Inspection on 22/02/10 for Ashdown Nursing Home

This inspection was carried out on 22nd February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdown Nursing Home 22/04/10

Ashdown Nursing Home 02/07/09

Ashdown Nursing Home 09/07/08

Ashdown Nursing Home 15/08/07

Ashdown Nursing Home 20/11/06

Ashdown Nursing Home 13/04/06

Ashdown Nursing Home 13/09/05

Ashdown Nursing Home 24/05/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Ashdown Nursing Home 2 Shakespeare Road Worthing West Sussex BN11 4AN     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: Annie Taggart     Date: 2 2 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 33 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 33 Information about the care home Name of care home: Address: Ashdown Nursing Home 2 Shakespeare Road Worthing West Sussex BN11 4AN 01903211846 01903208680 mgnewcare@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Newcare Homes Ltd Name of registered manager (if applicable) Mrs Susan Georgina Green Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Ashdown Nursing Home is situated in a residential area of Worthing in West Sussex. The registered providers are Newcare Homes Ltd who purchased the home in 2004. The registered manager is Mrs Susan Green Ashdown Nursing Home is registered for 40 residents over the age of 65 years who have dementia. The communal areas consist of a lounge and a lounge/dining room on the ground floor and a second lounge Care Homes for Older People Page 4 of 33 Over 65 0 0 40 40 0 2 0 7 2 0 0 9 Brief description of the care home on the first floor. There are other small sitting areas in the entrance hall and upper and lower corridors, which lead to bedrooms. A passenger lift is available for rooms on the upper floor. There is a garden to the rear of the property, which is not currently available for use by residents. The current scale of fees being charged at the home is from 600 to 700 pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: In order to plan for this inspection we looked at the last inspection report and any information that we have received about the home including recent information gained from safeguarding investigations being undertaken by the West Sussex Safeguarding team. The unannounced visit was carried out by two inspectors at 9am on Monday 22nd February 2010 and the visit lasted for six and a half hours. During that time we spent time with service users in communal areas and in their private bedrooms we observed the staff caring for people. We spoke with six members of care staff and four ancillary staff and we observed lunch, the main meal of the day being prepared and served. Care Homes for Older People Page 6 of 33 Six service user care plans and supporting documentation were tracked and we looked at evidence of how risks are assessed and managed and how peoples health care needs were being addressed. We looked at records including complaints and concerns, staff training and supervision, evidence of providers visits and how the home carries out quality assurance processes. Concerns about the way the home is being run were given to the manager Mrs Green during feedback and an immediate requirement was made regarding the length of time people were going without nutrition at night. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available about the services on offer and people have their needs and wishes recorded before coming to live in the home. Evidence: There is information available about the services on offer in the home and two family members confirmed that they were given a Statement of Purpose and Service User Guide and had been able to visit the home prior to their relative moving there. From looking at records we saw that people have their individual needs and wishes assessed and recorded and families are involved in the process. From tracking six assessments and care plans we saw that although people have their needs identified and recorded, they are not all being met and evidence of this is recorded in other parts of this report. The home does not provide intermediate care. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are potential risks to service users by care plans not being kept up to date to identify the current care needs of the people being cared for in the home. Evidence: For each person living in the home there is a plan of care in place to guide the staff team to the needs and wishes of the people they are supporting. The care plans contained risk assessments and a Deprivation of Liberty form but the information contained on the forms was basic and we saw no evidence to show that referrals had been made to the Deprivation Of Liberties (DOLs) team. We tracked the care plans for six people and found that although the plans were in place and had been regularly reviewed by the manager they did not reflect the current needs for a number of people. At the last inspection visit the manager told us that life histories were to be added to plans and that they would be more person centred, at this visit we saw that the life histories were still not in place for eighteen of the people living in the home. Care Homes for Older People Page 12 of 33 Evidence: At 9am there were fifteen people up and sitting in the lounge, most of them asleep, some people were also up and sitting in other parts of the home such as corridors. We asked the staff on duty what time people were assisted to get up and were told that as soon as people awoke they were assisted, this was sometimes 5.30am or 6.30am . We checked the care plans and for most people there was not a preference form in place for the time they wished to go to bed and get up. We asked the manager about this and she confirmed that there were few night time care plans in place for people but that this was being addressed. From tracking care plans we saw that there were inconsistencies in the information that was provided, leading to peoples individual needs not being met. Examples of these included, for one person a pressure mattress was fixed at the maximum setting, we tracked the persons weight chart and found that they were not of a heavy weight. We asked the manager why the bed was set so high as there was no record of this in the care plan and were told that the person had suffered from a small pressure area that was now healed. We asked why the bed was still being used as this was a risk to causing pressure sores and the manager could not explain this. In the daily treatment plan summary kept in the home we saw that for one person it stated that dressings should be completed daily due to non compliance with dressings, the form had not been signed for the 1st, 2nd, 4th, 7th and 9th February, this was also the case with three other records where the frequency of dressings completed did not match the dates signed or the signing had been missed. One service user had a large raised bruised area on their leg and also extensive scratching and bruising to both legs. The person was sitting on the upstairs landing and had been suffering from a diarrhea and vomiting bug that was in the home. The care plan had a body chart completed on admission and this showed a bruise to the leg but there were no recent body charts to reflect the changes in condition. We spoke to a member of staff about the care of the service user and were told that the person was very restless and sometimes caught their legs through the bed rails at night, they also scratched themselves. We asked why the person was sitting on the landing and were told by the staff member that the persons behaviour upset other people so they are isolated. The persons care plan said, to nurse in quieter areas but with close regular supervision where applicable The care plan for this person was also inconsistent in that it said that the persons legs should be dressed but did not say how often and by checking regularly during the course of the visit we saw that the person received very little attention from staff. We spoke to the manager and asked if there was an updated care Care Homes for Older People Page 13 of 33 Evidence: plan in place for the current care of this person and she said that the person was receiving antibiotics but there was not an updated care plan completed. The manager denied that the person was isolated saying that they preferred to sit on the landing but there was no evidence to support this in the records. The manager also denied that the person caught their legs in the bed rails and said that they had scratched the injuries themselves. Although the care plan stated that the persons legs should be dressed, they were not covered. We discussed with Mrs Green the infection control risk because of the stomach bug in the home and she agreed that this was not good practice. There are policies and procedures in place for the administration of medication and this is carried out by the trained nurses on the staff team. When tracking the medication system we saw that where there was covert medication used for one person and an agreement was in place and had been signed by five people including a doctor and the persons representative. The registered manager told us that covert medication was not in place for any other service users. Medication Recording Sheets (MAR) were current with no gaps in signing Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provides in the home do not meet the individual needs of service users and there are risks to people by good nutritional guidelines not being adhered to and recorded. Evidence: The home employs an activities co coordinator and there is a published programme of activities in place that included arts and crafts , reading to people, group sessions and some one to one time. We spoke with the activities coordinator who was able to show us records kept of daily engagement with people and how they had interacted. For some people this was working well but as there are many people with poor communication and mobility and apart from the time spent with them by the activities person, they spend much of the time being unoccupied. During the morning of the visit no activity was being provided and most people were asleep in their chairs until lunchtime. We asked the coordinator why there were no morning activities and she replied, we are struggling today. A craft session was held after lunch and one person was preparing to celebrate their birthday. In care plans it was recorded that a number of people needed one to one support, for example for one person it said, to engage in activities she prefers one to one Care Homes for Older People Page 15 of 33 Evidence: attention, aromatherapy and looking at pictures to minimise aggression by constant re-assurance and support. For most of the day this person was on their own in an upstairs corridor and we observed another person was constantly walking up and down a set of stairs for most of the day. Other people were wandering or asleep in chairs. One person does not come out of their room very much and said it was because she did not like the other people. The activities person said that there was no budget in the home to provide for day care and a family member said that they had brought in craft equipment and games and they were also paying for an entertainer for their relatives birthday. We discussed with the manager why there was no budget for day care and she said that there was no identified budget but that people only had to ask and equipment etc would be provided. Mrs Green said that occasional entertainment is provided and if the daycare person and families wished to bring in paper and games to the home this was their choice. From looking at menus we saw that a variety of food is provided but that this does not always meet peoples individual choice and needs. Most people had porridge and toast for breakfast and a drink was provided mid morning. We observed that many of the drinks were taken away untouched. The activities coordinator went round to people to ask them what they would like for lunch but as there were no prompts such as pictorial menus or pictures, it was difficult to ascertain peoples real choice. One inspector observed lunch, the main meal of the day being served. As there is not enough seating for everyone at the tables, a number of people were assisted by feeding in chairs in the lounge or in other areas of the home, including corridors. Lunch was minted lamb pie with mashed potatoes and peas. The meat was tough and a family member feeding their relative said that he was having difficulty with eating it. Staff were engaged in supporting people but a number of people had to wait. Most staff spoke to service users and were patient with them. One member of staff was supporting a person who had a meal that had been pureed, they mixed the meal altogether, did not tell the person what they were eating and only spoke to the service user to ask them to open their mouth. The person was also not offered a drink any time during the meal. We fed this back to the manager after the meal and she said that she would address this. One person had salad with a fried egg on top and we were told that they chose this Care Homes for Older People Page 16 of 33 Evidence: most days, the person slept throughout the meal, eating nothing and the meal was then removed from the table without an alternative being provided. Another person also ate none of their meal and the manager asked a staff member to remove the person from the table because, they were getting distressed We asked the manager when these people would eat and she said that they would be offered meals again later. We tracked the records for detailing the nutrition people were offered and found that these were basic and did not give accurate information. Examples of this are that in the records of weights for people one person had gone from 59.1kg to 51kg in one month. The care plans recorded, she had adequate nutritional intake. Ensure adequate diet and fluid intake, give supplements to ensure extra nutrition. The records then said ate and drank well. There was no assessment of how often the supplements should be supplied and we saw that only six had been recored for the month of February. The records are a numbered system, the highest being 4 (all meal eaten) this was ticked most days for people with no further information provided. When checking the home, we noted that some people were still having breakfast at 10am in the morning, the staff said this was because it was their choice or they had been having a bath. We saw that the last meal of the day was at 5pm and this meant that some people had not eaten for seventeen hours. We spoke to the manager about this and she said that people could have something after 5pm if they asked. We discussed that as people have dementia this was not likely to happen and the manager agreed. An Immediate Requirement was made for the home to review the way peoples nutrition is provided and to ensure that there is no longer than twelve hours between supper and breakfast. Comments seen in staff meeting minutes for 27/01/2010 said, fresh fruit and vegetables would be appreciated on a twice weekly basis. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are risks to the safety of service users by the staff team not having the training and understanding they require in order to care for people with dementia and by the homes policies, procedures and working practices not following current guidelines for dementia care. Evidence: The home has a complaints policy and complaints are recorded. The manager told us that there had been no recent complaints made about the home. We looked at evidence that the staff team receive training in the protection of vulnerable adults from abuse and harm and saw that eight people had not attended training. The manager told us that six people had attended in February 2010 but that certificates were not yet back. When talking to the staff on duty, we were told that people would report any suspected abuse but one person did not show an awareness of the procedures to follow. During the visit we saw evidence of poor practice such as described when people are being fed and also by people not having their basic needs met but the staff did not seem to understand that this constituted neglect. Care Homes for Older People Page 18 of 33 Evidence: We discussed this with the manager who told us that all staff have an awareness of safeguarding issues and that the only concerns she had were that some staff had poor manual handling practice. Records show that there are a number of people in the home who at times become distressed and anxious, which can lead to them displaying aggressive behaviour. There are no detailed plans in place for how this is managed other than to say that people need one to one support, for one person their care plan stated, supervise at all times. We discussed with the manager how this would happen given the number of staff and service users and she agreed that more detailed plans needed to be in place. When asked if the staff team had received training on dealing with challenging behaviour, the manager said, not as such. Records showed that of thirty seven staff, fifteen have not received training in dementia awareness. There have been a number of incidents and concerns reported regarding the home and these are being investigated under West Sussex County Council Safeguarding procedures, this had resulted in new admissions to the home being suspended while the investigations are being held. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not clean or well maintained and the manager and staff do not display a working knowledge of current infection control guidance and practice. Evidence: The home is a large detached building over three floors and there is a passenger lift that was in working order. During the visit we spoke with service users in their bedrooms and in communal areas and as a result we observed that there were concerns about the cleanliness of the home and the safety of service users. There was a stomach bug in the home, the first cases identified in the diary as being on Thursday 18th February and by the date of the visit, eight people had contracted the illness. The manager said that the outbreak had not yet been reported to the Commission or other relevant agencies as she had been off duty. Examples of issues that were of concern identified at the visit included, In one bedroom there was a very strong smell of urine and a large amount of vomit on the floor near the foot of the bed, the bed had been made. We brought this to the attention of the cleaner and asked whos responsibility it was to clean it and we were told that the care staff should clean it up and then the cleaners would shampoo the carpet. We spoke to Mrs Green about this and were told that they were aware of the smell in the room and perhaps needed to change the carpet. In four bedrooms we Care Homes for Older People Page 20 of 33 Evidence: found stained bedding in beds that had been made, there was dried faeces on the radiator cover in the upstairs bathroom and on the floor near the door on the downstairs bathroom. Bedding was of a poor quality, very thin and looked old and hoists were dirty and in need of cleaning. Two reclining chairs in the upstairs lounge had rips in them and we saw that in one bedroom there was a threadbare rubber incontinence cover on the bed and in another room an incontinence sheet had been left on the floor. We observed a red soiled linen bag tied to the handle of a trolley containing clean towels and pads in the downstairs corridor and upstairs we saw that an open plastic bag containing used pads hanging from the clean linen trolley. We spoke to the manager about our concerns and asked if she was aware of the Infection Control Guidance for Care Homes that the Department of Health had produced. Mrs Green said that she had not seen it and they did not have a copy. We later saw a copy of the guidance in the office and brought it to the attention of Mrs Green. There were steep sets of stairs on the landing with no restrictors or safety gates and the door did not shut properly. We observed service users open the door and stand at the top of the stairs. We checked with the manager and asked why the stair gates that had been in place at the last visit had been removed and were told it was because people might climb over them. There were no risk assessments in place for the stairs and the door was not closing properly. We identified the risk to the maintenance person who had repaired the door by 1pm. Requirements have been made for the management of infection and for the use of the stairs to be risk assessed. There is a maintenance person in place who told us that they worked thirty hours a week but in this time they also had to maintain the gardens and also the house and garden of the staff accommodation next door. An annual assessment returned to the Commission by the manager for the last inspection told us that a maintenance person worked in the home thirty hours a week. We spoke to the manager about concerns regarding infection control and and Mrs Green told us that an infection control champion had been identified on the staff team. From looking at records we saw that there was a named person but that an audit had not been carried out since July 2009. When checking cleaning schedules we saw that the one for the kitchen had not been signed for the 16th 17th 18th and 21st February 2010 and there were no blue aprons located outside the kitchen door. When checking with training records we saw that nineteen staff did not have current infection control training in place. Care Homes for Older People Page 21 of 33 Evidence: A conservatory to the building that was built without the correct building consent being gained is due to be demolished, Mrs Green did not know when this would be. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Their are risks to service users by the staff team not having the skills and training they need to care for the needs of people with dementia. Staff are also not supervised or organised in a way that provides effective and consistent care. Evidence: On the day of the visit, there were two trained nurses, five care staff, and five ancillary staff on duty and the manager was extra to the staffing rota. From looking at the staffing rota we saw that there are two nurses on duty on the morning shift, one in the afternoon and one at night. The manager told us that there are only three nurses employed by the home at the present time, two of them covering both day and night shifts, meaning they are working long hours. Mrs Green said that they are in the process on employing more nurses. Most of the staff team are overseas staff who stay in the home for a maximum of twenty two months and then are changed for new staff and we discussed with he manager how this did not provide continuity of care for people with dementia. During the visit we spoke with six of the care staff on duty and also to the cleaners, maintenance person and ancillary staff. Some of the overseas staff spoke English well but we found that some had difficulty in explaining themselves and in communicating Care Homes for Older People Page 23 of 33 Evidence: with service users. We saw the records for two recently recruited people and found that all of the relevant documentation including a current Criminal Bureau Check (CRB) and evidence of an induction was in place. The seemed to be little organisation about the way staff were carrying out their duties in the home and on two occasions we heard staff arguing in corridors about the tasks to be carried out. On one occasion we heard them arguing in a different language. We also observed two staff upstairs lifting a service user under their arms. During the day we also saw staff walking past people who were wandering up and down stairs and around the building without interacting with them or trying to engage them in more meaningful activities or conversation. From looking at training records we saw that for a number of staff, mandatory training was out of date and all staff did not have training in caring for people with dementia. Of thirty seven staff identified on a training matrix, seventeen did not have current manual handling training, nineteen had not had recent infection control, fifteen did not have dementia awareness, twenty two did not have current heath and safety and five people did not have food handling. There was no evidence that staff had received training in dealing with challenging behaviour and we were told that the home was waiting for the certificates for six people who needed safeguarding training. We discussed the failure to provide adequate training for staff with the manager Mrs Green and she told us that she was aware that the training was poor but that she had only just taken over managing it. Records showed us that staff supervision was out of date, of eight records that we checked, all were out of date some being last recorded as 22/01/2009, 3/6/2009 and 27/4/2009. Mrs Green agreed that supervisions were out of date and said that because of the safeguarding concerns in the home she had recently begun to meet with all of the staff but did not have any records of this as evidence as they were on her computer. We asked if the weekly staff presentations in place at the last visit that discussed service users case histories were in still place and we were told they were not. Two visitors in the home at the time of the visit said that most of the staff were kind and caring and one person said that it would be better for service users if the staff team could communicate with them better. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are risks to service users by health and safety issues not being addressed and by the staff team not having the effective management, leadership, supervision and guidance they require to provide effective care for people. Evidence: The manager was in the home during the visit and in discussion with the inspectors stated that she was very stressed and she was quite visibly distressed. From looking at records we saw that Regulation 26 registered providers visits are not being carried out in order to monitor the service, the last recorded were 30/06/2009 and 10/12/2009 . There has been no quality assurance process carried out in order to elicit the views of service users, families and other people involved with the home since the last key inspection visit. Care Homes for Older People Page 25 of 33 Evidence: We spoke to a staff member about the management and running of the home and asked if this was effective, the reply was no comment. We also spoke to a family member who said that they regularly visit the home but did not really know the manager as they did not see her around. We spoke to Mrs Green about there being an impression that there was a lack of guidance and management of the home and Mrs Green could not explain why this was. Mrs Green agreed that standards had dropped since the last visit but said that, she tried her best but couldnt do everything. We checked the system for recording service users monies, three records were seen and all were correct against the monies held, some service users belongings were also held for safe keeping and this was recorded. During the visit one of the inspectors observed a service user falling in the lounge and injuring themselves, although there was a nurse and the deputy around there was a general panic about what to do, the deputy manager called a nurse away from her break who then took charge in dealing with the situation. Although there was a sickness bug in the home we saw people being cared for in chairs in open corridors with other people passing, when we spoke to the manager about this, she said that people have dementia and wandered. We observed that two of these people were not mobile and the manager agreed that they were not. As recorded in other parts of this report there are risks to service users by health and safety issues not being addressed and managed and this includes care plans, infection control, staff training and supervision, the cleanliness of the home and quality of furnishings and bedding, unguarded stairs with no risk assessment in place and poor manual handling practice by staff. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 15 16 16.2 (1) The home must provide nutritious food at regular intervals of no more that 12 hours between supper and breakfast This is because at the visit we found that some people were not having nutrition for 17 hours between the evening meal and breakfast. 11/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15.1 and 2.The registered manager must ensure that there are clear and current care plans in place that are regularly updated This is to ensure that people are receiving the care and support they need at all times. 17/04/2010 2 8 12 12. 1 and 3. The registered 17/04/2010 manager must ensure that the use of pressure relieving equipment is clearly documented and regularly reviewed Care Homes for Older People Page 28 of 33 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 This is to ensure that people are not put at risk by incorrect pressure care being provided. 3 12 16 16.2 (m) The registered manager must ensure that the programme of activities on offer meets the needs of people with dementia This is because although there is a programme of activities in place it does not meet the needs of all of the people in the home. 4 15 16 16.2 (i) The registered manager must ensure that advice is gained from a nutritional expert. This is to ensure that the home provides good quality nutrition that is suitable for all service users. 5 18 13 13.6 The registered manager must ensure that the staff team have a working knowledge of how to protect people from risk of abuse or harm. This is to ensure that there is an awareness of all forms of abuse and how to identify and report them. 17/04/2010 17/04/2010 17/04/2010 Care Homes for Older People Page 29 of 33 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 6 24 13 13.4 (a) to (c)The registered 17/04/2010 manager must ensure that all furniture is safe for use and that people have clean and good quality bedding. This is because there were ripped armchairs and dirty bedding that was in a poor and threadbare condition in use in the home. 7 26 13 13. (3) The registered manager must ensure that infection control best practice is followed and that the staff team all receive training. This is because a number of infection control issues were identified during the visit, putting service users at risk. 17/04/2010 8 30 18 18. 1 (a) to (c)The 17/04/2010 registered manager must ensure that training for staff is provided and is kept up to date This is to ensure that people are being supported by a well trained and competent staff team 9 31 26 26. 1 Regulation 26 providers visits must be undertaken and recorded. 17/04/2010 Care Homes for Older People Page 30 of 33 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 This is to ensure that there is a system for monitoring the management and day to day running of the home 10 33 24 24. 1 to 3 There must be a quality assurance system carried out on a regular basis at least annually. This is to ensure that the views of service users, families and other people involved with the home are heard. 11 36 18 18. 1 and 2 The registered 17/04/2010 manager must ensure that the staff team receive supervision and appraisal on a regular basis. This is to ensure that the staff team are supported and their practice monitored 12 38 23 23. 1 and 2 The registered manager must ensure that all health and safety issues are addressed and that includes risk assessments for unguarded stairs and safety of the environment This is to ensure that service users are kept safe and that there are processes in place to monitor their care and safety at all times. 17/04/2010 17/04/2010 Care Homes for Older People Page 31 of 33 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 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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