Inspection on 25/11/09 for Belvedere

This inspection was carried out on 25th November 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Belvedere 03/06/09

Belvedere 03/09/08

Belvedere 13/09/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Belvedere Wellington Street Accrington Lancashire BB5 2NN Lead Inspector Mr Jeff Pearson Key Unannounced Inspection 25th November 2009 09:45 DS0000069343.V378190.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 2 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 Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belvedere Address Wellington Street Accrington Lancashire BB5 2NN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01254 238248 01254 872161 Unlimitedcare Limited Care Home 38 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (38) of places Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 38 Date of last inspection 13th September 2007 Brief Description of the Service: Belvedere is registered to provide accommodation, nursing and personal care for up to 38 older people. A maximum of 11 of the 38 people may also have dementia. The home is situated close to Accrington town centre and all amenities and transport links are nearby. Belvedere is a purpose built home for older people. There is a small car park to the front of the home and enclosed private garden to the rear. The home offers 38 single bedrooms, all of which have en-suite toilets. Accommodation is provided over three floors, a passenger lift is available. On the ground floor there is a large lounge, smaller lounge and a dining room. There are further lounges and a dining room on other floors. There are accessible toilets and bathing facilities. The home had available a Statement of Purpose and Service User Guide providing information about the support, care and services available. Previous inspection reports were available on request, from the homes office. This information should help people make an informed choice about moving into Belvedere. Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 5 At the time of the inspection visit the range of fees was between £366.00 and £545.00 per week. Hairdressing, newspapers and private chiropody were not included in the fees. Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means people using this service experience poor quality outcomes. A key unannounced inspection, which included a visit to the service, was conducted at Belvedere on the 26th November 2009. The visit took over 8 hours and was carried out by three inspectors, one being a specialist pharmacist inspector focusing on medication management practices. The people living at the home and their relatives were invited to complete surveys, to tell the Commission what they think about the care service provided at Belvedere. Some were received at the Commission and some results have been included within this report. The files/records of six people were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of people living in the own home. We spoke with people living at the home; the deputy manager, owner, staff and visitors. Various documents, including policies, procedures and records were looked at. Most parts of the home were viewed. A random unannounced inspection had been carried out at Belvedere on the 9th September 2009; the reason for this inspection was to monitor the progress made in meeting the statutory requirements made at the Key Inspection of 3rd June 2009. We found some progress had been made, but shortfalls in relation to medication management and care planning remained. What the service does well: We received the following positive comments from relatives of people living at Belvedere - “They look after mum, keep her safe and well” – They take care of my relative exceptionally well, greatly improved since being in Belvedere – “They try to do what the resident wishes” – “They keep me updated of my mothers needs and her health, my mother has had excellent care”- “They always have birthday parties” -“No complaints” A report about the care given to each person using the service was written during each shift. This ensured that all staff had some up to date information about the condition of each person to ensure continuity of their care. Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 7 Visiting arrangements were good; relatives were being made welcome at the home. One relative wrote, “Always welcome visitors whatever the time” The home was warm and pleasantly decorated for the comfort of the residents; the lounges had good quality furnishings. The home offers 38 single bedrooms, all of which have en-suite toilets. Residents’ discussion meetings were being held, which gave people some opportunity to be involved in day to day matters. Members of staff were seen to be polite and friendly. One person said the staff were helpful and another person said they were obliging. What has improved since the last inspection? What they could do better: The inspection visit showed the management of the home needed much improvement; to make sure the home is run in the best interest of the residents. To help make sure people are considered properly, there should be a better way of finding out about their needs and abilities before they move into the home and sharing the information with staff. All resident’s must have individual care plans, which include full details of all their needs and how they are to be met, they should be kept under review and up to date, to ensure staff know exactly what to do for each person. Belvedere DS0000069343.V378190.R01.S.doc Version 5.2 Page 8 People using the service or their relatives should be involved in care planning, this will help ensure people are cared for in the way they prefer. To make sure that people receive appropriate healthcare attention, action must be taken ensure health care professionals and services are contacted as appropriate. To help to prevent the formation of pressure sores, cushions should be available for people who use wheelchairs. To make sure people are properly and safely supported with their medication, medication practices, instructions and records needed improvements. Where people are managing their own medication, this must be carefully considered and planned for. Catering arrangements need to be improved; to make sure healthy diets and choices are promoted. Better arrangements were needed to ensure individual social care needs are responded to, for peoples well being and stimulation. To make sure people are properly and safely supported, staffing levels should ensure there are at all times sufficient numbers of suitably trained and competent staff. To protect the privacy of people using the service, the use of CCTV must be not be used in areas where people using the service may be accommodated. Staff recruitment practices must ensure all the required checks are carried out for the protection of people using the service. To promote the well being and safety of people using the service, visitors and staff, improvements were needed to identify and reduce potential risks and hazards 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. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People using the 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 admission process did not always ensure peoples’ needs; abilities and preferences were known and planned for, before they moved into the home. EVIDENCE: We did not have opportunity to evaluate the homes written information during this inspection; however, six residents indicated in surveys, that they did not receive enough information about the home prior to moving in. Eight residents indicated they were not aware of the homes terms and conditions of residence Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 11 or of any written contracts with the home, one relative spoken with said contracts had been agreed and signed. Pre-admission assessments were seen in the files of two people admitted recently to the home. We found that peoples’ needs were being considered with records kept, before they moved into the home. The records of assessments seen were quite brief and lacking in sufficient detail, to provide meaningful information about peoples’ individual needs, abilities and preferences and how they were to be met. However, there was no evidence to suggest that pre-admission assessments had been carried out for two people who had been admitted for respite several times during the last few years. This lack of information meant it was not clear, that individual needs had been carefully considered and planned for and staff may not understand the particular needs of the person. There had been emergency admissions to the home; we found that not all relevant paperwork had been obtained from Social Services, prior to them moving in. We found proper consideration was not always being given to the residents’ specialist, or complex care needs, or the skills, ability or knowledge of the staff team caring for them. At the time of this inspection visit, Belvedere did not provide intermediate care. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care practices and procedures were not effective in ensuring people’s individual needs are appropriately and safely met. EVIDENCE: Of the ten residents completing surveys, seven indicated they always get the care they needed, one said they usually did and two said they sometimes did. Of the eight relatives completing surveys, six considered their relatives’ needs were always met and two indicated they were usually met. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 13 Nine residents completing surveys indicated they always get medical care they need, one said they sometimes did. There were records of the involvement of GPs and other healthcare professionals including the chiropodist and district nurse, in the care of people who use the service. However, we found that proper timely arrangements had not been made for one person to receive the attention of medical professionals. At our last inspection visit we found some progress had been made with care planning. However, on this inspection we found care plans were not being effectively used to communicate peoples’ individual needs to the staff team. We looked at the care plans of six people using the service. These plans did not accurately identify all the care needs of each person or give clear directions for staff to follow to ensure their individual needs were met. Although an overview of the health and personal care needs was in place for two people admitted recently to the home detailed care plans were not in place. One of these people had a high risk of falling but there was no guidance for staff to follow explaining what they needed to do to manage this problem and prevent the person from falling. Another person suffered from diabetes but there was no reference at all to this in the care records. We only became aware of this when the pharmacist inspector said this person was prescribed medication for diabetes. Discussion with a care worker confirmed that they were aware this person had diabetes. However, having detailed care plans in place ensures all members of staff have the information they need in order to provide person centred care for people living at the home. The care plans for two people admitted for respite care had not been reviewed since their previous stay at the home a few months ago. A falls risk assessment for one of these people was undated making it impossible to determine if the information was still relevant. We were told, staff had not had time to write the care plans. Several people were identified as being at risk of falling out of bed and bed rails were in use. However, the risk assessments carried out did not identify the risk factors to determine if the use of bed rails was the safest way to manage this problem. Moreover, we found a recent report about one person that had been found down the side of the bed and bed rails. Although action had been taken to prevent a recurrence of this a care plan for the safe use of bed rails was not in place for people where bed rails were used. Having a detailed risk assessment and care plan in place, helps to ensure that bed rails are used safely. During this visit we observed people sitting in wheelchairs for long periods of time. Some people were not sitting on cushions which aids comfort and helps to prevent the formation of pressure sores. Although we were told that it was not appropriate for some people to use footrests they were not in place for a Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 14 number of other people. Not having footrests in place can cause injury to people using a wheelchair. A written report about the care given to each person using the service was written during each shift. This ensured that all staff had up to date information about the condition of each person in order to ensure continuity of their care. There was little evidence to suggest that people using the service or their relatives were involved in care planning except to sign their approval for the use of bed rails. We looked at the arrangements in place for the safe handling of medicines to see how weaknesses identified at previous visits had been addressed. We were concerned to find that some weaknesses remain to be addressed. We looked at medicines administration. As seen at previous visits records showed that medicines were normally given between 8 o’ clock in the morning and 8 o’ clock at night. During our visit we again saw that morning medicines were being administered until 11 o’ clock but, this was not reflected in the medicines records. This increases the risk that where doses of the same medicine are repeated throughout the day they will be given too closely together, or that doses will be missed. Records were completed at the time medicines were administered and a sample check of medicine stocks against these records showed that tablets could generally be accounted for. But, we were concerned to again find that there was not always clear written guidance about the use of prescribed nutritional supplements. For example, one person had recently been prescribed supplements, staff spoken with did not know why. There was no record of any healthcare professional consultation about the use of nutritional supplements. A second person was no longer being given supplements started the previous month, due to weight loss. There were no supplements in stock but this had not been followed-up by care staff. It is important that instructions about the use of nutritional supplements are recorded and followed to help ensure peoples health and well-being is protected. (See Complaints and Protection) We looked at the arrangements in place for supporting the safe selfadministration of medication and were again concerned to find that written risk assessments were not always completed. We also again found that changes to peoples’ medicines were not always well managed. For example, one person had recently been prescribed a cream which they self-administered. There was no record of why the cream was prescribed, no reference to selfadministration, or about where it was to be applied. It is important that safe self-administration is assessed and kept under review so that any problems can be identified and managed, to help keep people safe. At this visit we also found that checks were not always made to confirm people’s medicines when they come to the home. For example, information from the hospital said that one person’s medication patch needed to be reviewed by the doctor. Staff Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 15 were uncertain whether a patch was applied when the person left hospital and the doctor had not been contacted for advice. This needs to be addressed to reduce the risk of mistakes. We looked at medicines storage and found that all medication including controlled drugs were safely locked away. The owner continued to carry out checks of medicines handling but as previously discussed a ‘wider’ audit is needed to help ensure any weaknesses are identified and can be promptly addressed. Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One person said the staff were helpful and another person said they were obliging. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for social and recreational interests were not always effective in responded to people’s individual needs, preferred lifestyles and choices. EVIDENCE: We made recommendations within our last inspection reports, on promoting interesting and stimulating lifestyles for the residents, by arranging and offering suitable activities, with particular consideration being given to the needs of people with dementia. However, of the ten residents completing surveys, five said there were never activities arranged they could take part in. Four indicated there usually were activities and one said there always were. A Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 17 resident spoken with said a residents meeting had recently been held, also a reminiscence discussion. Although care plans provided some information about peoples daily routine there was very little information about their individual interests and hobbies. The daily routine described in two of the care records we looked at stated the time the person liked to get up and go to bed. Activities during the day were generally sitting in the lounge, watching television and chatting to other others. During the visit we observed people watching television but not really talking to each other. Very little interaction was observed between people sitting in the lounge or dining room and members of staff. One relative suggested the home could improve by having, “More games etc to involve the residents and make their stay more relaxing and enjoyable e.g. sing along exercise to music” The homes’ visiting arrangements were included in the homes’ guide; the residents spoken mentioned the contact they were having with families and friends. One comment from a relative was, “Always welcome visitors whatever the time”. Routines in the home seemed flexible, people spoken with said they could get up and go to bed whenever they wished. However, it was apparent from observation and discussion, people needing support with mobility and personal care, may be helped at times influenced by staff availability. We noted that more flexible arrangements were in place to promote choice, in that hot drinks were now being offered in the lounges. Six residents said in surveys they always like meals provided at the home, three indicated they usually did and one said they sometimes did. Some progress had been made with the catering arrangements, choices were being offered at lunch time and the cook said fresh vegetables were now being used. However, we did not consider the menus were being well planned, as some options were very similar, for example fish fingers or haddock. On one occasion the option at lunch had been soup which was not an equivalent main meal option. Two puddings were on offer on the day of the inspection visit, we were told alternatives were available, but were not always promoted. The home still had a flexible approach to menu planning; the cook explained that the menu was decided the day before with, which meant limited scope for forward planning and preparation. However, the cook said a four week menu was being devised. A new system had been introduced for recording the meals served, we found records were not sufficient in detail and were not always being completed, this meant we could not properly gauge if people were being offered a satisfactory diet, the owner agreed to ensure appropriate records are kept. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may have had their health and well being neglected, due to not being given nutritional supplements. EVIDENCE: Of the residents completing surveys, nine said there was someone they could speak with informally if they had concerns and that they were aware of the homes complaints procedures, one person indicated they were not aware. Six relatives said they were aware of the homes complaints procedure, two were not aware. A more ‘user’ friendly complaints procedure was seen to be displayed in the trance hallway; this explained how people should raise concerns and include the contact details of the owner, Social Services and the Commission. The telephone number of the Commission needed changing to include the up to date information. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 19 Records and discussion showed arrangements had been made for staff to received Protection Of Vulnerable adults training, staff spoken with expressed an awareness of the action to be taken in relation to allegations and incidents of abuse. Recruitment practices did not fully safeguard people using the service (see staffing) Following the inspection, we reviewed the evidence we had obtained in relation to nutritional supplements, we were concerned that people’s health and wellbeing may not be sufficiently protected (See Health and Personal Care). It was therefore necessary for us to make a safeguarding alert to Social Services. At the time of writing this report this matter was still being pursued. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Belvedere offers some comfortable accommodation, but not all facilities and furnishings promoted the well being and safety of the residents. EVIDENCE: The main lounge to provided comfortable accommodation, there were sofas, mirrors, pictures, a large screen TV and assistance call points, the residents appeared comfortable and all said they were happy with the room. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 21 At our previous visits, we found there were several significant environmental matters in the home needing attention, for the benefit and well being of the residents. This visit showed some progress had been made to improve matters. Action had been taken to tidy the first floor shower room and the door had been fitted with a suitable lock. Some of the light fittings on corridor ceilings had been adjusted to a safer height and warning signs had been displayed. A warning sign had also been displayed in the passenger lift to advise people of the jolt when it arrived on the ground floor, hand rails were provided. The rotary iron was still being stored on one corridor, which presented as potentially hazardous to residents; the owner said it was usually covered over with a duvet to offer some protection. We again found the restrictor on the small lounge window to be ineffective; this meant the window could be fully opened, providing potential for people to climb out. The owner arranged for this to be fixed at the time of the inspection. We found two en-suite toilets were fitted with inappropriate locks which would not enable easy accesses to be gained in an emergency situation. A panel next to a window frame in one bedroom was coming away from wall; this matter had not been reported in the maintenance book for attention. The owner showed us a room which housed a lagged hot water storage tank, the door was fitted with an appropriate lock, but the door was not locked and therefore presented as a potential risk to people using the service. On arrival at the home, we found CCTV cameras in operation filming activity in the office, on the corridor outside the office and in the seating area in the entrance hallway; the position of these cameras had potential to intrude upon the daily life of people using the service. Eight of the residents completing surveys, indicated the home was always kept fresh and clean, two considered it usually was. We found most areas of the home to be clean and free from unpleasant odours. A cleaner was employed at the home but was currently on leave, the hours had not been covered, therefore care staff again had additional responsibilities for providing this service as part of their daily duties. Liquid hand soap and paper towels were available in the laundry. Staff spoken with indicated an awareness of the homes laundry procedures. Cleaning products were no longer being stored in the laundry. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements at Belvedere were not always satisfactory in providing people with effective care and support; recruitment practices did not fully safeguard people using the service. EVIDENCE: During our previous inspections we had some concerns about staffing levels, we therefore recommended, that to ensure people are effectively and safely supported, staffing levels should be continually reviewed and adjusted accordingly. This inspection visit showed some progress had been made; however, we found that there may not always be sufficient staff; to provide effective care and support for the numbers needs and choices of the people living at Belvedere, this being highlighted in the previous outcome areas within this report. Six residents completing surveys said there were usually enough staff available when they needed them, with three saying there always were. One person said sometimes staff were available when needed. Three staff Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 23 completing surveys indicated there were usually enough staff on duty, five indicated there were always enough. One comment fro a resident was, “Staff are very good no problems”. We looked at the files of two members of staff. From the records seen, we noted that they had completed an application form and Police clearance checks had been carried out before they commenced work at the home. However, dates of further education had not requested and gaps in employment history had not been explored with records kept. Applicants were requested to declare any convictions, but this did not include cautions and there was a lack of clarity about the expectations of the rehabilitation of offenders Act. References were available, but they had not all been sent for by the home, some had been obtained by the applicants as testimonials. The application form did not request the names of suitable referees. Notes had not been kept of recruitment interviews, or of significant matters arising as part of the recruitment process. It is important to thoroughly check all new staff prior to employment, to ensure they are suitable to work with vulnerable people. Keeping good records shows checks have been properly carried out. Records seen of initial induction had been further developed, but were still very brief and did fully show new employees had received and understood their initial basic training in all key areas. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 People using the 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 administration practices were not effective in ensuring the home is run for the benefit of the people using the service. EVIDENCE: During our previous inspections we had concerns about the management practices at the home; we therefore recommended that management Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 25 arrangements be given attention, to ensure Belvedere is effectively run for the benefit of people using the service. We advised that the outstanding issue in relation to a lack of registered manager needed to be resolved as soon as possible. We were told at this inspection the application for registered manager was being progressed. This inspection showed there was a lack of consistent, proactive management practice at Belvedere. Although some progress had been made at the home; there were some matters as highlighted within this report which had not been sufficiently addressed, we also identified further matters which were in need of attention for the benefit and wellbeing of people using the service. Health and safety risk assessments had been carried out, with action being taken to identify and minimize risks to residents. However, we again found several matters which had potential to be a risk to health and well being of the residents, including, residents using wheelchairs without foot rests being in place or properly used, an ineffective window restrictor and an accessible hot water storage cylinder. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X 1 Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 31/12/09 2. OP7 13(4) 3. OP8 13(1)(b) A Care plan must be in place for each person living at the home. Care plans must accurately identify and address all the care needs of each person using the service. They must also be reviewed on each admission for people who are regularly admitted for respite care. This will ensure that staff know what they need to do in order to meet the needs of each person using the service. (Timescale of 18/11/09 not met) Risk assessments for the use of 31/12/09 bed rails must clearly identify all the potential risk factors. This will determine if the use of bed rails is the safest and most appropriate way to prevent a person from falling out of bed. Action must be taken where 31/12/09 necessary, to ensure people using the service receive treatment advice and services from health care professionals. This will ensure that people receive the healthcare attention they need. DS0000069343.V378190.R01.S.doc Version 5.3 Belvedere Page 28 4. OP9 13(2) 5. OP9 13(2) 6. OP19 12(4)(a) 7. OP29 19 8. OP38 13 (4) Where people self-administer medication written risk assessments must be completed and kept under review to help ensure people always receive any help they may need to administer their medicines safely. (Timescale of 18/11/09 not met) Effective arrangements must be put in place to ensure that all medication is safely administered to service users in accordance with the prescribers directions. This is to help protect service users’ safety and wellbeing. (Timescale of 18/11/09 not met) Action must be taken to ensure the use of CCTV cameras is restricted to entrance areas for security purposes only, so that there is no intrusion upon the privacy and dignity of people using the service. All relevant recruitment documentation must be collated in line with legal requirements and be available for inspection. This is to ensure the registered person can clearly demonstrate that staff are properly checked before they commence work in the home. Effective arrangements must be made to identify and reduce potential risks and hazards in the home. This will promote the well being and safety of people using the service. 31/12/09 31/12/09 31/12/09 31/12/09 31/12/09 Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations A way of effectively assessing and recording needs and abilities should be devised and introduced, to ensure all needs are properly identified and planned for before people move into the home. When a care plan is reviewed the exact date and not just the month should be recorded, this will ensure a more effective monitoring process. All care records should be dated and signed to determine if these are current. People using the service or their relatives should be involved in care planning. This will ensure people are cared for in the way they prefer. Suitable cushions should be available for people to sit on in wheelchairs. This helps to prevent the formation of pressure sores. To promote continuity of care and good communication practices, care records should include notes of all discussions and contact with health care professionals and appropriate others. To promote interesting and stimulating lifestyles for the residents, the home should continue to arrange and offer suitable activities, with particular consideration being given to the needs of people with dementia. To promote person centred care, care plans need to take proper consideration of peoples’ capacity, choices and preferences. Catering arrangements should continue to reviewed and developed, to ensure an effective response to group and individual preferences, healthy eating and independence. To ensure people are effectively and safely supported, staffing levels should be continually reviewed and adjusted accordingly. To ensure all new staff effectively trained; the induction programme needs to be further developed in line with current good practice. (Scils for care - www.scils.co.uk ) Management arrangements need attention, to ensure Belvedere is effectively run for the benefit of people using the service. The outstanding issue in relation to a lack of registered manager needs to be resolved as soon as DS0000069343.V378190.R01.S.doc Version 5.3 Page 30 2. OP7 3. 4. OP8 OP8 5. OP12 6. 7. 8. 9. 10. OP14 OP15 OP27 OP30 OP31 Belvedere possible. Belvedere DS0000069343.V378190.R01.S.doc Version 5.3 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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