Inspection on 05/11/09 for Ashlett Dale Rest Home

This inspection was carried out on 5th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashlett Dale Rest Home 31/03/08

Ashlett Dale Rest Home 21/08/06

Ashlett Dale Rest Home 16/11/05

Ashlett Dale Rest Home 04/11/04

Ashlett Dale Rest Home 03/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

Key inspection report Care homes for older people Name: Address: Ashlett Dale Rest Home Stonehills Fawley Southampton Hampshire SO45 1DU     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: Joyce Bingham     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ashlett Dale Rest Home Stonehills Fawley Southampton Hampshire SO45 1DU 02380892075 02380890573 fred.liddington@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Frederick William Liddington,Mrs Maureen Mary Liddington care home 16 Type of registration: Number of places registered: 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 to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Ashlett Dale is situated in a semi rural area in Fawley on the outskirts of the New Forest. There is a public house within a short walking distance and a number of other Care Homes for Older People Page 4 of 34 Over 65 0 0 16 16 16 0 Brief description of the care home amenities and leisure activities a short car journey away. The home is a two-storey building having a reasonably good sized garden in which the residents spend some time during the warmer months. There are parking spaces in the grounds close to the home. In addition to the homes fees there are additional charges for hairdressing, chiropody, newspapers, magazines, medical requisites, luxury items and toiletries. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These include the Annual Quality Assurance Assessment (AQAA) completed by the home. This is the homes own quality assessment and it gives statistical information about aspects of the service. This was provided when we asked for it. We also obtained confidential surveyed comments from fourteen out of sixteen residents we asked and seven from among the seventeen staff we asked. Care professionals were also consulted. An unannounced visit to the home took place on 5 November 2009, starting at 09:45 and lasting until 15:45. We were unable to access records in the locked office in the grounds of the home so a second visit was arranged on 9 November from 10:00 until 12:30. During the first part we were able to walk around part of the premises, including seven bedrooms, two bathrooms, the lounge, dining room, laundry and Care Homes for Older People Page 6 of 34 kitchen. The registered manager was not available due to a hospital appointment. Assistance was provided by a senior carer on the first visit and the registered manager on the second one. We spoke with twelve residents and greeted all the staff on duty, speaking privately with two of them. We sampled staff and service user records, and policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Care Quality Commission (CQC). Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The absences of the registered manager this year has meant that leadership has been provided by different people, with the Manager on call. The lack of cohesive, consistent oversight has meant the management of the home has fallen down in a number of respects which are outlined in the body of the report and potentially people are at risk of not receiving the service they need. Three repeated requirements figure again in this report indicating these matters have not been fully addressed. Care Homes for Older People Page 8 of 34 A comprehensive plan of care is not always formulated before a resident is admitted, and inattention to admission detail is evidenced. Risk assessments are not quickly established as working documents for staff as and when interventions become necessary which means people may not receive the help they need from the outset, or as their needs change. The home is failing to supply correct information in the Service User Guide to enable potential and new residents to fully understand the service the home offers. Inattention to detail was evidenced in a significant record that could have placed a resident at risk of harm. Recruitment processes are not sufficiently robust to ensure that residents are fully protected. Criminal records checks are not always processed before a carer commences, two references are not always in place; there has been no vetting of a short term volunteer carer. Staff supervision is currently limited to on the job prompting by the shift leader and does not include formal supervision covering all aspects of practice, so all service users needs may not be fully met. The complaints procedure is out of date and not appropriately activated when concerns are raised, as evidenced by an incomplete complaints log. This means residents concerns may not be adequately responded to. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process means that potential residents are enabled to meet the manager and very basic information is collected about them and their needs. A plan of care is not formulated before the person is admitted, and inattention to admission detail is evidenced which means people may not receive the help they need from the outset. The home is failing to supply correct information required by law to potential residents, to enable them to fully understand the service the home offers. Standard 6 was not inspected as the home does not provide intermediate care. Evidence: Confidential surveys taken up prior to the inspection from fourteen residents indicate that they each had been provided with information about the home and its services before they moved in to equip them to assess if the home was suitable and would Care Homes for Older People Page 11 of 34 Evidence: meet their needs. One said, As some people here I knew, and the home was suitable I came here. Another commented I didnt think I would be here this long but it is very nice. Another said Living here is very, very nice. Its a treat to come here. During the morning we asked to see the Service User Guide that would be issued to any prospective residents. The senior carer produced a file with some care home information that was significantly incorrect in some of the detail and out of date. Apart from the Manager only one of the Registered Persons was named in the information; the registration details wrongly stated the home is registered to admit people with a physical disability; the complaints procedure referred to named individuals and contact details that no longer apply; it lacked a copy of the most recent inspection report; and no quality assurance views of the residents were included. We looked at five service user files, including one former resident, recently admitted who stayed only a short period. We examined the pre-admission information collected by the home which is necessary for them to meet the persons needs as soon as they are admitted and to start the development of an individual care plan. In most cases the manager had visited and met with the service user before admission. Most were admitted from hospital with some information supplied by family members and also by care professionals. The home does have documentation that has been developed for use with preadmission assessments. In each case basic information had been collected including the persons medical history, height, weight, smoking, drinking, exercise, vaccination profile. For one person the pre-admission paperwork was dated the same day as the admission records. Some contained more information than others but prior to admission there was no evidence of information about social interests, hobbies, religious or cultural needs, personal safety or risk. The senior carer told us that as soon as a person is admitted the care plan is developed in more detail. They had come to the home that morning with the intention of producing a care plan for one resident admitted the day before. In this case we expressed concern that a resident had been admitted with a significant medical condition and already, within 24 hours, an incident had occurred that should already have been set into a strategy of risk management and care to ensure minimum risk for the individual. We also noted a serious misnaming of the resident on medication records which took place as they were being admitted. This was immediately drawn to the senior carers attention. They guessed that the name on the drug record differed from the written assessment record as it may have been the persons preferred name. This was checked and found to be incorrect. Care Homes for Older People Page 12 of 34 Evidence: On the second visit we spoke with the Manager about the admission process. She confirmed that normally she met with the potential resident, and took down basic information from them or their family, but emphasised that their needs could only be fully assessed once they were living at the home. She felt that this was one reason why the contracted trial period was in place. Care Homes for Older People Page 13 of 34 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. Residents are supported with personal care plans that refer to basic care needs and identify some risks with strategies of management for the staff. However, they are not comprehensive; risk assessments are not quickly established as working documents for staff as and when interventions become necessary, so consistent action by all staff may be hit or miss. This means that all residents needs and preferences may not be identified or met. Medication procedures are good generally but inattention to detail in an important aspect has been evidenced. Reoccurrence of this failure would place residents potentially at risk. Evidence: From the fourteen confidential surveys received from the residents eleven said they always receive the support and care they need. Three said they usually do. Each one said the home always makes sure they receive the medical care they need. To the question what the home does well one person said, takes good care of the residents; another said the staff are respectful of each individual, another said lots Care Homes for Older People Page 14 of 34 Evidence: of things, and another nearly everything. On the day we spoke with all the residents who were present in the lounge and joined in the exercise activity organised by one of the carers who had been designated for therapy. The chiropodist was present in the home and was using a screened area of the dining room for treating people. Residents were supported by staff one at a time to go to the dining room and sit and wait in an adjacent chair for their turn. As the chiropodist was present over the lunchtime into early afternoon the residents were given their lunch on small tables in the lounge. We drew to the Managers attention on the second visit that this was poor practice, and recommended that in future the chiropodist should move to treat each person in turn in their own rooms. We noted that during treatment very little conversation took place, so an opportunity for the residents to enjoy some verbal stimulation was missed. One resident was significantly unsettled by not eating in the dining room and refused her lunch inspite of staff providing her with an alternative venue in her bedroom. The four care plans of the same current residents were examined. They had been completed and included some risk assessments of identified needs e.g. falling, wandering off, attacking with objects. However, in places they provided vague detail and were limited in value e.g. needs assistance with dressing and undressing covers a wide range of need and may be applied differently by each carer. In one case we identified through the daily notes that the need for monitoring and intervention by staff seemed to have been recognised; this was not recorded in the appropriate care plan, for example one resident demonstrating inappropriate motherly/sexual behaviour towards another resident had no written risk assessment or related strategy for staff managing this in their care plan. In another case when certain behaviour was demonstrated by a resident (refusing food) we were told she often does this, but no record was made in their plan of care to guide carers to recognise the triggers or how to respond. In another case significant confused behaviour had not been profiled within the risk assessment strategy of the residents care plan. This means that peoples needs may not be identified or fully met. We spoke with a number of staff during the day. We asked one carer about their perceived value of the care plans and she said she had been told to read them when less busy. She was kept busy at work and had not up to that point (approximately two months later) had the opportunity to read the care plans. She was one of the two carers left in charge of the residents on the afternoon and evening shift. Her records indicate she had not received training in control of infection, food handling, first aid, health and safety or dementia care, so they may not, therefore have the skills and Care Homes for Older People Page 15 of 34 Evidence: knowledge to meet peoples needs. personal care can be offered in the privacy of peoples own rooms. The flush toilets in bedrooms are screened by a curtain, and we saw that each bedroom is lockable so people can be private. We noted that the first floor communal bathroom lacks a lock on the door and we were told that everyone is supported and supervised by carers when they are bathing. However this means someone could walk in while a resident is bathing or using the toilet and does not provide adequate privacy or protect their dignity. The home uses a pre-dispensed system for administration of medicines. The blister packs are clearly named and the timing of medicine administration is also clearly marked on the drug charts. These were observed to be completed regularly with no gaps. We found a serious error of misnaming (referred to in section 1 of this report) and this was brought to the attention of the senior carer. We discussed the services drug procedure with the senior carer and she informed us that the home is about to change to a new supplier. The current controlled drug cupboard fails to meet the standard now required for care homes and the Manager confirmed that a new lockable trolley and integral controlled drug cupboard is on order and will be put in place with the homes new supplier. We discussed the absence of written guidance for staff either in the individual care plan or in the medicine records when as and when needed medication is prescribed in order to ensure that decision making is not left to the discretion of individual staff members. A senior member of staff has been designated with a lead on pharmacy matters. Care Homes for Older People Page 16 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by routines for daily living that can be flexible. There are activities arranged regularly in the home for people to join in with. The home supports visiting at all reasonable times so that residents can see family and friends. Mealtimes provide choice and home cooked nourishing meals, normally taken in pleasing surroundings of their choice. Evidence: During the day we observed that the residents moved freely around the home, into the lounge and back to their rooms when they wanted to. We were told by them that they can get up when they want and go to bed when they want to. The confidential surveys indicate that six people felt the home always arranges activities they can join in with; five felt they usually did, and two sometimes. One relative commented The staff provide regular activities weekday mornings which vary from day to day (i.e.. gentle exercises, quizzes, bingo, memory games etc). We saw that the duty roster identified the staff member on certain shifts who has a lead in therapy. This seemed to be for group activity that those who wished to could join in. Staff spoke of Care Homes for Older People Page 17 of 34 Evidence: individual hobbies and activities that are encouraged at times. On the morning of the inspection the activity was chair skittles followed by a reminiscence quiz. There was good hearted banter and warm encouragement given by staff to each resident to join in. Residents were observed to be smiling, and some conversation was taking place between a number of them. Two were focused on their daily newspaper, one had their finger nails painted during the morning. We noted that there are a couple of caged budgies in the entrance hall to add interest and movement, and an appropriate style and level of music was played throughout the day. In relation to meals eight felt they always like the meals the home provides; five felt they usually did, and one felt they did sometimes. One person identified as something the home does well, Meals, plenty of drinks and considerate of needs. Every day the staff take orders for the next days food, giving a choice. The food is excellent. We saw that the lunch was served on tables in the lounge (owing to the chiropodist using the dining room). The meal consisted of casseroled steak, with mashed potato, swede and cabbage followed by blackcurrant cheesecake. The meals were nicely presented. Staff confirmed there were no special diets required at present; there was no need for pureed meals and no-one needing assistance with feeding. The menu follows a 4 week plan and provides a range of interesting meals. The regular cook, who is also a senior carer, has worked at the home a number of years and is familiar with the likes and dislikes of the generation. We saw that some residents chose to take their meals in their own rooms and this choice was respected. Staff told us that family members visit the home often and that residents can make use of their rooms for private conversations if they wish to. The Service User Guide and a notice displays welcome to visitors at reasonable times. There were no visitors on the occasion of this inspection. We saw that residents are free to bring to the home personal possessions and small items of furniture. Many rooms expressed peoples personalities and interests by their ornaments, photographs and pictures. We spoke with staff and the manager about any improvements the residents may wish to have and the main response was that residents would like to go out more for trips in the minibus or outings to places of local interest. We were told by the manager that arranged trips were hampered this year by the limited number of staff who can drive the minibus, and local occurrences of swine flu. The homes AQAA told us that the service has no rules in daily living although health and safety is made a priority, and there are no set visiting times. The home does not Care Homes for Older People Page 18 of 34 Evidence: handle any personal monies for the residents. Lockable facility is placed in each bedroom and all rooms are single. Care Homes for Older People Page 19 of 34 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. Residents are not supported by an accurate procedure detailing how and where to complain, and not all complaints are appropriately logged, so the home does not have in place a system for handling complaints that ensures peoples concerns are responded to appropriately. The home has demonstrated limited understanding of the principles of safeguarding, so service users may potentially be at risk. The incomplete recruitment processes do not provide residents with adequate safeguarding from potential abuse. Evidence: Each of the residents who completed a survey indicate they know who they could talk with if they were concerned about anything. Most knew who they could make a formal complaint to should it be necessary or were confidant their family member would know. Some commented that complaints are not necessary, nothing to complain about, Keep doing what theyre doing, it works well. To the question what the home could do better, we heard, nothing. The complaints log was not available on the first day of the inspection. The AQAA informed us that all staff were trained and knew the importance of a complaint and how to process one and the procedure is clear and available. However the procedure shown to us with the Service User Guide was out of date with named individuals that Care Homes for Older People Page 20 of 34 Evidence: are out-of-date and incorrect contact details for referral in offices that have closed. We were told by the Manager there had been no complaints. The log book detailed the last recorded complaint was received in the year 2000. We therefore progressed discussion about what constitutes a complaint, the importance of an open culture, the positive aspects of receiving a complaint, being an opportunity for improvement which can demonstrate the action the home takes as a result of listening to concerns. We drew to the managers attention that not all complaints were being recorded adequately e.g. the daily notes of one resident, recorded in July and August 2009, indicated they had wandered into another residents room when the occupant was using the wc and refused to leave the room. It was recorded by the staff member that the resident concerned was very angry and had made a complaint. The record went on to say that other residents and their families had been upset and complained about this person wandering into their bedrooms. The manager said that nothing had been put in writing so this had not been logged. It was not clear, therefore that peoples needs had been responded to and their concerns properly addressed. We spoke with staff about the level of their training (as part of the National Vocational Qualification) in detecting and recognising abuse and what they would do about it. They expressed good values and responses in relation to whistle blowing should it ever be necessary. However, the staff records indicated that not everyone functioning on team on the two days of the inspection had been vetted through the Protection of Vulnerable Adults Register (POVA), and this failing exposes residents to a risk of potential abuse, though not through deliberate intent. A recent notification was submitted by the home to the Care Quality Commission about one residents sudden termination of residence. The circumstances surrounding this warranted immediate referral to the Local Authority for safeguarding assurances, however, the home failed to recognise this or process it until prompted by the CQC Inspector several days later. The AQAA informed the CQC that the policy of the home is not to hold any personal monies on behalf of the residents. Each resident is supplied with a private lockable facility within their room. Care Homes for Older People Page 21 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from a home which is accessible, kept clean, odour free and well maintained; they live in a homely and comfortable setting. Physical adaptations and guides that one would expect in a home offering a specialist service for people with dementia are not in evidence, so residents may not benefit from all the potential assistance they need to move independently. Evidence: Ashlett Dale is a large detached house located on a country road on the edge of Fawley village. It has parking for several cars and a well maintained garden at the side of the property. Visitors sign in and out so staff can know who is present. The decor is in good order and the home is well maintained. Residents responses to surveys indicate in their view the home is always fresh and clean. One said The home is clean and well run; another said, The home is very clean. We walked around parts of the home and saw seven bedrooms, the lounge, dining room, laundry, and kitchen. The bedrooms are single and were all very clean and odour free. Apart from the two new ensuite rooms which has toilet facilities in a separate area the rooms have a flushable toilet within the bedroom, screened by a curtain. We were told the residents really do like having the wc accessible to them and Care Homes for Older People Page 22 of 34 Evidence: this arrangement, which is unusual, does not present a problem for them. Each door is fitted with a lock for privacy. The flooring is of a hospital-style washable surface; the appearance is softened with large mats. There was evidence of personal items of furniture the residents had brought in. Many rooms contained ornaments and pictures that were significant to the person; some lacked any visible personal items but we were told the residents chose to have their rooms in that style. The small laundry is located with access from outside the home. Staff confirmed the route for carrying soiled laundry avoids passing through the kitchen. It is fitted with a sink and drainer, commercial washing machine and dryer. We noted that the residents were well dressed and seasonally clothed. Their dress was clean and in good repair. Soft furnishings, towels and sheets were clean and in a good order. We observed the absence of visual mobility guides or colour coding which is normal in homes offering a service to people with dementia to assist them in locating their rooms and identifying the bathrooms. Professionals visiting the home have also commented on the absence of these aids in a home for people with dementia. When this was raised with the Manager we were told that the current residents had objected to what they perceived to be childish pictures fitted to their doors that were unhelpful and devaluing. We noted that the door to the first floor bathroom is without a lockable facility, which is important for peoples privacy and dignity. The senior carer agreed this would be corrected quickly. The home was able to provide evidence of recent fire checks, weekly alarm testing, and servicing of fixed equipment and fire fighting equipment. Records of staff training was up-to-date. Care Homes for Older People Page 23 of 34 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. The recruitment procedure for new staff is far from robust so that residents are not assured they are protected from potential harm. This important aspect of care is not being addressed properly as this features as a repeat requirement from the last key inspection. The records of training indicate some carers are well equipped to meet peoples needs, while others have significant gaps in the mandatory fields of training which means people will not be well supported at all times. Evidence: We arrived at the home to find a good number of staff on duty and an activity happening in the lounge. We looked at the duty roster and saw that the normal pattern is to provide three carers from 7 to 9am; three carers from 9am to 1pm plus a designated cook and designated cleaner. One of the three carers is designated with a lead for therapy. In the afternoons from 1pm to 6pm there are two carers; and two carers from 6pm to 10 pm. Two staff are recorded at night from 10pm to 7am and we were told they are both awake staff. When we queried the unacceptably long working hours for one carer we were told that that night the carer sleeps in. Two other queries were made about the duty roster and we were told the duty roster had been amended but not changed on the record and one shift was still to be filled. We discovered that Care Homes for Older People Page 24 of 34 Evidence: one person who we observed to be a team member (though not rostered) was a volunteer. There was no staff record, POVA check or CRB for this person. The Manager was advised that engaging a volunteer within the home required the same level of vetting, supervision and recruitment checks as paid staff. A requirement was made that at no time should she be unsupervised until the necessary recruitment checks have been carried out. We examined the staff records and found examples of one carer employed without a CRB or POVA clearance; one CRB was incorrectly treated as portable from earlier employment; one carers file contained only one reference. The staff application form only asks potential staff to declare convictions that have not been spent, but it was brought to the Managers attention that in fact no convictions are ever spent and therefore non- declarable, if the person is working in the care field with vulnerable people. The legal requirement for staff declaration of their medical and mental health is covered only by a question on the application form of the number of days off sick in the past 12 months. This is weak and does not alert an employer to health risks. In relation to the staff support confidential survey returns from the residents said The staff are efficient and very friendly and caring. Homely, understanding us. Warmth, very kind. The staff are always handy. Staff are approachable. Staff treat residents well with a friendly manner. One member of staff said, The residents are all very relaxed. Theres a brilliant atmosphere. All staff are very friendly. The management are very helpful. On a less positive note one relative said They have problems with staff (young girls who at times dont really care). Seven out of seventeen staff completed and returned the confidential surveys. They indicate that carers are satisfied with the induction they were offered and are kept upto-date with information they need to fulfill their role. They said that training is good and they expressed a positive attitude towards the level of management support they receive. Each one felt there were always enough staff on duty and they had sufficient knowledge and experience to meet the residents needs. To the question what the home does well one commented Everything. All staff and residents are very happy. Problems are always sorted. We looked at the summary of training completed by the staff team for twenty staff. We were told that the home engages a reputable company to provide the training and all training is done in-house. These training records showed that a number of the staff have received comprehensive training in all the mandatory fields. Some of the staff feature on the roster for both day and night duty. However, as some of them did not feature on the duty roster, we were told that three had left and two of these people Care Homes for Older People Page 25 of 34 Evidence: were on maternity leave. The majority of the staff team had records of training in moving and handling, mental capacity, fire protection and medication administration. Two staff had no recorded training that had been completed on the document made available for inspection. The senior carer acknowledged these records were probably not fully up to date. The AQAA told us that new staff come for an induction and then shadow some shifts before starting work; all staff complete their basic training within the first 6 weeks of employment; all staff have completed or are doing their NVQ 2 or 3. The AQAA states that this is offered to each carer within a month of employment. We spoke privately with two staff members, and engaged with each staff member who was on duty. We observed kind interaction between the staff and the residents. We concluded a good and harmonious team spirit was operating and carers worked well together. Issues arising from staff comments include improvement for residents if an additional carer was rostered at going to bed time, as there are periods when the two carers were busy so that residents who are still in the lounge are left unsupervised. More trips out for residents were recommended. More training and understanding in the needs of people with dementia was identified by the staff. Care Homes for Older People Page 26 of 34 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. Service users live, and staff work, in a family run home, where management on a day to day basis is provided by different family members across three generations. This brings benefits for the residents in some respects but carries with it some tensions and inattention to important detail that impacts the service in a negative way. The homes reliance is mainly on verbal communication. A lack of thoroughness is evident in relation to paperwork. An ethos of kindness and valuing the elderly is mixed with defensiveness and reluctance to adopt new and professional ways of working. Evidence: Collette Willis is the Registered Manager (RM) of the home and she is also the daughter of the owners, Mr and Mrs Liddington who are the Responsible Individuals (RIs). She has 26 years care experience and has obtained the Registered Managers Award (RMA) and the National Vocational Qualification in care level 4. She has received training in dementia care and participates in all in-house training along with her staff team. Care Homes for Older People Page 27 of 34 Evidence: On the first day of the inspection she was not available, so it became necessary to meet with her on another day for necessary access to complete the examination of records. The RIs were present at the home during the first morning of the inspection but did not participate with the inspection. The first part of the inspection focussed on contact with the residents, and examination of their primary records held within the home. After the midday/afternoon staff shift change the RIs were no longer present and access to the external office in the grounds, where the staff, historic resident records and complaints records are kept, was not available. The home was required, under relevant legislation, to make available for inspection at all times all records required by law. During the second visit we emphasised to the RM that the service was responsible for ensuring access to records required by law. The Manager explained about her absences from the home in the current year and that during these periods Mrs Liddington had been managing the home and some tasks had been delegated to senior care level. She said she was always available on call if needed. This was confirmed by some carers who told us that they looked to Mrs Liddington as the leader on care shifts, and she was the person who told them what to do. We asked what form staff supervision took and learned it is telling carers what to do on shift. A carer we spoke with did not have opportunity to sit with the manager to look at her role and discuss training needs, although we heard that would be nice. No evidence was seen on staff files of formal supervision taking place, which means individual training needs and support issues may not be identified. Contact with visiting professionals informed us that at times leadership and management has been provided by Mr Liddington, one of the RIs. We were told that Collette is often not there but will ring back and seems to be in touch with what is happening. We discussed the requirement for a registered manager to be present and in control of the day to day functioning of the home, and ways of complying with this through delegation, even if physical hands-on care is not possible. The patchy absence of the registered manager this year has meant that leadership has been provided by different people, with the Manager on call. The lack of cohesive, consistent oversight has meant the management of the home has fallen down in a number of respects outlined in the body of this report. Three requirements featuring in this report are repeated from the last key inspection report, indicating that issues raised are not being properly addressed. During discussion with the Manager she complained of the amount of paperwork now necessary in running a care home and felt the balance had changed from what it should be. Office requirements had previously been very limited and were containable within the care home and now required a dedicated building in the grounds that made Care Homes for Older People Page 28 of 34 Evidence: access difficult when the owners or manager were not there. We raised with the Manager two serious failings identified during the inspection that had potentially placed service users at risk ( in relation to drug recording and staff vetting procedure) and were told that in each case they were the responsibility of different family members. We discussed the absence of colour coding in the home, or meaningful aids to guide people with dementia as, not only were these absent by observation, but the lack of the homes application to current thinking in relation to dementia care had been raised by visiting professionals. We were told that the manager had tried a pictorial approach to identifying peoples bedroom doors but that some of the residents had objected to being treated as children. Any further progress in this areas had apparently been halted. We requested evidence of Ashlett Dales internal quality assurance process and the manager provided the historic draft questionnaire supplied by the Care Homes Association. She said that this had been used and a review had been conducted. We were told the only improvement suggested by the service users was more trips out in the minibus. She was unable to show us a survey form that had been adapted for use by the home or a composite of comments. No summary of survey user views had been added to the Service User Guide. There was no evidence of any improvement plan which had been informed by a quality assessment process to ensure the service is run in the best interests of the residents. The AQAA informed us that the home does not take any responsibility for holding or managing personal monies on behalf of residents. The accident book was inspected. A recent fall had not been recorded. We drew the seniors attention to the need to notify the Care Quality Commission when emergency services are called following an accident, and when a service user is taken to hospital for other than routine appointments. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 (4) (c ) The home must identify all 01/06/2008 risks to the health and safety of individual service users and as far as is reasonably possible, eliminate them. These should be recorded in the care plan. When medication is 01/06/2008 administered it must be clearly recorded each time, to ensure that people receive the correct levels of medication. The home must obtain two written references for any person employed to work at the care home to ensure service users are protected. 01/06/2008 2 9 13 (2) 3 29 19 (1) (b) Care Homes for Older People Page 30 of 34 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 37 17 Records specified in Schedule 16/12/2009 4 of the Regulations must be at all times available for inspection to ensure evidence is provided that service users are protected and their wellbeing promoted. 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 3 14 The provider must assess and record full and accurate details in pre-admission assessments to ensure the home is equipped to meet all the residents needs in an appropriate way as soon as they are admitted. 29/01/2010 2 5 5 The provider must produce and maintain an accurate and up to date Service User Guide to enable potential residents to be clear that the service will suit them and meet their needs. 29/01/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 7 13 The provider must identify all risks to the health and safety of individual service users and as far as reasonably practical eliminate them. These should be recorded in the care plan to safeguard the well being of all service users. 16/12/2009 4 9 13 Proper attention to detail must be followed with the recording of drug information and the identity of service users so that service users are protected from errors. 16/12/2009 5 16 22 The registered person must provide a clear and up-todate complaints procedure and keep a record of complaints received. to ensure any complaint is received, investigated and responded to in a satisfactory way. 29/01/2010 6 29 19 Two written references, POVA and CRB checks must be completed before carers are employed. This applies to volunteer staff to ensure that service users welfare is protected. 16/12/2009 Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 31 39 The registered persons must 29/01/2010 give notice in writing of any proposed changes to the management or responsible individuals to ensure legal responsibility is clear and upheld. 8 36 18 All staff must receive 29/01/2010 supervision at least six times a year and a programme developed and records maintained to ensure residents receive a consistent service in all aspects of practice. 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 33 of 34 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 34 of 34 - 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!