Inspection on 17/02/10 for Aquarius Lodge

This inspection was carried out on 17th February 2010.

CQC 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aquarius Lodge 19/08/09

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Aquarius Lodge 20 Approach Road Margate Kent CT9 2AN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Crosby     Date: 1 7 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Aquarius Lodge 20 Approach Road Margate Kent CT9 2AN . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aquarius Lodge Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home was re-registered as a new service on the 10 March 2009, due to its change in status to a limited company. This is the second inspection visit since re-registration. Aquarius Lodge is a three-storey detached building with a lower ground floor, ground floor and first floor. There are fifteen bedrooms, including two doubles. There are five ground floor bedrooms, two lower ground floor bedrooms and eight bedrooms on the Care Homes for Older People Page 4 of 36 Over 65 17 0 1 9 0 8 2 0 0 9 Brief description of the care home first floor. There is a stair lift to the first floor, but there are five additional stairs up to bedrooms on one part of the first floor landing and four stairs down to bedrooms on the other side of the landing. Service Users occupying the two lower ground floor bedrooms need to be able to manage one flight of stairs. Bedrooms have call bells and television points. There are three lounges, one on each floor, plus a dining room on the ground floor. The home is situated in the residenital area of Cliftonville (Margate) within walking distance of most local amenities. Staffing consists of a team of carers who work a rota that includes one person on waking duty at night and one person sleeping in. Information previously provided by the Responsible Individual states that the fees range from £322.00 to £650.00 per week. Care Homes for Older People Page 5 of 36 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: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This is the second key inspection visit since the home was re-registered as a new service on the 10 March 2009, due to its change in status to a limited company. The overall quality judgement rating of this home is poor. This is clearly evidenced by: shortfalls in care planning, reviews and risk assessment; insufficient staffing levels and gaps in staff training; the poor condition of the environment; the outstanding four requirements made at the time of the last inspection visit for which Statutory Requirement Notices will be issued; and the additional eight new Requirements made in this report. This report contains the findings of the homes key inspection and takes account of Care Homes for Older People Page 6 of 36 information obtained from various sources. The key inspection visit was unannounced and carried out by two inspectors on Wednesday 17 February 2009 between 09.30 and 15.00. During the inspection the inspectors spoke with the newly appointed manager, the general manager, staff on duty and people who use the service. Various records were seen during the visit, together with observation of interactions and a walk around some areas of the premises. The Annual Quality Assurance Assessment (AQAA) documentation was not due for return until 22 February 2010. The AQAA documentation received is dated 26 February 2010 and indicates that the manager is working to address issues raised in this report. Eight surveys for people who live in a care home for older people were sent out, two of which have been completed and returned at the time of the report being written. There were no written responses to the questions; what does the home do well; what could the home do better; is there anything else you would like to tell us. Eight surveys for staff who work in a residential care home were sent out of which six have been completed and returned at the time of the report being written. See comments from staff under What the care home does well. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. To check compliance with the one immediate requirement made in relation to the safety of the Parker Bath and the eleven requirements made in the last report dated 19 August 2009 concerning a range of health and safety issues. The aim was also to ascertain what action had been taken to address the Statutory Requirement Notice served in relation to Regulation 26. This is with regard to the home owners assessing the quality of care at the home and taking action to address areas that are identified as not of a good standard. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with the manager and the general manager throughout and at the end of the visit. Action had been taken to address the Statutory Requirement Notice served in relation to Regulation 26 visits, the Immediate Requirement made by replacement of the Parker Bath and six of the Requirements made in the last report. However, the home has failed to meet four of the Requirements made as a result of our last inspection of 19 August 2009. These were in relation to care plan reviewing; risk assessments; the safer administration of medicines; staffing levels and staff training. A Code B Notice was served and signed by the general manager in relation to the four requirements that were judged as not being met. We held a Management Review Meeting following the inspection visit and it was decided that five Statutory Requirement Notices would be issued in relation to Care Planning, Risk Assessment, Medication Administration, Staffing levels and Staff training. As a result of this inspection, we have made eight additional Requirements. These are Care Homes for Older People Page 7 of 36 for further amendments needed to the Statement of Purpose and Service User Guide for the documents to comply with regulation. To only provide accommodation at the care home if the care home is suitable for the purpose of meeting the service users need; to make proper provision for the health and welfare of service users; the provision of recreational activities; replacement of the stairlift; and suitable arrangements to be made to prevent the spread of infection in the home; promotion of service users dignity and privacy. These actions will better promote service users needs and safety. Care Homes for Older People Page 8 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Amendments to be made to the Statement of Purpose and Service User Guide in order for these documents to comply with Regulation 4 Schedule 1 and Regulation 5. The registered individual must only provide accommodation in accordance with the registration certificate i.e. older person category. Ensure that person centred care plans are completed. Regular reviews need to be carried out in accordance with regulation and all appropriate risk assessments completed to enable staff to provide care that meets individual needs. To promote and make proper provision, for the health and welfare of service users. Ensure that administration of medication is recorded in accordance with the homes policy. In order to promote service user privacy and dignity, obtain and document consent if people are willing to share double rooms; provision of appropriate screening in double bedrooms; carrying out further work to the sluice and adjoining service user toilet. Provide and implement a programme of activities, and maintain a full record of any activities undertaken. All Staff to undertake mandatory training that must include Safeguarding of Vulnerable Adults, Moving and Handling, First Aid, Fire Safety, Health and Safety, COSHH, Care Homes for Older People Page 9 of 36 Infection Control and Food and Hygiene. Replace the antiquated stairlift with one that ensures a higher level of safety for the people that need to use it. Replace the worn and stained hallway and stair carpets. Review the staffing levels in the home to ensure there are sufficient staff on duty at all times to meet the needs of the service users. Make suitable arrangements to prevent the spread of infection in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 36 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 11 of 36 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. The Statement of Purpose and Service User Guide does not provide people with all the information they need to make a decision about moving into the home. The assessment process does not make sure that the needs of the person can be met at the home. Evidence: A Requirement was made in the last inspection report for amendments to be made to the Statement of Purpose and Service User Guide for the home. Amendments were needed to keep these documents up to date. For example, references were made to provision of care for persons with dementia, but the home is not currently registered to admit persons diagnosed with dementia. It was evidenced that these documents had been updated in September 2009. This Requirement was judged as met. However, the Statement of Purpose requires further amendments as it was found that the document contained, for example inaccurate information about the current organisational structure, the staffing ratio and staffing qualifications. Care Homes for Older People Page 12 of 36 Evidence: At the last visit to the home it was found that the Service User Guide required updating in order to comply with regulation. For example, it did not contain a standard form of contract for the provision of services and facilities in the home. The Service User Guide has been updated, however the copy provided did not contain information about the standard terms of contract. Information in relation to how to make a complaint, does not detail how a person actually does it, only the process. It was seen that there was a copy of the complaints procedure and Service User Guide in the entrance hall. The Statement of Purpose and Service User Guide documents would benefit from having an index, and being written in a way that people who live at the home could easily understand. A Requirement is made for further amendments to be made to the two documents in order that they meet the requirements of regulation. The previous completed AQAA documentation states we encourage the clients to visit the home/trial visit, day visit or overnight stay before making their decision. It also reports that pre-admission assessments are recorded and will usually be discussed with staff. Pre-assessment documentation was seen as part of the care planning system together with information provided by either the local care management team or the hospital. Pre-assessment documentation was viewed for the two newest admissions to the home, both of which indicated that the persons had dementia. As the home is not currently registered to provide care for people diagnosed with dementia, a Requirement is made in relation to the registered person providing accommodation only if the care home is suitable for the purpose of meeting the service users needs in respect of health and welfare. (See information in outcome area 7 in relation to management of the home.) Care Homes for Older People Page 13 of 36 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 do not benefit from care plans that show that person centred care is promoted. The safety of service users may be put at risk because of the need for medication practices to be improved. Health care needs are not always met. Personal care is mainly offered in a way to protect peoples privacy and dignity. Evidence: A Requirement was made in the last inspection report to ensure that person centred care plans are regularly reviewed and updated in accordance with regulation, together with ensuring that all appropriate risk assessments are undertaken, recorded and reviewed in the person centred care plans. This is to make certain that residents assessed health, emotional and social needs are met and to ensure their health and welfare are safeguarded in the home. This Requirement has not been met and a Statutory Requirement Notice will be served. The newly appointed manager has worked hard to implement a new set of care planning documentation that will provide person centred planning. Two care plans Care Homes for Older People Page 14 of 36 Evidence: were seen for the most recent admissions to the home. It was evidenced that for the person who had been at the home for a month the care plan was not completed. The falls risk assessment and waterlow chart were not completed. There was no risk assessment for problems associated with indwelling catheter, and no catheter care instructions to staff. The KCC assessment documentation stated particularly enjoys films however there was no information in relation to interests and hobbies. Likewise for the person who had been at the home for one week the care plan was not started and documentation for example, personal profile, waterlow chart, falls risk assessment and moving and handling assessment were not completed. The care plan viewed for a person who had lived at the home for sometime was seen to have been rewritten on the 25 November 2009 by the manager. Since that date there had been no review of the documentation. For example for skin integrity the documentation stated no problems, but the manager indicated that this is an ongoing issue for which she recently sought medical advice. This action is not recorded in the persons care plan. The manager said that she was aware that the reviews of the care plans had not been undertaken and that all appropriate risks assessments had not been completed. The manager agreed to address these issues of concern, and made some amendments to the documentation at the time of the visit. From documentation seen it is indicated that health care needs are not being met. For example weight charts not filled in on admission to home, catheter care needs not being met, including no date for when catheter is due to be changed. A person who lives in the home spoke about their concern in relation to a health care need. The manager said the GP had been informed and medication prescribed, but this was not documented. A Requirement is made in relation to promoting and making proper provision for the health and welfare of service users. A Requirement was made at the last inspection visit that the registered person must ensure that appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are maintained to ensure that service users health and welfare are safeguarded. This Requirement has not been met and a Statutory Requirement Notice will be served. Medication audits are now being undertaken. Two audits for December 2009 and one for January 2010 were seen and indicated that over this period there were gaps on medication charts that some night medication was not being administered and controlled drugs were not being double signed. The documentation indicated that these issues had been discussed with staff. Medication MARS sheets were seen and some gaps in recording were seen. For one medication the typed instruction on the Care Homes for Older People Page 15 of 36 Evidence: medication box had not been transferred accurately by hand onto the MAR sheet (Medication Administration Record). A prescribed cream to be applied to affected area twice a day had the written instruction self-medicates. However, there was no risk assessment documentation to support whether this person had the mental capacity or was able to self-medicate and no consent form to self medicate was seen. The preassessment information stated that this person was allergic to Penicillin, however this was not highlighted on the MAR sheet. The manager immediately addressed this issue. For one person where medication changes had taken place there was no indication if this had improved the persons health. It was seen that eye drop medication had been recorded inaccurately and administered wrongly. This was followed up during the visit and is now going to be administered and recorded correctly. The home has no medication trolley to aid in the administration of medicines. There is no wash hand basin in the medication room, to promote good infection control practice. The copy provided of the staff training matrix indicates that five staff have undertaken safe handling of medication training, and the training is recorded to have taken place on 28 January 2010. It was observed that staff are discreet and treated service users with dignity. Enclosing the toilet surround of the single toilet and adjoining sluice room, together with provision of appropriate screening in double bedrooms would further promote privacy and dignity for service users. When a new admission for a person diagnosed with dementia arrived at the home, he was going to be admitted to a double room. His notes were viewed and indicated that he was restless at night. The manager explained that his wife would like him to share a room since it may settle him, and that he had not been restless at night during a previous stay at the home. When the general manager and manager were asked, if the other person had been consulted about sharing a room, they said no. This evidences a lack of promoting services users dignity and privacy. Care Homes for Older People Page 16 of 36 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. People cannot be confident they will have satisfactory opportunities regarding lifestyle choices. People are supported to maintain contacts with families and friends. People are mainly provided with a balanced and healthy diet buy may not always enjoy a good variety or choices of foods. Evidence: A Requirement was made at the last inspection visit to find out from service users what activities they like to participate in, and based on the findings provide a programme of activities for the home. This is to ensure that people are supported to participate in activities in the home and are provided with opportunities to participate in activities outside the home if they so wish. The Requirement has been partly met in that service users have been consulted at a residents meeting about activities, and the manager has set up a programme of activities that includes movie afternoon, cards, life history, fitness and ball games. The manager agreed that activities were difficult to implement with the current staffing levels, and said that a person who wished to go for a walk was taken by one of the carers after the carer had finished her working shift at the home. An impact of the current staffing levels at the home is that service users may not be able to access external recreational activities should they wish to do so in Care Homes for Older People Page 17 of 36 Evidence: the afternoon. Activity records seen as part of the care planning system were not completed and had not been fully completed at the last inspection visit. The two surveys completed and returned by people who live in a care home for older people stated usually in reply to Does the home arrange activities that you can take part in if you want. A Requirement is made in relation to the provision of recreational activities. Visitors are welcome at anytime, and some of the service users are enabled to go out with family and friends. A Requirement was made that the registered person must provide varied, wholesome and nutritious food for people living at the home and in consultation with service users, review the menus. The improvement plan provided by the home states that the menus have been revised and this was confirmed by the cook. Food stores were viewed, and the cook agreed that mainly value or smart price foods products were in evidence. Service users said the food was better, and the two completed surveys for people who live in a care home for older people stated usually in reply to Do you like the meals at the home. The Regulation 26 report for the home for December 2009, stated that residents were happy with the food. It was stated that one person said they would like bigger portions, and one person said they would like more fruit. The Regulation 26 report for the home for January 2010 does not provide follow up information, as to whether these issues have been successfully addressed. The Providers quality assurance process should also evidence dissatisfaction and provide an opportunity for residents to suggest menu ideas. The Requirement was judged to have been met at this inspection visit, but overall this standard was quality judgement rated as adequate. At the previous inspection visit the expert by experience reported that the staff at all times had a tremendous rapport with the residents, they were kind, attentive, shared some humour to residents and each other when they briefly met and were very genuine in their care for the residents. Care Homes for Older People Page 18 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their complaints will be listened to and acted upon. People are not protected due to lack of staff training in identifying abuse. Evidence: The home has a complaints procedure, and this was seen as part of the Statement of Purpose documentation. The documentation does not detail how a person actually makes a complaint, only the process. There is a copy of the procedure in the entrance hall. Staff confirmed that both providers are contactable by telephone and always telephone them back if they leave a message. Service users were clearly at ease in the company of the various staff members on duty during the day of the visit and with the providers. The two completed surveys for people who live in a care home for older people confirmed that there was someone they could talk to informally if they were unhappy, and also confirmed that they knew how to make a formal complaint. A Requirement was made at the last inspection visit for staff to undertake training in relation to Safeguarding of Vulnerable Adults and the last inspection report stated that the home has a policy and written procedures on abuse. A copy of the staff training matrix provided at the last inspection showed that of the twenty one staff listed, thirteen had not undertaken training in relation to the Safeguarding of Vulnerable Adults. The copy of the staff training matrix provided at this visit indicated that none of the staff had undertaken training in relation to Safeguarding of Vulnerable Adults. Therefore it cannot be ensured that service users are properly protected. It is required Care Homes for Older People Page 19 of 36 Evidence: that action needs to be taken for all staff to attend training. This Requirement has not been met and a Statutory Requirement Notice will be served. The last inspection report stated that staff need to undertake training in relation to the Mental Capacity Act and the general manager confirmed that six members of staff were booked on training for 26 August 2009. The copy of the staff training matrix provided does not confirm that this training has been undertaken. Care Homes for Older People Page 20 of 36 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. People do not benefit from living in a home where the routine maintenance, decoration, and renewal of the fabric of the premises are well maintained. Evidence: The Immediate Requirement made at the last inspection visit in relation to the replacement of the damaged Parker Bath has been met. A replacement Parker Bath is now in situ. A requirement made at the last inspection visit in relation to ensuring that the premises are of sound construction and kept in a good state of repair externally and internally. The Requirement has been met in that as requested a copy of the maintenance programme has been received and work is in progress. It was reported at the last inspection visit that the kitchen is insufficiently ventilated; there is one window that was dirty on the inside and one small very dirty extractor fan in the kitchen. It was extremely hot in the kitchen on the day of the inspection visit. The home has a domestic four ring cooker and the Cook said that it is sometimes difficult due to limited oven space to cook a meal. Staff care time is also taken up with washing up as there is no dishwasher at the home. It was seen that action has been taken to repaint the kitchen walls and window, and a new small extractor fan has replaced the old one. The Service Improvement Plan for 2010 indicates that costing Care Homes for Older People Page 21 of 36 Evidence: for a Dishwasher is to be sought in June 2010. It was reported at the last inspection that the garden area is maintained but was seen to be mainly used for hanging out the washing. Appropriately placed tables and chairs would provide service users with a place to sit and enjoy the area if they wished. One service user commented that they would like to sit outside weather permitting. Suitable risk assessments of walking areas, bearing in mind the frailty of some of the service users and the risk of falls would need to be undertaken. The Service Improvement Plan for 2010 indicates that garden furniture is to be purchased in June 2010. At the last visit to the home the hall and stair carpet was stained and worn. The homes Service Improvement Plan for 2010 states that quote needed but no timescale had been recorded. At the time of this visit the carpet had not been replaced and remains in a poor condition. Action has been taken to improve the sluice area. The sluice area is one of a pair of toilet cubicles with the other still in use as a service users toilet. Hot and cold water has now been installed, and the surface surrounding the sink has been tiled. The manager agreed to refer back to the Environmental Health Officer as the grouting surrounding the tiles may not promote good infection control practice. At the time of the visit the sluice area contained no equipment or cleaning materials.The manager said that the sluice was being used by staff. A Requirement was made in relation to suitable arrangements being made to prevent the spread of infection in the home. This was namely that appropriate clinical waste bins are provided, ensuring that the sluice area meets the required infection control standard, and seeking the advice of the environmental health specialist in relation to the kitchen, bathroom and sluice areas of the home. This Requirement is judged as being mainly met. A number of issues in relation to poor infection control practice at the home were evidenced. There were unpleasant odours noticed in toilet adjacent to bedroom 10 and along some of the corridors, a soiled pad was seen in a service users wardrobe, a plastic bag containing a soiled pad was seen left in a corridor and a wood commode surround lacked varnish. A Requirement is made in relation to infection control practice to protect and ensure the safety of the staff and residents. A Requirement is made in relation to the replacement of the stairlift, as the inspectors observed that the arm of the chair was down and obstructing access to the stairs. Care Homes for Older People Page 22 of 36 Evidence: When this was lifted up it immediately fell down again. Evidence seen at the last inspection visit from the Accord Lift Services routine maintenance dated 12 August 2009 reported routine maintenance, stairlift requires new springs to arms and seat. This work has not been carried out and on the day of the inspection visit the stairlift engineer was visiting the home. He said that the lift was potentially unsafe in that it had no battery backup and therefore would fail if there was an electrical power cut. In this situation the person using the chairlift would be stopped on the stairs and unable to move up or down. A requirement has been made for the replacement of the stairlift. Evidence was seen that service users safety is not promoted at all times. Two razors had been left in one of the bathrooms, hospital type screens on wheels were seen in one of the double bedrooms (appropriate screening needs to be installed), an electric heater was balanced on a bedside chest, hot water in some rooms was very hot, and bedroom doors are propped open with a variety of objects which presents a risk of a fire spreading should one occur. The manager agreed to address these issues of concern. Care Homes for Older People Page 23 of 36 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. Peoples needs may not be met at all times by the numbers and skill range of the staff. The homes practice regarding the recruitment of staff ensures that people are protected. Evidence: At the last visit to the home the staff rota, indicated that at times there were insufficient staffing levels which may affect service users quality of life. The rota for Monday 17 August 2009 to Sunday 23 August 2009 showed that from 2.00pm to 8.00pm there were only two carers in the home for ten residents providing a range of duties including personal care, teatime duties and washing up. One carer spoken with said that bathing of service users is also generally carried out around teatime. A Requirement was made to review the staffing levels in the home especially with regard to the number of staff on duty between 14.00 and 20.00 each day, and the night staffing level to ensure that there are sufficient staff on duty at all times to meet the needs of residents. This requirement has not been met and a Statutory Requirement Notice will be served. The home had fourteen residents on the day of the inspection visit. The manager confirmed that the general manager finished at 2.00pm and that she finished at 4.00pm, after which time there are two carers on duty in the home. The cook Care Homes for Older People Page 24 of 36 Evidence: confirmed that she did not work at teatime and that the carers prepared and served the tea. The manager said that she fills in if there are staff shortages and when this happens it does not allow her to fulfil her management duties. It was reported at the last inspection visit that there is one waking night staff and one member of staff sleeping in. The general manager said at that time that laundry duties are mainly undertaken at night which the waking carer is required to undertake. It was discussed at that visit with the general manager and the responsible individual that as dependency levels increase and possibly the number of service users accommodated rises, the responsible individual will need to take action to provide a second waking night staff in order that service user needs can be met. The reviewed Statement of Purpose states that there are two waking carers at night. However the manager said that currently there is still only one waking carer and one carer sleeping in. This indicates that the needs of service users are not being met, especially as documentation for two people currently at the home indicate they are prone to wandering at night. At the last visit to the home the general manager said that there had only been one new carer start at the home, and the staff file for this person was seen. It contained all the relevant components as required by regulation for example application form, CRB and POVA check and two references. It was evidenced at that visit that the home was undertaking a thorough recruitment procedure for all new members of staff. Staff files were not seen at this visit. The local induction documentation seen at the last inspection visit was duly completed together with Common Induction Standards 1 to 6. These were completed, but not signed and dated for the person whose staff file was seen. Induction documentation was not seen at this visit. A Requirement was made at the last inspection visit in relation to staff receiving training appropriate to the work they perform. This Requirement has not been met and a Statutory Requirement Notice will be served. The copy of the staff training matrix provided by the manager showed that one member of staff has a certificate in First Aid. Best practice dictates that a trained firstaid carer be working on each shift. Since the last inspection visit, nine staff have undertaken training in Moving and Handling and Health and Safety. Eight staff have undertaken Infection Control and Food and Hygiene training. Six staff have undertaken POVA/Safeguarding training. Whilst acknowledging the training that has taken place, the staff team is still not trained in all areas to ensure peoples health, Care Homes for Older People Page 25 of 36 Evidence: welfare and safety are promoted. It was reported at the last inspection visit that staff at the home have either completed or are undertaking NVQ Level 2, and some staff have completed NVQ Level 3. The copy of the staff training matrix provided at that time did not provide this information clearly. One carer said that she had completed the NVQ Level 2 and was just about to start NVQ Level 3. The copy of the staff training matrix provided at this visit did not provide any information in relation to NVQ training. Care Homes for Older People Page 26 of 36 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 are not currently benefiting from good leadership and cannot be confident that the home is well run. The health, safety and welfare of residents and staff are not always promoted and people may not always be protected. Evidence: A Requirement was made at the last inspection visit to ensure that an application for registration is made in respect of the appointed manager of the home. This Requirement is judged as being met. Since the last inspection visit the responsible individual has appointed a qualified experience manager to run the home on a day to day basis. The inspectors were informed that the application for registration had been sent to the Commission office by recorded delivery on the day of the inspection visit. A Requirement was made at the last inspection visit that the registered provider or their appointee must visit the care home unannounced once a month and prepare a written report on the conduct of the care home. Evidence was seen that these visits Care Homes for Older People Page 27 of 36 Evidence: and reports are now being undertaken as the reports for December 2009 and January 2010 were seen. It was noted that no evidence was seen in relation to talking to staff. The aim of these visits is to identify any shortfalls in the delivery of the service. The number of requirements made in this report evidenced that these visits are not effective in assessing the level of care provided at the home and it is required that the home now does so. This Requirement is judged as partly met. A Requirement is being made that the home, supply us with a copy of these reports until they meet the required standard. At the last inspection visit service users records of personal allowance monies were seen and indicated that a clear system of recording with receipts kept was maintained to safeguard peoples best interests. One issue in relation to monies held in the Aquarius Lodge Client Account was discussed with the responsible individual and the general manager, and they agreed to take action to address this. This issue was not discussed at this inspection visit. At the last inspection visit a file was seen that contained the individual supervision records for staff. The general manager at that time confirmed that supervision was undertaken on a regular basis with written records maintained. Staff supervision was not discussed with the manager at this inspection visit. The manager said that the quality assurance surveys sent out to service users to gain their views about the home had been returned. She said that they contained positive feedback although this could not be evidenced as she was not able to find them on the day of the inspection. The manager said that she was due to send out surveys to relatives. It was discussed that in order to comply with regulation when the completed surveys are received the manager must write a report on the outcomes and then action it. It was discussed with the responsible individual and general manager at the last inspection that the homes current registration is for older persons. Therefore, they are in breach of the regulations if they admit anyone outside of this category. Despite this warning, the documentation for the two most recent admissions to the home evidenced that they had a diagnosis of dementia. This indicates a breach of the Care Standards Act, Section 11, and we are minded to take legal action. The overall quality judgement rating of this home is poor. This is clearly evidenced by: shortfalls in care planning, reviews and risk assessment; insufficient staffing levels and gaps in staff training; the poor condition of the environment; the outstanding five requirements made at the time of the last inspection visit for which Statutory Care Homes for Older People Page 28 of 36 Evidence: Requirement Notices will be issued; and the additional eight new Requirements made in this report. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that person centred care plans are regularly reviewed and updated in accordance with regulation Ensure that all appropriate risk assessments are undertaken, recorded and reviewed in the person centred care plans To ensure residents assessed person, health, emotional and social needs are met and to ensure their health and welfare are safeguarded in the home 31/10/2009 2 8 13 The registered person must ensure that appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are maintained To ensure that residents health and welfare are safeguarded in the home 30/09/2009 3 27 18 The registered person must 31/12/2009 ensure that staff employed at the home receive training appropriate to the work they are to perform for example Moving and Handling training Page 30 of 36 Care Homes for Older People 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 and Safeguarding of Vulnerable Adults To ensure peoples health, welfare and safety are promoted 4 27 18 The registered person must 30/09/2009 ensure that sufficient numbers of suitably trained staff are employed to meet the needs of residents in the home Review the staffing levels in the home especially with regard to the number of staff on duty between 14.00 and 20.00 each day, and the night staffing level to ensure that there are sufficient staff on duty at all times to meet the needs of residents To ensure residents assessed personal, health, emotional and social needs are met and to ensure their health and welfare are safeguarded in the home Care Homes for Older People Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must make further amendments to the Statement of Purpose and Service User Guide. To ensure people can make an informed choice as to whether the services provided at the home meets their needs. 31/05/2010 2 3 14 The registered person shall 31/03/2010 not provide accommodation to a service user at the care home unless the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. Provide accomodation for people only within the specified registration category of older person 3 8 12 The registered person shall 31/03/2010 ensure that the care home is conducted so as to promote and make proper provision Page 32 of 36 Care Homes for Older People 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 for the health and welfare of service users. To ensure that residents health and welfare are safeguarded in the home. 4 9 12 The registered person shall 31/03/2010 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service user. To ensure that residents privacy and dignity are respected. 5 12 16 The registered person shall 30/04/2010 having regard to the size of the care home and the number and needs of service users (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of the service users, activities in relation to recreation, fitness and training. To ensure that people are supported to participate in activities in the home and be provided with opportunities to participate in activities Care Homes for Older People Page 33 of 36 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 outside the home if they so wish. 6 19 23 The registered person shall 30/04/2010 having regard to the number and needs of the service users ensure that (c) the equipment provided at the care home for use by service users or persons who work at the care home are maintained in good working order. Replace the stairlift to ensure the safety of service users and staff. 7 26 13 The registered person shall 31/03/2010 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. To ensure peoples health and safety 8 33 26 The registered provider shall 30/04/2010 supply a copy of the monthly Regulation 26 report to the Commission. To ensure that the care home is managed and run in the best interest of the people using the service. Care Homes for Older People Page 34 of 36 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 3 Carry out an audit of all people living in the home to establish if they are within the category of the homes registration Provide suitable equipment for the administration of medicines. Provision of a wash hand basin in the medication room to promote good infection control practice. 2 3 9 26 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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