Key inspection report
Care homes for older people
Name: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP 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: Gail Richardson
Date: 2 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home
Name of care home: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sheval Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection Brief description of the care home Asheborough House (previously called Beech House) is a detached property set in its own grounds with a lawned area to the side and rear. Car parking is available in the Care Homes for Older People
Page 4 of 36 Over 65 0 0 31 31 31 0 0 4 1 2 2 0 0 9 Brief description of the care home grounds of the home. Saltash is approximately five minutes away by car and has all the usual facilities of a small town. Accommodation and care to include nursing is offered at the home in the category of dementia or mental disorder. The home is entered via secured garden gates into an entrance with communal areas off to include a lounge and a dining room. A shaft lift is available to all the bedrooms in the home on the first and second floor. The laundry and kitchen are on the lower ground floor area of the home. Fees range from £550.00 to £700.00 per week (Fees correct as to the time of this report ). An additional charge is made for dry cleaning, visits from a hairdresser and chiropody. The Statement of Purpose and Service User Guide (available in an easy read format) are available on request. Care Homes for Older People Page 5 of 36 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over two days on the 17th and 21st May 20101 by Compliance Inspector Gail Richardson. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 25th August 2009. We have visited the home on three occasions to undertake random inspections, 04/12/2010, 05/02/2010 and 23/03/2010. These visits were to review how the home had managed the Statutory Requirements made at the key inspection. We also received two letters from the then current manager, these explained how requirements were being met We met with the provider on two occasions to discuss how the management of the home was sustaining changes and improvements to the service. Care Homes for Older People Page 6 of 36 A tour of the home took place and some of the bedrooms and all communal areas were seen. There were 30 people currently residing at the home Most of the people using the service who we spoke with were unable to provide an opinion about the home and the care provided. We spoke with ten members of staff and the responsible individual was available throughout the inspection. We looked at records relating to care including four care plans, four staff files, finances and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Information supplied by the home needs to be reviewed to ensure that it is correct and ensures that prospective people can make an informed decision about the facilities available at the home. People admitted to the home must first received a pre admission assessment to ensure that the home can meet their needs. This information should then be made available to staff. The home needs to develop a plan of care and include any assessments of risks and a plan of care to meet those risks safely. This plan of care should be produced within a reasonable timescale to ensure that staff are aware of how to meet the persons needs in a person centered way. Medication systems need to be reviewed to ensure that they are safe and in line with the Royal Pharmaceutical Guidelines. Staff need to be aware of peoples choice and preferences and each persons care plan needs to reflect this. This includes their preferred term of address and how they choose to spend their day. Activities at the home need to be developed to meet peoples social and recreational preferences. The activities undertaken need to be recorded and used to develop person centered activity provision. The management of complaints needs to be developed to ensure that all concerns and complaints raised are handled in line with the homes complaints policy. The records of any investigations need to be maintained as proof of actions taken. The management of the home must ensure that peoples needs can be met by the Care Homes for Older People
Page 8 of 36 service with any specialist care and equipment needed. This includes appropriate bathing facilities and hoists to enable all people using the service the facility to bathe. The bathrooms and toilets of the home need to be developed to ensure that they are specific for use and are in good repair so as no to pose a risk of cross infection. The home needs to ensure that hot water outlets in the bathrooms are monitored to ensure that they are safe and do not pose a risk of burns and scalds. Staffing levels need to be measured to ensure that they meet the dependency of people using the service. That way the management of the home can be confident that there are sufficient staff available to meet peoples needs. The recruitment of staff needs to be robust and all checks must be in place before people start work at the home. This is needed to make sure that people are safe from harm. All new staff need to complete an induction in an appropriate timescale to ensure that they have sufficient skills to meet the needs of people using the service. The management of the home need to ensure that staff have sufficient skills both individually and collectively to meet the specialist needs they offer to provide. This means that all staff must have dementia care training. Further training in all mandatory areas is needed to ensure that staff have the skills to meet peoples needs and ensure that the people in their care are safe. These areas include moving and handling, fire training, protection of vulnerable adults and infection control. The management of the home needs to be developed to ensure that the home is run in the best interest of people using the service. The management of the home need to review the quality of care provided and ensure that an appropriate standard is met and maintained. The registered person must ensure that all areas of health and safety management are reviewed and met so that people can be confident that they are being cared for safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their families are provided with a brochure which is incorrect and details facilities which are not currently available at the home.This does not enable people to make an informed decision about the service provided. A detailed pre-admission assessment is not always made prior to admission, to ensure that identified needs are able to be met. Not all staff have received training in dementia care. Further dementia care training is needed to support the specialist needs of people using the service. Evidence: The Homes Statement of Purpose and Service User Guide outline the care services available. They are available in large print and picture format for people who may have communication difficulties. These documents also include the homes complaints
Care Homes for Older People Page 11 of 36 Evidence: procedure, a range of fees charged and a sample of the homes contract. The home has produced a brochure which advertises services which are not available for use. These services include, safe and secure gardens, a newly developed sensory room and a working hydrotherapy bath. This means that people may not receive access to the facilities they were expecting. We looked at the pre admission assessment for the most recently admitted person to the home. No pre admission documents were available. Staff told us that they had not seen any pre admission assessments for this person and that they had only become aware of the prospective admission on the same day as admission took place. This lack of information may mean that the home and staff do not have the skills and facilities available for the prospective person. This person had not been provided with a care plan or risk assessments for staff and so there was very limited documentation available for staff to follow. The home provides staff with both Registered General Nurse Training and Registered Mental Nurse training. However not all care staff have received dementia care training. The homes brochure tells us that All our staff are coached and trained to make sure they have the right skills to give the best care. The staff training matrix tells us that nine out of 22 staff have undertaken dementia care training. The responsible individual told us that dementia care is undertaken as part of the induction for new staff. We looked at two new staff files and no such training had been undertaken. Care Homes for Older People Page 12 of 36 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further review of care plans are required to ensure that any changes to a person condition are reflected in the plan of care. Peoples care needs are mostly met with dignity and respect . The management of medication requires review to ensure safety in all areas. Evidence: We looked in detail at four care plans of people living at the home who had dementia care needs and physical care needs. The homes brochure states We provide risk assessments and comprehensive management strategies to work in conjunction with care plans. The risk assessments and care plans seen, were not sufficient to ensure that the safety and well being of the people involved . In one instance the care plan for a person with no capacity to accept instruction and mobility issues had not been updated to reflect a deterioration in condition. As a result, inexperienced staff used the care plan for reference and the moving and handling techniques contributed to the person having to be lowered to the floor to avoid an accident. Another care plan had not been updated to reflect care
Care Homes for Older People Page 13 of 36 Evidence: being provided for an acquired infection. This may pose a risk to other people using the service and staff. One person was seen to be cared for in their room. This person required pressure area and continence care. There were not monitoring records to identify when care was given and what regularity of care was needed. The person did not have the capacity to call staff. No call bell or appropriate arrangements were in place to summon or monitor staff contact. The person did not have access to a drink and there was no evidence of when the person last had a drink. This area of care provision has been identified on two occasions at this home. A further care plan identified that a person with challenging behavior did not have risk assessments and appropriate plans in place to ensure the safety of other people using the service and staff. It was evident from observation of staff that they were aware of the peoples needs, however the documentation did not accurately reflect the current status of the peoples wellbeing and this may put both people using the service and staff at risk. There were no updated reviews of those peoples care and the documented visits of health professionals were not all accurate. The daily records for peoples care appeared to be written by the evening and night staff and did not identify care provided during the day. The homes brochure says We provide advanced care planning and We provide individualized person centered care plans. The shortfall areas identified all present a risk to the person and others at the home. Risk assessments and care plans must be current and reflective of the care needed to ensure that peoples needs are met safely. Staff were noted to be respectful towards people using the service and were observed treating people with dignity and kindness. However, it is concerning that a staff member refereed to people who required assistance with eating and drinking with pureed diets as softs and feeds. This does not promote peoples dignity and respect. It was noted that the management of the home advertises the facility of a hydrotherapy bath. Staff told us that this bath was not available for use and had never been used todate. They told us that no baths were available to people using the service who needed a hoist to access the bath. They told us that the practice of the home was that, any person who needed a hoist to access the bath, could not have a bath and would have a bed bath instead. The responsible individual for the service was not aware of this or of how long this situation had been ongoing. There was no lockable storage evident in the home for people to store personal items. Care Homes for Older People Page 14 of 36 Evidence: This is recommended to ensure that peoples personal items can be appropriately stored. We were told by staff that they felt that they knew people at the home well and that the standard of care was good. We were unable to access this information from people using the service. We observed that people had locks on their door for privacy but these were also a mechanism to be accessed by staff in an emergency. Staff were observed to knock on doors before entering. Shared rooms have a curtain for privacy. We looked at the care plans for people who share a room and could not identify any rationale or plans in place to ensure that this was or would have been that persons choice or preference. There are both male and female staff available at the home should people have any preference of gender to care for them, their choices would be recorded within their care plan. Medication systems were examined. Nobody at the home currently self medicates. Records are maintained of all medications brought into and out of the home. Records are maintained of all prescribed medications, including creams and nutritional supplements being administered. The home is required to ensure that all hand transcribed medications are signed by two staff and dated when commenced to ensure that there is no risk of error in transcribing. This was identified as needed at the previous key inspection. We noted that on three occasions medications had not been signed for and that a hand written change of prescription had not been signed and dated. All prescribed medications must be signed and dated when altered to provide a clear audit trail. We noted that he homes policy for covert medication administration had been signed by the GP. We could not find any assessment of capacity to identify how this decision had been made. The registered person must ensure that the controlled drugs cupboard is re sited on a fixed wall to ensure that it meets with the Royal Pharmaceutical guidelines. We looked at how two recent medication errors had been handled by the responsible person. These errors had been investigated but documentation needed to provide an audit of how the incidents were reported, investigated, managed and actions taken, was not complete. We require that this area be addressed to ensure that medication practices are managed safely. Care Homes for Older People Page 15 of 36 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further development is required to support specific and meaningful activity in the home and development of how this is recorded is needed. Visitors are made welcome and can visit at anytime. The meals in the home are of a good standard, development is needed of some aspects of the dining experience to ensure people are supported to enjoy a full diet. Evidence: The homes brochure states We provide an increasing range of activities supporting the residents in the home and also out in the wider community to help reduce the stigma of their condition. The home does not currently have any designated activity hours or a designated activity staff. Activities are currently undertaken by care staff when time allows. The notice board did not advertise any activities past or planned and there was no evidence of contact with the local community. We looked at recent records and found that whilst some people had records of interactions, these were all similar and mostly included listening to music and watching the birds. We observed that whilst staff were kind and courteous , they spend time with people using the service when undertaking tasks and did not appear
Care Homes for Older People Page 16 of 36 Evidence: to have time to sit and chat. We were told that in the afternoon people would be assisted to access the garden area. We did not see this take place and noted that whilst the homes brochure describes the garden as safe and secure, any person using the service would need to be escorted to ensure they did not fall down the concrete ditch at the edge of the garden, at the side of the house. Activity provision needs to be developed to ensure that activities are made available to all people using the service which are varied and suit peoples expectations, preferences and capacities. Staff told us that activities are provided when there is time, usually in the afternoons. Two staff told us that they organised activities and that these were recorded. The responsible individual was unaware of this, however , records did not indicate that that this current activity provision was sufficient. People at the home have access to visiting clergy and would be supported to access any specific religious preferences both at the home and in the community. Care plans identified peoples preferences but not how they are supported to access this preference. This area is recommended to be developed to support peoples spiritual needs. Meals are served in the dining room or peoples bedrooms. Staff told us that people who need more help are assisted to eat and drink first to allow them more time. Lunch was served a little later in the dining room. Lunch appeared pleasant and appetizing and the kitchen staff demonstrated that they provide for specialist diets and have current information to support managing these diets. The evening meal is a lighter snack type meal and hot drinks are provided throughout the day. Everybody appeared to enjoy the meals and staff told us that the quality and choice of meals were always good. We have previously been advised that menu cards were planned to enable people using the service to make an informed decision about the meal choices. We observed that this did not take place. Care Homes for Older People Page 17 of 36 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is not accessible or displayed. The management of the home do not follow the complaints procedure. The policies and procedure in place and staff training provided promotes the protection of people from abuse Evidence: The complaints procedure and the homes current CQC inspection report are not publicly displayed in the home. The notice board in the front hallway refers to the complaints procedure but it is not accessible. The Statement of Purpose and Service User guide have a copy of the complaints procedure, however, the management of complaints is unclear and there is no evidence that complaints are managed correctly. The home has received two complaints since the last key inspection, the complaints record of the home is empty and there is no evidence of how complaints are managed or responded to. As a result of this, the responsible person of the home is under the impression that no complaints were received and the risk is that complaints will not be managed effectively to support people using the service. We are advised that an advocacy service can be accessed should this be needed. The home has policies and procedures in place for the safeguarding of vulnerable adults. Staff training in this area is ongoing but not all staff have received current
Care Homes for Older People Page 18 of 36 Evidence: training in this area. Care Homes for Older People Page 19 of 36 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant environment for people using the service. Further improvements and upgrades are ongoing. The provision of hoists for bathing requires review and the upgrade of bathrooms and toilets require review to ensure adequate facilities are available. The standard of hygiene is good. Evidence: The home is a grade 2 listed building set in its own grounds. care is provided over three floors and access is available by stairs and passenger lift. The home has continued to improve some areas. Further upgrades are needed to ensure that all areas are suitable and to a good standard, these areas include bathrooms and toilets . A hydrotherapy bath has been fitted. We were told by staff that this has yet to be used as there is insufficient hoisting equipment available for that and any other bath in the home. Another bathroom is in need of repair on the middle floor and the bath on the upper floor is not in working order. We noted that hot water outlets in one bathroom exceed the Health and Safety upper limit of 43 degrees. We looked at the records maintained to monitor and record the temperature of the water to ensure that it dose not present a risk of burns and scalds to people using the service. We found that this bathroom was not included on the list to be checked. We spoke with staff who confirmed that the bathroom is in use. We requested that urgent action be taken to address this risk. The responsible person has
Care Homes for Older People Page 20 of 36 Evidence: advised us that on the following day, Thermostatic Valve Controllers were fitted and the temperature of all hot water outlets is being closely monitored to ensure the safety of people using the service. The home has improved access to ground floor toilets and people are now able to access a toilet independently with handwash and apertowels being accessible in an adjacent bathroom. We looked at most bedrooms and all communal areas. The bedrooms were personally decorated and reflected peoples personal preferences. Some people share a bedroom, where this takes place curtain screening is provided. It is not identified in the care plans the rationale used to establish why a shared room is appropriate for these people. Some people at the home are at risk due to their lack of appreciation of danger. There is a key pad locking systems throughout the house which means that stairways and office space is made safe. There is a security system on external doors and a restricted gate from the garden to the car park. These systems are in place to promote the safety of people using the service. It was observed that there was always a staff member in the lounge to ensure the continued safety and support of people using the service. The home appeared clean with only malodour evident in some bedrooms. Cleaning is undertaken by staff at the home when they are not on care shift. We saw evidence of carpet cleaning taking place. Care Homes for Older People Page 21 of 36 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are not regulated by the dependency level of people using the service. Recruitment and induction procedures are not robust and may place people using the service at risk. Further training is needed in some mandatory areas to ensure staff have a clear understanding of their role and a the needs of people using the service. Evidence: We looked at staff rotas and spoke with staff. Staff told us that busy times of the day are morning and evenings. They told us that the amount of people living at the home had increased, however, staffing levels had not significantly or consistently increased to meet the increase in demand. We observed that in the mornings staff were busy until lunchtime and that they appeared to havevery little time other than task related interaction. Staff appear caring and concerned about the well being of people in their care, they appeared to know peoples needs and worked together to support care provision. On the day of inspection, the Manager Designate was on an induction day with the responsible individual, there was one qualified nurse and six care staff on duty. Also on duty were a cook and kitchen assistant, administrative staff, laundry staff and cleaner and a further care staff to assist with supporting people with eating and drinking at breakfast time. Staff rota showed that staffing levels varied between 5 and 7 carers each day with one person on breakfast on some occasions. The week
Care Homes for Older People Page 22 of 36 Evidence: previous, three days had six carers on duty and no extra staff to assist with breakfast. Staff appear to have several roles throughout the day, changing clothes to become laundry and cleaning staff. We asked the responsible individual how staffing levels were calculated. It is evident that the dependency of people using the service is not used to measure staffing levels. This area requires review to ensure that sufficient staff are available to meet the needs of people using the service. Staff who start work at the home are given an induction pack to follow. We looked at two recently started staff induction records. One staff member had started the induction in February 2010 and had not yet completed all relevant sections. Another staff member had been at the home for over two months and had not yet completed an induction record. A third staff member had been at the home two weeks and had not yet started the induction record. We noted that two of those staff have not yet received moving and handling training and are working unsupervised in the home. It is unclear what fire training had been undertaken at this time. The responsible individual was asked to address these areas as a matter of urgency. Recruitment records were looked at for the four most recently employed staff. Not all recruitment checks were complete. It was noted on the second day of inspection, that one new staff member was working unsupervised whilst having received the ISA First (Independent Safeguarding Authority check) but before having received the Criminal Record Bureau check. This supervision is needed until all required recruitment checks are in place. We also observed that another new staff member was on their second day of induction whilst no ISA or CRB check had been received. This is poor practice and may place people using the service at risk. Staff files did not contain job descriptions or contracts of employment which would give staff a clear picture of their roles at the home. Staff training at the home has been improved and some staff have received training in the mandatory areas. The record of attendance is maintained on the staff rota. However, it is not clear from the staff training matrix if all staff have received the appropriate training. It is evident that there are some shortfalls in moving and handling training, protection of vulnerable adults and fire training. Furthermore it is evident that perceptership training has not been provided where required. These areas must be addressed to ensure the safety of people using the service and staff. Staff told us that they were happy working at the home and they felt that provision of training had improved. Care Homes for Older People Page 23 of 36 Evidence: Staff supervision has not been undertaken and is required to ensure the good practice and improvement in standards of care at the home. Care Homes for Older People Page 24 of 36 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have an established management in place to promote the leadership and management of the service. The monitoring of quality at the service is not managed in the best interests of the people using the service. Health and safety and record keeping are not well managed and may place people using the service at risk. Evidence: The home has recently employed a manager designate who started the role on the day of inspection. As such the manager designate cannot be assessed. The management of the home has recently been undertaken by the responsible individual and directors of the service, this was an interim measure. Evidence from inspection would indicate that there are serious shortfalls in management all outcome groups of this report. It is concerning that people using the service have been placed at risk due to the poor management and lack of quality
Care Homes for Older People Page 25 of 36 Evidence: review of the service provided. The management of the service have not undertaken a review of quality of care since the last key inspection. The home is required to supply Regulation 26 reports to the commission for our review. The reports are inaccurate because the records maintained are incomplete. At present nobody at the home manages their own money. The systems in place to manage peoples money were reviewed and appeared safe and well managed. We have already identified shortfalls in the management of health and safety which include water exceeding hot water upper limits, lack of training in moving and handling, management of infection control and fire safety. Accident are audited monthly but the information is not used to identify trends and incidences to promote accident prevention. Information about a recent accident should have been audited to be used to develop staff training to ensure the safety of people using the service. Records maintained within the home are not stored in line with the Data Protection Act. The details of some peoples medical conditions are noted on the dining room wall to tell staff who is diabetic. Care plans are stored in an unlocked filing cabinet in a room which was observed to be left unsupervised for periods of time. All records relating to people using the service should be stored securely to ensure that they remain confidential. Care Homes for Older People Page 26 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 24/09/2009 ensure that monitoring and a record of this monitoring is undertaken for people who are nursed in bed and do not have access to summon assistance. This will ensure that people have access to staff when needed. 2 12 16 (2)(m) People must be able 31/01/2009 to engage in local, social and community activities, within their capabilities, and as they wish. Arrangements for this should be part of care planning. So people can live a fulfilled life and are not socially isolated. 3 12 16 The registered person is required to develop a programme of meaningful activity for each person. This actvity should be recorded to further develop activity to support people choices and preferences. 30/09/2009 4 18 12 The registered person must ensure that all staff have received training in abuse awareness. 30/10/2009 Care Homes for Older People Page 27 of 36 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 This is required to ensure the protection of people using the service. 5 29 19 The registered person must 30/10/2009 ensure that all staff have recruitment checks in place which include two references, this is to include one from the most recent employer or the reason why this is not possible. This is required to ensure the protection of people using the service 6 29 19 The Registered Person must ensure that all appropriate recruitment checks are in place prior to people commencing employment at the service. This must include a full employment history and appropriate police checks. This is to ensure that people using the service are not at risk of harm. 7 30 18 (1)(c) Staff must be trained and competent in all conditions which affect people at the home, especially dementia. So that people receive appropriate and effective care. 8 38 26 The responsible person must 26/02/2010 forward all Regulation 26 monitoring visit reports to
Page 28 of 36 02/03/2010 31/03/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action the lead inspector. This is required to ensure that we can continue to monitor closely the development of the service. 9 38 18 The registered person must 19/03/2010 ensure that all staff have the skills both individually and collectively to provide the care to meet peoples needs.This is with reference to moving and handling training. This is required to ensure that staff and people using the service are not placed at risk of injury. Care Homes for Older People Page 29 of 36 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 1 3 The registered person must ensure that information supplied to prospective people using the service is an accurate reflection of the services provided. This will enable people to make an informed decision about the services and facilities available. 24/06/2010 2 2 14 The registered person must ensure that a pre admission assessment is undertaken for all new admission to the home. The pre admission assessment must be made available to staff prior to admission. This is required to ensure that the home is suitable for the purpose of meeting the needs of thep prospective person using the service. 24/06/2010 3 7 15 The registered person must ensure that risk 24/06/2010 Care Homes for Older People Page 30 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action assessments and appropriate plans of care are put in place for each persons areas of assessed needs. These care plans need to be reviewed and updated to reflect any changes in care need. This is required to ensure that people using the service receive the care they needs and staff have a current plan to follow. 4 8 12 The registered person must ensure that the facilities for bathing are put inplace and monitored to ensure that peoples bathing needs can be met. This is required to ensure that personla care choices and preferences can be met. 5 9 13 The registered person must ensure that the controlled medication cupboard is correctly sited on a fixed wall. This is required to ensure that it meets with the Royal Pharmaceutical guidelines. The registered person must ensure that all hand transcribed medications are signed by two people. It is 24/06/2010 24/06/2010 6 9 13 24/06/2010 Care Homes for Older People Page 31 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action further required that any changes in rescriprion on the medication administration record is signed and dated by the person making those changes. This is rerquired to provide a clear audit trail of any changes. 7 9 13 The registered person must ensure that the mediaction administration records are audited and any gaps investigated and a coded indicator inserted. This is required to ensure that there is evidence of prescribed medications being given or thje resons provided for them when not given 8 16 22 The registered person must 25/06/2010 ensure that complaints are managed in line with the homes complaints procedure. All complaints must be investigated and a record maintained of actions taken. This is required to ensure that there is clear evidence of the management of complaints. 24/06/2010 Care Homes for Older People Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 9 25 12 The registered person must 25/06/2010 ensure that all hot water outlets are monitored to establish that they do not exceed the health and safety hot water upper limits. This must be undertaken to ensure that there are no risks of burns and scalds to people using the service. 10 27 18 The registered person must ensure that there are sufficient numbers of staff consistently available to meet the needs of people using the service. The means to measure service user dependency must be taken into consideration when providing staffing levels to ensure that the levels of staff are correct to meet peoples needs. 25/06/2010 11 30 18 The registered person must 25/06/2010 ensure that all staff complete an induction program within a reasonable timescale before they work unsupervised in the home. This is required to ensure the safety of people using the service and staff members. Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 12 36 12 The registered person must ensure that all records relating to people using the service are stored confidentially and in line wit the Data Protection Act. This is required to ensure the dignity and confidentiality of people using the service. 25/06/2010 13 37 12 The registered person must ensure that accidents are recorded and audited. This audit is then used to promote accident prevention. 25/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 7 8 The registered person is recommended to ensure that daily records are updated by staff providing the care. The registered person is recommended to implement staff training to ensure that the terms of reference staff used for people using the service are not feeds and softs and reflect their preference of name. Lockable storage is recommended to ensure that peoples personal items can be appropriately stored. The registered person is recommeded to review and improve the management of investigates related to mediaction errors to ensure that they are managed clearly and safely. The registered person is recommended to establish and
Page 34 of 36 3 4 8 9 5 9 Care Homes for Older People 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 record the capacity of people to understand and agree to the adminstration of covert medication. 6 16 The registered person is recommended to ensure that a copy of the complaints procedure is displayed and made accessible to all people using the home. The registered person is recommended to provide all staff with a contract of terms and conditions of employment and a copy of their job description. This will enable staff to be clear about their role at the home. The registered person is recommended o review the use of Perceptorship supervision for newly qualified staff. 7 29 8 30 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 36 of 36 - 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!