Inspection on 11/06/09 for Bedford Park Care Centre

This inspection was carried out on 11th 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedford Park Care Centre 26/06/09

Bedford Park Care Centre 07/11/08

Bedford Park Care Centre 10/05/08

Bedford Park Care Centre 26/06/07

Bedford Park Care Centre 20/09/06

Bedford Park Care Centre 12/01/06

Bedford Park Care Centre 05/10/05

Bedford Park Care Centre 01/03/05

Bedford Park Care Centre 07/09/04

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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: Bedford Park Care Centre Pearn Road Mannamead Plymouth Devon PL3 5JF     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: Caroline Rowland-Lapwood     Date: 1 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 45 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 45 Information about the care home Name of care home: Address: Bedford Park Care Centre Pearn Road Mannamead Plymouth Devon PL3 5JF 01752770477 01752785090 manager.bedfordpark@aermid.com www.aermid.com Aermid Health Care Properties Ltd care home 104 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: DE(E) Maximum registered 39 service users Maximum of 104 service users accommodated at any one time OP Maximum registered 65 service users PD(E) Maximum registered 39 service users Registered for 65 years and over Date of last inspection Brief description of the care home Bedford Park Care Centre comprises of three separate units known as the Manadon Gardens (Nursing Unit), Compton Gardens and Pearn Gardens (Residential Unit). All units are laid out over two floors with wheelchair access via ramps or passenger lifts. Care Homes for Older People Page 4 of 45 Over 65 39 65 39 0 0 0 Brief description of the care home Bedford Park care centre is situated on the outskirts of Plymouth close to local amenities. Staff within Manadon Gardens provide 24 hour nursing care to a maximum of 38 people. Staff within Pearn Gardens provide personal care to a further 38 people and staff within the Compton Unit are able to provide personal care to a further 26 people. People with dementia are cared for in all units. The maximum number of people at the home should not exceed 104. Communal rooms are available in each unit and the home benefits from large landscaped gardens, which are accessible from Pearn Gardens. Manadon Gardens has a sheltered patio area and people within the Compton Unit are able to access both areas when staff are free to accompany them. The home is owned by Aermid Health Care Group PLC a national care home provider (www.aermid.com). The current weekly fees in the residential unit and Compton unit range from 357 pounds to 393 pounds and in the nursing unit range from 468 pounds to 562.65 pounds (June 2008). All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The last inspection report and Statement of Purpose are on display in the entrance foyer to each unit. Care Homes for Older People Page 5 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 3 people living at the home. Three surveys were returned from staff and two from outside professionals. The comments and responses we received have helped us to form the judgements we have reached in this report. This unannounced inspection took place as part of the normal programme of Care Homes for Older People Page 6 of 45 inspection. The site visit was undertaken over one day present were three regulatory inspectors and the lead pharmacy inspector. One inspector each looked at one unit of the home. As a way of judging the service overall, during our visit, we (the commission) spent time talking with people who live at Bedford park. Most people living at the home were seen or spoken with during the course of our visit. We spoke with care and ancillary staff, the unit managers and the homes general manager. We looked at the care and accommodation offered to nine people living at the home and observed the care and support provided by staff. We also looked at a number of records the home is required to keep, including assessment and care plan files, daily reports, staff recruitment and training records. Care Homes for Older People Page 7 of 45 What the care home does well: What has improved since the last inspection? What they could do better: Some requirements made at the last inspection are still outstanding. This relates to; Care plans not being reviewed. Risk assessments of bed rails not being effective or accurate to show the persons wishes. People are still not being given access to a call bell. Issues around privacy and dignity including personal information being displayed on bedroom doors. There is concern about the detail of information in plans of care. Assessments are not always being updated where changes have taken place and the detail in care plans and risk assessments do not describe how individual needs are to be met. Without good quality information that is reviewed and changed to take into account peoples changing needs, the quality and consistency of care could be compromised. The management of medicines may mean that people do not always receive medicines as they have been prescribed. Also poor temperature control may compromise the effectiveness of some of the medicines administered. Improvements are needed to ensure that peopless social and leisure needs are met and recorded, especially those with limited capacity or specialist needs. The management of complaints must be improved so that people can be assured their concerns are acted upon and reviewed. Improvements must be made to the continual maintenance and carpets so that the people living there are comfortable and happy and their privacy and dignity is Care Homes for Older People Page 8 of 45 promoted at all times. Staff must be adequately trained to meet the needs of people living at the home. Several aspect in respect of Health & Safety has been identified and poses a risk to people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 45 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 45 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. Generally the admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Some improvements could be made with the management of people receiving intermediate care. Evidence: People we spoke to in the Compton Gardens Unit told us family had helped with the move to the home. One person told us they had only been at the home for a few weeks but already felt settled. Pre admission assessments are performed on people before they move into the home. The manager of Compton Gardens told us that the pre-admission assessment document had been changed to include prompts to ask hospital staff whether people Care Homes for Older People Page 11 of 45 Evidence: had been swapped for MRSA or were awaiting results for urine and blood tests. The pre-admission assessment had also been improved to ask people whether they consented to staff using terms of endearment, and asking the question whether they would like the occasional hug. Staff also informed us that they were in the process of introducing welcome packs to new residents. We would told disinformation would include details of the menu, hairdresser, staff uniform, key worker information, and times of meals. Care plans contained information on specific conditions for staff reference. Examples included leaflets on diabetes. The unit manager told us she prints off information from the Internet so staff have the necessary information for reference. The four people whose care was followed all had assessments of their needs completed. The two people who had been at the home the longest also had a revised assessment to reflect their changed care needs. The homes manager has risk assessment documentation for manual handling, pressure sore risk and nutritional risk. A dependency rating assessment is also completed on admission. In addition to the homes own assessment copies of the social services care plan and assessment prior to admission were available with the care plan information. The home does not provide intermediate care in the fullest sense. However they do have dedicated respite rooms, which can be used at short notice. The respite beds also used as crisis intervention admission to the home, where people can return home following their stay. One of the people whose care was followed had been admitted following a crisis at home where the family were unable to cope. A dedicated area for respite or short-term admissions was not provided in Manadon Gardens. Respite beds were available throughout the unit. Pre admission assessments seen for people in the residential unit, Pearn Gardens, were comprehensive and contained relevant information which was used to then develop a plan of care for the individual.The unit manager confirmed that she visits people at home or in hospital prior to admission and if possible invites them in to visit the home prior to admission, often they come in for lunch.We witnessed one person being shown around the home by a member of staff, she was looking for a home for her relative; staff were kind and sensitive to her needs. Care Homes for Older People Page 12 of 45 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good system for recording peoples care needs however these had not all been reviewed monthly or as their needs change meaning that people are not getting the appropriate care as planned. Staff do not always meet the needs of the people living at the home. Some aspects of medication practice is poor and puts people at risk. Privacy and dignity is not always respected by all staff. Evidence: The home provides nursing care for people who live in Manadon Gardens. At the time of this inspection 24 people were living in this unit. Registered nurses who cover a 24hour period seven days a week oversee their care. People have access to health care professionals who provide advise support and treatment for the people living there. Care Homes for Older People Page 13 of 45 Evidence: Each of the four people whose care was followed had a plan of care in place, which had been developed from an assessment of need. One of these people had been admitted to the home as a crisis admission 48 hours earlier. This person had a copy of the community assessment and care plan as well as the homes own assessment and care plan completed. The care plan gave information about the persons GP, their next of kin and family contact numbers. The reason for their admission in the past medical history had been clearly recorded. Risk assessments had been completed for manual handling, pressure sore risk and possible use of bed guards. The assessments identified that the person was at high risk, care plans have been put in place where risk of being identified to guide staff had a persons care should be delivered. Although the persons care plan included a psychological needs care plan, which identified their concerns about the terminal nature of their illness. An end of life care plan, which clearly stated their wishes, had not been recorded. Their GP had requested oxygen when they were admitted however at the time of the inspection this had still not been provided. The person and their family were distressed that the oxygen was taking so long to organise. The manager and the registered nurse in charge of the unit were speaking to the GP and pharmacist during the inspection to try to get this done. The person and their family were spoken to in privacy. The family said they had not been at the home long enough to comment about the care. They did say staff had been very friendly and were trying to help their relative settle. The manager had advised that end of life care planning would be introduced when the initial problems with the oxygen had been resolved. Another person was being cared for in bed. They had the radio playing a local radio station; the information in the care plan didnt include what type of most music or programs the person like listening to. The manager advised that staff get to know peoples preferences and will ensure that they have something to listen to that they enjoy. During the inspection the person was asleep in bed the majority of the time it was noted that staff attended to and changed their position twice during the morning. Carers who went into the room were signing a record of half hourly checks. The care plan stated that the person was unable to use a call bell and a half hourly checks had been instigated to make sure the person had all they needed. The person appeared to be comfortable, they had clean bed linen and were wearing clean nightclothes cloths. The room was fresh and clean. The person had a PEG feed running. The instruction in the persons room stated that the feed had been started at midnight. The en-suite toilet was being used as a store for the PEG feed equipment and feed bottles. The person was being cared in a hospital style profiling bed with an overlay airflow pressure relief mattress, which had been placed on top of an existing mattress. The overlay mattress was smaller than the existing bed mattress; this left a gap at the end Care Homes for Older People Page 14 of 45 Evidence: and a smaller gap at the side of the bed. The distance between the overlay airflow mattress and the bed guards being used for the person was more than 10 cm. This was reported to the manager at the time it was noticed. A consent form for bed guards signed by the persons relative who had power of attorney was dated 2005. A risk assessment for the bed guard was not available. The manager confirmed that the persons care needs had changed since the consent form was completed. The pressure area risk assessment recorded a very high risk of pressure sore development. However this had not been up dated to reflect further changes in the persons health. The care plan had been up dated in September 2008. The last recorded review was April 2009. The persons care plan and risk assessments had not been reviewed monthly and risk assessments had not been changed when the persons care needs changed (information in the daily statement indicated these had changed in April 2009). The record of the persons weight showed that they had lost weight between January 2009 and April 2009. The person did not have a social care plan provided, which would have given information regarding the persons interests and what they enjoyed doing. A life history was not completed, which would have given staff an insight into the achievement of the persons life. We visited another person who was receiving end of life care. The person had been admitted to the home in April. A care plan had been developed form their initial assessment of need, which provided guidance for staff how the persons care should be provided. They were being cared for in a hospital style profiling bed with an airflow overlay mattress on top of the existing mattress for pressure relief. During the inspection person was asleep in bed the majority of the time it was noted that staff attended to the person and change their position twice during the morning. Carers who went into the room were signing a record of half hourly checks. The care plan stated that the person should have their call bell with in easy reach. However it was clear the person was no longer able to use the call bell and staff were completing half hourly checks make sure the person had all they needed. The person appeared to be comfortable, they had clean bed linen and were wearing clean nightclothes cloths. The room was fresh and clean. The person had been seen by the tissue viability nurse who had provided instruction and advise for staff regarding how to manage the person wound care. This was recorded in the persons care plan. However ongoing assessment, which recorded the state of the wounds when dressing were changed had not been recorded.The person had been started on the Liverpool Care Pathway two days earlier. This is a system for ensuring people receive the care they need when they are dying. A syringe driver, which administers a regular dose of pain relief and symptom control medication, had also been started. The prescription for the medication used in the syringe driver had been completed by the doctor and staff had been recording the amounts and type of medication used each time the syringe was Care Homes for Older People Page 15 of 45 Evidence: changed. Two registered nurses had signed this. However there did not seem to be a system in place to check the syringe driver was still working to deliver the monitored dose over the 24-hour period. The Liverpool care pathway had been completed to show what the aims for the persons end of life care were. And regular checks (4 hourly) up until AM on the day of the inspection had been recorded. These indicated that the care stated in the plan had been achieved for the person. Although the manager stated that the registered nurse had checked the person that day this had not been recorded in the pathway record. A large notice out side the persons door warned that the person had an infection and advised the use of gloves and aprons. Another person had been admitted to the home in April. A care plan had been developed from their initial assessment of need, which provided guidance for staff how the persons care should be provided. The persons preferred name and the contact details for their next of kin had been recorded. They were being cared for in a hospital style profiling bed with an airflow overlay mattress on top of the existing mattress for pressure relief. Bed guards with bumpers had been fitted to the bed. The person appeared to be agitated and asking for help. They did not look comfortable. Their room was fairly clean although it looked untidy. The equipment for the PEG feed was being stored in the en-suit toilet; some was positioned closed to the toilet. Several boxes of nutritional supplement drinks were being stored in the persons room. The stored equipment and nutritional supplements being stored in the persons room made the room look more clinical than homely. The person had their television on but did not appear to be watching this. Staff spoken with said the person liked watching television and they usually spent their day in bed. The care plan did not have a social care plan, which had recorded what the person liked to do. The person did not have their call bell with in easy reach. The care plan did not have a risk assessment for use of the call bell or state the person was unable to use this. The past medical history noted that they had a bi polar disorder. Although a psychological support care plan had been recorded this did not included this as part of the persons care management information. A fully completed risk assessment for the use of bed guards and a consent form was not seen. There was evidence in the care plan that the person had been referred to the stoma nurse specialist and the Speech and Language Therapy team. The persons manual handling risk assessment was not with their care plan information. However it was stuck to the wardrobe door in their room, along with instruction for staff how much nutritional supplement drinks they should be given. We visited another person who was sitting in a wheel chair in their room. Their arm was being supported with cushions. They did not have a call bell with in easy reach although their care plan indicated they were able to use a call bell. In the en-suite we saw a prescribed treatment cream which was being used for the person in that room , Care Homes for Older People Page 16 of 45 Evidence: it had been prescribed for a different person in the home.The persons care plan had been up dated and reviewed in March, there was no record of the care plan having been reviewed since then. The person did not have a social care plan that identified what activities or entertainment they enjoyed. Other observation of people living in the nursing wing included; One person sitting in their wheel chair waiting for a visitor their call bell was not in reach. They said that staff dont always give it to them and if they havent got the call bell they just wait until some one comes into their room. We saw another person who had three prescribed treatment creams in their en-suite, which had been prescribed for three different people living in the home. In addition to these three they did have one treatment cream that had been prescribed for them. People on the Compton Garden unit appeared well cared for. People being nursed in bed appeared comfortable, pain-free, warm, and well cared for. Regular check documents were well completed and showed that the person had been turned 2 hourly. Less frail people also appeared well cared for with the finer details of care being attended to such as haircare, eye care and appropriate footwear. Each person has an A4 folder which contained care plans risk assessments and other documents relevant to that person. All records were well maintained, up to date and easy to follow. Systems were in place to ensure risk assessment and care plans were reviewed on a regular basis. There was also a checklist to ensure other documents such as admission information and property checklists were updated on a regular basis. Where people required adjustable beds these were provided. Specialist mattresses to aid with pressure relief provided, and mobility equipment such as walking aids, hoists, stand aids, grab rails were present when necessary. The activities programme showed that people who use the service have opportunities provided to do exercises in their chairs. One person told us that she found the exercises great fun. Staff were seen to assist people in a sensitive and timely manner. People said they had their call bells answered promptly, but on occasions had to wait when staff were busy. Creams and lotions prescribed for people within the Compton Garden unit were used Care Homes for Older People Page 17 of 45 Evidence: only for those people. It was unclear when these creams had been opened. Care plans were looked at for three people living in the residential unit. Each care plan contained clear information for staff to clearly understand the individuals needs. One persons care plan clearly stated they did not eat pork for religious reasons, this was understood by staff and was written clearly in the kitchen. However, on the day of the inspection they were given pork sausages for thir lunch. This had been reported via an anonymous complaint to the Care Quality Commission prior to the inspection and was described as always happening . Another person care notes were seen, in them were details of an occasion when the person had been late for breakfast, it described how the person would have to eat in your room if they were late again as breakfast was finished. This is unacceptable and is not allowing choice and shows an institutional approach. This issue was also notified to the CQC anonymously prior to the inspection. We discussed this with the home manager, she agreed it was unacceptable and said that she would investigate and deal with it as a matter of urgency. We spoke to several people about day to life at the home they all said they were happy; some comments made include, they are really kind and the staff are very good. Those people who use bed rails had assessments completed within their care plans, however these did not show why these rails are needed and who was involved in the decision making process. We talked with staff about their daily work, we witnessed staff showing kindness and having some gentle banter with the people living at the home. Most of the staff were in and around the lounge area on the morning of the inspection, we heard staff talk about toileting rounds and routines in general which suggests that the home uses a task based ethos instead of person centered care which looks at the individuals need. People living at the home said they were comfortable and well cared for. We also looked at the way in which medicines are handled within the home. On each unit there is a dedicated medicines storage area and they also have lockable trolleys to transport the medicines around the home. We found however that on some of the trolleys that each persons medicine was not carried and that people were administered medicines from other peoples supplies. This is not good practice as medicines when prescribed are the property of the person to whom they are prescribed. It also means Care Homes for Older People Page 18 of 45 Evidence: that it is no longer possible to audit the medicines relating to an individual. There are dedicated medicines fridges, the temperatures of these are monitored but not all units record the temperature range meaning that it was not possible to be certain that the medicines were stored safely. We also found that the temperature of the medicines rooms was also not monitored and it could not be established if the rooms are maintained below the temperatures as specified by the manufacturers of the medicines. Within the medicines fridge we found some eye drops in current use. The manufacturer recommends that these are stored at room temperature when in use. Also for some of these eye drops there was no indication when they had been opened so it was not possible to establish if it was still safe to use these drops. We found also that some people had not had their medicines administered as prescribed as the Medication Administration Record (MAR) charts indicated that they were out of stock. On discussion with the manager and other staff it was established that there was no clear system to monitor stock levels or chase up the supply of orders once placed. It may be that this situation was compounded as the home is in the process of changing supplying pharmacy but this would not have occurred had there been safe and robust systems in place. We also found on all units that the staff were carrying out blood sugar monitoring for people using lancets that were labeled as being suitable only for self testing people only, this may increase the risk of needle stick injury occurring and also increase the risk of cross infection. We also found opened and part used dressings labeled as either sterile or for single use only. This again increases the risk of cross infection. We found that some people were prescribed medicines to be administered when required. We could find no specific protocols or directions on how the decision to use these was to be taken and also no record of how the decision had been taken on the occasions that they had been administered. This means that people cannot be confident that they will have this type of medicines administered consistently. We found that whilst the administration of oral medicines was well recorded there was no clear system for recording the application of externally applied medicines. We also found that for one person receiving regular injections that there was no agreement between the home and the community nurses for sharing the records of administration. Care Homes for Older People Page 19 of 45 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. Peoples personal choices and preferences for activities are not routinely recorded in their plan of care. This may mean staff do not have all the information they need to plan social interaction, activities or support for people that they will enjoy. This may mean the people less able to express their preferences clearly will not be given opportunity to participate in the activities they enjoy the most. Evidence: The people whose care was followed did not have a life history or completed social care plan with their care plan information. Limited information about individual preferences for activities or type of music they liked to listen to was available. People whose care was followed who were in their own rooms were listening to different types of music or television during the inspection. This suggested that staff were aware of the persons preferences. When the inspection started at 9:00 am one person was sitting in the lounge between the nursing and residential unit. They were sitting in their wheel chair. No television or music was playing. By mid morning two other people had been brought to the lounge. Both were sat in front of the television in their wheel chairs. A childrens programme Care Homes for Older People Page 20 of 45 Evidence: was on the television and neither person was watching this. A member of staff said they had just brought them to the lounge and would be transferring one of them to an easy chair. They said the other person preferred to stay in their own wheel chair. When asked about the TV programme that was on the television they said they had just turned the TV on when they had brought the two people into the lounge and had not noticed what was on. One relative spoken with said their relative had told them they did not want to drink the water because it tasted funny. They were buying bottled water for them to drink. They also said staff had been very helpful to them and felt their relative was being looked after well. Staff told us that usually there are four activities coordinators within the home, but due to sickness this had been reduced to two. The activities coordinators have an office within the Compton unit. Records are kept by the activities coordinators for each person who attends the activities and records the reasons why people did not participate. Once these records are complete they are transferred to the persons care plan records. We were told structured activities occur on a daily basis and regularly include: chair aerobics, bingo, quizzes, walks in the garden, and the occasional trips out. One person said they had been at the home very long time and that staff were lovely. This person said I love the bingo but especially loved the trips out. We recently went up to Plymouth Hoe which was lovely. A person who lives at the home told us that they had recently had a new chef, who had taken some getting used to, but had settled in very well. One person told us the food is excellent and theres always plenty of it. Staff told us menus have been changed since the last inspection and now included a choice of two main meals plus alternative meals should person not to like either of two choices. The kitchen was well organised, clean and tidy. Staff told us there was sufficient equipment however the potato peeler had recently become faulty which meant that kitchen staff were spending long periods of time peeling potatoes. Cleaning schedules, fridge and freezer temperatures, and food temperatures were recorded within the safer food better business program recommended by the food standards agency. A recent environmental health inspection showed there were no recommendations made for the kitchen. Kitchen staff told us that the likes and dislikes people were recorded in the kitchen. We were shown a whiteboard showing this information. Information such as diabetic diets and specific dislikes, allergy information and religious dietary Care Homes for Older People Page 21 of 45 Evidence: information were contained on this whiteboard. However this information was not adhered to on the day of the inspection ( see Health & Personal Care outcome group). Generally people living at the home that were able to say told us that they could get up and go to bed when they choose; we arrived at 9AM and all the people living in Pearn Gardens unit were up. Staff said they knew who likes to get up and go to bed early and that they do not follow any strict routines. Once up people are put into the lounge where they have their morning coffee and afternoon tea. We saw a member of staff involved in giving out the drinks giving out biscuits; she was not offering a choice but giving biscuits out one at a time to people who wanted one. This is not giving people freedom of choice. Staff talked about toileting rounds and routines in general which suggests that the home uses a task based ethos instead of person centered care which looks at the individual need. Care Homes for Older People Page 22 of 45 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to however generally the systems in place are not effective for dealing with complaints adequately Staff do not fully understand the principles of adult protection, which does not fully protect people living in the home adequately. Evidence: The Care Quality Commission has received four complaints since the last inspection; one was regarding lack of cups and some issues with equipment this was addressed by the home and the matter resolved. The other three have been made anonymously and are about poor cleanliness throughout the home, the rubbish piled up outside and general areas of poor practice. These issues were looked at on the day of the inspection and our findings are throughout the body of this report. Staff on the Compton Garden unit told us that they had received no formal complaints about the unit and that minor issues are dealt with on an informal basis before they become complaints. Staff told us that senior staff had attended a recent safeguarding and deprivation of liberty training session. A member of staff on the Compton Gardens unit informed us that they had not had to refer anyone for deprivation of liberty, but had to considered a specific incident in recent weeks. This situation was resolved by the discharge of a person from the home. Care Homes for Older People Page 23 of 45 Evidence: All but one of the six staff files inspected showed that staff had received in-house training on the protection of vulnerable adults. However, some staff were unaware of who to report allegations of abuse to outside of the organisation to which the home belongs. There were no signs of restraint seen on the Compton Garden unit. People being cared for in bed with the use of bed rails had been assessed for the need for bed rails. Evidence of family involvement was seen and a full risk assessment of the use of the equipment was maintained and kept under review within the care plan. The general manager provided the complaints folder, which covers all three units at Bedford Park. Not all had the information regarding the actions taken to address the concern raised had been recorded. The manager advised that since she had started work at the home this had been kept. Head office had been dealing with any complaints prior to the managers appointment. This showed five complaints had been received this year. Four of these related to Manadon Gardens. Concerns included lack of cups, poor quality bed linen and lost item. The manager was able to provide a copy of an order she had put into head office in April for new sheets and pillowcases and an order for new crockery. However the manager advised that these had yet to be authorised by the purchasing team at head office. No records of any concerns staff had raised with the manager or senior staff were being kept in the complaints folder. The manager advised that this information was kept in individual staff files. Discussion also revealed that where concerns are raised these are dealt with as they occur and are not recorded as a complaint but with individual peoples care plans. When asked to provide the records of complaints received in Pearn Gardens we were told I dont record them I just deal with them. This is poor practice as any actions taken following a complaint should be reviewed to ascertain their effectiveness and provide feedback to those concerned. Two relatives spoken with during the inspection said that staff responded to any concerns they had raised well. Both said they knew who to speak to if they had any concerns. Care Homes for Older People Page 24 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally individual bedrooms appeared homely although the storage of equipment and medical supplies made some cluttered and clinical. Some equipment was not clean. Carpets throughout the home are in need of replacement. Not all equipment used met the needs of the individual. Evidence: A tour of manadon Gardens was completed. Some peoples individual rooms, communal areas and disabled access bathrooms and toilets were viewed. The treatment room and the sluice facilities used were also seen. The staircase from the main entrance was used to get to Manadon Gardens. It was noted that the two windows in the stair landings could be opened the full extent. The manager advised that people living in the home do not use the staircase. However neither the ground floor or first floor door to the stairs was locked. This could mean people who are prone to wander could access the staircase with out supervision if staff were busy and did not see them. Two of the people whose care was followed required PEG feeding, which required equipment and bottled nutrition supplements. Both en-suite facilities were being used as a storage area for equipment and nutritional supplements. In one instance tubing used for the PEG feed system was being stored in a box next to the toilet bowel. Both Care Homes for Older People Page 25 of 45 Evidence: had other equipment and or feeds stored in their rooms. This reduced the floor area and made their rooms look like a clinical area. People who were being cared for in bed had hospital style beds, which were easy to adjust. Overlay airflow mattresses had been provided for the people who had been identified as at risk of pressure sore development. Disabled access bathrooms were available on each floor for people to use. One of the bathrooms (opposite room 14) had a cleaner trolley in it. A green liquid in a spray bottle was on the bottom of the trolley. No label had been put on the bottle to say what chemical was in it. A small bathroom shelving unit in the same bathroom had a bar of soap and a dispensing bottle of Diprobate cream. It was unclear if this belonged to one person or if staff were using these for each person who used the bathroom. Two of the sluice rooms were being used to store cleaning chemicals on the floor. The doors to both sluices did not have locks. This means that people could have easy access to the chemicals being stored. The flooring in one sluice had been taken up and the floor exposed. This was not easily cleanable. No hand wash facilities or sanitising hand gel were provided in one of the sluice rooms. This had a hopper style sluice, which means staff have to manually empty commode pots and urine bottles into a flushable sink height bowel. The manager advised that staff usually wash their hands in the staff room, which was close by. One sluice room had a macerating sluice for disposable of cardboard commode pots, bedpans and bottles. However the way things were being stored in the room would make it difficult for staff to easily get to the sink to wash their hands. No sanitising hand gel was provided in this room. All the bedroom entered during the inspection had freestanding wardrobes, which had not been attached to the wall or floor. These could be tipped over very easily using one hand. They presented a possible risk of a wardrobe falling on some one. Risk assessments for the wardrobes in individual rooms were not seen during the inspection. There were no evidence of odours within the Compton Garden unit. The majority of areas appeared clean and tidy. Domestic staff told us that there is a central cleaning team but that is generally the same cleaning staff go to the same unit to provide continuity. We were told that one or two cleaners are tend to the Manadon unit, two cleaners attend the Pearn unit and one cleaner attends to the Compton Garden unit. Staff told us the cleaning staff generally work within home until 3 p.m. People told us that their rooms were cleaned on a daily basis. One person told us that the bed was pulled out approximately once a week. Bathrooms and toilets on the Care Homes for Older People Page 26 of 45 Evidence: Compton Garden unit were clean and odour free. We were told it was the responsibility of care staff to keep comodes clean. On the Compton Garden unit we saw four comodes with dirty and soiled frames and seats. The comode bowl it self however was clean. The commodes were shown to the manager on duty. All rooms on the Compton Garden unit had been personalised by the person occupying the room. All rooms were well-equipped with the exception of one room which was waiting for a new carpet and bed. Staff told us this had not been delivered by the company due to non-payment of bills of the organisation. A new carpet within the corridor areas of the Compton Garden unit had been fitted since the last inspection. Other carpets within peoples rooms were stained and worn. The unit manager informed us these had been identified and were planned for replacement on a rolling programme. All windows within the Compton Garden unit had window restricters and all radiators were wall mounted and guarded. The majority of furniture was of a satisfactory standard with some new furniture having been recently purchased. One or two items well worn and in poor condition which potentially could cause the spread of infection. These items of furniture were highlighted to the manager on duty. The laundry was well equipped and contained washing machines capable of dealing with foul laundry. Walls and floors were easy to clean. Evidence of the loves aprons and hand washing facilities were present. Information on the spread of infection was also made available for staff. Staff spoken to told us they had not received training in infection control. Staff files also confirmed that only two of the six staff had received training in infection control. The downstairs communal toilet within the Compton Garden unit contained a hand towel. This is seen as poor practice regarding infection control. Staff told us that the reason for this was because the paper towels had been removed by people with dementia and put down the toilet. It is suggested that specialist advice is gained from health protection agency regarding this. Pearn Gardens was clean and free from odours on the day of the inspection. All bedrooms were tidy and mostly clean. The communal areas were clean although the carpet in the lounge was badly stained and needs replacing. Care Homes for Older People Page 27 of 45 Evidence: Many of the beds used in this unit are divan beds whilst some people were happy with this and found them comfortable others were not fit for purpose. One bedroom had the bed next to the wall and the person using this bed needed a hoist to move and two people; clearly this is not good practice and puts the person and the welfare of the staff at risk. Outside of the home there was a mountain of refuge sacks full of rubbish which posed a health hazard. We were told this was because the bill had not been paid so the company had not collected the waste. The manager acted upon this and whilst we were in the home arranged for it to be removed as a matter of urgency the following day. The clinical waste bins were not overflowing and we were told had been emptied regularly. Care Homes for Older People Page 28 of 45 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 are adequately trained to meet the needs of the people living at the home. Recruitment systems used at the home are not robust and have the potential to place people at risk. Evidence: The staffing rota shows that a registered nurse is on duty each shift over a twentyfour hour period. The rota shows that more staff are on duty at peak times. The manager advised that when Manadon Gardens is up to full occupancy two registered nurses as well as her are on duty during the day. However when numbers are below 25 one registered nurse is on duty each shift. Staff spoken with on Manadon gardens appeared to know the care needs of the people whose care was followed. They said they had handovers each shift, which enabled them to know about any changes that had happened while they were off duty. People who were being cared for in their rooms had half hourly observation charts, which were being completed by staff during the inspection. These observation charts were for a period of one week and were timed from 8 am to 8 pm. Staff had completed these for the people whose care was followed. In addition to this check two hour turns were also being recorded when a person had their position altered in bed to further Care Homes for Older People Page 29 of 45 Evidence: reduce the risk of pressure sore development. Staff told us that the staff group remained stable on the Compton Garden unit. However, staff told us that morale generally within the home was low at present. New staff on the Compton Garden unit told us that they had received a lot of support from the unit manager. Staff told us that there is a general encouragement to do NVQ (National vocational qualification) training. One member of staff told us that she had received support to do a fast track NVQ 2. Staff told us that they had not received infection control training. Of the six staff files inspected only one had received training in infection control. One registered nurse file confirmed the mandatory training has not been a priority since her employment. This member of staff confirmed that she had not received training in fire safety, infection control, and first aid. Some of the other mandatory training had been provided by previous employer. Of the six staff files inspected, one was registered general nurse and four of the remaining five had a minimum of NVQ 2. Staff told us that the induction at home was excellent and the best Ive ever received. We were told that staff attend an induction day where staff were told about the differences between each unit, the job role and responsibilities, emergency procedures and fire information, information about the call bell system, and other general information. Staff explained that then they worked for two weeks and were not allowed to do anything apart from follow experienced staff. Staff told us that this induction was paid for and that a booklet was used to check that staff had been provided with relevant information. These induction booklets are then kept on the personnel files. In contrast to this agency staff told us they had received no induction when first working at the home, and had to find out information on emergency procedures themselves. The staff recruitment at the home follows the same process for all staff. All staff are asked to fill in an application form and asked to provide the names of two references, provide evidence of identity, have an interview and expected to have a criminal records bureau and protection of vulnerable adults check. Interview records are maintained to show that the process is consistent. However, the exception to this was that four of the six files did not contain a recent photograph. All staff are expected to complete the health declaration to show they are fit to perform their roles. However despite these processes being followed and information being obtained, there was no evidence that safeguarding assessments had been made when receiving unsatisfactory Care Homes for Older People Page 30 of 45 Evidence: responses. In one case a member of staff was working at the home despite having a very poor reference written by an ex employer. In another example a member of staff had declared on the application form that they had no criminal convictions or cautions yet had been employed after receipt of a positive criminal records bureau check. There were no records to show that a risk assessment had been performed. This lack of safeguarding process potentially places people at harm of being cared for by people with unsatisfactory recruitment checks. Following the recruitment process the majority of staff had received in-house training to prepare them for working with vulnerable adults. The exception to this was one registered nurse, who had not received via training, infection control training and first aid training. Care Homes for Older People Page 31 of 45 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 home is well managed in some areas this is not consistent throughout the home. This does not promote and safeguard the health of people living in the home. People may not have confidence that the home was being run in their best interests. Not all staff are adequately trained to protect and help the people living at the home from fire, infection or injury. Evidence: Staff on the Compton garden unit told us they felt well supported by the unit manager who was approachable and supportive. Staff in general told us morale was low within the home. Valid insurance certificates were displayed within the home. Care Homes for Older People Page 32 of 45 Evidence: Staff told us they had received recent supervision and found this process very useful. One member of staff said it was an opportunity to discuss any concerns they had. The new general manager told us she had addressed the shortfall of supervision since her arrival and was working to make sure that all staff had received a supervision and appraisal. Supervision records and appraisal records are kept within the staff file. Not all records will well written within the home. Discussion with staff confirmed that when staff are absent from work due to ill health they are expected to complete an absence report. Staff told us these absence reports are pinned on a noticeboard until they are processed. Inspection of the absence reports showed that some information potentially could be confidential and not be appropriate to share with all staff. Staff told us that they had not received infection control training. Of the six staff files inspected only one had received training in infection control. One registered nurse file confirmed the mandatory training has not been a priority since her employment. This member of staff confirmed that she had not received training in fire safety, infection control, and first aid. Some of the other mandatory training had been provided by previous employer. These included people living at Bedford Park their relatives and the staff working at the home. The last surveys sent out were for people living at Bedford Park. These were sent out in May 2009. The manager advised that the survey was for the three units at Bedford Park, the nursing unit, residential unit and the dementia care unit. The manager also advised that of the 50 survey forms sent out 40 were returned. It was also confirmed that other years individual units had had surveys done separately each time. The Quality assurance information in 2008 in the folder showed that of the 25 surveys sent out for the residential unit 56 were returned. A summary of the survey completed over the 12 months was not currently provided. When the manager was asked how she ensured people knew the results of the surveys she advised that residents, relatives and staff meetings are used to feed back the results. We looked at the personal allowances of the people who live at the home; we found these to be accurate and well documented. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the safety of the environment; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. Care Homes for Older People Page 33 of 45 Evidence: Records and discussion confirmed that not all staff has had regular training in fire safety infection control and first aid, this puts people at risk. Radiators throughout the home are covered and the water temperature was satisfactory. Care Homes for Older People Page 34 of 45 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(2)b The Manager must make 01/10/2008 sure care plans and risk assessments are: Accurate Reviewed to show changes Contain accurate information to enable staff to provide care in a safe and consistent way The Manager must make 01/10/2008 sure risk assessments contain accurate information to enable staff to provide care in a safe and consistent way. This relates to the inadequate bed rail assessment and moving and handling assessments 01/08/2008 2 7 13(4)c 3 8 12(1)a13(4)c The Manger must ensure people who use the service have access to a call bell or systems are in place to ensure people are safe if they are unable to access or use a call bell. 4 10 12(4)a13(4)c The manager must ensure 01/08/2008 staff work in a way that respects the privacy and dignity of people who use the service. This must be done by ensuring: The language used that Page 35 of 45 Care Homes for Older People 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 refers to people who use the service is appropriate. (i.e. not using expressions such as doubles and feeders) Staff communicate when providing personal care or assistance to people who use the service. Staff are aware of their actions when working with people who use the service. Moving and handling assessments containing personal information are removed from bedroom doors People who require assistance with cutting up meals are given adequate assistance 5 18 12(4)a The manager must ensure work practices within the home are performed in the best interest of people who use the service and show they are not institutional approaches. 01/08/2008 Care Homes for Older People Page 36 of 45 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The manager must ensure care plans and risk assessments are accurate, are reviewed to show changes and contain accurate information to enable staff to provide care in a safe and consistent way. This will ensure staff will be aware at all times what care an individual needs. 30/06/2009 2 9 13 (2) Arrangements must be 31/07/2009 made to ensure that there is a system in place to ensure that medicines are available to administer as prescribed. This will mean that people will receive the medicines prescribed for them 3 9 13 (2) Arrangements must be made to ensure that all medicines are stored in accordance with the 31/07/2009 Care Homes for Older People Page 37 of 45 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 directions of the manufacturer. This is to ensure that medicines administered are safe and effective 4 10 13 The manager must ensure 31/07/2009 staff work in a way that respects the privacy and dignity of people who use the service. This must be done by ensuring The language used to refer to people who use the service is appropriate ( not using expressions such as toileting rounds). Infection control information is removed from bedroom doors. This promotes privacy and dignity 5 12 18 The responsible person must 31/07/2009 ensure that staff shortages do not mean that the activities programme is reduced for people in the home This will ensure that all people are able to participate in meaningful activities and lead a more fulfilling life. 6 12 16 You must consult with people about their social 31/07/2009 Care Homes for Older People Page 38 of 45 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 interests and make arrangements to enable them to engage in a range of activities according to their ability. This relates to people less able and those spending considerable time in their bedrooms. This means all people living at the home have a good quality of life and are able to participate in things they enjoy. 7 18 13 18 13 (6) The Responsible person must ensure any training provided to staff in respect of the protection of vulnerable adults means staff are aware of how to correctly report allegations of abuse outside of the organisation. 30/06/2009 This will help to keep people safe at all times. 8 19 13 The registered person shall ensure that- all parts of the home to which service users have access are so far as reasonably practicable free form avoidable risks. This includes window restrictors, freestanding wardrobes and chemicals not locked away properly. 31/07/2009 Care Homes for Older People Page 39 of 45 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 his will ensure peoples safety 9 19 16 Financial shortfalls must not prevent rooms being carpeted and provided with bed. This will ensure people get the room they request and will be furnished appropiately. 10 26 16 The Responsible person 30/06/2009 must ensure satisfactory standards of hygiene are maintained within the care home. This must include ensuring the commode frames are kept clean. This will mean the risk of spreading infection is kept to a minimum. This means people live in a clean safe environment. 11 29 19 Systems must be in place to 30/06/2009 show what action has been taken to safeguard people when receiving unsatisfactory checks and information regarding staff during the recruitment procedure. This must include action but has been taken following receipt of poor references, and what steps have been taken to 30/09/2009 Care Homes for Older People Page 40 of 45 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 safeguard people when a positive conviction has been received on the criminal records bureau check. This will show safeguards are in place to protect people who use the service This will mean that people can be safe and looked after by people suitable to do so. 12 29 19 The responsible person must 30/06/2009 ensure no staff work at the home until satisfactory checks and information is obtained the member of staff. This must include: a recent staff photograph. This will show that the recruitment procedure is robust and means that staff working with vulnerable adults have had a satisfactory checks performed. This will mean that people can be safe and looked after by people suitable to do so. 13 30 13 The responsible person must 30/06/2009 ensure all staff, including agency staff, are provided with an induction prior to working at the home. This will mean that all staff are aware and familiar with emergency procedures such Care Homes for Older People Page 41 of 45 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 as the fire and emergency systems within the home. This will mean that people can be safe and looked after by people suitable to do so. 14 33 38 The responsible person must 30/09/2009 ensure all staff working at the home have received mandatory training which must include infection control, first aid, and fire safety. This will ensure people living at the home are looked after by people trained to do so. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The Registered person should consider ways of managing the intermediate care facility that now operates within the home taking into account the guidelines contained within the National Minimum Standards. This includes providing dedicated accommodation, together with specialised facilities, equipment and staff to deliver the short-term intensive rehabilitation, which enables people to return home. Risk assessments should be thorough and include other professionals in the decision making process. Wound care plans should demonstrate how the wound is healing and what dressings are being used. This means that healing will not be delayed because all staff will have the correct inforamtion to carry out the task. 2 3 7 7 Care Homes for Older People Page 42 of 45 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 5 7 7 Overlay mattresses should be fitted properly to beds so that people are comfortable and free from harm. Call bells should always be provided. Where people are unable to use a call bell then a risk assessment should be completed and a plan drawn up as how to manage this Agreement should be reached over the sharing of medicine administration records completed by visiting healthcare professionals. individual supplies of medicines should be use at all times so that people only recieve those medicines prescribed and dispensed for them. Social histories should be recorded in each care plan so that activities can be tailored to the individuals needs. The manager ( residential unit) should consider keeping a record of all concerns and complaints not just the written complaints. This would provide a clear audit trail of how complaints and concerns are managed in the home. This would enable people living at Bedford Park to have confidence that any concerns they raise with the staff are taken seriously and provide the manager with information that could help to improve practice. Kitchen equipment should be replaced when needed ( poato peeler). Worn furniture should be replaced The manager should review the risk assessment for the windows opening in the stair case landings between the ground floor and first floor of the nursing unit. And consider providing restrictors for these to reduce the risk. The manager should review the risk assessment for the windows opening in the stair case landings between the ground floor and first floor of the nursing unit. And consider providing restrictors for these to reduce the risk The programme of replacing work and stained carpets should continue. Risk assessments should be completed for the wardrobes people are using in their individual rooms to ensure people are not at risk of pulling the wardrobe over and injuring themselves. 6 9 7 9 8 9 12 16 10 11 12 19 19 19 13 19 14 15 19 20 Care Homes for Older People Page 43 of 45 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 16 22 The manager should consider providing alternative storage for people who need disposable equipment or nutritional supplement in their rooms. This would ensure people who need this equipment still have a pleasant homely room to live in. Advice should be obtained from the health protection agency regarding the use of communal hand towel in the downstairs toilet of the Compton Unit. The manager should consider analysing the results of the quality audits over a twelve-month period and provide the results for the people living at Bedford Park and the Commission. It is suggested that all confidential information, including information regarding staff is treated sensitively. 17 26 18 33 19 37 Care Homes for Older People Page 44 of 45 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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