Inspection on 19/08/09 for Aquarius Lodge

This inspection was carried out on 19th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aquarius Lodge 17/02/10

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 18/02/2010.

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 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 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 first 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 32 Over 65 17 0 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 32 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. 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 first inspection visit since re-registration. This report contains the findings of the homes key inspection and takes account of information obtained from various sources. The key inspection visit was unannounced and carried out on Wednesday 19 August 2009 between 09.30 and 16.30. During the inspection the inspector and the expert by experience spoke with the Responsible Individual, the General Manager, assistant manager, staff on duty and people who use the service. Various records were seen during the visit, together with an accompanied tour of some areas of the premises. Care Homes for Older People Page 6 of 32 An expert by experience is a person who, because of their shared experience of using services, visits with an inspector to help them get a picture of what it is like to live in or use the service. Information provided in the report submitted by the expert by experience has been used when completing this report. The Annual Quality Assurance Assessment (AQAA) completed by the Responsible Individual was discussed with them at the time of the visit. The AQAA documentation made many statements that indicated compliance with the regulations, without quantifying or providing examples as to how this was achieved. Some of the information has been used together with information gained and observations made at the time of the inspection visit, all of which has been used when completing this report. Ten 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. One person commented that the staff are all very friendly and look after me. They are always available to listen to any concerns I have. The home is kept clean and tidy. 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. 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 Responsible Individual and the General Manager throughout the visit and at the end of the visit. An immediate requirement was made in relation to the damaged condition of the Parker Bath in the ground floor bathroom making it unsafe for use by service users and staff. Immediate action needs to be taken to address this issue in order to ensure the health and welfare of service users and staff, together with promoting good infection control. Care Homes for Older People Page 7 of 32 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 to ensure that prospective service users, service users/relatives have all the information they need to make an informed choice about the services provided by the home meeting their needs. Implement and maintain a person centred care planning system that provides all components required by regulation and enables staff to provide the care that meets individual needs. Health care needs to be comprehensively recorded to ensure that staff are provided with the information they need to enable them to meet the needs of service users. Provide all appropriate individual risk assessments as necessary. Keep the individual service user plan under regular review in accordance with regulation. Ensure that administration of medication is recorded in accordance with the homes policy. Provide a programme of activities, and maintain a full record of any activities undertaken. Review the menus of the food provided, considering the suggestions made by service users and staff in order to provide more variety, and ensure that alternatives that are available are offered. Replace the unsafe and damaged Parker Bath. Replace the worn and stained hallway and stair carpets. Provide a rolling programme of re-decoration for the home. 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. Update staff mandatory training in relation to for example First Aid, Moving and Handling, Safeguarding of Vulnerable Adults. Appoint a manager and submit an application to the Commission for the manager to be registered. Care Homes for Older People Page 8 of 32 The Responsible Individual or their appointed person, to undertake monthly Regulation 26 visits, providing a written report a copy which to be kept at 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 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 is thorough and makes sure that the needs of the person can be met at the home. Evidence: A copy of the Statement of Purpose and Service User Guide for the home, were provided at the end of the visit. Both documents were prepared and provided at the time of the re-registration of the service. Amendments are needed to keep these documents up to date for example the change of the name of the Commission in the Statement of Purpose, and reference to provision of care for persons with dementia as the home is not currently registered to admit persons diagnosed with dementia. The Service User Guide requires for example the addition of a standard form of contract for the provision of services and facilities by the registered provider to service users in order to comply with regulation. Care Homes for Older People Page 11 of 32 Evidence: The 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 two care plans viewed. This was information completed and provided by either the local care management team or the hospital. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 offered in a way to protect peoples privacy and dignity. Evidence: Two service user care plans were seen, and although both were muddled and in no clear order, these did contain information in relation to pre-assessment information, a form of care plan, daily records, risk assessments and reviews of the care plan as required by regulation. The assistant manager said that currently work was being undertaken to improve the recording system to provide person centred care planning documentation with assistance from Social Services Contracting Department. In relation to one of the care plans seen the assistant manager was able to provide clear information about the persons health care needs, however this was not supported by the information in the care plan. There was no risk assessment in Care Homes for Older People Page 13 of 32 Evidence: relation to catheter care, and information found in relation to the changes of the catheter undertaken by the District Nurse was not clear as to whether the catheter had been regularly changed. The date was not indicated when the catheter was due for renewal. From information discussed it was indicated that the person suffered with a re-occurring skin integrity problem, and there was no risk assessment in place to ensure that staff were made aware of changes that they may observe that would require further action to be taken. The other care plan seen indicated within the documentation that two of the persons medications had been increased, although there was no evidence seen in the review format as to whether this change in medication had had any beneficial effect or otherwise. It was observed that the reviews of the care plans were not up to date, and the assistant manager said that the reviews of the care plans were all behind. The medication records MARS sheets were viewed and it was seen on the previous months records that on every sheet there was at least one gap in recording. The completed AQAA documentation states there have not been any serious incidents, involving controlled drugs within the last twelve months. The controlled drugs book was viewed and one issue was discussed with the General Manager who said that he would investigate this. The issue in relation to the gaps in the recording of the MARS sheets was discussed with the General Manager and later with the Responsible Individual. The General Manager confirmed that all staff who administers medication at the home had undertaken a distance learning training course in relation to the administration of medicines. The contents of the medication fridge were viewed, and the General Manager stated that a record of the daily fridge temperature had not been kept. He confirmed that he would address this issue. 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 expert by experience reported her observation that staff were discreet and treated service users with dignity. Care Homes for Older People Page 14 of 32 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 may not be provided with a balanced and healthy diet and may not enjoy a good variety or choices of foods. Evidence: The expert by experience spoke to most of the ten residents, and reports that one resident told her that she recently enjoyed a quiz, otherwise there was not much to do. Another resident also told the expert by experience there was nothing much to do. The residents and staff said that occasionally someone came in to play music and they had a sing song. In the lounge the expert by experience saw a variety of current video tapes, a large bag of knitting wool, some magazines, dominoes and other board games, but did not see these in use during the visit. The activity records were seen when providing feedback to the General Manager and the Responsible Individual and it was said that these records had not been fully completed. An impact of the current staffing levels at the home is that service users may not be able to access external recreational activities or participate in assisted activities in the home should they wish to do so in the afternoon. Care Homes for Older People Page 15 of 32 Evidence: Visitors are welcome at anytime, and some of the service users are enabled to go out with family and friends. The expert by experience reported that the menu for the main meal of the day consisted of sausage casserole, potatoes, cauliflower and carrots. The expert by experience further reported that she was shown a book with the planned menus and afternoon tea consisted of a choice of sandwiches plus cake. Talking with service users and staff it was indicated that it was a choice of sandwiches for tea every day. The expert by experience stated that one service user said the food is boring, another said the food was poor and another said they did not like what was for lunch today. The expert by experience reported that she asked the cook if she made cakes and the cook told her that this did not appear to happen often due to the time factor. There were no cakes seen in any of the storage cupboards that were viewed. The expert by experience observed the lunch period where the food was well presented and served on moderate size plates. However, there was a lot of waste both of the main meal and the dessert supporting the statements of residents to the expert by experience. It was observed that staff time was taken up bringing food from the downstairs kitchen to the upstairs dining room as well as catering for those who preferred to eat in their bedroom. This practice may result in food which was cool in temperature and less appetising. The expert by experience reported there was general agreement between residents and staff that the menu needed to be changed to include more variety and more interesting meals and that the afternoon tea of a sandwich could be better but that residents did not say how. The Providers quality assurance process should evidence dissatisfaction and provide an opportunity for residents to suggest menu ideas. 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. One service user who had been at the home for a few days, said that the staff are wonderful. Care Homes for Older People Page 16 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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. 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 home has a policy and written procedures on abuse. A staff training matrix provided shows that of the twenty one staff listed, thirteen are not recorded as having undertaken training in relation to the Safeguarding of Vulnerable Adults. To ensure that service users are properly protected action needs to be taken for all staff to attend training. Staff need to undertake training in relation to the Mental Capacity Act and the General Manager confirmed that six members of staff are booked on training for 26 August 2009. Care Homes for Older People Page 17 of 32 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 good. Evidence: Information contained in the completed AQAA documentation states all equipments are serviced and are in good working order. All repairs are done promptly. Regular Vaxing of carpet. The accompanied tour of some areas of the home showed that the premises are in need of re-decoration for example hand rails have lost the surface finish and door frames were seen to be lack paint in places. The hall and stair carpets were dirty and heavily stained in places. The expert by experience reported that some light fittings were not working and this may be a hazard to service users and staff. 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 for ten service users. Staff care time is also taken up with washing up as there is no dishwasher at the home. 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 Care Homes for Older People Page 18 of 32 Evidence: 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 residents and the risk of falls, would need to be undertaken. At the key inspection visit dated 08 January 2007 it was reported that a corner of the parker bath is beginning to crack and show signs of wear. This was discussed with the manager as a possible infection risk and he agreed to add the replacement of this bath to the homes business plan. The manager also agreed to consider the future provision of an improved sluice facility to clean commode pans. At the key inspection dated 25 October 2007 it was reported that it was again identified that the Parker bath is showing signs of wear and the bathroom would benefit from an upgrade. This had been in the homes business plan for this year, but a quote had been too expensive, so this has been deferred for the time being. Future plans also include upgrading the sluicing facility. An issue of serious concern discussed with the Responsible Individual and General Manager in relation to the health and welfare of service users and staff and the promotion of good infection control practice was the condition of the Parker Bath seen at this inspection visit. The Parker Bath is located in the ground floor bathroom and evidenced to be in a potentially unsafe condition. The surface of the seat of the bath showed signs of multiple cracking. Other areas of the surface of the bodywork of the bath were also seen to be compromised. The joint on the arm of the side of the bath that opens to allow bodily access was badly rusted, the metal strip was damaged leaving a jagged edge, and the surrounding bodywork surface was badly damaged and dirty. A member of staff confirmed that the Parker Bath is currently in use most days. An immediate requirement was made in relation to the Responsible Individual taking action to replace the damaged Parker Bath and to take appropriate interim measures to ensure the health and welfare of service users and staff. In relation to the Parker Bath the General Manager provided information from Accord Lift Services Ltd dated 12 August 2009 stating that routine maintenance had been undertaken, however during further discussion it was indicated that this was in relation to new parts needed for the stair lift not the bath. Although the home does not provide nursing the inspector was shown a pair of toilet cubicles one of which had been converted to house a sluice. It was seen in the sluice area that the mixer tap only supplied cold water. The stainless steel sink size was not much bigger than a commode pot and was fitted into a plain wood work surface that did not have an impervious finish. The toilet was still in place minus a toilet seat and Care Homes for Older People Page 19 of 32 Evidence: the gap between the top of the toilet and the bottom of the sink would not aid ease of use. The sluice area does not promote good infection control practice. It was also observed that the one remaining toilet and the sluice/toilet had gaps at the bottom and top of the framework that may mean that service users privacy and dignity may be compromised. The second cubicle is still in operation but should only be used by staff and not residents due to the potential for infection and contamination. Other issues discussed in relation to poor infection control practice included the swing bin for kitchen rubbish had no lid, the two clinical waste bins seen (both stainless steel type kitchen pedal bins) that were noticeably dirty inside the lids of both bins. One had a broken foot pedal. No wash hand basin was provided in the medication room. Care Homes for Older People Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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: A copy of the staff rota for the current week was provided. It indicated that there are insufficient staffing levels, affecting the quality of life at the home for the residents. 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. Due to the cook not working at the home during the week of this inspection, care staff were also to cover cooking duties. The rota seen further showed that on Thursday, Saturday and Sunday there are two carers on duty from 8.00am to 2.00pm and from 2.00pm to 8.00pm for 10 residents. The rota evidenced that the General Manager is working from 8.00am to 2.00pm on four days of the week in question. There is, however, a person on the rota to cover domestic duties each day of the week either from 9.00am to 1.00pm or from 8.00am to 2.00pm. Staff spoke of not having time to spend with service users to listen to them and enable them to pursue their chosen Care Homes for Older People Page 21 of 32 Evidence: leisure activities, indicating that the needs of service users are not being met. There is one waking night staff and one member of staff sleeping in. The General Manager said that laundry duties are mainly undertaken at night which the waking carer is required to undertake. It was discussed with the General Manager and later with the Responsible Individual that a requirement would be made to review the current staffing level in the home especially in relation to the times between 2.00pm to 8.00pm. As dependency levels increase and possibly the number of service users accommodated at the service increase 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 General Manager reported 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 that the home is now undertaking a thorough recruitment procedure for all new members of staff. The local induction documentation was seen duly completed together with Common Induction Standards 1 to 6 completed but not signed and dated for the person whose staff file was seen. The staff training matrix showed that not all staff had received training in relation to First Aid, and staff who had training certificates were dated between 2002 and 2006 and may now need updating. Best practice dictates that a trained first-aid carer be working on each shift. The staff training matrix shows that four staff have not had fire training, five staff have not had infection control training, seven staff have not had health and safety training, eleven staff have not had moving and handling training, nine staff have not had food and hygiene training and thirteen staff have not had adult protection training. Staff at the home have either completed or are undertaking NVQ Level 2, and some staff have completed NVQ Level 3. The staff training matrix does 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. Care Homes for Older People Page 22 of 32 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: The home does not have a registered manager, and the General Manager said that a person was about to be appointed, but was currently awaiting recruitment checks. It is an offence against the Care Standards Act 2000 Regulation 11 for a person to be in day to day management of a registered service and not be registered with CQC. The General Manager confirmed that no Regulation 26 visits had been undertaken by the Responsible Individual or a person appointed by him to undertake these visits. There were no reports to be seen since the home was re-registered in March 2009. This is a breach of regulations and may result in enforcement action; the Responsible Individual said that he would address this issue. Care Homes for Older People Page 23 of 32 Evidence: 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. A file was seen that contained the individual supervision records for staff, and the General Manager confirmed that supervision was undertaken on a regular basis with written records maintained. The completed AQAA documentation states that regular satisfaction surveys are undertaken, and the Responsible Individual said that these were part of the quality assurance system used by the home, together with service user and staff meetings. Overall issues already reported in relation to care planning reviews and risk assessment, recording of administered medications, provision of a programme of activities, reivew of staffing levels and staff training needing to be undertaken, condition of the environment and no registered manager support the overall quality judgement rating of these standards as poor. Care Homes for Older People Page 24 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 32 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 1 21 12 The registered person must 21/09/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents Take immediate action to replace the damaged Parker Bath, and to take appropriate interim measures to ensure the health and welfare of residents and staff To ensure peoples health, welfare and safety 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 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 30/09/2009 2 7 15 The registered person must ensure that person centred care plans are regularly reviewed and updated in 31/10/2009 Care Homes for Older People Page 26 of 32 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 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 3 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 4 12 16 The registered person to find 31/10/2009 out from service users what activities they might like to participate in Based on the findings provide a programme of activities for the home 30/09/2009 Care Homes for Older People Page 27 of 32 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 To ensure that people are supported to participate in activities in the home and be provided with opportunities to participate in activities outside the home if they so wish 5 15 16 The registered person must provide a varied wholesome and nutritious food for people living at the home In consultation with residents review the menus To ensure that people are provided with a varied and nutritious diet and alterntives are available 6 19 23 The registered person must 30/09/2009 ensure that the premises are of sound constructions and kept in a good state of repair externally and internally Provide a copy of the maintenance programme for the home 30/09/2009 To ensure peoples health and welfare are safeguarded in the home Care Homes for Older People Page 28 of 32 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 7 25 13 The registered person must 30/09/2009 make suitable arrangements to prevent the spread of infection in the home Provide appropriate clinical waste bins Ensure that the sluice area meets the required infection control standard Seek the advice of the environmental health specialist in relation to the kitchen, bathroom and sluice areas of the home To ensure peoples health and safety 8 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 and Safeguarding of Vulnerable Adults To ensure peoples health, welfare and safety are promoted 9 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 Care Homes for Older People Page 29 of 32 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 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 10 31 8 The registered person must ensure that an application for registration is made in respect of the appointed manager of the home This is to ensure that residents benefit from a home that is run by a manager registered as fit to manage the home 11 33 26 The registered provider or 30/09/2009 their appointee must visit the care home unannounced once a month and prepare a written report on the conduct of the care home A copy of these reports to 28/02/2010 Care Homes for Older People Page 30 of 32 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 be kept at the care home To ensure that the care home is managed and run in the best interest of the people using the service 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!