 4. standard 6 does not apply to this home. People who enter the home have their needs fully assessed by senior staff and comprehensive written information about the home is provided for residents and prospective residents. This enables all parties to feel confident that the home can meet all individual needs. However current service provision in the home is not adequate to meet the specialist needs of people who have dementia. Evidence: The acting manager told us that the homes written Statement of Purpose and Service Users Guide will be updated when the management changes in the home are completed. In the meantime relatives and any prospective residents are being kept up to date with changes taking place, through relatives meetings and written newsletters. Care Homes for Older People Page 11 of 33 Evidence: We were provided with a copy of the latest newsletter during the inspection. During the visit we checked a selection of residents records and saw evidence of the individual needs assessments which had been completed by senior staff in the home. Written care summaries had also been provided by referring agencies for the people whose records we checked. Initial care plans had been drawn up from the recorded information and details of how needs should be met were in place. This information is needed so that care staff can be clear about the way care should be provided for each resident. The acting manager also provided details of recent re-assessments which have taken place in partnership with other professional agencies. As a result, it has been established that the needs of some residents can no longer be met in the home and planned moves will be taking place for these residents. The home is registered to provide specialist care for people with dementia, however we found little evidence that the homes environment had been adapted to provide the stimulation and guidance currently recommended to assist those who are confused. Bedroom doors had peoples names displayed but no pictorial guidance to show who the room belonged to. Some bedroom doors had been locked previously to prevent residents entering other peoples rooms. Appropriate signage on doors may well have helped prevent residents from entering the wrong room. Current guidelines for dementia care also demonstrate that having appropriate visual and sensory equipment around communal areas can help to keep confused people stimulated and interested in their surroundings. We found little such equipment in communal areas in the home. The gardens were very well kept and looked attractive but again there could have been more appropriate equipment provided and a more imaginative use of facilities so that people with dementia could enjoy the outside space to the full. We spoke with the homes gardener who was aware of current thinking about what can be beneficial to confused people and they would be keen to introduce some of these ideas such as having special colours for seating and artificial lamp posts and bus stops. Some of the care records we inspected set out plans of how the confused individual should be approached by care staff such as providing one-to one contact or assisting a resident to walk at times during the day. However, although we spent time observing staff and resident interaction in the lounges, we saw little communication provided by staff. Care staff seemed unaware of how to provide comfort or stimulation for residents by talking to them or even by making eye contact and most staff passed by residents in the lounges without even a glance. One visitor who spoke with us during the inspection said that their relative suffered from delusions and could hit out as a result but said that some staff seemed unaware of this. This visitor also said that their relative opened their mouth when they spoke to them because staff only speak to them when they provide food, so their relative thinks they are to be fed when they hear a voice. There were no pictorial menus available in the home during our visit and these Care Homes for Older People Page 12 of 33 Evidence: are also recommended as an aid to providing choices of meals for people who are confused. Other examples of poor dementia care provision are described later in the report. The home does not provide intermediate care and so Standard 6 is not applicable. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. Care planning and the provision of care is currently under review at the home. When this procedure is completed people who use the service should benefit from having their needs met in an appropriate way. However not all residents have all their needs met at present. The system for administering medication in the home is generally sound and helps to protect residents from harm. Evidence: We spoke with residents in the home, where this was possible, and spoke with several visitors to the home. We observed residents in communal areas and in individual bedrooms. We also spoke with care staff about the care they were providing to specific residents. We then tracked a selection of care plans, which related to the people we Care Homes for Older People Page 14 of 33 Evidence: had seen. The care plans we checked were mostly detailed and most entries were up to date and reflected individual needs. Care plans showed the name of the linked key worker for the person concerned and there were detailed plans in place in most records to show how individual needs should be managed. However, in some cases the care we had already observed, provided by care staff and as described by visiting relatives, did not reflect the directions in the care plans. A recent entry in one plan showed that one-to one interaction with staff was beneficial to the resident concerned. We saw no interaction take place and a relative confirmed that this was never given. Another care plan recommended the resident was provided with a well balanced soft diet as they will not chew food. The plan was not specific about what soft foods the person could eat and other entries showed they had been given pureed food, with no explanation. Other entries advised that extra portions should be given at each meal as well as Ensure plus three times each day. No additional notes had been written to show why and if this was taking place. Later notes showed two entries where hot drink and tea with sandwiches were given. The care plan here was confusing and reflected no clear policy for this individuals nutrition and swallowing needs and could put the resident at risk of harm. One updated care plan did show that the individual had been referred to a dietician. Another care plan advised staff to stop and talk to the resident throughout the day. We had watched this person who had been in a lounge for most of the day and saw no staff speak with them on any occasion. There were no entries in the care plan to show when any such comfort had been provided. One plan detailed the very difficult behaviour exhibited by one resident but there was no management plan in place to show staff how this should best be handled. Before this inspection the homes management had already introduced procedures into the home to review and update all care plans and since the inspection an Action Plan has been provided for us showing that this process is on-going. We were told that currently only one resident has a pressure sore and staff confirmed that the BUPA Tissue Viability Nurse is liaising with nursing staff to ensure that appropriate treatment is provided. The care notes we saw fully documented the progress of this treatment. During the visit the acting manager confirmed that she has ordered more blood glucose testing machines as people who need these should not share them and should have their own individual equipment. We saw profiling beds in place in bedrooms where this equipment was needed and saw the one-to one care being provided for one resident who was remaining in their room, sitting on their bed after fracturing a limb. Care staff were providing two-hourly shifts where they remained with this resident. We spoke with one such care worker who was from an agency and this member of staff was unaware of the daily routine recommended for Care Homes for Older People Page 15 of 33 Evidence: this resident and did not know whether the person wanted to stay in their room or move to the lounge. We also advised the staff member that the resident was in a potentially un-safe position and asked a senior on duty to rectify the situation. One care worker on duty also stated that they had never seen a care plan. We spoke with some of the care staff on duty and heard that some residents wander and fall over and that residents are frequently left on their own in the lounge. We were told that one resident had behaviour problems and that four members of staff had held the person down to remove stitches but nevertheless one member of staff had been hit round the head. The care worker was not aware of any behaviour management plan for this resident. One visitor told us that their relative was wet most of the time and that the family had provided a new chair as the homes chair had smelled badly. Since the inspection the Commission has been made aware that alternative incontinence pads are now in use and that this situation is now resolved. The also relative said that they frequently found no staff present in the lounge where several residents spent their time. This clearly puts residents who are confused and have mobility problems at risk of harm. The relative also pointed out a cut on the residents head which was new but there was no entry about this in their care plan when we checked this record. We observed one resident who was walking about the home in slippers which had their heels squashed down and had the rubber on the back flapping. This was a potentially dangerous situation for a person whom staff said always walked about. We asked the acting manager to check the residents foot wear immediately. One care worker spoke with the inspector and said they had just reported bruising they had noticed on a resident who had frequent falls. We were told that the procedure was that nursing staff then checked the resident and recorded the bruising in the care plan, initiating any necessary actions. We saw written policies for the prevention of falls in the care plans we checked. Body charts and photographs had been included where appropriate. We also saw folders in individual bedrooms, where appropriate, which contained food and fluid charts and details of the assessed incontinence management plan. We spoke with two other sets of visitors during the inspection. In both cases the relatives told us that they were happy with the care being provided at the home. We concluded that the care provided for residents is currently inconsistent and suggests that staff competency is in urgent need of review. This is addressed in a later section of the report. Since the inspection the Commission has been made aware that alternative incontinence pads are now in use We observed a medication administration round and checked the medication storage in the home. One nurse was seen coming out of a bedroom holding a tea spoon and said this was used to put tablets on when they were offered to the residents. The acting manager confirmed that small pots were available for this process and that nurses Care Homes for Older People Page 16 of 33 Evidence: would be reminded of this. The system for administering medication was seen to be thorough and controlled drugs were being stored and recorded appropriately. The temperature in the store room was checked and was at a correct level for the safe storage of medication. However we noted that the morning medication round, although starting fairly early, was not completed until 10.30 am. This means that those needing medication at 8 am received this late in some cases. In some cases it could also means that there is insufficient time between the morning and mid-day medication administered for some residents, which could adversely affect their health. This situation also suggests that staffing numbers and ways of working need reviewing. The manager said this situation would be reviewed. The visitors we spoke with confirmed that personal care was always provided in private and that staff generally addressed their relatives appropriately. Visitors also confirmed that visits from health professionals always took place in private in individual bedrooms. Care Homes for Older People Page 17 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. People who use the service are not provided with adequate or appropriate activities or stimulation to ensure they enjoy contented daily lives, although visitors are welcomed at all times. Meal provision is chaotic and does not always provide a highlight of the day for residents to enjoy. Evidence: There was an activity plan displayed on a notice board in the home stating that there would be three activities provided for residents that day. We only saw the third advertised activity provided during the day, which was a television film shown late in the afternoon in the activity room. We had been in the activity room at 11.45 am and spoke with one resident whom we have spoken with during a previous inspection. This resident said that it was too early for activities, but that there was usually something going on. The television was on in the activity room during the morning and we saw three residents watching it. One resident was colouring a book and another was asleep. One other resident was just sitting quietly and another was sitting in their chair but had strong sun light in their eyes and needed the curtain pulling. There was no Care Homes for Older People Page 18 of 33 Evidence: member of staff in the room. During the day we did not see any other activities provided, but were not in the area of the activity room at all times. However, some residents remained in other communal areas all day and only had the television switched on for entertainment or music, which was playing in one area. During the afternoon we saw two staff sitting in a lounge with residents . The television was on but only the staff appeared to be watching this, one of whom had their feet up on a stool. Residents appeared to be being ignored. As already noted there were no items of visual interest displayed around these communal areas and we did not see any stimulation provided for the residents in the lounges. In one small lounge during the morning we saw four of the six residents there asleep. The television was on but only one resident was sitting in a position where they could see the screen. There were no staff present on this occasion. As we watched, an agency care worker brought a standing hoist to this lounge and positioned it in front of the television so that no one could see the screen. The hoist had been placed there in preparation for assisting a resident who was not yet in the lounge. We saw no care staff attempt to provide any activituies or stimulation for residents at any time during the day. The activity coordinator was present during the visit but was presumably in the activity room for most of the day. We did not speak with this member of staff on this occasion. However it was clear that to provide residents with adequate stimulation during their days spent in the home, care staff would need to assist with activities as residents sit in a variety of rooms in the home and only a few remain in the activity room. The visitors we spoke with confirmed that they were welcomed in the home at all times and could see their relatives in private if they wished. The staff we spoke with said that none of the current residents could handle their own financial affairs and that families generally looked after these matters. We visited the kitchen during the morning of the visit. The chef was not working on that occasion and the chef from a sister home was covering their duty. A new system for providing breakfast had just been introduced and staff told us that this was a great improvement. The chef working that day had completed cards which enabled staff to provide peoples preferred choices of meal at breakfast time and part of the kitchen had been streamlined to make serving the meal more efficient and more beneficial to residents. Staff told us that the new system had meant that residents received breakfast much more quickly and that today the breakfast was finished by 9.30am. We were told that previously the meal had not finished being served until nearly lunch time. This meant that often residents did not eat their lunch and were then hungry later on. In the main kitchen we saw a list of the special diets required by residents displayed on the wall so that staff could be sure people were given appropriate food. The home generally follows the BUPA four week rolling menu plan for main meals Care Homes for Older People Page 19 of 33 Evidence: although the staff said this could be adapted where appropriate, according to residents choice. We inspected the fridges and freezers in the kitchen and saw several items of food stored which were out of date or past their use by date. We also saw rotting fruit in one fridge and six trays each containing thirty eggs which were date stamped as having to be used by the previous day. We saw another packet of ingredients which was to be used by the previous November. The chef confirmed that all this food would be destroyed. The main meal provided on the day of the inspection was not as advertised on the menu as the food to be destroyed had been part of the planned meal. We did not see any Food Hygiene training records for kitchen staff during the visit and the chef confirmed that they were training staff on the job that day to ensure good practice was maintained. We saw the chef preparing snacks to be provided for residents during the day and staff confirmed that night bites were available during the night for everyone living in the home. The chef said that care staff were responsible for providing any thickened drinks for residents. We found no evidence of records showing what individual residents had eaten each day and the acting manager said she would check that these records are kept as required by the Care Homes Regulations and Environmental Health Regulations. Not all areas in the kitchen were completely clean on the day of the inspection and we recommended that the door to the staff toilet should be kept closed as it opens onto areas of the kitchen and could present a health hazard. We were informed that the main BUPA chef was due to reassess the kitchen and procedures followed later that week. We observed the mid-day meal served during the visit. The system for serving the food appeared chaotic. People sitting at the same table were served at totally different times so that some people had eaten their main course while their neighbour was waiting for their food. This could be distressing for some residents. We also saw one care worker blow on the meal they were serving to cool it. This is not an acceptable procedure for reasons of hygiene and infection control. We saw some residents who, we were told, like to remain in the activity room to eat their meals. We were informed that one resident likes to eat their meal with their fingers and the area they were sitting in was screened off for privacy. This resident had three courses of their meal in front of them, and no staff member in the room. The acting manager must ensure that it is appropriate to serve all three courses at once, especially as some food could be cold before it is eaten. Care Homes for Older People Page 20 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. Standards 16 and 18. Procedures followed by staff at the home ensure that all complaints will be listened to and acted on but further staff training is needed to ensure that people who use the service are protected from abuse at all times. Evidence: The home has written policies covering complaints, safeguarding and whistle blowing and these have been examined during previous inspections. We spoke with care staff during this visit and most were aware of the complaints procedures. Most visitors we spoke with were also aware of this procedure. We saw records of complaints and actions taken during the visit and we also saw copies of these records kept in the care plans of the residents concerned. One newer care worker said they were not aware of the whistle blowing policy or what the implications of this were. However the Commission has been informed by the management that all new care staff have had a written guide which includes this policy and that a copy is displayed in the staff room. Another care worker said they were not sure that currently staff felt comfortable pointing out examples of poor care practice to senior staff. One care worker also said they had watched a safeguarding video but did not feel this was adequate training to cover this subject. The acting manager has Care Homes for Older People Page 21 of 33 Evidence: confirmed that a review is underway of staff training and that safeguarding and whistle blowing will be subjects covered in updated courses. Currently there is one on-going investigation about the home, which is being dealt with under the Hertfordshire County Council Adult Care Services Safeguarding of Adults procedures. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 21 and 26. Improvements are needed to the maintenance of the home so that people can live in comfortable surroundings. Currently the home is not clean enough and residents cannot always easily access toilets and bathrooms which may compromise good infection control. Evidence: During the inspection we visited all areas of the home. There were areas, especially in corridors where paint work was chipped and where wooden doors and frames were very scratched. Some of the furniture in the lounges was worn and we saw foam protruding through the base of one chair. Several of the seating cushions on the arm chairs were squashed and looked worn out and food spillages were also evident on furnishings. On one wing in the home we found bathroom and toilet doors locked, as we had found at the last inspection. The care staff we asked said that these doors were usually locked. This means that people who are already confused are further hindered if they try to find a toilet and this is not acceptable practice. The one bathroom we did find unlocked in this area contained a range of toiletries, a hairbrush, powder and clothing. These items should be kept in the rooms of the people they belong to. In a bathroom further along the corridor we saw a dirty standing frame, and Care Homes for Older People Page 23 of 33 Evidence: a variety of equipment stored as well as clothing on pegs on the wall, shower gel and shampoo. We also saw a bathroom where the belongings of a resident who has challenging behaviour was being stored. The items left there included a wardrobe with clothing, a suitcase and shoes. We also saw a basket, left quite accessible near the open door, containing shaving foam and razors amongst other toilietries. The acting manager removed this basket when this hazard was pointed out. A management plan must be implemented to deal with the storage of these belongings, without storing them in this bathroom. It is not acceptable to leave bathrooms so cluttered, especially where some are in effect out of action as they are kept locked. Some of the toiletries left accessible also constitute a hazard to residents. The practice of using bathrooms to store equipment and clothing was discussed at the last inspection and must now cease. Bathrooms and toilets must be left open for residents to use at all times and staff numbers must be adequate to assist residents where this is needed. In some bedrooms we saw call alarms which had no cord attached so that residents might be unable to use these alarms from all areas of their rooms, which could put them at risk if they fell. The acting manager confirmed that the BUPA estates manager was soon to make an audit of the whole site and repairs would then follow. During the visit soap dispensers were being installed in bathrooms so that liquid soap could be used as advised in guidelines for good infection control. However there were areas of the home, including bathrooms, which were not clean and where stains and food spillages had not been removed. We were told by care staff that on one day that week the housekeeper had been working in the home without any other domestic support. Enough staff must be on duty to ensure the home is kept clean and to ensure good infection control is maintained for the health of residents and staff. There is a sink unit in the laundry which is also broken and needs replacing. The acting manager confirmed that all care and nursing staff are provided with three uniforms so that these can be frequently washed as recommended for good infection control. Currently the home has no named nurse who will link with the Health Protection Agency as is recommended as good practice. The acting manager said she was aware of this and intends to establish this link. Since the inspection the Commision has been informed that a new nurse has been appointed Head of Care at the home and this link will be included in their role. Care Homes for Older People Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. Staff numbers and deployment are currently not adequate to meet the assessed needs of people living in the home. Staff are currently not adequately trained to provide a consistently professional service to residents. Procedures for recruiting new staff are generally thorough and help to ensure residents are protected from the risk of abuse. Evidence: During the visit we spoke with care staff in all areas of the home. Currently there are a high proportion of agency staff working at the home. One member of the homes permanent staff said that there are definately not enough staff working in the home. As already noted we found the meal time chaotic and felt that staff numbers and deployment should be reviewed at meal times. Another care worker we spoke with said that they had found that night staff do not undress all residents for bed and they sometimes remain in the previous days clothes the following day. This suggests that either there are insufficient staff on duty to complete all care tasks, or staff supervision is not thorough. One nurse told us that currently they could not fit care planning and recording into their work shift. We have already noted that we found staff were unaware of how to meet all the assessed care needs of residents and found that good dementia care was not being put into practice. We concluded that there were Care Homes for Older People Page 25 of 33 Evidence: insufficient senior staff on duty who were able to supervise and monitor care practice in the home at this time. One visitor we spoke with confirmed this and said that they had complained to the manager after they read their relatives care notes. These showed that the resident had been awake at 7am but had not been given a cup of tea or breakfast until 11.30 am. Care staff had told the family this was because staff had been assigned to other duties. The resident was then given their lunch at 12.30. The visitor also said care staff did not promote drinks for residents and that their relative always had dry lips when they visited. A complaint which had been made from a family and upheld indicated that a resident had been left alone and at risk in the lounge on at least one occasion as care staff had gone on their tea break. Again, we concluded that there are either insufficient staff on duty or that staff need closer supervision. The acting manager said that currently all staff training was being reviewed as it had not been clear which courses staff had attended. A staff training overview was being completed and the acting manager said that appropriate training would be booked. Training will include adult safeguarding and the acting manager is providing night staff with an evening course so that all staff members will have received this updated training. We checked the recruitment records of a selection of staff at the home. We saw evidence that all appropriate checks were in place before the employee started work. We just reminded the acting manager that at least one reference must be from a previous care setting or other employer, if previous employment has taken place and that two references from friends are generally not adequate. This is to ensure recruitment is thorough and that residents are protected from the risk of abuse. The manager said that care staff will be offered NVQ training but that currently there are not 50 of care workers with this qualification. Care Homes for Older People Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. People who live at the home can be assured that their views will be listened to and acted on and that the home is well managed. Reviews are taking place to ensure that procedures followed in the home promote the health and safety of both residents and staff. Evidence: The management of the home is currently being covered by the registered manager of a sister home, who is therefore currently managing two large residential homes. Two senior managers from the company are also working at the home at times during the week to oversee the care plan reviews and to ensure the Action Plan for improvements is implemented. Although there is a limit to how much one manager can achieve while running two large homes, we felt that the acting manager has a good understanding of the current problems and would ensure that changes were made. Care Homes for Older People Page 27 of 33 Evidence: We saw the minutes of a recent relatives meeting which had taken place. This was called as a result of some concerns raised by some relatives and so that changes to the management of the home could be explained to families. The acting manager also appointed two Relatives Representatives so that these family members coud liaise directly with the acting manager and ensure that good communication continued at the home. The acting manager is also sending out an information news letter every three months to relatives so that everyone can be kept up to date with what is happening in the home. A copy of the last news letter was provided during the inspection. In addition to this information sharing, the home is part of the formal BUPA Quality Assurance programme. Some residents have their personal allowances held at the home and there is a formal BUPA procedure for this. The allowances are held in a designated account and interest on the money is distributed proportionately to all the residents concerned. Formal monthly company audits take place to ensure this financial system is sound and records of the audits are available to view. The acting manager confirmed that she completes monthly monitoring audits on all complaints, accidents and incidents in the home. The manager also confirmed that she has completed spot checks in the home during the night to ensure night care is being properly provided for residents. Currently the acting manager is reviewing the risk assessments for all bed rails, wheel chairs and recliner chairs in use in the home. We have already noted that some bathrooms were cluttered with equipment and some toiletries and the acting manager said she will ensure that these areas are cleared as they clould be a hazard to residents in the home. The acting manager said she will also review the call alarms in bedrooms to ensure they are accessible to residents at all times or that reasons why they are not in place are recorded in individul records. We also discussed with the acting manager the safety issues which have arisen where one resident is locked into their room by care staff, out of choice. The manager will ensure thorough risk assessments are undertaken for this procedure especially with a view to fire safety. It may be that the reasons for locking the door could be addressed in another way. Care Homes for Older People Page 28 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 29 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 4 18 Appropriate and adequate 01/06/2009 specialist dementia training must be provided for all care staff and training must be translated into good care practice. This is so that appropriate stimulation and comfort can be provided for all confused people in the home. 2 4 12 Improvements must be made to the environment and appropriate equipment must be provided which will benefit people with a dementia. This is to benefit people with a dementia and to meet current guidelines for providing good dementia care. 01/06/2009 3 12 16 A suitable range of activities and stimulation must be provided for all residents in the home on a daily basis. 01/05/2009 Care Homes for Older People Page 30 of 33 This is to ensure that adequate stimulation is provided so that all residents are able to enjoy their lives as fully as possible. 4 15 16 Out of date food must be removed from the kitchen and never used for residents meals. This is so that residents do not have their health put at risk. 5 15 16 Systems for serving food must be reviewed and appropriate systems implemented. This is so that residents can enjoy their meals appropriately and gain as much benefit as possible from this nutrition. 6 18 13 All staff at the home must receive thorough training in Safeguarding Adults and Whistle Blowing and must demonstrate an understanding of the implications of this training. This is so that people who use the service are protected from abuse at all times. 7 19 23 A programme of maintenance and refurbishment must be implemented in the home and all areas must be kept in a good state of repair. 01/04/2009 01/06/2009 01/04/2009 01/04/2009 Care Homes for Older People Page 31 of 33 This is so that all residents live in comfortable surroundings at all times. 8 21 23 Bathrooms and toilets must 01/05/2009 be left accessible and free from clutter and not used for storage. This is so that residents have safe and easy access to bathrooms and toilets and are not put at risk of harm or of the spread of infection 9 26 23 All areas of the home must be kept clean at all times. This is so that residents live in a clean environment which is hygienic and where conditions help prevent the spread of infection. 01/04/2009 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 Evidence should be recorded to show that the care plan for each resident has been put into practice. This is to demonstrate that individual needs are being met or reasons given where they are not. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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!