Inspection on 01/06/09 for Batchfoot Country House

This inspection was carried out on 1st June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Batchfoot Country House 22/09/09

Batchfoot Country House 24/05/07

Batchfoot Country House 31/07/06

Batchfoot Country House 11/01/06

Batchfoot Country House 08/09/05

Batchfoot Country House 09/03/05

Batchfoot Country House 23/06/04

Batchfoot Country House 18/12/03

Batchfoot Country House 16/07/03

Batchfoot Country House 09/12/02

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

Key inspection report Care homes for older people Name: Address: Batchfoot Country House 181 Church Street Upwey Weymouth Dorset DT3 5QE     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: John Hurley     Date: 0 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Batchfoot Country House 181 Church Street Upwey Weymouth Dorset DT3 5QE 01305812143 01305812143 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs M C Taylor care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Batchfoot Country House residential home is established in a large detached Georgian listed building set in its own grounds and mature gardens. It is situated in the village of Upwey, half way between the seaside town of Weymouth and County town of Dorchester. The home is close to the local church, wishing well and other village amenities. The home is registered to accommodate a maximum of 16 service users in the category of old age. The service users accommodation is arranged over three floors, with three bedrooms at ground floor level, six at first floor level and four bedrooms on the second floor. For service users with limited mobility there are three stair lifts, one to the first floor and two to access the top floor of the home. There is a large communal lounge and separate dining room on the ground floor. At basement level there is a storage area, office, laundry room and a staff toilet/shower room. Care Homes for Older People Page 4 of 32 Over 65 16 0 Brief description of the care home A driveway leads to the home and a car parking area is available to the side of the house. The home is set in its own grounds with large landscaped front and side gardens which boast mature trees and shrubs. The fees for the home, as confirmed to the Care Quality Commission at the time of inspection, range from 401 - 495 pounds per week. Additional charges include hairdressing, chiropody and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home.aspx A copy of the homes inspection report will be made available to anyone wishing to read it upon request to the manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken over the course of one day in June 2009 by one inspector. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection (now the Care Quality Commission) Inspecting for Better Lives 2 Framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good adequate and poor. The judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. We looked at a selection care files in detail, the staff files, undertook a tour of the building and looked at all the documentation relevant to the running of a care home. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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 7 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes initial assessment establishes the needs of the individual and evaluates if the home can met those needs. Evidence: We looked at the assessment documentation relating to a persons who was attending the home on a respite basis. The home had a copy of the person needs assessment from the local Authority who had arranged the placement. The homes own assessment mirrored that of the Local Authorities but the care plan that had been developed from that assessment lacked the detail with which to guide and inform staff on how to assist the person, for example the care plan identified that the person would need help with bathing but did not explain what was required or preffered ie; the temperature of the hot water, if the person required the assistance of a hoist, what they could do for themselves and issues in relation to respecting their dignity. We had the opportunity to sit and talk with one of the people who had just taken up Care Homes for Older People Page 9 of 32 Evidence: residency and their visiting relative. They confirmed that whilst their relative had visited the home and made a number of decisions with regards to the suitability of the home to meet their needs on their behalf, they had been fully involved in the process. They informed us that they were very pleased with the decision to move in and felt that staff had worked hard to ensure that they felt welcome. We were informed that intermediate care is not a feature of this service Care Homes for Older People Page 10 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and subsequent reviews do not give an accurate picture of the person at the center of the care, which may mean they have unmet needs. The reviewing process must evaluate all information available to the reviewer in order to ensure people are protected from unnecessary risks. The administration of medication may put people at risk. Evidence: We looked at a sample of the care plans and reviews in order to assess how the outcomes and needs of the people who live at the home are consistently met. Care plans are generated from initial assessment of needs and reviewed thereafter. The plans give details of the tasks to be completed by staff but require to be developed to evidence that the home is providing person centered care, for example files state what the task is but not what staff have to do to carry out that task in a way that has been agreed with the individual. Care Homes for Older People Page 11 of 32 Evidence: There were some references to person centered care in the care files , for example references to a person expressing their sexuality. One section of a care plan noted what an individual liked to where and how they liked to present themselves. The reviews of care plans that we sampled did not take into account all of the persons needs and aspirations but contained sufficient evidence that the person at the centre of the care had been included in the reviewing process. When looking at the reviews it was noted that a number of specific risk assessments remained unchanged and had not been fully assessed for some time. One persons care plan review had been carried out by a local care manager, the home and the person who lived at the home at the beginning of the year 2009. A number of issues had been agreed but at the time of the inspection these issues had yet to be attended to, for example, It was agreed that the person required their food and fluid intake to be monitored. Following on from that review no nutritional assessment of the individuals needs had been undertaken to establish a baseline of the potential risks to the individual. In a subsequent review in April 2009 the care plan review conducted by the home commented that the person was eating and drinking fine, but no system to monitor food or fluid intake was available to support the statement. In May 2009 the person was weighed and it was found that they had lost 2lb in weight. A note was available to staff to monitor the situation but again no fluid or food monitoring system had been considered. We looked at another persons care plan documentation in relation to falls risk assessment and found that the last time this full assessment had been carried was 15/04/05. Subsequent reviews stated that risk assessment remains unchanged. However by sampling the recording in the daily records it was clear that the person had fallen in December 08 which had resulted in a head injury and advice had been given from paramedics who had attended the home. The advice was to monitor the person for the next couple of days. The daily records did not evidence that the persons needs had been monitored any differently than before the accident. There was also no subsequent review of the monitoring to establish if there had been a change to the persons wellbeing. The risk assessment remained unchanged and so may put the person at risk of further falls as factors contributing to the fall and any changes to the persons needs had not been fully evaluated. Care Homes for Older People Page 12 of 32 Evidence: We looked at the Controlled drugs register and found that it evidenced that staff regularly audit the register. A quick audit agreed with the home s representations. We briefly observed a small part of the medication administration round and observed that the staff member gave the medication directly into the mouths of the people who use the service, no gloves were used at any time. This is a possible route for cross infection and so undermines infection control within the home. It is also poor practice and does not respect the dignity if those receiving the medication. It was noted that some people require medication on a Per Required Needs (PRN) basis. No clear rationale for giving medication via this route was recorded. Staff need to have clear instructions for giving any medication on a PRN basis to ensure that it is given appropriately. We noted that a number of creams in the medication trolley did not have an opening or disregard date on them. We carried out a brief audit of one medication. The Medication administration records stated that the medication had been given 40 or more times, but the amount received into the home was 32. The packet still contained two tablets to be given. The registered manager explained that the tablets were dispensed from a previous supply of tablets but no record of this receipt was made and so it was not able to establish how many tablets were on the premises. The registered manager acknowledged this observation and suggested a carry forward system that would provide a robust audit trail. The home has a dedicated fridge for medication. The temperature of this fridge is regularly monitored to ensure the contents are stored safely. The people we spoke with during the inspection considered that they were treated with dignity and respect. We observed staffs interactions with the people who live at the home that appeared to confirm these representations. Care Homes for Older People Page 13 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to ensure all those who live at the home have opportunities to have their social and recreational needs met. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends Evidence: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Visitors were observed entering or leaving the home. All visitors were warmly welcomed. Peoples records and the visitors book in the entrance hall demonstrate contact with family and friends as well as visits by professionals. We observed that a person who lived at the home was escorted into the dining room at about 10 oclock. They were sat in the window area in the sun which was very hot , no drink was available and they appeared to be asleep. We sat in the area for 10 minutes writing up some of our observations and noted that no staff member came Care Homes for Older People Page 14 of 32 Evidence: into the room. At about 10.45 we were again in the dining room and although a staff member was in this area they made no contact with the person sat in the chair. At 11 oclock we looked in again and noticed that the person had a fan nearby blowing on them, a cup of tea and biscuits by their side, but they still appeared to be asleep. It was noted that there was no call bell available near the person. On the day of the inspection we did not note any planned activities or social stimulation that was not self directed. We discussed the budget for food with the cook on duty. They informed us that the budget had gone down but so had the occupancy. They considered that the budget for food was sufficient to ensure that they could give the people who live at the home a nutritious diet. The people who we spoke with confirmed that they felt they had a good choice of food and that the quality and quantity of food met their needs and expectations. One person who lived at the home informed us that staff inform them of what food is available that day and if they do not fancy it they can choose something else. Care Homes for Older People Page 15 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service felt confident that any complaints or concerns would be listened to and taken seriously. All staff should receive training with regards to the Protection of Vulnerable adults Evidence: We looked at the policy relating to complaints at the home and found that in general it gave good information on how to complain. However the policy stated that a person may contact the regulator if they are dissatisfied with the way the home has dealt with a complaint. People can complain to the regulator at any point in the process. The people who we spoke with informed us that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. Visiting relatives also felt this to be the case. The home keeps a record of any complaints made. There have been no issues recorded at the home. We looked at the staff training records and found that not all staff had received training with regards to Safeguarding vulnerable adults. This needs to be attended to Care Homes for Older People Page 16 of 32 Evidence: to ensure all staff including management are clear as to the expectations placed on them as a registered service. Care Homes for Older People Page 17 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Infection control practices within the home are poor and may put people at unnecessary risk The home lacks inward investment which means that it is not being maintained as fit for purpose. The arrangements made to protect people in the event of fire is poor and may put people at risk of harm. Evidence: On entering the home we were left unaccompanied for a short time in the main dining room. We noted that the dining room chairs were dirty with particles of food. This was still the case when we gave feedback at the end of the day. One chair was noted as broken, the radiator was unguarded. The dining room carpet was clean but caught the bottom of the fire door which meant it the door would not close automatically and so put people at risk of harm. The floor to ceiling sash windows were propped open with two bricks, again this may put people at risk if they tried to remove the bricks as the windows were found to be heavy. We walked through to the lounge at the rear of the ground floor noting that the fire door to the kitchen was propped upon despite a sign saying the door should be kept Care Homes for Older People Page 18 of 32 Evidence: shut. The rear lounge contained many seats and a very low settee which would prove difficult to get up from if the person had any mobility problems. The settee was showing signs of wear on the arms. The fire door was propped upon with a chair which when we removed the chair the door did not close automatically and so posed a risk of significant harm to those at the home. When looking around the lower floor it we observed that in the handymans room petrol was being stored as well as in garden machines . This room contained all the essential elements to start a fire, an ignition source, fuel and air. The door to this lower floor room was not a fire door. The corridor outside contained bags of rubbish waiting to be put out. The room opposite was full of used mattress which were coming out into the corridor. This is a potential fire hazard. This was pointed out to the registered manager. During our tour of the building we noted many of the peoples bedrooms did not have intumesent strips fitted to them or did not close properly. All bedroom doors should be self closing and be resistant to fire for 30 minutes. The responsible individual told us that they were aware of the shortfalls in fire safety and that not all doors identified by the fire officer in 2007 had intumesant strips fitted. They said they had fitted some but the lack of funds had meant that not all identified had been addressed. When looking around the environment we observed that not all of the wheelchairs were complete with footplates. This may put people at risk of catching their foot under the wheelchair when assisting a person.. The communal toilet on this floor was found to be pose an infection control hazard. The floor was badly worn through, a 6 inch tear in the lino type flooring meant that the floor could not be cleaned thoroughly. Continence aids were stored on the floor and there was no pedal bin in the area. It was noted that there was liquid soap and paper towels. The threshold plate between the lino and carpet in the hall was very dirty. We looked in the communal bathroom and noted that it was carpeted which means that it may pose an infection control hazard as it cannot be thoughly cleaned. The toilet was not fixed to the floor and there was no sink in the area. There was no pedal bin, the hot water temperature exceeded 45C . The window, which was at least 15 feet above ground level, was unrestricted and so may pose a significant risk of harm. Although there was two thermometers both were dirty. One was so old the scale was Care Homes for Older People Page 19 of 32 Evidence: worn aware. A bath hoist was available in this area to assist those who required it. A step ladder was also in the bathroom area. It was later explained that it had been used to change a light bulb. On the landing of the first floor there was a low settee which was in very poor condition, the arms were badly worn with the foam showing through. It was noted that the hall carpets had been renewed. People informed the inspector that they are able to bring personal possessions with them into the home. The inspector looked at a sample of the bedrooms used by people who use the service and found that they had been personalised with pictures, furniture and photographs to reflect the individuals taste. People said they enjoyed living at the home and found it to be warm and comfortable. We looked in the COSHH (Control Of Substances Hazardous to Health) cupboard and found it was tidy and well organized. It was noted that there was 17 bottles of bleach was stored. We asked to see the COSHH file but none was available. Therefore there is no directions to staff on how to use the cleaning materials or the risks they may pose to themselves or others. In the dry store and freezer area there was bottles of Vortex thick bleach which should have been locked away in the COSHH cupboard when not in use. One of the freezer doors was not closing properly. The thermometer indicated that the freezer was operating at -8 degrees centigrade. A food probe was placed in the freezer that indicated that the freezer was operating at 0 degrees centigrade.The recommended temperature for freezers is -18 to -22 . The freezer next to it contained a selection of homemade soups, these were not labeled with the date they entered the freezer or disregard date. The kitchen itself was found to be kept clean where possible but the wear and tear of the wall coverings around the cooker area meant that it could not be cleaned thoroughly. We looked at the laundry area and found that the domestic type machines in use washed up to 90 degrees centigrade. Soiled laundry was being soaked in bowls on the concrete floor. The possibility of splash or spillage of the soiled laundry in this area was high. No risk assessment was available relating to this infection control hazard. The metal draining board was covered with a clean towel. When we pulled this back we found that the metal had badly rusted away to the point that a section of the Care Homes for Older People Page 20 of 32 Evidence: profile was missing. We checked the hot water temperature at the sink and found this to be very hot, there was no warning sign relating to this. We also noted a number of commode pots in this area. We asked a member of staff how the laundry operates. They told us that the dirty water from the soiled buckets was washed down the sink and that the sink was used to clean commodes. We asked the manager where staff washed there hands. We were told that staff had to use the sink in the office opposite the laundry. There was no signs on the sink in the laundry area to warn people that this was being used to wash soiled commode pots or that the tap should not be touched only with gloves on due to the risks of infection. The practice of going through the office to wash hands undermines any infection control as door handles will need to be touched to get to the sink, assuming that the office is not busy. This was commented on to the registered manager who said that they always did it that way . They further commented that the drainer was due to be replaced. The laundry must be refurbished as a priority to reduce the risk of cross infection within the home. We asked for environmental risk assessments but none was available. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all staff have the necessary training with to provide a safe service to those who live at the home. The recruitment of new staff does not fully establish the fitness of those who wish to work at the home and may put people at risk of harm. Staff must have a comprehensive induction into the work that they do in order to promote the safety of those who live at the home. Evidence: The responsible individual gave us the names of all of the staff who had been appointed since the last inspection. We sampled these files to be able to comment on the recruitment process and staffing issues at the home. We noted that the application forms sampled did not contain any reference to establishing the persons ethnicity or religion. One application form did not have a full employment history and the reason for leaving the past employment was blank, not all references had not been requested or received. We looked at the dates that the Protection of Vulnerable Adults checks had been received and found that at last two people had started work some time before the Care Homes for Older People Page 22 of 32 Evidence: checks had been received,. We noted that in one case this was some 11 weeks after they had started work. This was evidenced through cross referencing with the controlled drugs registered where the staff member had signed it to say they had witnessed the giving of controlled drugs. Further evidence was available on the rota for that period. When looking at the rotas we found that there was a name of a person that appeared to have started work after Christmas 2008. This name was not given to us as a new start. We asked the Responsible individual for the persons staff file who informed us that there was not one as the person was a volunteer, but later agreed that they were on the rota as an staff member and working shifts, it was later established that this included night shifts. This lack of recruitment process puts people at risk of harm. We left and immediate requirement in relation to this issue informing them that the must not employee any person who has not had their fitness to work with vulnerable people fully established. We asked for the induction records for those staff who had started since the last inspection, none was available. The responsible individual was able to show us the documentation from the Skills for Care Council which will be used in the future for all new staff. We had a discussion with the cook with regards to their training. They informed us that they did not require any training as they were the cook. We discussed care plans and documentation with another member of staff. They informed us they had worked at the home for about two years. The described the tasks they perform as to help people get up, wash and dress. We asked them about the needs of the two people who had recently moved into the home but there were unclear as to what they were apart from the tasks outlined above. We asked a staff member about what training they had received. They informed us that they did not consider they needed any further training. We asked about formal supervision, they informed us that they do not have structured supervision but can go and talk with the manager if they have any concerns. They described there role as caring for the personal needs of the people who live at the home, a bit of cooking and cleaning. We were give the training matrix with regards to the training attended by the staff. This evidenced that not all mandatory training was being kept up to date. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management need to do more to ensure the National Minimum Standards are adhered too. The health and safety procedures at the home needs to be risk assessed in order to protect those who live and work at the home. The management needs to ensure it complies with fire regulations so that people are not at risk of harm. The management need to ensure that it keeps all records required by legislation in order to protect those who live at the home. Evidence: The registered manager has been in post for a number of years, they are supported Care Homes for Older People Page 24 of 32 Evidence: by the responsible individual who takes an active role in the running of the home. We looked at numerous records relating to the running of the home and in general terms they were well organized when available. We saw that the district nurses use a message book in the home. This is contrary to data protection Act and needs to be removed. The District nurses should be using the records of the people who live at the home to record their comments and observations. Whilst care plans did not fully demonstrate that the home met the needs of the people who live at the home again they were well organized. However records relating to staffing were not kept in order and many omissions in the recruitment process put people at risk of harm as already discussed under the Staffing section. Similarly the systems relating to staff supervision did not contain sufficient structure to formally supervise staff. The training of staff and their deployment did not appear to be managed and the shifts appeared to organized around staff availability rather than the skills of the staff matching the needs of the people who live there. This is with particle reference to the lack of induction we staff were working on a night shift were there was no evidence of induction for two out of the three staff. Whilst people who live at the home commented positively about the service on offer and the environment they live in significant improvements in Health and Safety need to be made. As discussed earlier we asked for environmental risk assessments but none was available, we asked for the records relating to the Control of Substances Hazardous to Health , COSHH, but none was available, issues relating to fire safety were found to be poor as well as infection control practices. There was evidence of the need to invest in the furniture and fittings to bring the home back to a better standard. We looked at a number of the homes service records in relation to Emergency lighting, Stair lift, fire extinguishers, fire alarms and Portable Appliance Testing. Some were valid and in date others were not for example; the Fire extinguishers had been serviced on the 6/08/08 and did not require further attention until the 6/08/09 whilst the fire alarm servicing was last carried out on the 19/03/08 and should have been attended to by the 19/03/09. In relation to the training of staff with regards to fire of the 14 staff on the rota only five had been trained. The two members of new staff had not received fire training. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 23(4) The registered person must 31/07/2007 ensure that the suitable arrangements:(a) for the evacuation, in the event of fire, of all persons in the care home and safe placement of service users. (b) for the maintenance of all fire equipment. (c) for persons working at the care home to receive suitable training in fire prevention. Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 23 You must take action to 13/07/2009 ensure that fire safety and a safe means of escape for those who live in the home is maintained at all times. To ensure the safety of all those who live work and visit the home 2 29 19 You must not allow any 13/07/2009 member of staff, or prospective member of staff, to work at the home until such time as you have all the information required with which to establish their fitness to work at the home. This is in order to protect those who live at the home. 3 38 13 You must ensure that fire safety polices are adhered too. To protect and promote the safety of all who live and work at the home. 13/07/2009 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 registered manager 20/07/2009 must ensure that all care plans and reviews accurately Care Homes for Older People Page 27 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action reflect the needs of the person and give enough detail to guide and inform staff as to how to met the agreed needs To ensure that Peoples needs are met 2 8 13 The registered manager must ensure that all accidents are recorded and evaluated To ensure to maintain the safety of those who live and work at the home. 3 9 13 The registered manager 15/07/2009 must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical requirements so as not to put people at risk of harm. To ensure that medication practices do not put people at risk of harm. 4 19 23 You must ensure that the 13/07/2009 home is maintained as fit for purpose. To ensure the continued well being of those who live and work within the home. 20/07/2009 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 21 23 You must ensure there are 04/08/2009 sufficient wash hand basins in the toilet areas to met the needs of those who live at the home. To ensure good and safe hygie practices. 6 26 13 You must update the current 30/07/2009 infection control policy with regards to the use of the laundry. To ensure poele are not put at unnessessary risk of harm 7 26 13 You must ensure that all food is stored in a safe and appropriate manner To ensure that people are not put at risk by poor food management 17/07/2009 8 26 13 The registered manager must ensure that infection control policies are adhered to. To promote the well being of those at the home 13/07/2009 9 30 18 The registered manager must ensure that all staff undergo a formal recorded induction into the work they are going to perform. 31/07/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure people are not put at risk from poor practice 10 30 18 The registered manager must ensure that all staff have the necessary statutory training. This is to ensure that peoples needs can be met in a safe manner 11 37 17 All records must be kept in accordance with the Data Protection Act This is to ensure the privacy of those who use the service 12 38 13 The management must 31/07/2009 conduct, record a environmental risk assessment. They must then take action to minimize any risks identified. To protect and promote the safety of all who live and work at the home. 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 10/08/2009 31/07/2009 1 12 More could be done to evidence that structured activities are available based on peoples individual needs and aspirations. Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 3 18 19 It is recommended that all staff including management update their Safeguarding Adults training. That the home carry out an occupation health assessment with regards to its fixtures and fittings to ensure that existing provision is being provided does not put people at risk of harm It is strongly recommended that more effort is made to evidence that Equality and Diversity issues are recognised within the home. Arrangements should be made to carryout formal supervision 4 27 5 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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