Inspection on 20/01/10 for Ashville Care Home

This inspection was carried out on 20th January 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashville Care Home 09/02/09

Ashville Care Home 20/02/07

Ashville Care Home 13/01/06

Ashville Care Home 30/06/05

Ashville Care Home 04/02/05

Ashville Care Home 20/07/04

Ashville Care Home 16/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Ashville Care Home 58 Sandmoor Garth Idle Bradford West Yorkshire BD10 8PN     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: Mary Bentley     Date: 2 0 0 1 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 32 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 32 Information about the care home Name of care home: Address: Ashville Care Home 58 Sandmoor Garth Idle Bradford West Yorkshire BD10 8PN 01274613442 01274618273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashville Care Home Limited 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 dementia Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Dementia - Code DE Date of last inspection Brief description of the care home Ashville Care Home is in Idle, an area about three miles from Bradford City Centre. It is registered to provide care for up to twenty-nine older people. The home is just off the main road and is well served by public transport. There is car parking to the front of the property. There is level access to the main door of the home and a stair lift is fitted to allow people with mobility problems to reach the bedrooms Care Homes for Older People Page 4 of 32 Over 65 0 29 0 9 0 2 2 0 0 9 Brief description of the care home located on the first floor of the building. The home does not have a passenger lift. All the communal areas are on the ground floor of the home. There are three lounge areas and one main dining room. The home had 3 double rooms but one of these has been changed to single occupancy. Many of the bedrooms have en-suite facilities which consist of a toilet and wash basin. There are three communal bathrooms and toilets, which are within reach of bedrooms and lounges. In January 2010 the fees ranged from 397.00 and 463.00 pounds per week. Additional charges are made for hairdressing, private chiropody treatment, reflexology, taxi fares and magazines if purchased by individuals and not provided by the home. Care Homes for Older People Page 5 of 32 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 is what we used to write this report: The results of any visits that we have made to the service in the last 12 months. We have not made any additional visits since the last inspection which was carried out on 9 February 2009. Surveys returned to us by people using the service or from people with an interest in the service. On this occasion we received 10 surveys from people living in the home and staff. Some of the surveys sent to people living in the home were completed by relatives on their behalf. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are Care Homes for Older People Page 6 of 32 called notifications and are a legal requirement. Relevant information from other organisations. A site visit carried out by one inspector between the hours of 9:30 am and 5:45 pm. The visit was unannounced. We were accompanied by an Expert by Experience from the organisation Help the Aged/Age Concern. An expert by experience is a person who, because of their shared experience of using care services, is able to help us get a better picture of what it is actually like for people using the service. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records,looked at some parts of the home and observed staff as they carried out their duties. The home had not received the annual quality assurance assessment (AQAA) when we visited. They have agreed to complete it and send us a copy as soon as possible. The home did not have a registered manager when we visited. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: During the visit we found that some peoples nutritional needs were not being identified and met. We discussed these concerns during the visit and following the visit we wrote to the owners to tell them what they needed to do to address these concerns. We will be following this up to make sure appropriate action is taken. When we inspected last year we told the home that the storage facilities for medicines classified as controlled drugs were no longer acceptable due to a change in the law. During this visit we found that although alternative arrangements had been made they were not appropriate. We have written to the home about this and we will be following it up to make sure safe storage is provided. At the last inspection we told the home that improvements were needed to the care records to reduce the risk of peoples needs being overlooked. They told us they would deal with this. During this visit we found shortfalls in the care records which contributed to some peoples needs being overlooked. This must now be dealt with to make sure people receive the care they need. At the inspection in February 2009 we told the home that more needed to be done to make sure peoples social care needs were identified and met. They told us about their Care Homes for Older People Page 8 of 32 plans to improve this aspect of the service. During this visit we found that improvements have not been made and peoples daily life has not improved. There is no outside space that is safe and suitable for use by people living in the home. This means that even when the weather permits people are not able to go outside to get fresh air and exercise. This has been an issue for some time and must now be dealt with. The home has been without a registered manager since September 2009. It was clear from our observations during the visit that staff are lacking leadership and support and despite their best efforts are finding it difficult to meet peoples needs. A new manager has been appointed and was due to take up her post in the week following our visit. She is enthusiastic about her role and is aware that a lot of improvements are needed. She will need support from the owners to make sure she is able to implement these improvements. 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 32 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 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the service and their needs are assessed before they move in. Evidence: We received six surveys from people living in the home. They told us they had been given enough information about the service before moving in. The home told us they have not had any new people move in since July 2009. They told us that people or those close to them are encouraged to visit the home before making a decision about moving in. The home carries out an assessment of peoples needs before they move in, this is to help make sure they will be able to meet peoples needs. We saw evidence of this in the care records. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are shortfalls in the care records and peoples personal and health care needs are not always identified and met. People or those close to them are not involved in drawing up their care plans and therefore care may not always be given in a way that takes account of peoples wishes and abilities. Evidence: When we visited last year we told the home that they must improve the way peoples care records were kept to reduce the risk of peoples needs being overlooked. During this visit we looked at three peoples care records. We saw that the home has started to take action to improve the care records, for example last year the home had completed assessments to identify peoples needs but not put any plans in place to show how those needs would be met. On this occasion we found that care plans had been put in place and some of them had details about peoples individual needs. However, we also identified a number of shortfalls. For example in the records we Care Homes for Older People Page 12 of 32 Evidence: looked at the care plans had been written in July and November 2009 but none of the care plans had been evaluated since then to show whether the actions were effective or not in meeting peoples needs. We did not see any evidence that people or those close to them are involved in planning and reviewing care. Staff told us that relatives can look at the care plans however when we spoke to relatives they told us they did not know anything about them. In one persons records the care plan relating to eating and drinking said they required a soft diet and needed to have fluids thickened. When we looked at the persons weight records we found they had not been weighed since January 2009 and at that time their weight was recorded as 33.10 kg. The records showed that the person had lost weight since November 2008 when their weight was last recorded. The care plan for eating and drinking gave no indication that this persons low weight was a cause for concern. A nutritional assessment had not been completed and there was no evidence that other professionals such as the GP or district nurses had been asked for advice on how to manage this persons weight loss. Staff told us they were completing a fluid chart, this showed that some staff were recording what the person had to eat on occasions but this was not done consistently and there was no way of knowing what the person was actually eating. In the other two peoples records we saw that nutritional risk assessments had not been completed. One of these people had lost weight since admission and the other person was someone the home told us they were concerned about because of their nutritional status. The home has a weighing scales however discussions with staff indicated that they have difficulty understanding the relationship between imperial and metric measurements and there was no conversion chart available in the home. During the visit we saw two people sitting in the lounge in the night clothes at lunch time. When we asked staff about this they said it was because people no longer had clothes to fit them because they had lost so much weight. They also said the people in question were only out of bed for a short time during the day because they are at risk of developing pressure sores. We discussed our concerns about how peoples nutritional needs are met and following the visit we wrote to the home telling them they must take immediate action to address these concerns. We will be following this up. Visits from health and social care professionals are recorded. Care Homes for Older People Page 13 of 32 Evidence: In one persons records we saw that a mental capacity assessment had been carried out and an advocate had been identified. In another persons records there was an entry saying the person was unable to make decisions about their care but there was no information about who would make these decisions on their behalf. There was no information about peoples wishes with regard to end of life care. We looked at how medicines are managed. When we visited last year we told the home the should provide suitable storage for medicines classified as controlled drugs. The home has purchased two new medicine trolleys, however, they do not meet the requirements for the storage of controlled drugs. Following the visit we wrote to the home about this and told them they must provide suitable storage facilities. When we looked around we found creams that had been prescribed for individuals in other peoples rooms. This could mean that the person for whom the cream was prescribed was not receiving it and that people could be receiving unprescribed medicines in the form of creams. There is also a risk of cross infection. This was discussed during the visit. During the visit we saw that staff were kind and respectful in their interactions with people. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always given the support they need to follow their personal interests and make the most of their abilities. Evidence: The care records we looked at had very little information about peoples backgrounds, their family and/or friends or their interests and there were no social care plans. The records have a sheet where staff record activities people have taken part in. The records we looked at showed that people spend most of their time in the lounges, watching TV or chatting. The acting manager showed us a personal profile record which he is planning to introduce. However, it is a concern that this information is not already available to help staff know and understand the people they are caring for. There is an activities programme displayed in the entrance area but there was no evidence that this is actually followed. The home does not have a dedicated activities organiser therefore it falls to care staff to do what they can to provide stimulation for people. Relatives spoken to during the visit and relatives who completed surveys for us commented on this. One said The carers are good but they are always busy with Care Homes for Older People Page 15 of 32 Evidence: things and dont get enough time to spend with people. Another said I havent seen any activities going on. and another said they would like to see more creative activities and more use of the garden when the weather permits. When we visited in February 2009 the home told us they were planning to employ an activities organiser and it is disappointing that no progress has been made on this. The home has a motivation session once a month run by an external agency. Staff told us there is Karaoke which people enjoy as they like to sing and dance. Visitors told us they can visit at any time and said they are always made welcome. The Expert by Experience spent time observing what daily life is like for people living in the home and these are some of her findings. During the day we observed that most people were just sitting around in the two smaller lounges, which were full, there was no stimulation other than the TV which at times was showing childrens programmes. After lunch a carer in the dining room was helping a person to do a jigsaw. The carers interacted well with people, providing guidance when necessary. She observed staff speaking to people respectfully and there was an exchange of friendly banter. As a team, staff were observed displaying positive interactions with people when carrying out their duties. People were spoken to by name, given eye to eye contact and staff explained what they were doing or where people were going. Staff told us it is difficult to meet peoples spiritual needs because of their confusion, however, this may not be the case for everyone. This is not helped by the lack of information about peoples life histories. The Expert had a meal with people at lunch time. People have a light meal at lunch time and the main meal is served in the evening. She found that the tables were not set, there were no tablecloths, serviettes, condiments or utensils. Each person was given their meal which arrived with the appropriate cutlery. Some tables has plates of buttered white bread to go with the soup, other tables did not. people were putting their bread on the table because there were no side plates. Some people were given a choice by staff showing them plated example, this is good practice. Pureed food was available for people who needed it. People were given time to eat their food but there was no way of monitoring what people had eaten or if they Care Homes for Older People Page 16 of 32 Evidence: had even received their meal. One person was asked by staff if they had enjoyed their dinner when they hadnt had any, on this occasion the person was able to say they hadnt had any but other people may not be able to. This was discussed. Many people did not have any dentures and one person without dentures seemed to have some difficulty with the pastry. We saw that a number of people looked quite thin although staff said people are well fed. After lunch one person said I enjoyed my dinner and another said this puddings lovely. During the visit the Expert had the opportunity to talk to the cook. There is nothing written down about peoples dietary needs and preferences. The cook said she knows everyones likes and dislikes and knows if people need a special diet. This information should be recorded so that it is available to everyone and to reduce the risk of peoples needs being overlooked. The home only has one cook, we asked who does the cooking when she is not there and the acting manager told us that sometimes the cook prepares the meals before her days off and sometimes they buy in food such as fish and chips. The home has four weekly menus and people are offered a choice at every meal. We saw drinks being served throughout the day and biscuits were served with morning and afternoon tea. However, there was no snack or finger food available for people. Care Homes for Older People Page 17 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure that complaints are listened to and acted on and to make sure that people are protected. Evidence: The home told us they have not had any complaints in the last 12 months and none have been referred to us. Information about the complaints procedure is not displayed in the home. However, the home sent a copy of the complaints procedure to everyone in December 2009. Six people who completed surveys for us said they know how to make a complaint if they need to. There is a suggestions/comments box in the entrance. Staff told us they have received training on the protection of vulnerable adults (safeguarding). They were able to give examples of what abuse is and know how to report any concerns they might have. There have not been any safeguarding referrals in the last 12 months. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is clean and comfortable but more needs to be done to make sure it is suitably equipped and maintained to meet the needs of the people living there. Evidence: The home has a secure entry system which means that people have to ring to be let in. However, when the Expert by Experience arrived she was let into the home, by two staff who were going out, without being asked to identify herself. As she had not visited the home before and was not known to staff. This could potentially put people at risk and staff need to be more vigilant about letting people they dont know into the home. The communal rooms are on the ground floor and consist of 3 lounges and a dining room. In one of the lounges a radiator had been removed leaving an exposed pipe jutting out which could have caused someone an injury. This was discussed and as a temporary measure a settee was moved in front of the pipe to reduce the risk of injury. There is no outside space suitable for use by people living in the home. There is a fairly large enclosed area at the back of the home but this is not a safe area for people because the roots of a large tree have lifted the tarmac making the surface very uneven. The tree is subject to a protection order and the home has been in Care Homes for Older People Page 19 of 32 Evidence: negotiations with the local council for several years to try to resolve this but as yet no agreement has been reached. When we visited this area was showing signs of neglect and did not present a pleasant view to anyone looking out of the dining room or bedroom windows. It was overgrown with weeds, littered with discarded cigarette ends and there was broken furniture left lying around. Another smaller enclosed area has fallen into a similar state of disrepair. When we looked around we found the home was generally clean. There was on odour in one bedroom but the home told us they are taking action to deal with this. At the last inspection we identified some concerns about the availability of hot water in some bedrooms, this has now been dealt with. Before we visited one person told us there had been a problem with the heating in some parts of the home in November 2009. This has now been dealt with and when we visited the temperature throughout the home was comfortable. Peoples bedrooms are suitably equipped and most people have personal belongings in their rooms, some more than others. There is very little signage around the home to help people find their way around. The acting manager told us about plans to put new sign on the bedroom doors. We identified a number of maintenance issues when we looked around and these were discussed. The owner was in the home on the day we visited preparing a refurbishment plan and the home have agreed to provide us with a copy of this when it is ready. The laundry is is the basement and is located in a boiler room which means it is very warm and cramped. There is not enough storage space and we found clean laundry thrown on the floor. The home only has one tumble dryer and it was not working properly when we visited which meant the laundry assistant was trying to dry clothing by hanging it from overhead pipes. The home only has one washing machine, this has a sluice cycle for soiled clothing. However, because the sluice cycle takes a long time it is difficult to keep up with the volume of laundry and return peoples clothing quickly. Peoples clothing is labelled however relatives told us they sometimes get mixed up and said on occasions they have seen other people wearing their relatives clothes. This was discussed during the visit and management team said they take would action to address this. There are hand washing facilities throughout the home and hand gels are provided to Care Homes for Older People Page 20 of 32 Evidence: help reduce the risk of cross infection. However, we identified some working practices which potentially increase the risk of cross infection, for example in one of the ground floor toilets we saw soiled clothing thrown on the floor before lunchtime and it was still there at 2.00 pm, this was discussed with the acting manager. The home has been given a 4 star (the highest is 5) rating by Environmental Health for its standards of food safety and hygiene. Care Homes for Older People Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually enough staff to meet peoples needs. However, more needs to be done to make sure that staff are getting the leadership and support they need to enable them to care for people properly. Evidence: People told us the staff are kind and caring. They said staff are usually available when they need them and usually listen and take notice of what they say. During the visit we saw that staff were kind and respectful and they showed a genuine affection for the people they care for. There are usually 4 care staff on duty in the morning, 3 in the evening and 2 overnight. Staff said this is usually enough to meet peoples needs. Some staff felt they do not get enough support from the management team particularly when it comes to making sure that peoples social care needs are met. Staff told us they get the training they need to help them understand and meet peoples needs. They said they have done training on safe working practices such as moving and handling and infection control and on other subjects such as dementia care and palliative care. The training records were not up to date but copies of training certificates were available in the staff files. Care Homes for Older People Page 22 of 32 Evidence: The home provides NVQ (National Vocational Qualification) training and 16 of the 21 care staff have achieved an NVQ at level 2 or above. The home has staff meetings but they seem to have lapsed, the most recent was in August 2009 when the manager told staff she was leaving. A plan for staff supervision for 2010 was seen, however it was not clear how often staff supervision had been done in 2009. In view of the management situation it is essential that there are effective systems in place to make sure staff are getting the leadership and support they need to care for people properly. We looked at the files of two newly appointed staff and they showed that all the required checks had been completed before they started work. Care Homes for Older People Page 23 of 32 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. More needs to be done to make sure that people experience good quality outcomes in all areas of the service. Evidence: The registered manager left the home in September 2009. We were not informed, this was discussed during the visit as providers have a legal obligation to inform the Commission about changes involving the registered persons. When we visited the administrator was in the position of acting manager. The owners have identified an new manager; she is an existing member of staff and was due to take up her post in the week following our visit. We spoke to her during the visit, she is very enthusiastic about her new role and has a lot of ideas about how to improve the service. The owners assured us she will have their full support. The home has not received their annual quality assurance assessment (AQAA) when we visited, they agreed to complete it and send it to us following the visit. Care Homes for Older People Page 24 of 32 Evidence: The home has policies and procedures in relation to the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). Some staff have received training on the Mental Capacity Act, it wasnt clear if training on DoLS has taken place. There was some information in the care records about peoples capacity to make decisions, however it wasnt always clear who was representing people who are not able to make decisions. As part of their quality assurance system the home sent questionnaires to people in December 2009. When we visited they had not all been returned. We saw a sample of responses and generally they showed that people are satisfied with the service. The acting manager told us the responses would be analysed and action taken to address any areas for improvement identified by people. The owners carry out monthly visits to the home, the reports from these visits were not available in the home, they had been taken for filing. Following the visit we were provided with copies of the reports from the last two visits. The reports highlighted some concerns about the environment and about staff morale. It was noted that staff were feeling they lacked leadership and support in the absence of a manager. However, we are concerned that the management team had not identified the concerns about peoples well being that we have highlighted in this report. There are no meetings for people living in the home or their representatives and people told us they are not involved in planning and reviewing care. The home used to do a newsletter to keep people informed about changes and developments but this has not been done since June 2009. When we visited last year the home told us they do not hold any money for people. Any extra services that are provided are charged on the monthly invoices. We confirmed that this situation has not changed. During the day we saw that people were being moved around in wheelchairs without foot plates. We asked staff about this, they said the night staff had removed the foot plates and they could not find them. We saw the foot plates in a bathroom on the first floor when we were looking around the home. Staff told us they have had training on moving and handling, however, there were no moving and handling assessments in the care records. The records showed that weekly tests are done on the fire alarm system and staff told us the have had training on fire safety. The home has a current gas safety certificate to confirm that gas appliances are safe to use. Care Homes for Older People Page 25 of 32 Evidence: Care Homes for Older People Page 26 of 32 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 15 Everyone living in the home 12/06/2009 must have a care plan which sets out in detail how their assessed needs in relation to personal, health and social care are to be met. This is to make sure people get the care and support they need in a way that takes account of their wishes and helps them to make the most of their abilities. Care Homes for Older People Page 27 of 32 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 8 12 Everyone living in the home 03/02/2010 must be weighed or their nutritional status established by using the alternative assessment as set out in the Malnutrition Universal Screening Tool (MUST). People who are at risk must be identified and suitable measures must be put in place to address this to include making sure the care plans relating to eating and drinking are updated and provide clear guidance for staff on the actions to take to deal with this. People who are identified as being at risk must be weighted at least every two weeks until their weight has reached an acceptable level. The Commission must be provided with the information requested in our letter of 21 January 2010. To make sure peoples nutritional needs are identified and met. 2 9 13 Storage facilities which comply with current legal requirements must be provided for the storage of Controlled Drugs. To make sure that medicines are stored securely and in accordance with current legislation. 26/02/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Everyone living in the home 19/03/2010 must have a care plan which sets out in detail how their assessed needs in relation to personal, health and social care are to be met. This is to make sure people get the care and support they need in a way that takes account of their wishes and helps them to make the most of their abilities. 2 12 16 People living in the home 19/03/2010 must be supported to take part in a range of social and leisure activities that take account of their interests and abilities and this includes providing opportunities for people to take part in activities outside of the home. To make sure that peoples individual social, cultural and spiritual needs are met. 3 19 23 Outside areas which are safe 19/03/2010 and suitable for use by people must be provided and appropriately maintained. Care Homes for Older People Page 29 of 32 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 So that people have access to a safe outside area where they can get fresh air and exercise. 4 33 24A The Commission must be provided with an improvement plan setting out how the service will be improved and this must include details of what action is to be taken, the person responsible for the action and the timescales. This is to make sure appropriate action is taken to protect people from unnecessary risks and to make sure people experience good quality outcomes. 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 19/03/2010 1 2 8 8 Staff should receive training on nutrition and in particular the nutritional needs of people with dementia. Advice should be obtained from health care professionals, for example, GPs and dieticians on how to meet the needs of people who are identified as being nutritionally at risk. A weight conversion chart should be provided to help staff understand the relationship between imperial and metric measurements, this will make it easier for them to identify when people have a low body weight. 3 8 Care Homes for Older People Page 30 of 32 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 4 9 More care should be taken to make sure that prescribed creams and only given to the people they have been prescribed for and to the recording of the administration of prescribed creams. More attention should be given to making meal times a social and pleasant occasion for people. More attention should be given to providing snacks outside of set meal times and finger food should be available for people to help themselves to. 5 15 6 15 A monitoring system should be introduced at meal times to make sure that everyone is getting their meals. Information about peoples dietary needs and preferences should be recorded so that this information is available to everyone, this will reduce the risk of peoples needs being overlooked. A copy of the refurbishment plans which include timescales for planned work should be sent to the Commission. This should include details of planned improvements to the laundry. Staff should be more vigilant about security and in particular about challenging visitors when they are entering the home. More attention should be given to making sure that control of infection procedures are followed. More care should be taken with peoples personal clothing to make sure people are able to wear their own clothes. The new manager should apply for registration with the Commission. Moving and handling assessments should be carried out to make sure that potential risks are identified and there are measures in place to deal with these risks. 7 19 8 19 9 10 11 12 26 26 31 38 Care Homes for Older People Page 31 of 32 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. 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