Inspection on 06/11/08 for Anson Court

This inspection was carried out on 6th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anson Court 14/11/07

Anson Court 13/09/06

Anson Court 30/09/05

Anson Court 15/04/05

Anson Court 09/11/04

Anson Court 18/05/04

Anson Court 16/12/03

Anson Court 22/07/03

Anson Court 28/08/02

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Anson Court Harden Road Leamore Walsall West Midlands WS3 1BT     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: Mandy Beck     Date: 0 6 1 1 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 34 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Anson Court Harden Road Leamore Walsall West Midlands WS3 1BT 01922409444 01922409111 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mandy Jane Halls Type of registration: Number of places registered: Manor Court Health Care Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Anson Court is a purpose built two-storey care home in the Harden area of Bloxwich. The Home provides accommodation for 33 people who have dementia. The Home is situated close to local shops. Each person using the service is able to have a single bedroom with an en suite toilet facility. The communal areas consist of a large lounge, one smaller lounge, a conservatory and a separate dining room. The Home has an enclosed, secure courtyard garden area with raised flower beds. Entrance and exit to the main door of the home is via a security system people are unable to leave the home without staff assistance. The current charges are not available in the service user guide. People are asked to contact the service directly for this information. Extras that the people using the service must buy themselves include personal toiletries, newspapers, chiropody, private healthcare, dentist, dry cleaning and hairdressing. 33 Over 65 0 Care Homes for Older People Page 4 of 34 Care Homes for Older People Page 5 of 34 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: Two inspectors carried out this unannounced key inspection on one day. We looked at all the information we have received, or asked for, since the last key inspection November 2007. This included information about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last twelve months and relevant information from other agencies We spent time talking to some of the people who use the service and to the staff who support them. We looked in depth at the care of three people who use the service. This is part of our case tracking process and helps us to make judgements about the homes abilities to Care Homes for Older People Page 6 of 34 meet peoples needs. We sent surveys to the home and to the people who live there. We did not receive any responses. We have also asked the home to provide us with an Annual Quality Assurance Assessment (AQAA), they have not done this. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. 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 Care Homes for Older People Page 8 of 34 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to live in this home do have an assessment of their needs but improvements are required if peoples needs are to be met. Evidence: We looked in depth at the care of three people during this inspection. We saw that people did have an assessment of needs before they were admitted and the manager had made sure that where applicable nursing and social workers assessments had also been obtained. Some of the information we would expect to see was not included and the home will need to improve upon this. For instance there was little information in the assessments about peoples choices and capabilities. When we visited the home in April 2008 we were told by the Responsible Individual Mr Wardle that staff training in dementia care had been arranged for all staff. This has not been done. The manager explained during this inspection that the funding had not Care Homes for Older People Page 11 of 34 Evidence: been secured and as a result staff had not been trained. The manager told us that further training has now been secured for staff and will start in November 2008. We did see that two short courses of two hour duration had been arranged in September and November 2008 but the home was unable to provide evidence that staff had attended these courses. We spoke to staff who told us we have had training it covered everything lasted about two hours. We asked if staff had learnt about person centred care or individual care. None of the staff we spoke said they had received any training in this area. The home offers specialist care for people with dementia, it is now very important that staff have further training in dementia care so that they can meet peoples needs. This home does not offer intermediate care facilities. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home do not always have their health and personal care needs met. Improvements are needed so that people can be assured they will be treated with respect and dignity at all times. Evidence: We looked at three peoples care records during this visit. We found the home needs to make improvements if people are to have the individual care they require. When we began this inspection we asked the night staff on duty for peoples care plans, we were told that they were locked away and they didnt have a key. The manager told us that the care plans and risk assessments were locked away for security. We explained that staff must have access to peoples care plans and risk assessments at all times. Staff will need to do this so they can be very sure of the risks associated with caring for people and of peoples specific healthcare needs. Care plans are pre printed and did not reflect peoples individual choices, needs and capabilities. For example one person had been assessed as suffering from constipation, there was no care plan in place that guided staff in meeting this persons needs. When Care Homes for Older People Page 13 of 34 Evidence: we spoke to staff about this persons needs none of them knew about the constipation. We saw that the home is not monitoring peoples weight as often as it should. We looked at the records of four people, we found that two people had no weight recorded at all, the other two people had not been weighed since June 2008. Records showed us that these people had lost weight but we could not evidence what the home had done about this. The manager also told us that they have to share weighing scales with their sister home. We have recommended the home purchase their own scales. They must begin to weigh people on a regular basis and take action when people lose weight. We looked at the fluid intake records for one person who was at risk of dehydration, we found that the charts had not been completed in full and the home could not provide any evidence this persons needs in relation to the prevention of dehydration were being met. This was especially concerning as this person had recently been discharged from hospital and the home had been instructed to monitor the fluid intake. Some of the staff we spoke to were aware that this person was at risk of dehydration others did not. The manager must make sure that all staff are aware of peoples individual needs so that they can be met. Medication systems in the home need to improve so that people are not placed at risk. The home has not met requirements from our last inspection October 2007. The home is failing to record the daily fridge temperatures as required. This means they cannot be sure that medication requiring cold storage is being stored safely. There is no accurate record of medicines being bought into the home. Staff do record on the medication administration record (MAR) sheet to medicine received in the dosette boxes but not peoples separately boxed medication. We looked at one persons prescribed medication, the dose was confusing and we were unable to check the correct dosage because the home had no records of this persons medication from their admission. The manager was asked to contact the doctor to clarify this promptly. We have also recommended that when staff hand write entries on to the MAR, two staff sign the entry to reduce the risk of error occurring. The home has reduced the amount of stock medication it has in storage. They are now sending excess medication back to the pharmacist at the end of each month. We have recommended that when people have medication left at the end of the month the home should carry forward the balance and refrain from ordering that particular medication for the next month. This will provide a better system of stock control and reduce the amount of waste medication being sent back to the pharmacist but not medication which is boxed separatley We made several observations during this inspection that show us the home needs to improve the way in which it preserves peoples dignity. For instance we observed each person in the communal lounge have their hair combed in turn with the same comb. The carer also said your hair is thick youll need the other one, we saw the carer then use a different comb for this person. In another instance we saw people able to access the toilet in the hallway whilst Care Homes for Older People Page 14 of 34 Evidence: another person was using it. The manager told us that people cant wait sometimes and will barge in on others. Other people cannot use the lock on the door. We recommend the home considers the use of a lock that is would enable people to have their privacy whilst using the toilet and prevent others from walking in on them when doing so. Peoples preferences for getting up and going to bed are not recorded. When we arrived at 6.45am to begin this inspection we saw that fourteen of the people living here were up, washed and dressed and sat in the communal lounge. The carer on duty told us they get up early but its the heavily incontinent ones that we tend to dress. We observed that of the fourteen people sitting in the lounge at total of ten were fast asleep in their chairs. We spoke to people who were awake, we asked them if they liked to get up this early. One person told us I dont mind, I will watch the telly but not the rubbish thats on now. They were referring to a music show. Others said it would be nice to have a drink whilst we are waiting. We looked at accident records for the home from the last month. We found that the majority of accidents were happening during the night. We recommended during our last key inspection in November 2007 that the home should increase the number of staff on duty during the night to meet peoples needs. This has not changed. Given the number of accidents happening during the night and the large number of people who are up washed and dressed before the day staff arrive on duty there is a need for night staffing levels to be reviewed promptly in order to meet peoples needs and to keep them safe. Care Homes for Older People Page 15 of 34 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 home provides attractive and nutritious meals and is supportive in enabling active contact with relatives and friends. Activity provision is not meeting some peoples activity or leisure time needs. Evidence: The home had made efforts during our visit in April 2008 to improve the activities on offer for people. Dominoes, bowling sets, draughts and a car racing game had been purchased. We spoke to staff about the activity provision in the home. They told us mainly musical instruments, they seem to like the Karaoke but the microphone has broken so we cant use it much. Other said We like to do something with them in the afternoon, we have a local singer who comes in, we did a Halloween party too. The home told us during their last inspection they were hanging photographs of old Walsall along the corridor walls as an aid to reminiscence activities, the photographs have been purchased and await framing. During this inspection it was evident that this still has not been done. There is little in the way of sensory cues in the home environment. Sensory cues would help provide stimulation and conversation for some people living in the home. We have recommended the home completes its plans with picture hanging in order to stimulate peoples interest and considers other ways it can Care Homes for Older People Page 16 of 34 Evidence: improve activity for people to take part in. The home has an open visiting policy. Relatives are encouraged to visit their loved ones when they want to. People visited on the day of the inspection and were seen to be taking people out for trips. Staff also told us that people go out with their families for trips and home visits. The manager has told us she works hard trying to maintain relationships with all relatives and family members. She told us during this inspection the office door is always open they can come to me anytime they know that. We had the opportunity to see some peoples rooms during this inspection. We saw that they were pleasantly decorated and in some cases has been personalised with peoples furniture, ornaments and personal possessions from home. We were told the menu is based upon a four weekly menu plan. People we spoke to said the food was nice. They said I like everything I have. The cook is very flexible and understands the different dietary needs of the people living there. Staff told us that drinks and snacks are available at any time if people ask. The home should consider that people with dementia may not always remember to do this or be able to verbalise their desire for a snack. It was observed in some cases people do not have supper, this means they do not have anything to eat until breakfast the following day. Tea is served about five PM and breakfast at eight AM. This is a long time for people to go without food and was discussed with the manager. The manager has told us that people always have a milky drink before they go to bed and they have biscuits with it about 8pm at night. Records of fluid intake for person showed us that this is not always the case. The home must make sure that people have sufficient diet and fluid for their needs. Care Homes for Older People Page 17 of 34 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. Complaints processes do not give assurance that peoples complaints will be listened to and acted upon. Processes are in place to protect people from harm or abuse. Evidence: The home has a clear complaints policy and procedure. It does however need to be updated with out details. The manager told us that she has only investigated one complaint since our last visit. Since our last visit in April 2008 we have referred three anonymous complaints to the registered provider. We have not been provided with a response to these complaints as we would have expected. There was no evidence that the complaints we have asked the service to investigate has been investigated. People we spoke to during this inspection were unable to tell us who they would talk to if they were unhappy with any aspect of their care. This was because of their communication difficulties. We did send surveys to the home for people to complete with their relatives but we have received no response. We looked at the systems in place for the protection of vulnerable adults. These are called safeguarding procedures. We talked to staff who were able to tell what they would do if people made an allegation to them. The home has had two safeguarding referrals this year and has worked with the safeguarding team as they have requested. The home has no current forms of restraint in use such as bed rails or lap straps for wheelchairs. Care Homes for Older People Page 18 of 34 Evidence: Efforts are taken when recruiting staff to make sure that some of the necessary safety checks are completed. This includes the Protection of Vulnerable Adults (PoVA) list and Criminal Records Bureau (CRB) disclosures. These checks will help prevent unsuitable people from working with vulnerable adults. Care Homes for Older People Page 19 of 34 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. The home is generally clean and tidy. The home is in need of refurbishment and redecoration, these improvements are needed to enhance the quality of life for people living here. Evidence: The home has not had the financial investment it has needed over the past twelve months. This has meant that standards of decoration and refurbishment have dropped. We saw stained and dirty carpets throughout the home. The manager told us that there are plans in the very near future to replace most of these carpets. This will make a welcome improvement to the home. Furnishings are worn and soiled and are in need of deep cleaning or replacement. When we visited the home in April 2008 we were told that new pictures of old Walsall were going to be put up in the corridors. These pictures have not been put up and the home lacks visual stimulation for the people living there. We did note however the home makes every effort with people when decorating their own rooms. People are encouraged to bring in some of their favourite pieces of furniture (space allowing) and ornaments to help personalise their bedrooms. People have their own en suite facilities and there are also toilets located throughout the building. We did notice that at times peoples privacy may be compromised whilst using toilets particularly the toilet in the reception area. People using the service are Care Homes for Older People Page 20 of 34 Evidence: not always able to lock the door behind them when using the toilet. This gives other people the opportunity to walk in on them whilst they are using the toilet. We observed this happening during the inspection. We have recommended the home considers replacing the lock on this toilet in the interests of peoples privacy. We looked around most of the home but not all of it. Generally it was clean and tidy. The home employs housekeeping staff to make sure the home is clean at all times. People have told us that at times it can take the home along time to replace items such as light bulbs, toilet rolls and toiletries. We discussed this with the manager, she told us the maintenance worker is shared between two homes and cannot respond immediately to requests. There can be a slight wait for this to happen. Staff are expected to help with the laundry throughout the night. They told us they are usually washing and ironing once people go to sleep. Staff have also have training in infection control. There are some measures in place to reduce the risk of cross infection to people such as the provision of liquid soap and paper towels in communal toilets and bathrooms, and the use of gloves and aprons when carrying out personal care. Care Homes for Older People Page 21 of 34 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. The home needs to make improvements in their recruitment processes. Induction processes do not ensure that staff have the knowledge or understanding to cater for dementia care needs. Staffing levels do not always protect people and need to be reviewed so that people are safe. Evidence: At our last key inspection in November 2007 we asked the manager to monitor and keep under review the staffing levels at night. It was disappointing to see that the night staffing numbers have not changed since this visit. We looked at accidents records the home has kept. We found during the last four weeks there had been six accidents that had occurred during the night time. We also saw that fourteen people were up, washed and dressed at the start of this inspection at 06:45am. No one was available to supervise these people because night staff were busy helping another person to get up. Whilst we sat in the lounge during this time we heard people asking for cups of tea and their breakfast. We have asked the home to make sure that people have snacks and drinks as they want them. The home has an outstanding requirement to ensure that peoples needs are met. We are taking further advice from our enforcement team about further action to take with the home in relation to staffing levels and meeting peoples needs. Staff recruitment was also looked at as part of our inspection process. We found that Care Homes for Older People Page 22 of 34 Evidence: there were still shortfalls in this process. We looked at the files for four staff, three were newly recruited staff. We saw that there was some of the information required by regulation but the home had failed to obtain two written references for all of the staff whose files we looked at. Failure to do this means the home is not taking steps to thoroughly check staff before they begin working at the home and may be placing people at risk. We made a requirement at the last inspection about recruitment practices, we are not satisfied this requirement has been met and we will be taking further advice from our enforcement team about the action we need to take to make sure improvement is made so that people are better protected. We have also made recommendations for practice. For example the home must make sure that when staff start employment with only a Protection of Vulnerable Adults list (PoVAfirst) check in place, there must be a written risk assessment and a desiginated senior worker to supervise that person until the return of a Criminal Records Bureau (CRB) disclosure. Staff training takes place and this was confirmed when we spoke to staff. We also looked at the training matrix the home has. This matrix gives us dates of training that has been arranged for staff to take part in. The subjects include health and safety, food hygiene and moving and handling. There is an outstanding requirement for all staff to have training in dementia care. The home told us during our visit in April 2008 that this training was to take place. This has not been done. The manager told us that the training was cancelled but has now been rearranged and is due to commence in December 2008. This requirement has not been met and we will seeking further advice from our enforcement team about actions to take with the home. Care Homes for Older People Page 23 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is managed in a way that keeps them safe but does not always meet their individual and specialist care needs Evidence: The manager of the service is Mandy Halls she has worked at Anson Court for many years. She has the required qualifications and is also a registered National Vocational Qualification (NVQ) assessor. We spoke to staff who told us the manager is approachable at all times, and they told us they felt supported by her. Staff confirmed that the manager does try to organise training for them as they need it. People who have contacted us have told us they find the manager to be approachable but defensive about complaints or criticism of the service. The manager herself told us she doesnt like having complaints but she will always address them. We discussed this and have said that complaints should be welcomed and seen as a positive event because it means the service can reflect and learn from the whole process. We looked at the quality assurance systems in place. We found them to be unchanged Care Homes for Older People Page 24 of 34 Evidence: since our last key inspection in November 2007. The manager told us that satisfaction questionnaires have not been sent out to people because she was working with their sister home to improve the questionnaires. It is hoped they will be sent out in the near future. The manager also told us that she has tried to survey health professionals and visiting doctors but had a very poor response from them. None of the health professionals surveyed returned the questionnaires. We have requested an Annual Quality Assurance Assessment (AQAA) from the home. It is a legal requirement to return this document. We have sent a reminder letter to the home but the AQAA has not been returned. Because they did not return their AQAA we will be taking further enforcement action with the home to make sure we receive the AQAA. This is the second occasion where we have had to take this action in order for the AQAA to be sent to us. A Statutory Requirement Notice was sent to the home during the last inspection for the same thing. The home must make sure that it is meeting its regulatory requirements. We have evidenced throughout this inspection shortfalls in care practice and record keeping that must be addressed. We have recognised that staff do have some training but have failed to be given the training in the specialist subject of dementia. This training should be viewed as essential for all staff. The registered provider must take action to meet these requirements in order fulfill their regulatory obligations and to protect the people living in the home. It is evident that the home has lacked the financial input from the registered providers and as a result the home is struggling to deliver a service. The manager told us that the home was up for sale and this is why there may have been a lack of involvement from the registered providers. The service is drifting and currently lacks direction and purpose. The registered providers and manager will need to address this for the benefit of the people living in the home. We looked at the way the home helps people manage their money. We found that the home does not always provide two signatures when recording transactions. People using the service are often in debt to the home. The manager told us that this doesnt happen often and the monies are usually recouped when the invoices are sent out on a monthly basis. We found that at least four people living in the home are still in debt to the home and between them owed almost four hundred pounds. We have discussed this with the manager. We have said that people should have access to their own money at all times. She explained that sometimes relatives are slow in bringing money in. We have said that this must not happen. The home should be requesting enough money for peoples needs from the person who is responsible for their finances. If problems occur in obtaining money the home should consider referrals to the safeguarding team in order to protect people. Health and safety risk assessments need to be updated and reviewed. The manager said that they were due to be done. During this inspection we saw one person being pushed in a wheelchair without footplates. This is not the recommended way to move people in a wheelchair unless there are specific reasons for not using footplates. We Care Homes for Older People Page 25 of 34 Evidence: asked the manager if there was a risk assessment for moving people in this way. She told us no. The manager has removed the wheelchair from use in order to reduce risk to people. We looked certificates that showed us the home is being maintained in peoples interests. We saw the Annual gas safety check, maintenance records for the lift, hoists and tests for the electrical equipment. As we have said staff do have training in health and safety, infection control, food hygiene and moving and handling. More recently the home has arranged fire training for staff and also fire marshall training for some senior staff. This will mean that staff should be clear of the actions they should take in the event of a fire. We have recommended the home seeks advice from the fire service in relation to the fire risk assessment and personal emergency evacuation plans for people. This should mean that the risk assessment will be up to date and that in the event of a fire the fire service will have clear information about the evacuation needs of the people living in the home. Accidents are recorded appropriately but the accidents are not reviewed by the manager. This means that trends, such as the ones we have identified are not being actioned. For example we found that in October 2008 most of the accidents that happened to people were occurring during the night. This should have led to the manager questioning why this was happening and what could be done to reduce the risk to people during the night. This has not been done. We were also made aware of hospital admissions for some people we had not been informed of under Regulation 37 of the Care Homes Regulations 2001. The home is not consistently reporting events using this regulation and must improve. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 4 12 (4) (b) The Home needs to consider how they can better meet the needs of people with specialist needs, including dementia. This includes activities, training for staff and individual care planning and risk assessment. This will ensure that the care provided focuses on the individual person and their specific needs. 30/06/2008 2 9 13 (2) The temperature of the medicines refrigerator must be taken daily with a maximum/minimum thermometer and recorded. 11/04/2008 3 29 19 (1) The manager must not 11/04/2008 employ a person unless he/she has obtained the information and documents specified in Schedule 2 and is satisfied as to the authenticity of the references for that person. This will ensure the people using the service are safeguarded. 4 30 18 (1) (i) The staff must receive more 30/06/2008 instruction and training as to Page 27 of 34 Care Homes for Older People how to meet the needs of people with dementia, to ensure that their needs are met. Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples needs must be recorded in a care plan that is individual to them. This will make sure that people are getting the care they want and need from the home. 31/01/2009 2 8 13 People who are at risk of dehydration must have a clear record of the fluid they consume. The home must also be able to demonstrate the actions it has taken to meet peoples needs in relation to dehydration. Peoples fluid intake will be correctly recorded and action will then be taken by the home to meet their needs. 31/12/2008 3 8 13 People must have their weight recorded at least on a monthly basis. The home must also demonstrate how it has addressed any 31/12/2008 Care Homes for Older People Page 29 of 34 unexplained weight loss or gain. This will make sure that those people at risk of weight loss are identified and the home will take action to meet their needs in relation to their weight loss. 4 8 12 Care staff must have access to peoples care plans and risk assessments. This must include the night staff. All staff should know what risks are involved with care delivery. This will also make sure that staff are aware of peoples needs and how to meet them. 5 9 13 The home must keep 31/01/2009 accurate records of peoples medication from the point of admission. These records should be updated to reflect changes and will make sure the home is very clear about the medication each person is to take. 6 16 22 The home must make sure that any complaint made under the complaints procedure is fully investigated and recorded. This will mean that people feel their views are important and that their views will be listened to and acted upon. 31/01/2009 31/12/2008 Care Homes for Older People Page 30 of 34 7 27 13 there must be at least one member of staff in the communal area where people are sitting at all times. This will mean that people are being observed and are not being left alone unsupervised. 31/01/2009 8 29 19 The manager must appoint 31/01/2009 an experienced worker to supervise new staff employed with only a PoVAfirst check in place until the return of a satisfactory CRB disclosure. This will offer an additional safeguard for people living in the home. 9 35 13 The home must review the 31/12/2008 way in which it manages peoples money. It must not allow people to be in debt to the home. This will ensure that people have sufficient funds to pay for their own extra services that are not included in the weekly fees for residency. 10 38 37 The home must report to the 31/01/2009 commission the occurence of deaths, illness and other events. They must do this to make sure they are meeting their regulatory duties under Regulation 37 11 38 12 When people are moved in the wheelchair without 31/01/2009 Care Homes for Older People Page 31 of 34 footplates. The home must complete a risk assessment that shows the risks involved in moving people this way and the steps the home will take to reduce the risk to people being moved in this way. This will make sure that people are safe when being transported about the home in a wheelchair. 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 7 Staff should have training in person centred care. This should help them with their understanding of people with dementia and the importance of person centred care when caring for people. The home should purchase its own set of weighing scales for people to use. This will make the regular recording of peoples weight easier for staff to do. Two staff should sign all handwritten MAR sheet entries. This will help reduce the risk of errors occuring. The home should not send back unused medication at the end of each month. It should consider carrying forward the balance and refrain from ordering that medication for the following month. This will reduce the amount of waste medication each month. The home should consider the use of suitable locks on the toilet door in the reception area. The lock should be able to be locked from the inside but easily released when people want to get out. The observed practice of communal hairbrushing must cease. Peoples hair should be combed when they are washed and dressed in the privacy of thier own rooms. One comb is not suitable for all. The home should consult with people and their families about peoples preferences for getting up and going to bed. This should be clearly recorded in peoples care plans and Page 32 of 34 2 8 3 4 9 9 5 10 6 10 7 10 Care Homes for Older People adhered to. This will ensure that people are not being got out of bed earlier than they would like. 8 12 The home should consider further training for staff that specifically looks at the types of activity they could offer to the people who live in the home. The home should make sure that each person living in the home is engaged in an activity they can take part in. The home should consider that people with dementia may not always be able to ask for snacks and drinks and will need to be offered these at regular intervals between meals and at supper time. The stained carpets that are evidence throughout the home need to be thoroughly cleaned or replaced. This will improve the environment for the people living there. All seating requires a deep clean or replacing where it is worn. This should be done for peoples comfort. When people are recruited with only a PoVAfirst check in place, the manager should make sure that a written risk assessment is completed and kept in the persons file. This will demonstrate what the home is doing to keep people safe until the return of a satisfactory CRB disclosure. The induction programme currently in place for new staff should be updated to meet skills for care standards. This will mean that people are supported when they begin work and will have the necessary skills to meet peoples needs. The home should contact the Fire Officer for advice about updating the homes fire risk assessment. The risk assessment should also include individual Personal Emergency Evacuation Plans for people. This will help in the swift evacuation in the event of fire breaking out. The broken bath seat evident during this inspection should be repaired promptly for peoples comfort when bathing. 9 10 12 15 11 19 12 13 19 29 14 30 15 38 16 38 Care Homes for Older People Page 33 of 34 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 © (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. 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