Inspection on 06/04/09 for Autumn House Nursing Home

This inspection was carried out on 6th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Autumn House Nursing Home 21/04/08

Autumn House Nursing Home 03/10/07

Autumn House Nursing Home 11/10/06

Autumn House Nursing Home 09/08/05

Autumn House Nursing Home 13/04/05

Autumn House Nursing Home 08/09/04

Autumn House Nursing Home 27/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Autumn House Nursing Home 2 Station Road Worsbrough Dale Barnsley South Yorkshire S70 4SY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jayne White     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Autumn House Nursing Home 2 Station Road Worsbrough Dale Barnsley South Yorkshire S70 4SY 01226243057 01226247651 autumn.house@hotmail.co.uk None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Nurjahan Hossain,Mrs Vijay Kumari Singh care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is 35 The registered person may provide the following category of service only: Care home with nursing - Code N 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 of places: 35 Date of last inspection Brief description of the care home Autumn House is a care home providing personal and nursing care for up to 35 older people. The home is situated in a residential area of Worsborough Dale, close to all local amenities and bus routes. 0 Over 65 35 Care Homes for Older People Page 4 of 33 Brief description of the care home Accommodation is provided over two floors served by a passenger lift and stairs. The home has 23 single and six double rooms, three of the double rooms have en-suite facilities. Communal accommodation consists of two lounges and a dining room. Sufficient bathing facilities are available, with aids and adaptations in place. A central kitchen and laundry serve the home. The home is in an elevated position in its own grounds and is reached by a steep tree lined driveway. Car parking is available. Fees were 351.50 pounds per week. Hairdressing, toiletries and newspapers were not included in the weekly fee and were charged separately. This information was provided on 6 April 2009. The service user guide and inspection report that would give people information about the home was displayed in the entrance hall. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection conducted by Jayne White, inspector. We visited without giving the service any notice. Mrs Jenny Gorvin, the manager was present during the visit. She is not yet registered with the Commission. The manager completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 21 April 2008 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Care Homes for Older People Page 6 of 33 We sent surveys to people living at the home, asking them about their experiences of living there, health professionals who visit the home, asking them their experiences about working with the home and staff, to ask them about various aspects about working at the home. Three were returned by people living there, three were returned by health professionals and three were returned by staff. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as were some of their representatives. We also spoke with three health care professionals about their experiences of working with the home. The care provided for four people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. The CSCI wishes to thank people living at the home, the staff, the manager for their assistance and co-operation during the visit. 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 that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: So that the service can be confident they can support people, all people should have a needs assessment before they are admitted. An immediate requirement was issued for the service to implement a care plan for a person who had been admitted, to inform staff and demonstrate how their health and personal care needs were to be met and monitored. When falls risks assessments were reviewed, they need to ensure they take account of accidents that have happened since the last review and that the review demonstrates why further intervention to minimise further risks of falling is not necessary. So that people were protected by the homes policies and procedures for dealing with medicines, the medication administration record for controlled drugs must include the name of the person whom the medication is for and the correct dosage of the medication to be administered. Staff must check this against the actual medication being administered, to make sure it is correct. This includes the person confirming the administration and record. So that people are protected by the homes policies and procedures for dealing with medicines, nurses dealing with medicines should have competency assessments to Care Homes for Older People Page 8 of 33 monitor they continue to deal with medication safely. People responsible for their own medication and finances must have a locked facility to store it safely. To show people are treated with respect, people should wear their own clothes at all times. So that people and their representatives can feel confident that any concerns they have will be listened to, taken seriously and acted upon all complaints must be investigated and the heating kept at a suitable temperature so people are kept warm. So that staff receive training appropriate to the work they perform all staff should receive adult safeguarding training. To verify the qualifications and training staff have undertaken, certification should in place on their files. A risk assessment should also be in place to assess what training is required for staff to provide first aid in the event of an emergency. In addition, that documentary evidence is in place that confirms nursing staff are qualified to provide nursing care. An immediate requirement was made for this to take place and the service verified all had up to date registrations. So that peoples privacy is maintained and the possibility of them being locked in their room without being able to get out is removed, doors to peoples private accommodation needed to be fitted with locks that were suitable for them and accessible to staff in emergencies and the hook and eye locks on the outside of those doors removed. So that a recruitment procedure is used that protects people, information and documents required should be in place before staff commence duty to make sure they are suitable to care for people. 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 set out 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. On the whole, people could be confident the care home could support them. This was because in most cases there had been an assessment of their needs, which told the home about them and the support they needed. Evidence: Information about the home such as the service user guide and the latest inspection report were displayed in the main entrance to the home. When we looked at peoples surveys and spoke with them and their representatives it told us people had received enough information about the home before they moved in so they could decide if the place was right for them. We looked at four peoples files to check that pre admission assessments had been undertaken. There was information on three files that a needs assessment had been carried out. Care Homes for Older People Page 11 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. People were receiving the health and personal care they needed, despite one person not having a plan of care. People able to, managed their own medication. Where they couldnt the service did not always support them in a safe way. In the main, peoples right to privacy was respected, but they did not always get support from staff that maintained their dignity. Evidence: The AQAA told us care plans were in place, which meets the needs of the individual. We looked at four care plans to check this. For one person, although an assessment had been completed, a care plan had not been formulated, including any assessments of presenting risks. An immediate requirement was issued for one to be put in place, so that there was detailed information for staff of the care to be provided, monitored and reviewed. Since the inspection, the service have confirmed this has been completed. The other care plans included good information about people. Comprehensive risk assessments were in place for pressure areas, falls, infections and nutrition. However, Care Homes for Older People Page 12 of 33 Evidence: care must be taken that when reviewing the risk assessments for falls, the review takes accounts of accidents that have happened since the last review and the review demonstrates why further intervention to minimise further risks of falling is not necessary. Inventories of peoples personal furniture, equipment and other belongings were in place on three of the four files, but one wasnt dated or signed by the person (previous requirement). The care plans identified that health care professionals did visit people to assist in maintaining their health care needs. Three health professional surveys were returned and we spoke with three visiting health care professionals during the visit. Two of the surveys said the service usually sought advice and acted on it to manage and improve peoples individual health care needs and that peoples health care needs were met by the service, one always. They commented, I think they seek to respond to individual health needs well, they seek medical advice appropriately, theyre helpful and they seem to have their clients best interests foremost, (they) liaise with district nursing team if any concerns re residents and yes within the limitations of the home and using supplementary health care professionals. When we spoke to the visiting health care professionals they said, found staff good, proactive at getting GP and following instructions - files are always available, they know the person and there arent any problems. Decor/tidyness not always up to much, but care ok. When we looked at peoples surveys they all stated they always receive the personal and medical care they needed. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. Three staff returned their surveys. Two staff thought they were always given up to date information about the needs of the people they cared for, one usually. They commented, we get a daily report every shift change so I feel we are always up to date and the care plans are much better now. All stated they felt they had the right support, experience and knowledge to meet the different needs of people using the service. They commented, through our training sessions I feel we are prepared to meet different needs of service users and (we) treat service users as individuals who all have different needs. The AQAA stated the service values and respects the privacy of people. We observed staff working to check this. There was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff spoke clearly and at Care Homes for Older People Page 13 of 33 Evidence: a steady pace with people. On the whole, we saw that people looked clean, were well dressed and appeared to have received a good level of personal care. This indicated respect and dignity by staff when caring for them. We did observe, however, where a person was taking off their cardigan to see whose it was. It wasnt theirs and a carer stated it doesnt matter. To show people are treated with respect, and dignity it does matter that people wear their own clothes. One person also said, I get looked after and (they) treat me well, respect me, but whats poor is they talk together and dont go to them when they need help. Two of the health professional surveys that were returned stated the service always respected peoples privacy and dignity, one usually. A sample of three peoples medications in stock and medication administration records were checked. It was noted that handwritten entries were countersigned as good practice, to confirm the information was correct (previous requirement). We also looked at the medication administration records for two people where controlled drugs were administered. One of these was poor. There was no name of the person on the record to whom the medication needed to be given to, although the manager knew. The record of the medication to be administered was incorrect and did not relate to the medication being administered. This highlights staff are not checking the actual medication to be administered against the record, including the person confirming the administration and record. When we spoke to the manager it highlighted nurses continuing competency to deal with medication was not assessed. Medication storage arrangements for medication held by the home were stored securely in locked trolleys within locked cupboards. Two of the health professional surveys returned stated the care service always supported people to administer their own medication or manage it correctly where this was not possible, one stated they couldnt comment. Their comments included, there appears to be a structured approach to medication distribution and we have recently been visiting a client who was administering their own insulin and managed their own medication from a dosette system supplied by the chemist. The manager told us of someone managing their own medication. There was a risk assessment in place to make sure this was safe, however, a locked facility was not provided to store their medication safely. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person was treated as an individual and they were part of their local community. The care home supported people in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had meals that were good quality and on the whole met peoples expectations. Evidence: The AQAA told us an activities person was employed. When we spoke to the manager, she told us the activities were carried out by two carers. We spoke with one of them and they explained both group and individual activities took place. They said they take different people out each week and every month they go to The Oaks for entertainment. We looked at the activity book they kept and it showed a variety of activities including bingo, The Oaks, individual reading, DVD, baking, play your cards right, dancing, an outing for dinner, a trip in to Barnsley, a trip with 2 residents to the park, making a cream tea and music. We spoke to people and their representatives to confirm the information wed been given. A relative said theyd seen them playing bingo and theyd taken them out at Xmas to a pantomime. They said, when its their birthday, cards get put up and they have a party and cant fault them. People told me they have a hairdresser and Care Homes for Older People Page 15 of 33 Evidence: theyre having a buffet tea at Easter. Comments included, its alright. Surveys returned by people told us two thought there was always activities they could take part in , one usually. One commented, I like the bingo. Two of the health professional surveys that were returned stated the service usually supported people to live the life they chose, one said they couldnt comment. Their comments included, within the overall home environment and limitations created by others, appear to offer choices to individuals and would benefit from providing more social activities/therapies for residents to provide stimulation. The surveys that were returned told us everyone always liked the meals that were served. They said, meals are very good and lovely food. When we spoke to people about the meals it told us that generally people liked the meals they were served. They commented, very tasty, always banana custard or milk pudding and not as hot today. The provider, subsequent to the inspection stated the person making the comment about banana and custard always requests this for their desert, despite the menu offering at least four choices. We saw the lunch time meal being served. The dining room was comfortable and provided a pleasant environment for people to dine in. A choice of meals was offered on the menu board, but all people had one option. One person was seen asking and being given a tomatoe sandwich. People were served good portions. Generally, it was a positive and pleasant event. The meal smelt nice and looked appealing for people. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people had concerns with their care, they or people close to them knew how to complain. However, not all complaints had been looked into and action taken to put things right. Policies and procedures were in place to protect people from abuse, but staff training was needed in those procedures. Evidence: The AQAA stated a complaints procedure was in place. We saw that a complaints procedure was in place, however, information about the Commission, now needs updating, which the service need to address. The AQAA told us 3 complaints had been received in the last 12 months, none were upheld and were resolved in 28 days in line with the services complaints procedure. When we checked this, the complaints were upheld and the service had taken steps to address the complaints. However, two of the complaints related to rooms being cold in January, with radiators not working. Today in the main lounge it felt cold. Residents said they were cold. One person commented the heater was missing and a carer stated heating hadnt been working since Saturday (now Monday). Clearly, whatever steps the service were taking to try and keep the home warm were not working and more action is required so people are warm at all times. There was one complaint made regarding a member of staff that hadnt been looked into. This was brought to the attention of the manager to deal with. Care Homes for Older People Page 17 of 33 Evidence: Surveys returned by people told us they always knew who to speak to if they were not happy and knew how to make a complaint. This was confirmed when we spoke to people. They said they had no grumbles and had never seen anything untoward. They said, wed go to Jenny, shes approachable. One health care professional survey told us the service always responded appropriately if they or the person using the service had concerns about their care, one usually. Surveys returned by staff told us they knew what to do if the person or their representative had concerns about the service. Their comments included, I would immediately pass any concerns on to my manager or the nurse in charge, report back to nurse in charge or manager and see nurse in charge, manager and document in care plan. Similar information was received when we spoke with them, including reporting any allegations, although they said they had no concerns about any care practices. However, not all staff had received adult safeguarding training, including nurses in charge of the shift. The AQAA told us there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had been reviewed in February 2009. The service had the local adult safeguarding policy and procedure, which was readily available for guidance if an incident took place. The manager had received adult safeguarding training and was aware of the multi agency procedures to be followed in the event of any allegation being made. She was also aware of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards to be used when people cannot make decisions for themselves. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a well maintained living environment that was clean, tidy and a comfortable environment for people to live and enjoy, but it needed to be warmer in parts and doors to peoples private accommodation be fitted with locks that are suitable for them and accessible to staff in emergencies. Evidence: The AQAA told us refurbishment took place. Two peoples surveys told us they thought the home was usually fresh and clean, one always. People were happy with their rooms, that most of them had personalised with pieces of their own furniture and possessions. When we looked round the home, the environment was suitable for the needs of people that lived there. Generally, the home was clean and well decorated and maintained. However, it was a concern that on bedroom doors that we looked at there was no lock on the inside, but the door could be locked from the outside. When we spoke to a carer they said all doors were like this. In addition, on some of the doors we saw hook and eye locks on the outside of bedroom doors. The carer said, to stop wanderers going in. A cleaner said, it is used when room is cleaned for next person. We discussed that it means people could be locked in their rooms. They agreed, but said, theyd never seen it done. Care Homes for Older People Page 19 of 33 Evidence: There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible and the service had made some attempts to make these more domestic in appearance. The toilets had been adapted to assist people with their independence when going to the toilet. The communal lounges and dining area were generally well decorated and were a comfortable environment for people to live. 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 have appropriate support as there were enough staff on duty. People could not always have confidence in the staff, because sufficient checks had not always been done to make sure they were suitable to care for them. Peoples needs were met and in the main they were cared for by staff who received relevant training and support from their manager. Evidence: When we looked at the surveys returned by people it told us that staff listened and acted on what they said. Two said staff were always available when they needed them, one usually. One commented, they are lovely staff. This was reflected when we spoke to people during the visit. Two staff surveys that were returned told us there were usually enough staff available to meet peoples needs, one always. One commented, I feel that staffing levels are more than satisfactory and meet the individual service users needs. When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The AQAA told us staff were trained in equality and diversity. They employ a trained Care Homes for Older People Page 21 of 33 Evidence: teacher and lecturer who was trained in care theory for health and safety, control of substances hazardous to health, moving and handling, equality and diversity, communication skills and confidentiality. It stated 24 staff were trained in the prevention and control of infection and this has lowered the incidence of urine infections. The AQAA stated all new staff received induction training to Skills for Care Standards, which must be completed in the first six months and all staff have 6 weekly supervision and appraisals. The AQAA also stated 24 staff were trained in malnutrition care and assistance with eating and 3 catering and 11 care staff were trained in safe food handling. The three staff surveys that were returned stated their induction covered everything they needed to know to do the job when they started very well. They all stated they were given training relevant to their role, helps them understand and meet the needs of people and keeps them up to date with new ways of working. Comments included, my induction was very informative and we attend regular training sessions provided by our home. I am always learning new things. I am currently doing my NVQ 2. We looked at three staff files for their training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place in all of the files, including, induction, fire safety, moving and handling, food hygiene, adult safeguarding, control of substances hazardous to health, prevention and control of infection, health and safety, equality and diversity, syringe dirver, palliative care, nutrition and specialist feeding via PEG. However, there wasnt always training certificates on file to verify the training and if there were they werent always dated. When we spoke to the manager she stated no staff were trained in first aid and there wasnt a risk assessment in place to demonstrate that she felt nurses were sufficiently qualified to carry this out. Two of the health care professional surveys that were returned stated staff usually have the right skills and experience to support peoples social and health care needs, one always. Comments included, there is a clear pathway of responsibility within the staff for appropriate need. Experienced delivery. Good interaction, they seem to and staff have needed support at times in administering drugs in a syringe driver, due to not having opportunity to perform this procedure on a regular basis. All the staff surveys that were returned stated the service carried out checks such as CRB and references before they started work One actually commented, my CRB and references were both returned before I started work here. The AQAA also stated new staff were vetted by CRBs and references and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks. Care Homes for Older People Page 22 of 33 Evidence: However, when we looked at two personnel records to check this, this was not always the case, which meant the recruitment procedure was not always conducted in a way that protected people. One of the files did not have a full employment history and the other although no start date was recorded on the file, the staff member told us theyd started in October/November time. References and CRB were received for the person after they had commenced employment and there was no evidence a POVA first check had been issued. An old CRB from a previous employer identified they had worked in care elsewhere. This was not on their employment history and there was no evidence that this had been checked out with them. There was no evidence that nurses PIN numbers were up to date. This is required to demonstrate nurses can provide nursing care to people. An immediate requirement was left for this to be checked. Information from the service since the inspection confirms they were up to date. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could have confidence in the care home because it was led and managed appropriately, but the manager needed to submit an application to be registered. People controlled their own money where they were able and chose how to spend it, but did not have a safe place to store it. Where the service held monies on behalf of people, these were kept in good order. On the whole, the environment was safe for people and staff, because appropriate health and safety practices were carried out. Evidence: We received notification that from 01.12.08 Mrs Jenny Gorvin, RGN Level 1, employed at Autumn House for the last 4 years had agreed to carry out the manager position on a 3 month trial. She has the Registered Managers Award. An application to register as manager has not been submitted. Health care professionals in their surveys commented, I feel that through the staff:public interface the presentation is of a settled environment, where staff are relaxed in their dealings and are settled with their provision. They are interested, I Care Homes for Older People Page 24 of 33 Evidence: find Autumn House a settled home and receptive to external input and individual need and provide a relaxed homely environment for residents. Staff surveys told us the manager met with them to provide support and discuss how they were working. They commented, I am very happy with the feedback I get from my manager, we provide a friendly, relaxing, homely environment to all our service users, all our service users look happy and content so I wouldnt be able to say anything needed improvement, I am happy working here and feel we provide an excellent service, it provides a home from home environment and cares for the needs of relatives as well as service users, I love working at Autumn House. It has a kind, loving home from home atmosphere, it provides a home from home atmosphere both for residents and their families. It makes everyone feel welcome and you can clearly see staff love being at work and I am happy working here and love coming to work. Two of the staff surveys stated ways information is passed about people who use services between staff always works well, 1 said usually. One commented, I find that the report at the beginning of shift is a very good way to pass on all information. When we spoke to staff they said the manager was approachable and they felt confident in her. One commented, the atmospheres much better. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It provided satisfactory information of the current situation within the service, what they had improved in the last 12 months and what they could do better, to identify a plan for improving the quality of life for people. The AQAA indicated systems were in place to check the quality of the service provided, for example, through meetings. The action plan in place for 2009 was to include residents meetings, a medication audit and staff meetings. We had received reports from the owner visiting the home to assess in their opinion the quality of the service being provided. The AQAA stated peoples monies were recorded and monitored. We looked at the money kept by the home on behalf of two people. Records were kept and money tallied with the records. For people who kept their own money they did not have a locked drawer to enable them to keep it safe (see health and personal care). The AQAA stated maintenance of equipment was in place for portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, premises electrical circuits, heating and gas appliances. The maintenance for Care Homes for Older People Page 25 of 33 Evidence: the emergency call equipment was blank. We checked this and it had been serviced on 22.12.08 and there was a soiled waste disposal contract in place. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. South Yorkshire Fire and Rescue had visited and advised preventative measures to prevent the spread of fire should be not wedging open self closing fire doors. Care Homes for Older People Page 26 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 27 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 1 7 15 Regulation 15 (1) A care plan must be put in place for the named person. So that there is information available about how the persons health and personal care will be met and monitored. 18/06/2009 2 29 19 Regulation 19 (1) (b) 19/06/2009 Evidence must be provided that nurses PIN numbers are valid. To verify they are qualified to provide nursing care. 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 9 13 Regulation 13 (2) This also links to standard 35, service users money. A locked facility must be provided for people when they are responsible for their own medication and money. So that they are able to store their medication and money safely. 17/07/2009 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 2 9 13 Regulation 13 (2) Staff must check the actual medication to be administered, against the medication administration record, including the person confirming the administration and record. So that people are protected by the homes policies and procedures for dealing with medicines. 17/07/2009 3 9 13 Regulation 13 (2)The medication administration record for controlled drugs must include the name of the person and the correct dosage of the medication to be administered. So that people are protected by the homes policies and procedures for dealing with medicines. 17/07/2009 4 16 22 Regulation 22 (3) 17/07/2009 All complaints that are made must be investigated. So that people and their representatives can be confident their complaints are taken seriously and acted upon. 5 19 12 Regulation 12 (1) (a) Doors to peoples private accommodation must be 17/07/2009 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 fitted with locks suitable for people and accessible to staff in emergencies. In addition, the hook and eye locks on the outside of the private accommodation must be removed. So that peoples privacy is maintained and the possibility of them being locked in their room without being able to get out is removed. 6 19 23 Regulation 23 (p)This also relates to standard 16, complaints. Heating must be provided that is at a suitable temperature for people. So that people are warm and the service can demonstrate they listen to their concerns, take them seriously and act on them. 7 29 19 Regulation 19 (1) (b) For staff that are employed information and documents as specified in Schedule 2 of The Care Home Regulations 2001 relating to that person must be in place, before they commence employment. 18/07/2009 17/07/2009 Care Homes for Older People Page 30 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 So that a recruitment procedure is used that protects people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 So that the service can be confident they can support people, all people should have a needs assessment before they are admitted. This also links to standard 8. To minimise the risks to people, the review of the risk assessments for falls should take account of accidents that have happened since the last review and the review should demonstrate why further intervention to minimise further risks of falling is not necessary. So that the service have information about peoples personal furniture, equipment and other belongings, there should be an inventory maintained on all peoples files, dated and signed by staff and the person or their representative. So that people are protected by the homes policies and procedures for dealing with medicines, nurses dealing with medicines should have competency assessments to monitor they continue to deal with medication safely. To show people are treated with respect, people should wear their own clothes at all times. This also links to standard 28 & 30. So that people are protected from abuse, all staff should receive adult safeguarding training. This also relates to standard 30. To verify the training staff have undertaken there should be documentary evidence of any relevant qualifications and training. This also related to standard 30 and 38. Page 31 of 33 2 7 3 7 4 9 5 6 10 18 7 28 8 28 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations A risk assessment should be carried out to assess that staff have the necessary skills and knowledge to carry out first aid to people in the event of an emergency. 9 31 So that the Commission can assess the managers fitness to be in day to day charge of the care home, the manager should submit an application to be registered. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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