Inspection on 05/01/10 for Baytrees Nursing Home

This inspection was carried out on 5th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Baytrees Nursing Home 25/03/10

Baytrees Nursing Home 07/07/09

Baytrees Nursing Home 15/07/08

Baytrees Nursing Home 21/01/08

Baytrees Nursing Home 02/05/06

Baytrees Nursing Home 06/10/05

Baytrees Nursing Home 12/05/05

Baytrees Nursing Home 11/01/05

Baytrees Nursing Home 24/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX     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: Lesley Webb     Date: 0 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 39 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX 01903693833 01903693822 baytreeshomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bay Trees Homes Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). Date of last inspection Brief description of the care home Baytrees Nurings Home is a care home proving nursing care and accommodation for 30 younger adults with physical disabilities. Baytrees Homes Limited owns the service and the Responsible Individual on behalf of the company is Mr T Francis. The Registered Manager responsible for the day to day running of the service is Mrs Denise McWilton. The home is located in Worthing and is close to shops, pubs and other amenities. The main house consists of a three-storey building, which has been extended and adapted. In 2004 a new extension for 10 service users was added to the premises this increased the registration to 30 service users. All rooms in the new extension and a small number of rooms in the main house have en-suite facilities. All rooms are accessible by a passenger lift. Service users have level access to two Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 0 Brief description of the care home lounges/dining rooms, a conservatory and a large decked area to the rear of the property. The fees charged range from £662.46 to £1500.00 per week. Additional charges are made for dry cleaning, newspapers, hairdressing, personal items, clothing and toiletries. Care Homes for Adults (18-65 years) Page 5 of 39 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home on Tuesday 5th January 2010, arriving at 9.10 am and staying until 7.00 pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The registered manager and managing director were present during our visit. Both assisted us throughout our visit. During our visit to the home we examined the care records of three residents and recruitment records of two staff. We also looked at other documentation maintained in the home such as health and safety records, staff training records and complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. An Expert by Experience accompanied us for part of our inspection. This is someone who has direct knowledge and experience of receiving a care service. The Expert spoke with nine residents in depth. Since our last key inspection of 5th July 2009 a pharmacy Care Homes for Adults (18-65 years) Page 6 of 39 inspection has been undertaken on the 11th August 2009. A pharmacist inspector accompanied us for part of this key inspection, assessing medication systems within the home. Information from all of the above sources was assessed and used to help us form judgements on the quality of service provided to residents. Care Homes for Adults (18-65 years) Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: Shortfalls in training and medication were previously identified at the July 2009 inspection and remain unmet. As a result of this, during this visit we issued code b notices for continued non compliance and informed the registered manager and managing director that the commission may consider taking further action. We will write to the home separately regarding this. Care plans on how medicine are taken must be kept up dated at all times and include all medicines. Some care plans require more detail so that people can receive the treatment they have been prescribed. When people manage their own medicines this must have the associated risks assessed and minimised. Residents must be supported to make decisions with respect to the care they receive. Particular attention must be given to choice of staff undertaking personal care, training Care Homes for Adults (18-65 years) Page 8 of 39 of staff to meet the communication needs of individuals and regular meetings where residents can express their views. Records must be maintained in the home that demonstrate residents receive an necessary treatment from dentists, opticians and chiropody services. Residents must be made aware of the complaints procedure and the home must be able to evidence that issues raised by residents are investigated and where possible acted upon. Staff must not work at the home without a full enhanced CRB disclosure unless records are in place that demonstrate this practice is used in exceptional circumstances to maintain staffing levels. Improvement to the environment must be undertaken. Particular attention must be paid to ensuring adequate heating in all areas of the home, that the home is kept in a good state of repair, that fire doors meet required standards of the fire department, that infection control measures in the kitchen meet standards set by the environmental health department and that staff receive training in infection control. A system must be introduced that ensures suitable numbers of staff receive training in all required areas. This must include moving and handling, infection control, safeguarding, food hygiene, first aid and health and safety. Staff must receive regular, formal supervision. Quality monitoring must be regularly undertaken. 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 Adults (18-65 years) Page 9 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 39 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service and their representatives have the information needed to decide if the home will meet their needs. However this is still not available in alternative formats. This might disadvantage people who cannot understand the written word. Assessment processes ensure prospective residents health needs are identified before the move into the home. Evidence: The homes statement of purpose and service user guide are displayed at the entrance of the home. At our last key inspection the managing director for the service informed us that the statement of purpose was going to be produced in audio format. No evidence of this being in place was available at this visit. As at previous inspections residents records that we looked at evidence that pre admission assessments are undertaken before people move into the home. The pre admission assessments we looked at cover aspects of needs and support required focusing on health. Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: The home uses a pre printed care planning document for recording assessments and care plans. We noted that a statement is printed at the front of this system that states fulfils National Minimum Standards 3 and 7 for care homes for older people. We discussed this with the registered manager and managing director as the home is registered to provide services to younger adults and as such is inspected against younger adults minimum standards. The registered manager and managing director were not aware of the differences in contents for younger adults until we directed them to these. For example we showed them additional areas that are recommended to be assessed for younger adults such as meaningful education and training, provision of disability equipment including arrangement for payment and supply and compatibility with others living in the home. The registered manager confirmed assessments of need undertaken do not include these areas. Care Homes for Adults (18-65 years) Page 12 of 39 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care planning and risk management processes give information to staff in order that they can meet individuals needs. Some efforts are made to involve residents in decision making but this continues to be limited. Evidence: We sampled three residents care plans and found these give instructions to staff, describing how individual residents health needs should be met. A life story document was also in place for two of the residents. This information is centred on the individual and gives an insight into their past experiences. Care plans were in place for areas including mobility and elements of personal care. All plans that we sampled had been reviewed on a monthly basis. We found no evidence that residents were involved in this process. This was identified as an area that the home should explore at our previous two inspections and still has not been acted upon. The home uses a pre printed care planning document for recording assessments and care plans. We noted that a statement is printed at the front of this system that states Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: fulfils National Minimum Standards 3 and 7 for care homes for older people. We discussed this with the registered manager and managing director as the home is registered to provide services to younger adults and as such is inspected against younger adults minimum standards. The registered manager and managing director were not aware of the differences in contents for younger adults until we directed them to these. For example we showed them recommendations that younger adults services should be able to demonstrate residents involvement in decision making and participation by providing information in alternative formats, ensuring staff can communicate with individuals with specific needs in this area and providing opportunities such as holding regular residents meetings, allocating key workers and involving in recruitment processes. The homes current care planning format centres on the health needs of residents and provides minimum information (and none in some cases) of social, emotional, cultural and recreational needs. The managing director and registered manager said that they would review the current system and introduce a new one now that this shortfall had been identified to them. As at the previous inspection the people who live at this home have a variety of communication needs. One resident is deaf and we were informed can lip read and understand sign language. One member of staff has knowledge of sign language. No staff employed at the home have been trained in sign language. Signage was not seen around the home that would aid this person to communicate. Since our inspection the home has informed us that all residents who have difficulty in communicating have pictorial communication boards. On the day of our visit we did not see any of these being used. With regard to this resident the Expert by Experience reports The entertainments lady is the only member of staff that knows some sign language, and as it was this residents birthday she showed the rest of the staff how to sign happy birthday which was so obviously enjoyed by this resident as it was reiterated throughout my visit, and she smiled enthusiastically by way of reply. Her sister arrived by way of a birthday visit, bearing flowers, which were so obviously welcomed as this resident could say flowers. Her sister sang happy birthday by mouthing the words. The delight was evident as she understood what was being said to her, I could sense her frustration as no one apart from her sister could understand her. After lunch as I walked past this resident she got my attention as she so obviously was trying to tell me something. I really could not understand her needs so I found a member of staff. They too could not understand her. Her sister was still on the premises and someone went to fetch her. She communicated what she was trying to say. Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: At our last key inspection in July 2009 the managing director agreed residents may benefit if the frequency of residents meetings increased. We found no evidence of this taking place with minutes available confirming that a meeting last took place on the 1st September 2009. The minutes of the meeting before this were for May 2008. Risk management forms part of the care planning system that is in place. This includes assessment of mobility, pressure care and nutrition. Care Homes for Adults (18-65 years) Page 15 of 39 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. In the main residents have a choice of activities that they can participate in and receive a choice of well balanced, nutritious meals. Evidence: As at our last key inspection in July 2009 a notice board in the main lounge area displays information regarding forthcoming activities. These include arts and crafts and forthcoming day trips to a garden centre, museum and the zoo. One of the residents that the Expert by Experience spoke with confirmed information is given regarding forthcoming activities stating, Wow, we have a good amount of activities going on, quiz nights, bowling, shopping, all sorts. Its all on the board in the hallway out there. During our visit to the home we did not observe any in house activities taking place. Residents were seen to be watching the television. Since our inspection the home has Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: informed us that on the morning of our visit an exercise class was taking place in the top lounge. In the main all residents that the Expert by Experience spoke with confirmed their satisfaction with the choice of activities on offer. For example one resident informed the Expert, Theres lots to do here and we get to go out quite frequently, you name it we go there. The Expert by Experience also reports one gentleman so obviously enjoyed the outings that had been arranged. The bowling was a recent highlight, and he enthused about the photos of their day that adorned the walls as a reminder. These had quips attached to them making them all the more fun. Apparently the photos were taken by one of the residents and a member of staff. Another resident was full of the fact that they were off to Horsham the following day for a shopping trip. These outings were in his view run well and fairly administered, as obviously they could not take everyone one every trip due to the size of the bus. One resident informed the Expert that they do not participate in activities as they cannot remember when events are planned. We were informed that a newsletter is distributed that includes information about activities, however none of the residents that the Expert spoke with had seen this. As at our previous inspection specialist diets are catered for and a menu was seen to be on display that offers a choice of meals at every sitting. The majority of residents that the Expert by Experience spoke with confirmed their satisfaction with meals provided by the home. For example comments made include Oh, we get given a choice by X each day. Like omelettes or egg and chips, nice food and X is wonderful, there is a good choice of food, and if you really dont like something they do listen and try to find an alternative. Two of the nine residents that the Expert by Experience spoke with commented that choice is limited. For example one stated, X says something like gammon or salad? I hate salad. I dont like gammon so I had ploughmans but that was full of salad. Care Homes for Adults (18-65 years) Page 17 of 39 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The principles of respect, dignity and privacy are put into practise, however choices can sometimes be limited. The health needs of residents at risk of dehydration or pressure areas are now monitored safely and consistently. Systems are not in place that ensure all residents receive health care attention with regards to sight, foot and mouth care. Some areas of medication continue to require improvement to offer safeguards to residents. Evidence: As at our last key inspection in July 2009 residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. Staff were observed speaking and assisting residents with dignity and respect. For example staff were observed to knock on bedroom doors before entering and using individuals preferred choice of name when having conversations with them. With regard to personal care the Expert by Experience found that the majority of residents receive this to their satisfaction. One resident stated they do not. The Expert reports one person was very well presented and took an obvious pride in their appearance. The home encouraged this by arranging for a manicurist to attend at this Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: residents request, in order that they could have their nails done professionally. Due to a physical condition one resident relies on the staff for much of their needs. They take a pride in their appearance and told me that they were pleased with their choice of attire, which I too had to agree looked good. The resident stopped smiling and seriously proceeded to tell me of a general toiletry/health care request they had. They informed the Expert they had asked not to be bathed/toileted by the younger femals carers but the resident was told they had to have care from the staff available. When looking at the records of three residents none detailed advice or treatment from chiropodists, dentists or opticians. We discussed this with the registered manager who produced a separate book for chiropody and dental treatment. This did not include treatment for the three residents we had identified. The registered manager went and spoke with the residents and informed us two access chiropody services outside of the home, that one had received treatment but that records were not in place regarding this. We informed the registered manager that a requirement would be made regarding this. Records do show that residents have access to community based health professionals such as district nurses where appropriate and general practitioners. We sampled three residents care plans pertaining to health care needs. The care plans sampled were being used in conjunction with other monitoring documents that are used as part of the care planning process for individuals. These had been completed in full, demonstrating that the contents of the care plans are being complied with. This meets a requirement made as a result of last key inspection. As a result of our last key inspection on the 7th July 2009 a random visit to the home was undertaken on the 11th August 2009 where medication was examined. Two requirements relating to medication were found to be met and two new requirements relating to medication were made. At this key inspection the pharmacist inspector visited the home to assess the medicine management in the home and found that the home had good provision for safe storage and management of medicines. There are two storage rooms, a fridge and two medicine trolleys are available so that medicine can be kept and administered safely. We saw the records kept of temperatures of medicine storage areas which means medicines are stored at the temperatures recommended by the manufacturers. Records are kept of medicine received and medicine disposed off. Medicines for disposal are through a clinical waste disposal company as required by the law. Medicines given to people are signed for and good practise is followed. We noted some Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: gaps on the Medicine administration record sheet where medicine were not signed for and so we could not be sure that people had been given these medicine or not. There are good individual care plans showing how people take their medicines which incorporates a risk assessment and includes information about medicines to be taken only when needed and action to take if people refuse medicine. This is reviewed monthly. However, when a new medicine is started new information is not included in the care plan until the next review date. In addition we noted, for one person, for a medicine to be given only when needed which was not newly prescribed there was no clear detailed care plan and the medicine was not on the MAR chart. With regard to medication one resident informed the Expert by Experience, Im allergic to penicillin, I didnt know. I was taken to the dentist last month and he told me I was allergic, why did no one ever tell me. No one knew here apparently, but he had it on his records. She continued for a few minutes questioning why no one here knew, as it should be known. We examined the records for this resident and found that this information had been added after the resident visited the dentist and was not in place before. The home have since informed us that the resident in question did not inform them of this allergy when pre-admission assessments were being undertaken and that their General Practitioners records also did not include this information. One person was managing one of their own medicines. However there was no risk assessment relating to this. When information was handwritten onto the printed MAR charts this was not always dated nor initialled. One two occasions, new information relating to the dose of medicine was written over the old information. This is confusing and could lead to an error being made. Due to the two requirements made as a result of the random visit to the home in August 2009 not being met in full we copied some medication documents under Code b of the Police and Criminal Evidence Act. We will write separately to the responsible individual regarding this. Care Homes for Adults (18-65 years) Page 20 of 39 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Residents are able to express their concerns and have access to a complaints procedure. However their views are not always listened to and acted upon. Residents would be offered greater protection if more staff received safeguarding training. The systems for managing residents finances offer safeguards to individuals. Evidence: There is a complaints procedure on display in the home that informs people of their rights. There is also a suggestions box that residents can use to raise informal issues. The registered manager informed us this is checked daily. No evidence of this being used was available. The registered manager informed us that there has been one complaint received by the home since our last key inspection in July 2009. Records were in place regarding this including action taken by the home as a result. With regard to complaints the Expert by Experience found that the some residents knew who to complain to and others not. Many residents informed the Expert that they feel they are not listened to when raising issues. As the Expert reports one person told me Oh, if things arent right Im sure to say something, X is the person to see, but I dont need to very often. Another resident knows who to complain to if necessary, telling me it was matron. They said they have no qualms about complaining if they feel the need. But said it does not get you anywhere. Another Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: resident told me that if somethings not right then they tell whoever is around. They said they do not know if there is someone in particular they should see. A third resident when asked about complaints first said yes, they knew who to see. They then said But what good does it do? They elaborated explaining that there was a crack in the floor of the bathroom. The resident informed the home of the problem and also what to do to avoid the problem worsening, thinking they had done them a favour. The resident said they feel they were fobbed off, as they thanked him and said they would deal with it. Nothing was done. The next thing was they had to replace the whole flooring when it could so easily have been avoided. Two of the residents that the Expert by Experience spoke with explained that a suggestions box was in place. The Expert reports Suggestion box, the resident pointed to a large box situated in full view below the T.V. set, laughing wryly and said whats the point. The resident said they feel it is for show only. Another resident said I feel fobbed off explaining they were being told that they would look into a matter just to shut them up. They need to listen to us. The resident pointed across the room to the larger than life suggestion box saying they might as well not have one. The resident went on to tell me The top lounge is very cold and you may wonder why most of us come down here, well its ridiculously cold up there and pointing to their own and other residents wheelchairs said, we cant run around to warm up. We saw that the home has a copy of the West Sussex Multi-disciplinary safeguarding adult policy and procedures in place. During this visit we were supplied with training documentation that states there are currently fifty one staff employed at the home, thirty five of whom have not undertaken safeguarding training. Lack of training in this area was identified at our last key inspection in July 2009. This is discussed in greater detail in the staffing section of this report. One resident currently has a deprivation of liberty authorisation in place. We noted that information regarding this was not included in any care plans or risk assessments completed by the home. We were informed that no staff have received mental capacity or deprivation of liberty training. We were shown evidence that training had been arranged for some staff with regards to the Mental Capacity Act but this had to be cancelled due to a swine flu outbreak at the home. As at previous inspections there are systems in place to manage personal finances of Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: residents who are not able to do this. These include individual records that detail income, expenditure and balances. Care Homes for Adults (18-65 years) Page 23 of 39 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Deterioration in some areas of the home means that residents do not live in a safe and comfortable environment. Evidence: There is a large decking area accessible to people who use wheelchairs through the lounge/conservatory. As at previous inspections it was observed that most people living in the home stayed in the smaller lounge throughout the morning and also during lunchtime. Residents informed us this was due to the conservatory being cold. We noted that only one small electric heater is in place in the conservatory. With regard to the heating a resident informed the Expert by Experience The top lounge is very cold and you may wonder why most of us come down here, well its ridiculously cold up there. Another resident said, colder up there so less busy. Since our last key inspection in July 2009 the ceilings in the home have been redecorated. We looked around the communal areas of the home and at four residents bedrooms. Residents bedrooms have been personalised to suit their individual interests and hobbies. Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: We noted that many fire doors and surrounding frameworks we badly scoured and damaged. We also saw that part of the ceiling on the third floor was damaged and water stains were apparent around the emergency lighting. We were informed this was due to the leak roofing and that the ceiling cannot be repaired until fully dry. We informed the registered manager and managing director that we would contact the fire department regarding this. Since our visit the home have supplied additional information that informs us that the roof had been repaired at the time of our visit and that the ceiling has been repainted. Many waste bins around the home did not have lids and some were seen to be overflowing with items. We were informed that these were in the process of being changed. The shower room on first floor was out of use on the day of our visit. We were informed residents were using a facility on the ground floor until the repairs have been undertaken. The registered manager said that the shower room would be operational within two weeks. Two residents expressed the view to the Expert by Experience that some bathing facilities could be improved. They stated, Towel rails are missing, and making it difficult when you finish. We saw that a one residents bedroom currently has no heating. We were informed this had been the case since the week before Christmas. We spoke with the registered manager and managing director and informed them that if this was still the case when we had completed our visit we would have to issue an immediate requirement form. The managing director immediately unplugged an electric heater from the office and took this to the residents room. We saw several areas of concern in the kitchen. These include no food items being dated when opened, many also being inappropriately stored and one being out of date. Some wall tiles were chipped, dirt and grease was on shelves, cupboards, cooking utensils, the floor and walls and food debris was seen in the staff hand washing sink. Training records show that the majority of staff working in the kitchen have not undertaken food hygiene training. We informed the registered manager and managing director that we would contact the Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: Environmental Health Department regarding our concerns. They informed us that they were aware of the issues with the kitchen and that a meeting had already been arranged for Thursday to talk to staff. We asked if issues had been discussed before this and they said no. We said that the kitchen should not have been allowed to deteriorate to this level before management take action. The laundry room includes industrial washing and drying machines, flooring and walls that are washable and waterproof. There are also separate storage facilities for soiled and clean laundry. The home has two sluice rooms. Since our last key inspection in July 2009 one has been refurbished and both now include waterproof flooring and wall. During our visit to the home we were supplied evidence of fifty one staff working at the home. Eleven have received infection control training. Training was identified as an area requiring improvement at our last key inspection as remains an issue. This is discussed further in the staffing section of this report. Care Homes for Adults (18-65 years) Page 26 of 39 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Residents are supported by caring staff. Monitoring systems do not ensure sufficient numbers of staff are trained to care for residents. Not all recruitment practises offer safeguards to residents. Staff do not receive regular, formal supervision. Evidence: We were informed us that one nurse and eight care staff are allocated to the morning shifts and one nurse and four care staff of an afternoon. At night there is one nurse and two care staff. They also informed us that laundry and kitchen staff are employed seven days per week. Rotas that we looked at do not demonstrate staffing levels have been maintained to these levels at all times. All the residents that the Expert by Experience spoke with expressed satisfaction with staff. The Expert reports one resident said, Staff here are great. Another resident informed me they got on well with the staff and was genuinely pleased with the service received and said they were attentive and polite in all they did. A third resident said that they were quite happy with staff, they work hard and they really look after me. We examined the recruitment records for the two newest staff to commence working at the home. They included completed application forms, two forms of identification Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: and two references (meeting a requirement made at our last key inspection in July 2009). One did not contain evidence of an Enhanced Criminal Bureau Disclosure (CRB). An ISA Adult First check was on file. Documentary evidence that the member of staff has been allocated a supervisor who where possible is on shift with the new worker was not in place. We informed them that a requirement would be made regarding this. Evidence was in place that confirms all qualified nurses employed at the home hold a current PIN (this meets a requirement made at our last key inspection in July 2009). At our last key inspection in July 2009 a requirement was made that a system is introduced that ensures suitable numbers of staff receive training in all required areas. This must include moving and handling, infection control, safeguarding, food hygiene, first aid and health and safety. The registered manager informed us that the administration manager is responsible for arranging and monitoring training. We were given a training matrix that has been introduced to monitor staff training. We were informed this is accurate and up to date. The training matrix details fifty one staff employed at the home. It states that seventeen staff have not received fire training, thirty five have not received safeguarding training, forty who have not received infection control training, twenty who have not received first aid training and twenty three who have not received moving and handling training. The matrix also informs that two staff hold a National Vocational Qualification (NVQ) at level 2 with eight others in the process of undertaking this, two staff who hold both level 2 and 3 of this qualification and two staff who are about to start this. The matrix also states two staff are undertaking a NVQ but it does not state at what level. We noted that the matrix states refused next to two staffs names for NVQ. We discussed one of these people with the registered manager and the administration manager as the same person holds no qualifications at all. We were informed the member of staff refuses to attend training due to working nights. We were informed no actions have been taken as a result. The training matrix details other courses undertaken by staff as communication (one person), health and safety (two people), peg feed (six people), food hygiene (four staff) and medication (one person). As mentioned in the care planning section of this report one resident has specific communication needs. One member of staff knows some sign language. Due to the lack of staff who have been trained in this area the Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: resident is unable to communicate their views and wishes at all times. The training matrix details nine staff with no qualifications or training undertaken in any areas and eight other staff with training in one area only. We discussed this with the administration manager who informed us one of these people does hold certificates from a different employer and that these have been requested. Evidence of these were supplied to us the day after our visit. One of the members of staff who holds no qualifications works nights when only three staff are on duty and the majority of kitchen staff do not hold food hygiene certificates. We looked at the staff rotas for the 28th December to 5th January 2010 and cross referenced these with the training matrix. This evidences that six shifts in this time period were covered by a nurse with no training other than fire, six night shifts were covered by a care assistant with no qualifications at all, one morning shift had a care assistant with no qualifications at all and two other shifts had a care assistant with training in first aid only. We also found that on five shifts staff carrying out kitchen duties have not undertaken food hygiene training. We issued a Code b notice to the registered manager for the continued shortfalls with regard to training that were previously identified at the key inspection in July 2009. Records confirm that new staff receive a structured induction. When we asked to view staff supervision records we were given a document that details competency assessments undertaken in areas including assisting with personal care and meals. We asked to view supervision records for staff after they have completed the competency assessments and were informed none is undertaken. We noted that several staff members have been employed at the home for over two years. The Administration Manager confirmed that they would not have received formal, one to one supervision since completing their competency assessments at the beginning of their employment. The registered manager said that supervision used to be undertaken but was unable to say why this has ceased. When looking at the competency assessments we noted that care staff are being assessed to undertake enemas and catheter flushes. We asked the registered manager who trains the care staff in these practises and she supplied the name of a member of staff who holds no nursing qualifications. We questioned the appropriateness of care staff carrying out these practises when the home is registered to provide nursing care and has qualified nurses on each shift. The registered manager Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: agreed and said she would stop this practise immediately. At our last key inspection in July 2009 records were available that demonstrate staff meetings take place twice a year. This is below the National Minimum Standard for Younger Adults which recommend a minimum of six per year. At this inspection we were given the minutes of one meeting that took place for night staff and one for day staff. No other records were available for inspection that could evidence improvements have been undertaken in this area. Care Homes for Adults (18-65 years) Page 30 of 39 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Management and monitoring systems are not meeting all of the needs of residents safely and consistently with regards to some residents needs, the environment, staff training and supervision, medication and recruitment practises. Evidence sited throughout this report indicates that management of the home is reactive, based on outside agencies identifying shortfalls in service provision. This has resulted in an inconsistent quality service. Evidence: The registered manager was present when we visited the home as well as the director. Both assisted by providing written documentation and answering questions relating to the inspection process. The registered manager has been in post for several years and is also a qualified nurse. As a result of a requirement made at our last key inspection in July 2009 residents questionnaires have been introduced to seek their views on the service they receive. In October 2009 these were analysed with the majority of feedback positive. During this visit we were shown visitors questionnaires that have been introduced. These are located at the entrance of the home. The managing director informed us that as yet none have been completed. We asked if Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: questionnaires as sent to visitors and were informed they are not. As mentioned in other sections of this report this inspection has identified non compliance with the Care Home Regulations 2001 with regards to care records, the environment, staff training and supervision, recruitment and medication. These issues were not identified by the home within its own quality monitoring systems. Shortfalls in training and medication were previously identified at the July 2009 inspection. As a result of this, during this visit we issued code b notices for continued non compliance and informed the registered manager and managing director that the commission may consider taking further action. Care Homes for Adults (18-65 years) Page 32 of 39 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 35 18(1)(a)(c) The registered person must 07/09/2009 ensure that a system is introduced that ensures suitable numbers of staff receive training in all required areas. This must include moving and handling, infection control, safeguarding, food hygiene, first aid and health and safety. This must happen in order that residents are supported by suitably qualified staff at all time. 2 39 24 The registered person must 07/08/2009 ensure quality monitoring is regularly undertaken, including obtaining the views of residents. This must happen in order that residents receive a consistent and safe service in all areas. Care Homes for Adults (18-65 years) Page 33 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 In line with regulation 05/02/2010 12(2)(3)(4) The registered person must enable residents to make decisions with respect to the care they receive. Particular attention must be given to choice of staff undertaking personal care, training of staff to meet the communication needs of individuals and regular meetings where residents can express their views. This must happen in order that residents rights are promoted. 2 19 13 In line with regulation 13(1)(b) the registered person must be able to demonstrate through records maintained in the home that residents receive any necessary treatment from dentists, opticians and chiropody services. 05/02/2010 Care Homes for Adults (18-65 years) Page 34 of 39 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 must happen to ensure residents health needs are met in full. 3 20 13 In line with regulation 13(2) the registered person must have a care plan around medicine to be used only when needed for consistency. This was a previous requirement with a timescale of 15.09.09 This must happen to ensure residents medication is managed safely. 4 20 13 In line with regulation 13(2) the registered person will have a care plan around medicine being left for unsupervised consumption which includes a risk assessment for competence and a risk assessment. This was a previous requirement with a timescale of 15.09.09 This must happen to ensure residents medication is managed safely. 5 22 22 In line with regulation 22 the registered person must ensure that all residents are 05/02/2010 15/09/2009 15/09/2009 Care Homes for Adults (18-65 years) Page 35 of 39 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 made aware of the complaints procedure and be able to evidence that issues raised by residents are investigated and where possible acted upon. This must happen to ensure residents rights are protected. 6 24 23 In line with regulation 23(2)(b)(p)(4)(5) the registered person must ensure the environment meets residents needs. Particular attention must be paid to Ensuring adequate heating in all areas of the home, That the home is kept in a good state of repair, That fire doors meet required standards of the fire department, That infection control measures in the kitchen meet standards set by the environmental health department, And that staff receive training in infection control. This must happen in order that residents live in a safe and comfortable environment. 05/03/2010 Care Homes for Adults (18-65 years) Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 34 19 In line with regulation 05/02/2010 19(11) the registered person must be able to demonstrate that if a member of staff commences working at the home without a enhanced CRB having been obtained this is only undertaken in exceptional circumstances to maintain staffing levels and that records evidence the member of staff is allocated a supervisor who where possible is on duty at the same time as the new worker. This must happen in order that the homes recruitment practises safeguard residents. 8 35 18 In line with regulation 18(1)(a) the registered person must ensure that suitably qualified staff are on duty at all times. This must happen in order that residents are safeguarded from harm. 05/02/2010 9 36 18 In line with regulation 18(2) the registered person must ensure that staff receive regular, formal supervision. This must happen in order that residents are supported 05/02/2010 Care Homes for Adults (18-65 years) Page 37 of 39 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 by staff who understand their roles and responsibilities. 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 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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