Inspection on 05/05/10 for Ashwood Lodge Care Home

This inspection was carried out on 5th May 2010.

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

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

Other inspections for this house

Ashwood Lodge Care Home 16/06/09

Ashwood Lodge Care Home 27/06/08

Ashwood Lodge Care Home 29/06/07

Ashwood Lodge Care Home 04/07/06

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Ashwood Lodge Care Home Bedale Avenue Billingham Cleveland TS23 1AW     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: Jacqueline Herring     Date: 1 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Ashwood Lodge Care Home Bedale Avenue Billingham Cleveland TS23 1AW 01642361122 01642363710 ashwoodlodge@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nationwide Healthcare Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 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 categories: Old Age, not falling within any other category - Code OP, maximum number 27 Dementia, Code DE, maximum number 27 Date of last inspection Brief description of the care home Ashwood Lodge is a 27 bedded care home registered to provide care to older people for personal care and people with dementia. The home is situated in a residential area of Billingham. All rooms used and occupied by the residents are on the ground floor. The home provides both single and shared bedroom accommodation. Two of the Care Homes for Older People Page 4 of 33 Over 65 0 27 27 0 Brief description of the care home bedrooms have en suite toilet facilities. Both lounge and dining areas are provided for those residents who wish to socialise. The home provides car-parking facilities for visitors. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is no stars. This means the people who use this service experience poor quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by two inspectors across two inspection days. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Discussion also took place with the interim manager of the service, a number of staff and with people living at Ashwood Lodge. Care Homes for Older People Page 6 of 33 Surveys were also sent to the service, six were completed and returned by people who live at Ashwood Lodge, two by relatives, three from visiting health professional and eight by staff members. The Annual Quality Assurance Assessment had not been completed and returned. We have reviewed our practice when making requirement to improve national consistency. Some regulations 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 the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: There is currently no manager in post and it has been a significant time since the service has had a manager who has been registered with CQC. Steps must be taken to address this and a manager must be appointed and registered with CQC. A number of areas of serious concern were identified during this key inspection. The majority of this related to the environment which did not ensure safety to people living within the home. Immediate action was taken to address these matters. They included, unprotected electric heaters, unrestricted access to the kitchen, laundry and ironing room and a number of unrestricted windows. In addition, the fire alarm checks and water temperature checks were not being carried out at the intervals needed. Other improvements are also needed to the environment, including; locks needed to be fitted to bathroom, shower room and toilet doors, these areas also needed to improved in the way of decor and lighting and bedroom furniture needed to be replaced. A number of other areas were identified that needed to be improved upon. Assessments and care plans need to contain more specific detail to ensure that all aspects of peoples health and personal care needs are met fully. The pre admission assessment also needs to contain more detail and it needs to show that the service is able to meet peoples needs once they are admitted. Where accidents and incidents occur, the home must ensure that appropriate investigation is conducted to minimise or prevent further risk. There were some gaps on the medication administration records and there were discrepancies with some of the stock levels, on occasion there being too many tablets or less than there should have been. There needs to be effective audits systems in place for the management of medication. The temperature of the room in which medication is stored continues to be hot, this needs to be monitored and if it continues to be too hot additional measures to remedy this will have to be taken. The range and opportunities for social and recreational activities needs to be further Care Homes for Older People Page 8 of 33 developed and should include life history work. Menus should be reviewed. The complaints procedure should be updated so that people know who to go to should they want to make a complaint. New staff need to complete a relevant induction and all staff need to have regular formal supervision. Staff also have to have the training needed to do the job in a safe and knowledgeable way. This includes both mandatory and client specific training. The quality assurance and management systems need to be developed and implemented and should be able to demonstrate that they are operating on the best interests of people living at the home. The providers visits (Regulation 26 visits) must be conducted on a monthly basis and a report should be produced and be available within the home. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have their needs assessed in sufficient detail prior to be admitted to the service. Evidence: No AQAA was available. It was found in the service but had not been completed. Three sets of care records were looked at, one for the most recent person admitted to the service, one person with complex dementia care needs and one for someone who had lived at the home for some time who had personal care needs. Whilst pre admission assessments take place, care is needed with the level of detail contained within these. The most recently admitted person was admitted for a period of emergency respite care. The assessment was very brief and contained limited information about the person and their needs, there was also no care managers assessment available, this had not been requested. From the information available, it Care Homes for Older People Page 11 of 33 Evidence: was unclear what the persons full range of needs were or whether the service were able to meet these needs. No judgment about this had been included in the pre admission assessment. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not detailed enough. Improvements are needed in the management of medication. Evidence: Three sets of care files were looked at in detail. One for someone who had more complex dementia care needs, one for someone who had lived at the home for some time and one for the most recent respite admission. It was unclear if a full assessment had been completed as the physical and social assessments starts at number six, one to five were not available within any of the files and these would have included areas such as maintaining a safe environment, eating and drinking and continence. Additional risk assessment were in place for some of these areas. Care is needed with the completed of the care needs assessment as there was limited information recorded, these were very much of a box being circled rather than actual comment about the individual and their needs. In two of the care files looked at, the Care Homes for Older People Page 13 of 33 Evidence: aforementioned assessments were in place along with a range of other assessment tools that measured risk of pressure damage, falls and nutrition amongst others. This were being updated monthly and care plans were generally being evaluated monthly. In one of the files looked at there were a range of care plans in place, which were being evaluated monthly. There were however areas of need identified for which care plans had not been developed, this included a person becoming depressed and being prescribed antidepressant medication by their GP. In the daily records of care for this person it detailed that the District Nurse was attending to change dressings, this was not reflected in the assessment of need and there was no care plan in place. In the second file looked at, a number of the care plans had not been evaluated since March 2010. The monthly diary that is completed, only made reference to the persons mobility needs, there was nothing about their daily life, how they spent their time or how they had been over the past month. There was also some concern about the person being weighed as it was recorded, Unable to do in Jan, Feb, March. The person has since been weighed and it was confirmed that sit on scales are available. As identified within the first care file, a number of areas of need were identified through looking at these records for which no assessment or plans of care were in place. This person had more complex needs associated with their dementia. There was no psychological profile, no evidence of CPN involvement, no plan for when this person becomes aggressive and no record of any incidents that have taken place. There was evidence of other professionals being involved in peoples care such as the GP and district nurses. One person living at the home was very positive about the care provided. They said, The staff are helpful and friendly. My relative tells me my hair has never looked so good and I see the chiropodist, dentist etc, regularly. Its so much easier not having to organise it all myself. Three surveys were received from visiting health professionals, they were positive about the service and care provided. The medication system was looked at. The actual room in which the medication is stored is too hot, although there is a portable air conditioning unit in the room, this needs to be monitored further and steps need to be taken to ensure that medication is stored at the correct temperature. One person had not had their bowel medicine for some time, it was recommended that Care Homes for Older People Page 14 of 33 Evidence: if this was no longer needed then it should be reviewed by the GP. There were also some discrepancies with the amount of tablets still available, two more of one type of medication, one more of another type and one less of yet another. One person was prescribed a cream, this is not being signed for and again there were some additional tablets in place and gaps on the Medication Administration Record (MAR). Since the last inspection, the home has changed its registration from a care home with nursing to a care home for personal care, as such, there are no longer nursing staff available and it is the role of senior carer staff to administer medication. It was confirmed that all staff have the appropriate training in place. It was recommended that one staff members training be reviewed as it was unclear if this fully equipped them to be carrying out this task. It was also recommended that contact be made with the local pharmacy advisors from the PCT, with a view to carrying out an audit and offering further advice to the service. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People need to have more opportunities for recreational and social activities, which takes account of lifestyle and preferences. The menu needs to be reviewed so that it offers a comparable choice and the availability of fresh fruit and vegetables also needs to be looked at to ensure there is sufficient quantities. Evidence: A weekly activities programme is on display in the home and a copy was made available. There is no one employed to undertake the role of organising and delivering activities. Staff spoken to said they did what they could when they had time. They confirmed that the current programme did not take place. One member of staff said, Cant really do very much, no staff really to be able to do activities. Another member of staff said, Cant spend time with people. Some staff had tried to do some activities with people, planting seeds and going outside to the newly decked area when the weather was better. One person living at the home said, I sometimes feel a bit isolated and wish the staff could spend more time with me. Another person said of what the service could do better, More activities as there is none at present except for the telly which bores me. Care Homes for Older People Page 16 of 33 Evidence: People are able to have their relatives and friends visit when they choose to and they are able to keep in touch with them. The menu was looked at and whilst there was a choice on the menu is was not a comparable choice, for example the second choice would usually be a salad or sometimes beans on toast. Staff were spoken to about the meals, one person said, Home cooked/lovely choice. Quite good, lunch always a hot meal and desert, could do with more variety. The menu was looked at against the the food available in the kitchen, as the full weeks supplies had just been delivered. There was some concern about the quantity of fresh fruit, vegetables and salad, there was three cabbages, three leeks, three swede, three apples, three cooking apples, four under ripe bananas, six tomatoes, one lettuce and one cucumber, on the menu peoples second choice was up to four salads during the course of the week. There were items on the menu for this week, which were not in stock, for example, salmon salad, the cook said they never had salmon but there was tuna. It also specified pate on toast for five nights per week, there was no pate it was actually meat paste. One of the cooks also said they thought there was insufficient eggs for the week, there is a delivery of sixty eggs per week, eggs are on the menu everyday for breakfast and there are a further three meals that are egg based as well as any baking that takes place. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have not been protected by the policies and procedures in place within Ashwood Lodge. Staff have not received sufficient training or supervision to ensure they follow the correct procedures to promote the protection, welfare and wellbeing of the people they are caring for. Evidence: Four complaints had been recorded in the complaint record and in the main looked as if they had been appropriately handled. The actual complaints procedure does however need to be updated and there were two different versions in use. The procedure needs to be clearer and needs to specify who to take the complaint to if this can not be resolved by the provider. The contact details for all funding authorities are also needed. There is a copy of the Teeswide Protocols for Safeguarding of Vulnerable Audlts available. It was however unclear what staff had received training in regard to this or how up to date this training is as there is no training log or matrix available. Of three staff files looked at, only one contained any evidence that they had received this training. Care Homes for Older People Page 18 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from an environment that keeps them safe at all times and does not promote dignity. Evidence: A visit was made to the service and all communal areas were looked at including bathrooms, shower and toilets also a number of peoples bedrooms were visited. It was concerning to see that a number of bathroom, shower room and toilet doors did not have locks fitted which would ensure peoples privacy and dignity. Areas of risk were identified from the use of portable electric heaters, which were not low surface temperature as well as electric wall mounted electric heaters. Not only are these unsuitable for a care home environment, there was also no evidence to show they had been electrically tested prior to use or since. Immediate action was taken to address this, with them being put out of use or it was agreed that where there was a particular problem with the heating that arrangements to use a small number in the interim was permissible with a detailed individual risk assessment, increased observation of these areas and the necessary checks being completed. Other areas of risk was the access to the kitchen and laundry room, both of which were open and accessible to people living at the home, immediate action was taken to Care Homes for Older People Page 19 of 33 Evidence: address this. The laundry door did have a working lock so immediate action was taken and staff were instructed that this room must remain locked when staff were not in it. A number of unused bedrooms were fully of old equipment and mattresses, these areas were not locked and again posed potential hazards to people. A number of windows in the home could not be opened as they had been painted closed. In one bedroom the window was open and was unrestricted, again action was requested to address this and for a fully window check to be carried out. The bathrooms, showers and toilet were not particularly pleasant or welcoming environments, they all need to be decorated and freshened up. New toilet roll holders are needed as the current toilet rolls do not fit into the existing dispenser as such they are place anywhere near to the toilet. The shower room needs to be thoroughly cleaned as there was mildew around the walls and the shower curtain. Consideration should be given to removing the second shower from the shower room. Although there is a routine maintenance book, there are currently no arrangements in place to have this routine work completed. Items recorded within this book included broken toilet seats. At the last inspection a recommendation was made about the bedroom furniture, a number of bedrooms had broken bedroom furniture, this is not acceptable. It is also recommended that some research is completed in regard to appropriate environments for people with dementia and this should be incorporated into the environment at Ashwood Lodge. Care Homes for Older People Page 20 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the way the home recruits staff however induction training and other training does not fully ensure safety and wellbeing of people living at Ashwood Lodge. Evidence: On the first day of inspection, staff recruitment records and training records were not accessible to the inspector. These were available on the second inspection day. Three staff files were looked at, they contained all of the required information including completed application form, appropriate references and Criminal Records Bureau checks. There was evidence of Skills for Care Foundation standards in one of the files looked at and although completed had not been fully signed off for certification purposes. In one of the other staff files there was evidence of induction but it was not Skills for Care and in the third file, there was no evidence of induction at all. A new member of staff was spoken to about their induction, they said, I have started it but not finished. Another member of staff said their induction comprised of the basic routine and observing one of the Senior staff in regard to medication. Duty rotas were looked at and showed that there was always a SCA on duty throughout the 24 hour period. On the 8am - 2pm shift there were also two care Care Homes for Older People Page 21 of 33 Evidence: assistants, on the 2pm - 8pm shift and night shift there was one care assistant. The surveys that had been completed and returned stated that there was insufficient staff on duty. Staff were spoken to during the inspection and they said there were not enough staff to fully meet peoples needs and that particularly on an afternoon and evening, there was no one with the majority of the residents. One person said that five to six of the residents need two members of staff to help them and it was observed during a mealtime that seven people were in wheelchairs. There are also people living at the home that present with more challenging needs. There is no system to show how the current staffing levels have been calculated. No one is employed in a dedicated role to do activities. There is housekeeping and laundry available until 1pm everyday and catering staff cover seven days per week. There is no formal system in place that details that training that staff have undertaken or to demonstrate that staff have had the training necessary for them to fulfill their job roles. Two new staff members were spoken to and they said they had received no training since commencing employment, although one has recently commenced their NVQ II in care. Another member of staff could not recall if they had completed any training in respect of infection control and confirmed they had not completed training in respect of the Mental Capacity Act or Deprivation of Liberties, despite the home being registered for people with dementia. Although some staff have completed dementia care training, it is recommended that all staff complete this training and to ensure that the training fully provides staff with the knowledge they need to meet the needs of people with dementia. The AQAA had not been returned and there was no information available to demonstrate the percentage of staff who are trained to NVQ Level II in care. Care Homes for Older People Page 22 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no manager in post and the systems looked at do not ensure that the home is being run in the best interest of the people living there or fully ensures their health, safety and wellbeing. Evidence: There has been no registered manager in this service for a significant time. Whilst managers have been appointed they have failed to register with CQC. The most recent manager has left and the provider was asked to confirm what the interim management arrangements were. We received a email to confirm that a named member of staff would be the interim manager pending the successful recruitment of a new manager. On the first inspection day this named member of staff was not on duty and the SCA in charge was not aware that any such interim arrangements had been made. The provider gave reassurances on the phone that this named individual would now be appointed into the interim position this week and that a new manager would be commencing on 31/5/10. Care Homes for Older People Page 23 of 33 Evidence: A relative who had completed a survey said, Since the change in criteria I feel it has slipped in standards but I must emphasise it is not the staffs fault. Staff also said that an area of improvement was in relation to communication and that changes that are made within the service are not communicated to them and there is the need for more staff meetings. One member of staff said, Communication with regards - changes in the home, ie nurses to leave, no one informed, not enough senior carers trained to cover shifts. New carers taken on however carers hours are reduced to below contracted hours, without notice or discussion. Regulation 26 reports were looked at, the last one available was May 2009, which is not acceptable. There was no other evidence of any quality assurance that had taken place. Water temperature checks had not taken place since July 2009, immediate action was taken to address this and the checks were up to date prior to the inspectors leaving the service. Weekly fire checks had not taken place since, they had been intermittent since February 2010, immediate action was taken to address this and the checks were up to date prior to the inspectors leaving the service. None of the portable appliance appeared to have been electically tested as they did not have the PAT stickers on them. It was confirmed this had taken place and records were shown to evidence this. It was recommended that the way in which these tests are carried out is checked as it was unclear if the individual asset numbers corresponded with the equipment in each room as much of this equipment is portable. Training for staff that ensures health and safety is not up to date. A number of staff had not been trained in moving and handling, whilst other staff had not had this training updated. There was mechanism or system to show if staff were up to date with all of the mandatory training needed. Staff supervision was discussed and limited information was available, which was one batch of supervision records for February 2010. Not all of these records had been signed by the person whose supervision it was and there was no review date specified. A sample of maintenance and servicing certificates were looked at, initially if was difficult to establish if all of these were up to date as there was not effective system in place to demonstrate this. After much discussion and checking several files, the majority of these were in place and up to date. It is recommended that a system be Care Homes for Older People Page 24 of 33 Evidence: developed to ensure that this information is easily accessible. Care Homes for Older People Page 25 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 The assessment of need and 16/07/2010 care plans must contain specific information about the individual and their needs. Where areas of need have been identified, there must be a care plan in place detailing how this need is to be met. This will ensure that staff caring for and supporting people have the information they need to fully meet their needs. 2 8 12 In the event of 28/05/2010 accidents/incidents, effective measures must be in place to review, follow up and investigate any matters where necessary. This will ensure proper provision for the health and welfare of people. Care Homes for Older People Page 27 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 18 13 All staff must receive whistleblowing and protection of vulnerable adults training. This will ensure that staff have the required knowledge in the event there is a safeguarding incident. 16/07/2010 4 19 23 There must be a programme 28/05/2010 of routine maintenance. Areas that present risk to residents must be restricted, this includes the kitchen, laundry and laundry room. Unresticted windows must be restricted. This will ensure that the environment is a safe place for people to live. 5 21 12 Locks must be fitted to bathrooms, shower room and toilet doors. This will ensure that people have the privacy they require and their dignity is maintained. 28/05/2010 6 30 18 All staff must be provided 16/07/2010 with the training that is appropriate to the work they are to perform and that will equip them to meet peoples Care Homes for Older People Page 28 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action assessed needs. All staff must receive an appropriate induction. To ensure people living at the home are cared for by suitably skilled and trained staff. 7 31 8 A manager must be appointed and they must register with CQC. This will ensure that people benefit from the home being run by a person who has the appropriate knowledge and experience to do so. 8 33 26 An effective quality assurance system must be in place. Regulation 26 visits must be carried out monthly by the provider or their Representatives. This will ensure that the service is being run in the best interest of the people living there. 9 36 18 All staff must receive formal 16/07/2010 supervision every six weeks. 16/07/2010 16/07/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that staff receive the support and information they need to do their job. 10 38 13 The fire alarm system must be checked on a regular basis, usually weekly. This will ensure that the environment is safe for people living there. 11 38 13 Hot water outlets to taps which are accessible to people living at the home must be tested on a regular basis. The health and safety executive recommends this is weekly where there is full body submersion. This will ensure that the water is maintained at a safe temperature. 12 38 18 All staff must receive training that is appropriate to the work they are to perform. There must be sufficient staff employed at the home that are trained in first aid. This will ensure that peoples needs are being met by staff who have the appropriate knowledge, skill and experience. 16/07/2010 25/05/2010 25/05/2010 Care Homes for Older People Page 30 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessments should contain more specific information which will ensure that their needs can be met once admitted to the home. In the event of accidents/incidents, effective measures should be in place to review, follow up and investigate any matters where necessary. Accurate records should be in place for all medication administered. Regular audits should take place which will identify discrepancies in stock levels. A review should be undertaken to ensure that all staff who currently administer medication have received the appropriate training. The temperature of the room in which medication is stored should continue to be monitored and if it continues to be too hot then further measures need to be taken to remedy this. 2 8 3 9 4 5 12 15 People living at the home should have sufficient opportunities for recreational and social activities. The menu should be reviewed and there should be a comparable choice on offer to people living at Ashwood Lodge. There should be sufficient fresh fruit and vegetables available and stock levels should remain under review to ensure they are sufficient. 6 7 16 21 The complaints procedure should be updated and needs to include contact details for the funding authorities. Bathrooms, shower rooms and toilets should be redecorated. Floors need a thorough clean as does the shower curtain. New toilet roll holders should be fitted. 8 24 A number of pieces of bedroom furniture should be replaced as it is broken and drawers and doors do not close properly. Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 9 27 The staffing levels should be sufficient to meet the dependency needs of people living at Ashwood Lodge, these should be kept under review. 50 of care staff should be trained to NVQ Level II. The personal allowance systems needs to be reviewed and will be strengthened further with receipts being obtained for hairdressing, chiropody and other expenditure. A system should be in place to show when the maintenance and servicing of equipment is next due. The way in which the PAT is carried out should be reviewed to ensure that it is a thorough system. 10 11 28 35 12 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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