Inspection on 08/04/10 for Ashridge House

This inspection was carried out on 8th April 2010.

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashridge House 29/04/08

Ashridge House 17/12/07

Ashridge House 23/05/07

Ashridge House 20/07/06

Ashridge House 09/12/05

Ashridge House 23/06/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT     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: June Davies     Date: 0 8 0 4 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 38 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 38 Information about the care home Name of care home: Address: Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT 01424222200 01424222300 ashridgehouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sarojini Sivayogarajah Name of registered manager (if applicable) Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category 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 category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Ashridge House is registered to accommodate up to 29 older people in receipt of personal care, the registered provider is Mrs Sivayogarajah. Ashridge House is a large detached property situated on the outskirts of Bexhill on Sea. The town centre with its shops and access to bus and rail routes is approximately a mile and a local shopping centre is approximately half a mile. Accommodation is provided on three floors and a shaft lift is fitted to assist those service users who may have mobility problems. Care Homes for Older People Page 4 of 38 Over 65 29 0 Brief description of the care home Bedroom accommodation is provided in 25 single rooms and 2 double rooms. Two bathrooms are fitted with standing hoists. The home provides care and support to residents who are both privately funded and those who are funded by Social Services. Information regarding fees charged by the home can be obtained by application to the manager. Extra charges are made for hairdressing, toiletries,newspapers/magazines, chiropody and other luxuries. The homes literature states that the objective of the home is that residents shall live in a clean, comfortable and safe environment and be treated with respect and sensitivity to their individual needs and abilities. Care Homes for Older People Page 5 of 38 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 key unannounced inspection was carried out on Thursday 8th April 2010. During the inspection the inspector spoke to the registered provider, the appointed manager, four residents and three members of staff. Documentation relating to key standards inspected was viewed and some information contained within this report was obtained from the AQAA (Annual Quality Assurance Assessment). The AQAA did not contain any evidence that requirements made at the last key inspection on the 29th April 2008 had been met. Care Homes for Older People Page 6 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The home had not carried out or obtained a pre-admission assessment for its newest resident. There was no evidence that one particular resident was having their needs met or that staff had specialist communication skills to meet the residents needs. There is no evidence in care plans that appropriate individual risk assessments are carried out to give staff guidance as to how the level of risk can be kept to a minimum. Care plans do not give evidence of external health care visits and therefore it was difficult to ascertain if residents were being given the opportunity to access external health care professionals. More work needs to take place in taking into account residents wishes in regard to activities and access to the local community. There was evidence that complaints made had not always been recorded into the complaints file or investigated in an appropriate and timely manner. The home has an ongoing Safeguarding Vulnerable Adults referral. Staffing levels, the qualifications and training of staff both in mandatory training and work related training need to be improved on, so that residents needs can be met in regard to their personal care, health, safety and welfare. The registered person needs to ensure that prospective staff are appropriately vetted so that residents are not placed at risk of abuse. The homes registered manager resigned in February 2010 and since that time there have been two appointed manager in the home this does not lead to continuity of care for the residents and does not help to maintain a close working relationship with the staff team. The quality assurance system needs to be developed, to ensure that the views of the residents, relatives, stakeholders are sought. That appropriate regulation 26 visits are carried out and detailed reports are drawn up of the registered providers findings. Fire, health and safety risk assessments needs to be carried out on a regular basis for the home and the external garden area. Systems used in the home as well as staff training need to be monitored on a regular basis. From the findings of the questionnaires, monitoring and risk assessments an annual development plan needs to be drawn up to reflect the aims and outcomes for the residents. All staff need to receive training in mandatory health and safety issues and the registered providers need to provide staff with a mobile hoist so that residents can be handled at all times in safe manner. Care Homes for Older People Page 7 of 38 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 8 of 38 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 9 of 38 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 residents in the home do not have appropriate pre-admission assessments carried out to ensure that the staff have the knowledge and skills to meet their needs. Evidence: Looking at three residents personal care plans there is no evidence on two care plans that a detailed pre-admission assessment was carried out by the past manager of Ashridge House. Residents were admitted to the home without the staff having the skills and knowledge to meet the residents needs. There is no evidence that a Local Authority assessment had been obtained from the care manager for any of these residents. The present appointed manager who has been in post for two weeks showed the inspector a completed pre-admission assessment for a prospective resident. This has been completed with more detail, but had not been signed by the resident and or their relative/representative. A requirement is being made that for all future residents have a thorough pre-admission assessment carried out and signed by the prospective resident and or their relative/representative to show that their Care Homes for Older People Page 10 of 38 Evidence: personal, health and social care needs have been discussed with them and that they agree to the level of care they require and that the assessment reflects their choices, likes and dislikes and preferences. Ashridge House does not offer intermediate care. Care Homes for Older People Page 11 of 38 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. Care plans do not provide staff with sufficient information to meet residents needs in a safe manner. Medication practices are not safe and leave residents at risk. Staff do not show respect to residents when writing in daily reports. Evidence: Three care plans were viewed none of these care plans showed how residents were able to make choices in regard to their personal, health or social care needs. There is no evidence in care plans where residents have had access to their General Practitioner or other health care specialists. The only evidence found of health care contact was with an optician who visited the home in March 2010. No other reference was made in care plans regarding visits from General Practitioner, district nurses, chiropodists, dentists, continence nurses, Community psychiatric nurses, Psychiatrist etc. Risk assessments were generic and identified the risks around pressure areas and mobility but gave no guidelines to staff as to how they could keep the level of risk Care Homes for Older People Page 12 of 38 Evidence: minimal. None of the care plans had individual risk assessments relating to the health or social needs of the residents. One particular resident needs to be communicated with in sign language or writing and had been described as confused there was no risk assessment in place in regard to the outcomes if this resident does not receive regular communication from staff or how staff can communicate with this resident. In one care plan a resident was described as being Obese. In daily reports residents were being referred to as in mates. Daily reports were found to be generic and very similar in regard to residents daily lives and activities. There were dates written for care plan reviews but no writing to indicate that this review had been carried out. Requirements are being made in relation to care plans, risk assessments and access to health care professionals. A short audit of medication was carried out and the inspector found that where General Practitioners had prescribed medication to be taken four times a day this had been reduced to three times a day by staff, without any reference back to General Practitioner for a review of medication. In some cases there is evidence that either prescribed medication has not been given at all or that it has been stopped by the General Practitioner with no reference made to this. At the last key inspection in April 2008 a requirement was made that all eye drops, ointments and liquid medication should be dated on the bottle on the day of opening, this requirement has not been met. The home does not have a PRN (as required) policy and procedure and there were no risk assessments in regard to those residents prescribed PRN (as required) medication. One resident is self medicating, but there is no risk assessment in place and no planned monitoring of his medication to ensure that the resident is still able to safely administer the prescribed medication. The inspector noted that in two communal bathrooms there were tubs of prescribed creams with pharmacy label partially torn off and therefore no name of who this external medication had been prescribed for. A requirement is being made in relation to the receipt and administration of medication in the home. The inspector did find that the medication room was clean and tidy, that there was a Medication Policy and Procedure and that unused medication is returned on a regular basis to the supplying pharmacy. In general staff are polite and friendly when talking to residents, but there are concerns about derogatory remarks about residents in daily reports and care plans for example inmates, obese and confused for a resident who is unable to hear or make sense of what is being asked of her. The inspector did observe that staff do respect the residents privacy by ensuring that personal care takes place behind closed doors. A requirement is being made in relation to conduct of staff in regard to residents. Care Homes for Older People Page 13 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no evidence that residents are able to make choices in relation to their daily living routines, activities or outings into the community and places of interest. Meals in the home are well cooked but residents are not made appropriately aware of menu choice available to them. Evidence: A member of staff said that residents are got up about 6.00 am. every morning, they have their medication and breakfast at 7.00 am. One resident was able to tell the inspector that they have to get up early, they are not asked when they would like to get up or go to bed. The resident went on to say that because everyone is up so early everybody goes to bed early. There is no evidence in care plans to show that residents are able to make choices in regard to their daily living routines. There is also a notice on the notice board in the basement that stated the times for meals that were rather institutional with no flexibility of when residents are able to eat. On the notice board in the basement hallway there is a list of activities on offer to residents, these activities are difficult to read due to the format they are printed in. Many of the residents are not able to read and therefore have no understanding of Care Homes for Older People Page 14 of 38 Evidence: what activities are on offer. One resident said that she does not join in activities as she cannot understand what is being said. Another resident said that she enjoys ball games and music. One of the staff spoke to the inspector of how she had purchased materials for the residents to make Easter Cards. There have been no outings since the last key inspection in April 2008. Every fortnight there is a professional motivation lady who visits the home and a professional piano player every Monday afternoon. The local Church of England vicar visits the home on a monthly basis, to carry out a short service and Holy Communion. The newly appointed manager said that he is trying to recruit a part-time activities co-ordinator. The Inspector observed that residents are able to bring photographs, pictures, ornaments and small items of furniture into the home with them so they are able to personalise their own bedrooms. Evidence found in the daily handover book showed personal details were being recorded about residents, this contravenes the Data Protection Act 1998 and was pointed out to the registered providers and the appointed manager. All personal information about residents should be entered into the care plan or residents daily report sheet on the care plan. Eight residents in the home have requested that their relatives/representatives look after their financial affairs. At the time of the inspection the newly appointed manager is in the process of arranging appointeeships via Local Authorities for five residents who have learning disabilities. There is no information in the home regarding external Advocates who would act on behalf of a resident. Observation by the inspector showed that residents are able to bring photographs, pictures, ornaments and small items of furniture into the home with them so they are able to personalise their own bedrooms. There was no evidence of a rotating menu in the home, but meals were written on to a white board next to the notice board in the basement of the home. Some of the residents are unable to read and the menu is not produced in any other format. This was discussed with appointed manager who will try to ensure that menus are produced in pictorial format that residents can relate to. The inspector spoke with two residents, one who could not remember what she was going to have for lunch, and the other resident who said that she was not informed what was for lunch. Both residents said that food generally in the home is good. The inspector observed at lunchtime on Care Homes for Older People Page 15 of 38 Evidence: the day of the inspection, residents had beef stew, one resident had omelet and another residents had a salad, there was also fish on the menu. Mealtimes were unhurried, but residents were not happy with the new dining arrangement in the communal lounge/dining room. The appointed manager said that he will make changes so that residents have individual tables to sit at instead of all tables being put together in the middle of the room. The home does cater for specialised diets as an when required and at the present time just caters for diabetic diet. One resident has a liquidised meal, but is presently in hospital. Care Homes for Older People Page 16 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents must be made aware of how to complain should they need to do so. Staff have the knowledge through training to ensure that residents are not abused. Evidence: The complaints policy and procedure needs to be updated to reflect the change of name and address of the Commission. The Complaints policy and procedure is displayed in the main entrance hallway of the home. The inspector found a complaint made by a relative in 2009 in daily report for one resident but this had not been recorded as a complaint in the complaints file. The AQAA dated 22nd February 2010 stated that there had been no complaints made to the home since the last inspection in April 2008. One resident said that she had not been given information about how to make a complaint. At the present time there is an open Safeguarding Vulnerable Adults referral lodged with East Sussex County Council which is being investigated. Another referral to East Sussex County Council has also been made by the newly appointed manager in relation to a member of staff. Both incidents have been reported by previous appointed manager and recently appointed manager to the Care Quality Commission. From viewing the staff training matrix the inspector found that twelve out of fifteen staff have received Safeguarding Vulnerable Adults training. From viewing staff Care Homes for Older People Page 17 of 38 Evidence: personnel files it was found that one member of staff had not been appropriately checked prior to employment. This will be reported on further in the staffing section of this report. Care Homes for Older People Page 18 of 38 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. Internally Ashridge House is warm and welcoming and provides residents with comfortable accommodation, further work needs to be done to the back garden of the home to ensure that it is safe for residents to use. Infection control procedures are in place and throughout the home is clean and tidy. Evidence: Ashridge House provides residents with a warm, well decorated and attractive home. The communal lounge/dining area of the home has a new carpet and is in good decorative condition. Three bedrooms viewed were in good decorative order, well furnished and homely. The back garden of the home now has railing fitted alongside a concrete path that runs along the full width of the garden adjacent to the home. The inspector did note that the concrete path is in poor condition and an area to one side of the building is accessible to residents but not safe posing a tripping and falling hazard to residents who may access it. Staff reported that they do not have a mobile hoist in the home and have to manually lift residents who fall. Care Homes for Older People Page 19 of 38 Evidence: The communal toilets, bathrooms and laundry were all maintained to a good standard of hygienic cleanliness. Communal toilets and bathrooms are fitted with equipment to assist with mobility. It was noted that the communal toilet in the basement the vinyl flooring is badly rippled which could place residents as risk of tripping. Staff are provided with disposable gloves and aprons, that are used for carrying out personal hygiene care and to clean up spillages. Care Homes for Older People Page 20 of 38 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. Sufficient care staff are not employed in the home at all times to ensure the needs of the residents are met and that residents are not left at risk. Prospective staff are not being appropriately vetted to ensure that residents are not placed at risk of abuse. The registered provider and manager must ensure that staff have the appropriate training to meet the needs of the residents. Evidence: At the time of this inspection the inspector found that there were two care staff on duty one of the care staff was senior carer, one domestic, one cook and a handyman. The appointed manager was not on duty at the beginning of the inspection and was called in for this key inspection. Therefore there were not sufficient staff on duty to meet the residents needs as two residents need two to one attention for personal care and this leaves other residents unsupervised. On viewing the staff rota, it was found that there are two care staff (one a senior member of staff) on duty throughout each shift of day. The appointed manager works a five day week usually Monday to Friday. A requirement is being made that care staff must be employed in sufficient numbers to meet the residents needs. Care Homes for Older People Page 21 of 38 Evidence: Only 46 of care staff working in the home have achieved their NVQ level 2 or above in Social Care. Four staff are in the process of working towards their NVQ level 2 qualification. The home should maintain at least 50 of staff with an NVQ level 2 qualification to ensure that residents are being supported by staff who have the skills and knowledge to meet their needs. The inspector viewed three staff personnel files and found that application forms had not been completed fully and do not give full employment histories. In two instances telephone references had been requested but information recorded in regard to these references was not sufficient. These three staff had been Criminal Records Bureau checked after their start of employment date, there was only evidence of one Protection of Vulnerable Adults register check again after the member of staff had been employed by the home. One member of staff was working long hours in the home on a Student Visa from the Home Office. The newly appointed manager had noticed this discrepancy prior to the inspection and had been in contact with the Home Office and had received instructions on how to deal with this situation, by reducing the hours worked to allow sufficient time for attending college and study hours. A requirement is being made that the manager must ensure he follows the Care Homes Regulation for the recruitment of staff and that staff are appropriately vetted prior to being deployed to work in the home. Not all staff have received mandatory training in Health and Safety related issues and this will be reported on under Management and Administration in this report. Some residents in the home suffer with a Dementia illness and staff have only received minimal training on Dementia which has not given them sufficient knowledge to meet these residents needs. There was evidence that eight staff have received training in administration of medication and administration of insulin. A few staff have also completed work related training in palliative care, the Mental Capacity Act and care of heart failure. Care Homes for Older People Page 22 of 38 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 registered providers have not provided a consistent management structure to enable residents to have their care needs met safely. The newly appointed manager is able to recognise the improvements that need to be made in the home to ensure that the residents needs are met. The quality assurance system needs to be developed so that a clear view can be obtained as to the quality of care that residents receive. Further improvements to staff training and the provision of a mobile hoist will help to ensure that residents and staff safety is not compromised. Evidence: It is of concern to the Commission that since the resignation of registered manager in January 2010 there have been two appointed managers in post in such a short space of time. New appointed manager in post for three weeks, previous appointed manager Care Homes for Older People Page 23 of 38 Evidence: left in just under one month. Previous registered manager resigned and this is the second appointed manager in the space of two months. The present appointed manager has NVQ level 3 and Leadership and Management for Care Services Award. At the present time some of his mandatory training is out of date. Discussion took place in regard to the importance of him keeping up to date with work related training and mandatory training. Also discussed was the importance of applying for registration with CQC. The inspector observed the manager acting in a professional and caring manner to diffuse a situation where a resident had become distressed about the dining area seating arrangement. The registered provider carries out regulation 26 visits and produces a report, but in respect of events that have occurred in the home recently in regard to finance and staffing issues it is clear that systems used in the home have not been monitored by the registered provider in depth. There has been no development on the quality assurance system in the home since the last key inspection. Some residents, relatives and stakeholder questionnaires were sent out in 2009, but no action was taken in respect of the replies to these questionnaires received back to the home. There has been no monitoring of systems used in the home or monitoring of staff competency after training has taken place. It is of concern to the Commission that since the resignation of registered manager in February 2010 there have been two appointed managers in post in such a short space of time. On the day of this inspection the inspector witnessed that the communal areas of the home were undergoing an inspection by a Health and Safety Company regarding the compliance of fire safety standards. There is no evidence in the home that regular fire or health and safety risk assessments have been carried out for individual rooms and communal areas since the last key inspection in April 2008. The inspector found no evidence that the home has an annual development plan in place to reflect the outcomes for the residents. Therefore a requirement is being made for a satisfactory quality assurance system to be implemented that is based on the views of the residents, their relatives and stakeholders, that regular monitoring of systems used in the home takes place and that regular risk assessments are carried out throughout the home and its grounds for fire and health and safety. From the findings of questionnaires and monitoring, an annual development plan must be formulated reflecting the future aims of the home and the outcome for its residents. The newly appointed manager has developed a system to ensure that good evidence is available in regard to residents personal allowances that are kept for safekeeping by the home. Each resident now has their own wallet containing their personal allowance monies and individual finance sheets, a record is kept of all monies coming in and going out together with any relevant receipts of expenditure. Both finance sheets and Care Homes for Older People Page 24 of 38 Evidence: personal allowance monies a kept securely and safely in the home. There is some concern that no infantry is kept of residents personal belongings brought into the home and where the home is requested to look after items of value there is no infantry to described the description of these items or to which resident they belong. As mentioned previously under staff training, not all staff in the home have received mandatory training in relation to health and safety issues - moving and handling, fire safety, first aid, infection control, health and safety. Staff informed the inspector that there is no mobile hoist in the home and that staff are expected to lift residents who fall and this could lead to further injury for residents and lead to staff injuring themselves while lifting. A requirement is being made in relation to health and safety practices and training. The AQAA dated 22/02/2010 states that the home has up to date maintenance certificates for all equipment and appliances used in the home. There was evidence in the home on the day of the inspection that regular weekly checks are carried out of the fire alarm call points and hot water delivery temperatures. Fire Extinguishers, emergency lighting and fire doors are all checked on a regular basis. The last staff fire drill was carried out on 22/02/2010. The home has an accident book where all resident accidents are recorded. The newly appointed manager has also devised a form for monitoring residents falls and accidents so that he can obtain assistance and advice from external health care professionals where residents are experiencing regular falls. Care Homes for Older People Page 25 of 38 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 13 13(2) The registered person must ensure that eye drops, ointments and liquid medication is dated on the bottle/tube on the day of opening, to ensure that medication is not used after 28 days and to ensure a good audit trial for liquid medication. The registered person must ensure that staff, are employed in sufficient numbers to meet the needs of the residents. 16/06/2008 2 27 18(1)(a) 16/06/2008 Care Homes for Older People Page 26 of 38 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 3 14 The registered person shall 31/05/2010 not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in Care Homes for Older People Page 27 of 38 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 respect of his health and welfare. Service users should not be admitted to the care home unless the staff have the skills the knowledge to meet the service users, health, personal and social care needs. That services users consent to the care needs they require. That the service user and or their relative/Representative signs the assessment to agree with the care needs identified. 2 7 13 The registered person shall 30/05/2010 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to health or safety of the service users are identified and so far as possible eliminated, and shall make suitable Care Homes for Older People Page 28 of 38 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 arrangements for the training of staff in first aid. All residents must have individual risk assessments that relate to the personal, health and social care needs, with clear guidelines for staff as to how they can reduce the level of risk to the residents. 3 7 15 Unless it is impracticable to 31/05/2010 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. (2) The registered person shall (a) make the service users plan available to the service user; (b) keep the service users plan under review; (c) where appropriate and , unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users plan; and Care Homes for Older People Page 29 of 38 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 (d) notify the service user of any such revision. Residents must be involved in the drawing up of their care plans so they are able to receive the personal health and social care they require. 4 8 13 The registered person shall make arrangements for service users (b) to receive where necessary, treatment, advice and other services from any health care professional. The home must produce evidence in care plans for each individual resident in regard to the contact they have with all health care professionals 5 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home Residents medication must be administered in accordance with the General Practitioners prescription. 30/04/2010 07/05/2010 Care Homes for Older People Page 30 of 38 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 All medication administered must be signed off on the Monthly Administration Record to show that residents have received their prescribed medication. Any residents who are self medicating must be risk assessed and monitored on a regular basis to ensure they are not experiencing problems in self medication. 6 10 12 The registered provider and 30/04/2010 registered manager (if any) shall, in relation to the conduct of the care home (a) maintain good personal and professional relationships with each other and with service users and staff; and (b) encourage and assist staff to maintain good personal and professional relationships with service users. Staff must respect residents living in the care home and ensure that derogatory remarks are not made especially in daily recording on care plans as residents have the right to view their own care plans. Care Homes for Older People Page 31 of 38 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 12 12 The registered person shall 14/05/2010 so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. Residents should not be expected to stick to a daily regime and should be able to make choices in regard to their daily living lifestyles. 8 16 22 (2) The complaints procedure shall be appropriate to the needs of service users. (3) The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. (5) The registered person shall supply a written copy of the complaints procedure to every service user and to any person acting on behalf of a service user if that person so requests. Any complaint made to the home by a resident or on the residents behalf must be recorded and investigated appropriately. 28/05/2010 Care Homes for Older People Page 32 of 38 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 Residents must be made aware of the complaint procedure in a format that they can understand. 9 19 13 The registered person shall 31/05/2010 ensure that (a) all part of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The vinyl flooring in the basement communal toilet needs replacing to that residents are not placed at risk of tripping 10 27 19 The registered person shall 14/05/2010 not employ a person to work at the care home unless (a) the person is fit to work at the care home: (c) he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. 4 (b) the employer has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of Schedule 2. The registered person must ensure that all prospective Care Homes for Older People Page 33 of 38 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 staff are appropriately vetted prior to them taking up employment in the home to ensure that residents are not placed at risk of abuse. 11 27 18 The registered person shall, 31/05/2010 having regard to the size of the care home, the statement of purpose and the number and needs of service user ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff must be employed in sufficient numbers so as to meet the residents needs in relation to their health, personal and social care. 12 31 10 The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. The registered provider 10/05/2010 Care Homes for Older People Page 34 of 38 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 must ensure that the care home is managed in complianance with the Care Standards Act 2000 and the The Care Homes Regulations 2001. 13 33 24 The registered person shall establish and maintain a system for (a) reviewing at appropriate intervals; and (b) improving the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. The registered person must develop a quality assurance system, that includes seeking views of residents, relatives, stakeholders and regular reviewing of systems used in the care home to ensure that the residents receive the best quality of personal, health and social care. 14 33 26 Where the registered 31/05/2010 provider is an individual, but not in day to day charge of the care home, he shall visit the care home in accordance with this regulation. (4) The person carying out the visit shall (a) interview, with their 31/05/2010 Care Homes for Older People Page 35 of 38 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 consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; (b) inspect the premises of the care home, its record of events and records of any complaints; and (c) prepare a written report on the conduct of the care home. The registered provider must ensure that monthly visits to the home are detailed and ensure that the home is being managed where quality of care and interests of residents are reflected in the day to day management of the home. 15 38 18 The registered person shall, 31/05/2010 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are Care Homes for Older People Page 36 of 38 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 appropriate for the health and welfare of service users. At all times there must be appropriately experience staff on duty to ensure the health and safety of residents. 16 38 13 The registered person shall 28/05/2010 make suitable arrangements to provide a safe system for moving and handling service users. Staff must have access to a mobile hoist which they will use for residents who have fallen and need assistance, this is to ensure the safety of residents and staff. 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 14 The newly appointed manager to continue with appointeeship work with Local Authorities for five of the residents. Menus to be produced in pictorial format so that all residents are able to relate to what food they are being offered at each mealtime. 2 15 Care Homes for Older People Page 37 of 38 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. © 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. Care Homes for Older People Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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