Key inspection report
Care homes for older people
Name: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA 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: Susan Dale
Date: 0 5 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 37 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 37 Information about the care home
Name of care home: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA 01772686343 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexagon Healthcare (UK) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code 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 - Code OP.(maximum number of places: 2) Dementia over 65 years of age - Code DE (E) (maximum number of places: 20) The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief description of the care home Arundel Lodge is registered with the Care Quality Commission to provide personal care for 20 older persons within the category of Dementia and 2 persons within the category of Old Age (OP). The home is situated on the main road in a residential area of Kirkham and is within easy reach of community resources and facilities and is Care Homes for Older People Page 4 of 37 1 4 0 9 2 0 0 9 0 0 Over 65 20 2 Brief description of the care home located on a bus route. Accommodation is arranged over three floors. There are fourteen single and four double bedrooms. There is a passenger lift to each floor of the home, and ramped access to the garden and patio area. Currently the home is in need of renovation and some major work is required to the roof, inside and outside areas. There is a Statement of Purpose and Service User Guide that provides information about the services provided by the home available in the foyer. The current fees are £386:50 per week rising to £463:50 per week, further Information about fees can be obtained from the registered providers. Care Homes for Older People Page 5 of 37 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 inspection was unannounced and and focused on key standards and areas of concern from the inspections carried out over the last twelve months. Various persons were spoken with including the registered providers, acting manager, care staff, people cared for in the home and a visitor. Surveys were sent out prior to the site visit and nine staff surveys were returned, one on behalf of a person cared for and a social worker. The responses and comments are included in the report. The last key inspection was on the 9th June 2009. Two random inspections took place on the 17th July and the 14th September 2009 following concerns about the safety of the building. There are still ongoing concerns about the safety of the building and the management of the home. Care Homes for Older People Page 6 of 37 What the care home does well: What has improved since the last inspection? A party was held at Christmas and relatives were invited; carol singers attended the home and because they had brought a donkey with them they situated themselves in the back garden where they were able to be heard and seen by the people cared for in the home and staff. At the last inspection there was a requirement made for all staff to receive Safeguarding training to ensure the protection of vulnerable adults. All staff have since received the training and certificates were seen issued to staff in November 2009. The front and back garden areas has been tidied up and a new sign with the name of the home has been erected at the front. Previously it was difficult to identify the home and the front garden was overgrown and did not provide a good first impression to any person visiting the home. Care Homes for Older People Page 7 of 37 The home is in major need of refurbishment and some decoration and new carpets have taken place in some of the vacant rooms and new digital televisions have been purchased for both lounges. There is still a need to ensure that the rooms currently in use are also refurbished to ensure a safe and welcoming environment. What they could do better: The Statement of Purpose and Service User Guide do not reflect the services provided by the home and are misleading. Both documents include descriptions and a photograph of a home that is clearly not Arundel Lodge. The information included in the documents with regard to reporting any complaints should be updated to ensure the Care Quality Commission is a contact for advice only for any concerns. The record of weight for each individual had not been completed for approximately 12 months and according to staff this is because the sit down weigh scales had not been calibrated. According to the directors they have been calibrated although evidence of this could not be provided. It is important that a record of weight is maintained to ensure the health of the people cared for in the home. There is a need to include risk assessments for any person requiring bed rails including any consultation with health professionals. The risk assessment should also include an assessment of the the need for bed rail bumpers to ensure the protection of the person from impact injuries or entrapment. There was no evidence that bath hoists or the weigh scales had been serviced recently. Staff have been unable to weigh the persons accommodated because the weigh scales need calibrating. The registered provider has stated that the scales have been calibrated and they have been asked to provide evidence that this has taken place by a professionally qualified person. Appliances and equipment necessary for the care of the people accommodated should be serviced on a regular basis in order to protect their health and safety as well as the staff who operate the equipment. The care plans although very detailed would benefit from being organised so that the latest information was easy to read and summarised to include information gathered from any incidents or issues arising from the previous month. The accident book included a high number of accidents/incidents with unexplained injuries such as bruises. There is a need to cross reference the details in the accident book with the individual details recorded on the care plans in order to establish any patterns which may help to determine the circumstances under which the injuries have been caused and what action requires to be taken. The medication record was up to date and accurate. Medication is stored in a wooden cupboard and the padlock on the wooden cupboard does not provide enough security as it could be easily prised off. The existing wooden cupboard must be replaced with a metal cupboard with a secure lock in order to ensure the safekeeping of the medicines provided. There is no formal activities programme in place or trips outside the home. The majority of persons cared for were either watching television or asleep. A lack of stimulation does not help to promote well being or ensure good mental health for the people cared for in the home. There is no opportunity to go outside as staff confirmed Care Homes for Older People
Page 8 of 37 that they are still unable to assist the persons cared for into the garden area as the ground is still uneven and hazardous immediately outside the doors in the main lounge. This is an ongoing problem that has been reported at several previous inspections. Meals were being provided by a member of staff who is employed as a cleaner in the home. Although she has some kitchen experience the staff member does not have a food hygiene certificate which is required for any person who prepares meals in order to ensure food safety. The meals provided are adequate but do not offer choice. A complaint seen in the complaints record did not provide enough detail as to what investigation had taken place and the final outcome. The Care Quality Commission is also aware that a formal complaint has been made however, there was no record kept of this complaint. A good complaints procedure ensures that good standards of care are maintained and improvements are put in place for any complaint that has been substantiated. A part of the home has been sealed off because the flat roof has leaked and the ceiling has caved in causing significant damage with water dripping into a bucket and sodden plaster on the floor. The outside wall is rendered and the surface is cracked and bulging outwards. There is a need to ensure that the electrical systems in the home are safe following the leakage of water and that there is no danger to the people cared for and staff who are situated immediately below where the leakage has occurred. As at previous inspections, although some refurbishment is taking place in vacant bedrooms, there is a need to improve the environment with regard to furniture and fittings to ensure the home is comfortable and a welcoming place to live. There is also a need for a lockable facility for the safekeeping of any medication or valuables located in individual bedrooms. Two files were examined for newly appointed staff, there was evidence of preemployment checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults register. There was no evidence of references on both files or an application form, there was also no evidence of a contract of employment or evidence of induction training on one of the staff files. The reference request seen on one file had been made after the staff member had commenced duties. Poor recruitment procedures do not protect the vulnerable people cared for in the home. A review of the staffing levels should take place to ensure that sufficient staff are available at all times in the main lounge area and that the person acccommodated on the top floor would be cared for appropriately in the event of them requiring additional support. There has been no manager for over twelve months and no registered manager since Hexagon took over ownership of the home. Staff have low morale and no confidence in the current management arrangements. A suitably experienced and qualified manager must be employed and registered with the commission. There was no evidence of written reports undertaken by the registered provider about the conduct of the home as detailed under Regulation 26 of the Care Home Regulations. Regulation 26 reports are necessary to show that the home is being Care Homes for Older People
Page 9 of 37 managed effectively and the services and facilities within the home are suitable. All staff should receive regular one to one formal supervision at least six times a year to ensure they are supported and competent and have an opportunity to discuss any issues arising that may have an impact on their performance. 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 37 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 37 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 information available about the services and facilities provided by the home is misleading and requires a review. The assessment procedures are suitable and ensure the services provided meet individual requirements. Evidence: The Statement of Purpose and Service User Guide do not reflect the services provided by the home and are misleading and and should be reviewed. Both documents are available within the entrance hall. The Statement of Purpose describes the bedrooms as having en-suite facilities when they only have a wash basin. There is a photograph in the Service Users Guide of a bedroom which is in another home. The document describes a delightful front garden with patio and seating area which is not the case. The details also do not include any reference as to how any person with dementia would be supported and would benefit from living at Arundel Lodge. The complaints procedure contained within the documents is misleading as the
Care Homes for Older People Page 12 of 37 Evidence: Commission is not the lead authority for investigating complaints but can be contacted for advice. The Service User Guides contact details for the commission are incorrect and require updating to that of the Care Quality Commissions National Processing Centre. There is no information to show how a person with dementia would be managed by the home. The documents do not provide a full and accurate description of the facilities provided by the home and are misleading. There have been no new admissions to the home since the last inspection only two people for respite care and they are no longer at the home. The assessment format used by the home previously was not examined, there have been no changes to the format used previously for assessment. Care Homes for Older People Page 13 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate records are maintained with regard to care planning, health and medication. The people cared for in the home are treated with privacy, dignity and respect by staff. Evidence: The care plans were examined and found to be detailed with the past history and previous employment of the person supported recorded where the information could be obtained. Risk assessments and a care plan had been formulated in the following areas; Maintaining a Safe Environment; Sight, Hearing and Communication; Mobility and Dexterity; Hygiene and Bathing; Sleeping; Religious Observance; Diet and Weight including preferences; Daily Living and Social Activities. A diary of events was recorded for each area and they were up to date and included details of any health professional involvement such as General Practitioners, District Nurses, Opticians and the Memory Clinic. Care Homes for Older People Page 14 of 37 Evidence: There was good detailed information in order to identify any person in danger of developing a pressure sore and appropriate intervention had been recorded on the care plan. Nutritional Screening is undertaken and a record is maintained of food and fluids taken especially for individuals in danger of weight loss. The record of weight for each individual had not been completed for approximately 12 months and according to staff this is because the sit down weigh scales had not been calibrated. This issue was raised at the last inspection and it was confirmed by the provider that the weigh scales had been repaired. However the staff have no confidence that this was the case and there was no evidence available to demonstrate a repair had taken place. There is a need to include risk assessments for any person requiring bed rails including any consultation with health professionals. The risk assessment should also include an assessment for bed rail bumpers to ensure there is no danger of impact injury or entrapment of the individual concerned. Permission to use bed rails should be considered by discussion with the individual concerned or a relative. The care plans although very detailed would benefit from being organised so that the latest information was easy to read and summarised to include information gathered from any incidents or issues arising from the previous month. The accident book included a high number of accidents/incidents with unexplained injuries such as bruises. There is a need to cross reference the details in the accident book with the individual details recorded on the care plans in order to establish any patterns which may help to determine the circumstances under which the injuries have been caused and what action requires to be taken. People at the home received their medication as prescribed. The medication records were examined and found to be correct with regard to the medicines provided and when they had been administered. Good systems were in place to record the receipt and disposal of medication as prescribed. The medication is stored in a dedicated room within a wooden cupboard that is padlocked; there is also a purpose made secure trolley for when the staff distribute the medication. The padlock on the wooden cupboard does not provide enough security as it could be easily prised off. The existing wooden cupboard must be replaced with a metal cupboard with a secure lock in order to ensure the safekeeping of the medicines provided. The care home subscribes to a care Quality Management System based on equality and diversity principles. Staff are provided with the principles at induction training and Care Homes for Older People Page 15 of 37 Evidence: they are available to read at all times. Staff were observed to treat the persons cared for with dignity and gentleness and were very aware of individual requirements. All the persons observed were clean and tidy with newly washed hair and clean nails. One of the persons cared for commented that staff were very kind and helped her to shower in a way that did not make her feel uncomfortable; all her needs were being taken care of and she was very happy. A Social Worker made the following comments on a survey with regard to what the home does well: Individual care staff have been prepared to consider new ways of working with individuals where this is needed and have suggested this themselves. They have shown a willingness to input eg: in supporting a resident to go out for a drink at a local pub with her friend. Care Homes for Older People Page 16 of 37 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. There are no formal activities or outings taking place. The meals provided are adequate but, do not offer a choice of meal. Evidence: The staff understand the importance of treating each person as an individual and time has been taken to record the previous background and social history of the persons cared for where the information could be obtained. There is no formal activities programme in place or trips outside the home. The majority of persons cared for were either watching television or asleep. One person within the category of older person who resides alone on the top floor has strong connections with a local church and spends her time making up raffle prizes to assist in fund raising activities for the church. Although she is on her own, she is happy with her situation and has regular visits from friends and has previously received communion within the home. The staff recently made sure that a party was held for her birthday celebration. The majority of people cared for sit within the main lounge area where they watch television. There is very little stimulation other than what the staff strive to provide
Care Homes for Older People Page 17 of 37 Evidence: and they were observed chatting to the people cared for when they had the time. Staff confirmed that they are still unable to assist the persons cared for to the garden area as the ground is still uneven and hazardous immediately outside the doors in the main lounge. A party was held at Christmas and relatives were invited; carol singers attended the home and they brought a donkey. The singers and donkey situated themselves in the back garden where they were able to be heard and seen by the people cared for in the home and staff. Visitors attend the home on a daily basis and one visitor was spoken with who was happy with the level of care provided and with the level of information given to her about her relative when she visited the home. Advocates have acted in the past to ensure the best interests of the the people supported in the home. There was evidence in the care planning documents where consultation had taken place with Social Workers and relatives over the care provided. Meals are taken in the main lounge for the majority of persons cared for in the home with the exception being the one person cared for on the top floor who has a separate dining room and a microwave to ensure the meals served are hot. The cook was on leave and the meals were being prepared by another member of staff who is employed as a cleaner. The staff member has some kitchen experience but does not have a food hygiene certificate required for any person who prepares meals in order to ensure good hygiene measures with regard to food safety. According to staff, the regular cook places the food order and there is no restriction on the food budget. Fresh vegetables are delivered to the home. There was no fresh fruit seen on display but it was confirmed that fruit is available such as bananas and fruit salads. Sandwiches were seen to have been left in the fridge for tea. The staff member confirmed that the cooker is suitable for home baking and baking of cakes and desserts take place on a regular basis. The menu could be seen in the main office and does not offer a choice of food but staff confirmed that they would make something else to eat if requested. Special diets are catered for and staff are aware of individual choices and wishes. Staff were observed helping some of the persons cared for to eat in a discreet manner that was unhurried. People at the home were positive about the meals provided. Care Homes for Older People Page 18 of 37 Evidence: Staff comments when asked what the home does well included the following: The core of the staff care well for the residents and do extra for the sake of the residents eg buy things for the residents, toiletries, towels, clothing. Everything, the carers are very devoted to the residents. Care for the residents thanks to a good care supervisor and management have no input. A comment was received from a friend of one of the persons cared for: Provide some sort of of an activity to occupy ..... she is alone most days and could do with something to keep her mind occupied. Care Homes for Older People Page 19 of 37 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. There is a procedure in place for the reporting of concerns that needs to be strengthened to ensure investigations are carried out. Staff have received training in the safeguarding of vulnerable adults from abuse. Evidence: There is a copy of the complaints procedure in the Statement of Purpose and Service User Guide; as mentioned previously there is a need to review the complaints procedure and ensure that the contact details are correct and to make it clear that concerns should initially be raised with the home for investigation and that the Care Quality Commission can be contacted for advice. Other contacts with regard to any concerns should be Social Services. The complaints record contained one concern that required additional information as it did not include who had received and recorded the concern or any action taken and by whom. The complaints record did not include a concern sent to the provider by the Care Quality Commission for investigation in September 2009. Concerns should be recorded and investigated thoroughly to ensure good standards of care are being met and that improvements are made where a complaint has been substantiated. At the last inspection there was a requirement made for all staff to receive Safeguarding training to ensure the protection of vulnerable adults. All staff have since received the training and certificates were seen issued to staff in November 2009. The
Care Homes for Older People Page 20 of 37 Evidence: Lancashire Social Services policy on Safeguarding is available within the home for reference purposes but there is a need to set out a procedure for staff so that they are aware of the steps required to be taken in the event of any allegation of abuse and to whom any concerns should be reported. Staff training in safeguarding procedures is important to ensure the protection of vulnerable adults as well as staff. Care Homes for Older People Page 21 of 37 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. The environment is poor and needs urgent attention particularly to the flat roof and bedrooms below. Checks need to be carried out to ensure the electrical systems and equipment in use are safe and there is no danger to the health and safety of the people in the home. Although some refurbishments and decoration have taken place this should continue to all the bedrooms as some furnishings and fittings are old and worn. Evidence: There are some major concerns about the environment both inside and outside the home. A tour of the home took place. A part of the home has been sealed off because the flat roof has leaked and the ceiling has caved in below causing significant damage with water dripping into a bucket and sodden plaster on the floor in one room and evidence of water penetration in others. The outside wall is rendered and the surface is cracked and bulging outwards. A professional survey was provided that had been written following an investigation into the damage caused by water damage to the flat roof and the rooms directly below. The survey clearly stated that there was significant damage to the building and that it was unsafe for use. Care Homes for Older People Page 22 of 37 Evidence: The main lounge area below where the leakage has occurred is showing evidence of damp in the ceiling in two areas and there are concerns that the water seepage could cause problems to the electrical systems. A wiring check must be undertaken by a suitably qualified person to determine the current safety of the system in all areas of the home. The provider gave assurances that this check would be undertaken as a matter of priority and details of the findings submitted to the Commission. In other parts of the home, some of the vacant bedrooms have been decorated with new carpets and recently painted walls. Although this is necessary, it is the occupied bedrooms that are in need of refurbishment and decoration and should be prioritised for refurbishment. The furniture and fittings in the bedrooms are old and worn but servicable. There are no facilities within the bedrooms to lock any medication or valuables. Bed rails were in place in certain rooms, there were no padded bumpers for the bedrails in place in one of the rooms. As referred to previously this could be a health and safety hazard for the individuals concerned and requires an assessment. One of the bathrooms is a wet room; there is a need to conduct a risk assessment on toiletries seen on a shelf in a number of the bathrooms. There is a danger that shampoos and bubblebath could be ingested accidently by the people cared for. All the toilets have soap and disposable towels available. Staff confirmed that new towels have been purchased since the last inspection. There was no evidence on equipment such as bath hoists or the weigh scales that they have been serviced recently and this could have an impact on the health and safety of the persons accommodated. Two of the fire doors had been wedged open for ease of movement of staff and the people cared for in the home. It was advised that an appropriate method approved by the fire authority should be in place should these doors be left in an open position. The outside area of the home has been tidied up at the front of the home and at the garden area at the rear. A sign with the homes name is now in place at the front of the home. The patio area immediately outside the main lounge area remains hazardous to walk upon or be pushed in a wheelchair. The patio has uneven crazy pathing as well as an uneven area where the rotary clothes dryer has been removed with the metal base of the dryer protruding. One of the windows in the lounge area has been taped up as there are gaps in the seals around the window. The corridor leading into the main lounge area appears to have been cleaned as recommended at the last inspection but, is old and worn and Care Homes for Older People Page 23 of 37 Evidence: severely marked in places. Care Homes for Older People Page 24 of 37 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. Staff training has been provided that assists them in their role. There is a lack of evidence with regard to staff recruitment to show that pre-employment checks are carried out to ensure appropriate staff are employed to look after vulnerable people. Evidence: Currently there are eight persons being cared for, one of whom is within the older person category and resides on the top floor of the home with her own lounge and dining area. The other seven persons have dementia and are cared for in a different area of the home. The person residing on the top floor is fairly independant although requires some help with bathing. There was evidence in the record keeping that staff have asked if she would prefer to change rooms and be less isolated but she is happy to stay where she is. Staff are mainly involved in caring for the people with dementia and it would be difficult to manage any increased care needs for the person on the top floor. The staff observed in the lounge area provided good, positive intervention at all times. It was noted also that any personal care such as taking people to the toilet, required two staff members who had to leave the secure lounge area for up to 10 minutes at a time. This meant that the other people in the lounge were on their own. Staff training has continued with a training matrix available for inspection. Staff have
Care Homes for Older People Page 25 of 37 Evidence: received safeguarding training and are to undertake medication training on the 11th February 2010. As mentioned previously there is a need to ensure that any staff who prepare meals obtain a food hygiene certificate. The level of trained staff with a National Vocational Qualification (NVQ) in Care is high with the majority of staff obtaining an NVQ. The NVQ in Care is the nationally recognised qualification within the Social Care services. Staff spoken with had received induction training and other mandatory training such as moving and handling procedures and infection control and had also received training in dementia care. There is a suitable recruitment policy and procedure in place and the files of two staff were examined who had been recruited recently. Some of the necessary preemployment checks were missing from the paperwork seen. There were no references or contracts in place and one person had commenced work before a request for a reference had been sent. On one file there was no application form or evidence of induction training. A check had been undertaken with the Criminal Records Bureau and the Protection of Vulnerable Adults register. Poor vetting procedures can lead to unsuitable people being employed to look after vulnerable persons. Repeated requests were made during the inspection for evidence of the pre-employment documentation which was unable to be provided. Care Homes for Older People Page 26 of 37 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. There is a need to recruit a manager who registers with the Care Quality Commission. The manager needs to provide direction and leadership to staff and ensure the services and environment meet the needs of the people accommodated in the home. Evidence: There has been no manager since January 2009 and no registered manager since the ownership of the home was taken over by Hexagon in 2007. Oversight is being provided by three persons, the registered manager of another home owned by Hexagon, one of the directors of the company and the responsible individual for the company who is registered with the commission. It is clear from the findings of this inspection that the current arrangements are ineffective in ensuring positive day to day management of the home. The comments received indicate that the lack of management is having a negative effect on the overall service. Generally the care provided by staff is good but, some necessary management tasks for example reviewing the high number of unexplained
Care Homes for Older People Page 27 of 37 Evidence: bruises, is not taking place and this could have implications for the health and welfare of the people accommodated in the home. The first priority of the manager currently assisting is another home owned by Hexagon. Several meetings have taken place with the directors who have been advertising for a manager but have so far been unsuccessful. A recent interview for a manager has taken place but up to the time of writing this report there has been no confirmation that a manager has been appointed. It has been made clear to the directors that the lack of a manager is now a very serious concern. There has been no one to one staff supervision although the manager from the other home carried out appraisals in 2009. Staff meetings have taken place but minutes were not taken. Staff comments indicate they have low morale and no confidence in the current management arrangements. Get an efficient manager. Support the staff. Provide adequate equipment/supplies to care for the residents. Support staff training. Listen to the staff/follow through on their promises and follow through on safety eg portable appliance testing, replacing dangerous equipment. Provide hoist/lifting training. Provide entertainment/activities for residents. Show interest for the residents welfare and needs. The staff have to argue over equipment, money for residents (even the residents own money for hairdressing etc). Staff are very demoralised as wages are usually wrong and we have to argue and demand our rights constantly. Get a manager, sort the building, help when its needed, owners to help plus listen. I feel without our care supervisor nothing would be properly in place as she does almost everything. We want more training but when training is set up, due to staffing levels it usually has to be cancelled and is blamed on us which isnt the case. I feel let down by the directors. Family of residents thank us on numerous occasions for the care of their relatives which we do to the best of our ability. Get a manager. More support from acting manager and managing directors (MDs). Not seen the acting manager for about four weeks since the last staff meeting. When we ring the MDs their phones are always switched off and it takes three hours for them to get back to us. Care Homes for Older People Page 28 of 37 Evidence: A Social Worker also made comments about the management of the home: Management appears poor. No consistency re manager, I believe there is a temporary manager there who is also managing another home. It is difficult for me to know who to contact to ensure suggestions, recommendations get carried out. Company directors have poor awareness of for example, where a service users money was going. Difficult to contact manager/directors to discuss matters. There was a lack of evidence that equipment such as the weigh scales and bath hoists have been serviced recently and this could have serious implications for the health and safety of the people accommodated in the home. There was a lack of evidence that correct pre-employment security checks were being undertaken; this is necessary to ensure the integrity and character of the staff employed are suitable for the care of vulnerable people. Complaints had not been recorded or investigated appropriately and there was no system in place for measuring quality to help ensure the people accommodated are receiving positive outcomes of care. There was no evidence of any formal reports under regulation 26 of the Care Homes Regulations, according to one of the directors they are kept at another of their homes which, is inappropriate. Regulation 26 requires that a report is completed by the owners of the home once a month about the conduct and performance of the home. There are serious issues about the health and safety of the people cared for in the home and staff because of the poor state of the building and environment and the lack of action to repair and make improvements. Evidence was provided that a professional person had investigated the structure of the building and roof and there are serious concerns over its safety. The issue of the problems with the roof and exterior wall has been ongoing for some months. The Directors were unable to give an indication of when work would start to address the problems. The majority of persons accommodated are not capable of managing their finances. Any issues around finances were not looked at during this inspection. At the last key inspection inspection in June 2009, the acting manager confirmed that personal allowances belonging to the persons cared for are placed in separate envelopes and receipts are kept but they were not available at the last key inspection. A Social Worker also made the following comments when asked how the home could Care Homes for Older People Page 29 of 37 Evidence: do better: Difficult to contact manager/directors to discuss matters. Building is in a poor state, has a run down feel and it affects peoples perceptions and morale when they go in. Poor level of activities for service users; they all appear to be in the downstairs lounge with little/no opportunity to go out. The current environment issues and management arrangements have a detrimental effect on the overall service provided by the home. Care Homes for Older People Page 30 of 37 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 19 23 Repairs must be made to the 21/08/2009 roof where leakage is occurring. To ensure the health and safety of the persons cared for as well as staff. 2 19 23 The outside area must be made safe to allow safe exit by the persons cared for as well as staff. To ensure the health and safety of the persons cared for as well as staff. 21/08/2009 3 29 19 Evidence must be provided 10/07/2009 of security checks and appropriate references have been obtained prior to commencement at the home. In order to protect vulnerable persons cared for in the home. 4 31 9 A manager must be appointed who applies for registration with the commission once they commence duties. To ensure effective management of the home and that it meets regulatory standards of care. 23/10/2009 Care Homes for Older People Page 31 of 37 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 Statement of Purpose and Service Users Guide require a review and updating with correct information. In order that accurate information is available about the services and facilities provided. 31/03/2010 2 7 15 The accident records should be examined for any emerging patterns that have occurred around the circumstances recorded. In order to establish whether any changes are required in the way the care is being delivered in order to protect the health and welfare of the person concerned. 31/03/2010 Care Homes for Older People Page 32 of 37 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 3 9 13 The wooden cupboard used 25/06/2010 for the storage of medicines, must be changed to a metal cupboard with a secure locking facility. In order to ensure the safekeeping of medicines stored within the home. 4 16 22 The complaints record should include all concerns raised and include who has conducted an investigation and the final outcome. In order to ensure that all concerns are investigated thoroughly and who is accountable. To ensure the health and welfare of the people accommodated. 31/03/2010 5 19 23 Advice must be obtained from the Fire Service about any risks associated with propping open any of the fire doors. In order to ensure the health and welfare of the people accommodated. 31/03/2010 6 19 23 As at previous inspections, the bedrooms belonging to the persons with dementia require decoration and refurbishment. 30/09/2010 Care Homes for Older People Page 33 of 37 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 a welcoming environment. 7 19 13 A check by a qualified person should be undertaken to ensure the electrical systems within the home are safe in light of the evident water penetration. To ensure the health and safety of the people accommodated in the home and staff. 8 22 23 Evidence must be provided 31/03/2010 that equipment such as bath hoists and weigh scales have been serviced regularly and are suitable for use. In order to ensure the health and safety of the persons accommodated and staff. 9 22 13 The bed rails and need for bumpers must be assessed to ensure they are in place appropriately. In order to ensure the safety and well being of the individual concerned. 10 29 19 Pre-employment checks 31/03/2010 including references must be obtained prior to staff commencing duties. 31/03/2010 31/03/2010 Care Homes for Older People Page 34 of 37 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 In order to ensure the protection and safety of the people cared for in the home. 11 30 18 Any staff who prepares food must obtain a Food Hygiene Certificate. To ensure the health and welfare of the people cared for in the home. 12 33 26 Evidence must be provided of written reports undertaken by the registered provider about the conduct of the home as detailed under regulation 26 of the Care Homes Regulations. To ensure the services and facilities provided meet expected standards of care. 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 30/06/2010 31/03/2010 1 7 The care records would benefit from being re-organised in order that the latest information is readily available and provides and up to date overview of the individual concerned. There should be more opportunities for activities outings and stimulation according to the choices, wishes and capabilities of the people cared for in the home. 2 12 Care Homes for Older People Page 35 of 37 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 3 15 A choice of meal should be made available and the menu details clearly on display for the benefit of the all the persons cared for in the home. The complaints policy and procedure should be reviewed to ensure that the contact details for the Care Quality Commission are for advice over any concern. Staff must be made aware of the homes reporting procedures in the event of any allegation of abuse. In order to ensure that staff understand who they they should report any concerns to and the process that would follow. Any toiletries such as shampoo or shower gels should be risk assessed with regard to where they are stored to ensure they could not be accidently ingested by the people accommodated in the home. A lockable facility should be provided for the secure keeping of any medication or valuables. A review of staffing levels should take place in order to ensure that staffing levels are appropriate within the main lounge area at all times and the person accommodated on the top floor would be cared for appropriately should they require additional care. All Staff should receive regular one to one formal supervision at least six times a year to ensure they are supported and competent. 4 16 5 18 6 19 7 8 24 27 9 36 Care Homes for Older People Page 36 of 37 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 37 of 37 - 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!
