Inspection on 09/12/09 for Bethany Francis House

This inspection was carried out on 9th December 2009.

CQC found this care home to be providing an Adequate 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bethany Francis House 15/06/10

Bethany Francis House 08/03/10

Bethany Francis House 24/02/10

Bethany Francis House 19/01/10

Bethany Francis House 14/10/09

Bethany Francis House 28/09/09

Bethany Francis House 11/08/09

Bethany Francis House 02/07/09

Bethany Francis House 26/01/09

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Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Bethany Francis House Bethany Francis House 106 Cambridge Street St Neots Cambridgeshire PE19 1PL     The quality rating for this care home is:   one star adequate 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: Shirley Christopher     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bethany Francis House Bethany Francis House 106 Cambridge Street St Neots Cambridgeshire PE19 1PL 01480476868 01480473799 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ADR Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 34 The registered person may provide the following categories 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 Date of last inspection Brief description of the care home This home was sold in October 2008 to ADR care homes, who bought it as an ongoing business. They own several other homes. Bethany Francis House is a listed building, set back from the main St Neots to Care Homes for Older People Page 4 of 32 Over 65 0 34 34 0 0 2 0 7 2 0 0 9 Brief description of the care home Cambridge road. It has large extensive gardens. It is a victorian property which has been extended and provides spacious accommodation on two floors. The upper floor is accessed by a wide sweeping stair case at each end of the house. There is a lift available. The home can accommodate up to 34 people who fall into the category of older people, with or without dementia. There are three double rooms and 28 single rooms. 21 have ensuite facilities. The first floor has two bathrooms with hoists and toilets and two individual toilets and one shower room. There are attractive gardens and a number of the residents help with the garden. They have hanging baskets and raised flower beds. The grounds are enclosed and their are suitable seating areas. The home is situated just a few minutes walk from the market town of St Neots where a range of shops and leisure facilties can be accessed. It is close to public transport; the railway station and bus routes. A copy of the homes statement of purpose and service user guide are made available by the home. The current inspection report is available in the hallway. The reader should check what the current fees are for the service. At the last key inspection in January 2009 they were 358.00 to 550.00 a week. There are additional charges for personal items. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission (CQC) carried out a key inspection on the 9 December 2009. Before the inspection we looked at previous inspection reports, the service history and asked the home to complete and return a annual quality assurance form, (AQAA) which is a self assessment and focuses on how the home are providing good outcomes for their residents. The home was registered with new providers in October 2008 and we carried out the first key inspection of a new service in January 2009. The home was given an adequate rating. This year we have carried out a further three random inspections in July, August and September 2009. We carried out the first inspection because we were informed that the registered manager had left and we were unclear about what the management arrangements were. We had also received a number of complaints from staff still employed at the home and staff that had previously worked at the home. We were following these concerns up. A number of complaints from relatives had also been Care Homes for Older People Page 6 of 32 received. We arranged with the home manager to do an additional inspection the following month because we made a number of new requirements and some of the information we requested was unavailable. During our second visit in July, we asked the pharmacy inspector to accompany us. We made further requirements and there were some previously unmet requirements. We issued the home with a warning letter and requested an improvement plan. The pharmacy inspector carried out a separate visit to the home and was satisfied that the home had complied with the regulations he had previously made. On the third random inspection we were satisfied that the home had moved forward and had met most of the requirements. A key inspection was due within a year of the last key inspection. We brought this forward because we were concerned that a number of staff had left including the Operations manager, the manager, the deputy manager and the activities co-ordinator. We had been informed of a complaint regarding low staffing levels and had spoken to the providers asking them to confirm that there were adequate staff on shift. We wrote to the providers asking them what the interim management arrangements were in the home, and requested the staffing rota for the month. We were satisfied with the response we received. The home quickly recruited an experienced area manager and a manager who started several weeks ago. Other posts have been recruited to. We asked the pharmacy inspector to acompany us on the inspection and to ensure the home were maintaining safe practices in relation to medication. The inspector identified a number of medication breeches and will be going back to check compliance at a later date. We walked around the home talking to residents, staff and visitors. We observed care practices and spent time in all three lounges and the dining room. We met the new manager and spoke to the registered providers. We looked at a sample of records and our findings are summarised under the relevant outcome areas. We have sent out surveys to professionals, residents and staff and will use the findings to inform our inspection process. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 32 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have adequate information about a persons care needs before they move to the home. The home continue to assess them upon admission to ensure that needs can be accurately identified and met. Evidence: The home is registered for up to 34 older people who may have an additional diagnosis of dementia. On the day of inspection the home had thirty residents residents in situ, two residents had come in for a period of respite care. We looked at four files and noted the pre-admission assessment information was poor and gave very little detail of residents care needs or health issues. However the home had obtained other assessments and they write a 72 hour care plan which is informative and probably gives a better reflection of the persons needs. There is also a separate file for staff giving basic information about the care needs of residents coming in for respite care. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans must be a working document which reflect residents wishes and choices about how they wish to be cared for, and, or supported. Changes in residents needs must be clearly documented to ensure residents are receiving the right support. Safe practices in relation to medication must be maintained. Evidence: We looked at four care plans and they adequately described how to meet residents basic care needs. They had been implemented within 72 hours and covered residents physical care needs and social care needs. Care plans are reviewed monthly but a number of residents had a change in their health status through injuries and broken bones. This would severely impair their mobility and assistance they needed with personal care. This was not recorded in their care plans. One resident had broken their arm and required pain relief when necessary. There was no care plan for this, or guidance of when to administer the medication. The residents communication was described as muddled, so they may not be able to ask for it. Their mobility assessment had not been updated. We did not see a risk assessment or assessment of falls, although it was recorded that their mobility was worse due to the fracture. Care Homes for Older People Page 12 of 32 Evidence: Another person who had recent falls recorded did not have a risk assessment for falls and it was unclear from records, what actions the home were taking to reduce the risk from falls. Care plans did not look at how staff could promote residents independence and dignity. They simply stated needs full assistance. Presumably residents can undertake self help tasks however small. Mental health issues were recorded but vague language was used such as can be confused. The home has a bath rota and this recorded residents having a bath once a week. Care plans did not indicate if residents preferred a bath or shower and when they liked to have one and how often. Weight records seen were acceptable, but we only saw records over three months. We made a requirement following the random inspection on the 2nd July 2009 stating, The home must promote and make proper provision for the health and welfare of residents. Staff must be familiar with residents needs. These needs must be properly reviewed and recorded. Actions following a fall or unplanned change in health status must be clearly recorded. This was still an outstanding requirement in August and considered met by September. We shall be making a requirement. We looked at the practices and procedures for the safe use, handling and recording of medicines. Medicines are stored securely for the protection of residents. The temperatures of the rooms where medicines are stored are recorded and are consistently below the recommended maximum and ensure the quality of medicines in use for residents. But there is an inconsistent method of recording on the ground and first floors. We found some medicines in the fridge which were not recorded on the persons medication record. Medicine are only given to residents by suitably trained staff and the level of training provided is of a good standard, this is evidenced by training records. There is a record of when medicines are received into the home, and when they are disposed of which gives an account of the medicines in use. We looked at the records made when medicines are given to people and found some problems with these records, including, but not limited to: When medicines are given at time different to that printed on the medication record form the actual time it is given is not recorded and this could result in people receiving medicines too close together; When medicines are prescribed in variable doses e.g one or two tablets, the dose given is not recorded and this could result in people receiving too much or too little medication; Medication prescribed to be given on a when required basis but with no guidance in care plans of the circumstances these are used, and in some cases where guidance Care Homes for Older People Page 13 of 32 Evidence: was given the medicine was seen to be used at variance to that guidance; Medication given at variance to the prescribed instructions; Medication omitted as supplies had run out; The date on which medication was given was not clearly recorded. Some hand-written medication records were not signed and dated by the person making the entry or checked for accuracy by a second person which is good practice. We watched medicines being given to some people at lunchtime and, in general this was done safely with regard to peoples personal choice. We heard a staff member ask a resident if she was in pain and needed pain-killers and we heard another resident being asked if she wanted a medicine to stop her getting worried. But the resident was then given medication which was not in line with the guidance in the care plan. Requirements around the safe administration and storage of medication had been made earlier this year and met when a follow up inspection was completed. Further breeches have now been identified and requirements have been made. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home were not able to demonstrate how they encourage and promote residents preferred choices and routines of daily living. Evidence: The home had recently appointed an activities person who has since left. There was some very good evidence of residents being actively engaged in activities up until this person left. The home have since employed another person who was on their second day at the home on the day of inspection. They were engaging a small group of residents in an activity. There was some evidence that residents social needs were met but on the whole the evidence was poor. The home has a church service from two different nominations monthly. There is a visiting library service, a pat the pet scheme and they have a volunteer who provides a quiz twice a week. One staff member stated she comes in and does the residents nails in her own time. The home has a hairdresser. We spoke to lots of residents about their experience of the home. Some residents were able to answer our questions and stated that there was insufficient to do. There are a number of residents who remain reasonably able and felt that they were not able to easily engage with other residents because they were confused. We did not Care Homes for Older People Page 15 of 32 Evidence: see residents engaging in activities, such as reading a newspaper or following an interest or hobby. A number of residents stated the quality and quantity of food was poor. The home has employed a new cook who has only been in post a few months. The activities person just employed has a national vocational qualification and a qualification in the provision of activities, as well as a lot of experience. She told us she was going to assist staff in their role in meeting residents social care needs. Staff have received training recently in meeting the needs of people with dementia. We asked staff about the course and how they were putting it into practice in the work place. Staff talked about maintaining residents independence and about how to reassure them if they were confused or disorientated. From our experience during this inspection, staff were good at meeting the physical care needs of residents and their interactions with residents were appropriate. Residents may be at risk from falling because they are encouraged to be mobile. However we were in the lounges from 10.30 until 12.00 and in that time staff were still getting people out of bed and bringing residents down for lunch. The last resident was brought down at 11.45. In the time we were talking to residents we did not see any staff member in the lounges apart from thoseassisting residents into the area. One staff member brought round a cup of tea/coffee at 11 am. We saw no restrictions of visitors and spoke to one person who was happy with their relatives welfare. They received regular visits so were at the home at different times of the day. At lunch time, one staff member was serving the food, another taking it around to the tables and two staff members were assisting residents to eat. In the main lounge there was only one staff member so most residents once they had been brought their food had little or no interaction from staff. Food was served up and brought to residents without explanation. The lunch choice was quiche with vegetables or a liver casserole with vegetables. It was observed in the main dining room that residents were waiting for a long time whilst each dinner was individually served and brought into the dining room. The food was being served from a large heated trolley in the adjacent corridor. We asked why it was not in the dining room which would have speeded up the process and residents would be able to see the food being served up. Most residents had quiche and gravy was added without asking residents first if this is what they wanted. We asked residents if they wanted gravy. Five said no. We spoke to staff about the daily routines and they confirmed there was a hand-over and they read the daily notes before assisting residents with breakfast and getting Care Homes for Older People Page 16 of 32 Evidence: them up. Some residents require the assistance of two staff. Staff had a caring disposition and said it would be good to spend more time with residents but the mornings are very busy. The afternoons are quieter but the staffing levels are reduced to reflect this. We spoke to the providers about the increased frailty of residents and the fact that staff are very much task focused. The providers stated they have worked hard to change the culture of the home and to recruit staff who can deliver good care. They stated they will be employing additional staff at peak times of the day because they recognize that this is necessary. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has adequate systems in place to safeguard residents in its care. Evidence: We looked at the complaints procedure. There were four complaints logged and these had been dealt with within the timescales. We looked at the training schedules for staff which showed us that most staff had completed training in the protection of vulnerable adults in November 2009. The home have been proactive in reporting concerns to the Local Authority. They have let us know about events affecting the safety or well being of residents. On the day of inspection a number of residents had injuries which we had not received notifications for. The district nurse stated the home contact them on a regular basis to deal with skin tears or minor injuries. The nurses attend the home at least twice a week. We did not ask to see policies relating to adult protection, but saw information relating to making a complaint. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally maintained to a high standard but we identified some poor hygiene standards which would compromise residents well-being. Evidence: We looked around the environment and generally the home was well maintained and cleaned to a high standard. The providers have worked hard to improve the home. In the main reception area there is information about the home, including a list of social activities and social diary and further information about the home. The communal areas have been painted in pastel colours and fresh pictures hang up throughout the home. The home benefits from three communal lounges, where residents can choose to sit. There are comfortable chairs provided. We did not see any foot-stools, for residents who may need to elevate their legs. The home has a large dining room which accommodated most residents at lunch time. A number of residents eat in their bedroom. Some residents eat in one of the smaller lounges which has a separate, small dining area. The home employs a maintenance person who told us he works four hours a day. His job is some maintenance and refurbishment as requested and to complete all the health and safety records. Fire records and water temperatures. Clarification is Care Homes for Older People Page 19 of 32 Evidence: required about who is responsible for fridge/freezer temperatures. The home employ a domestic and this person works five days a week, two days for five and half hours and three days of five hours. There is no cover at the weekend or when the person was off recently for a couple of days. The home was generally maintained to a high standard of cleanliness with no obvious odors or hazards. We looked at a number of bedrooms. The first room was cold, although the radiator was on it was luke warm. The bedding was thin and when we pulled it back the sheet was wet and soiled. There was some discarded waste materials in the corner of the room on the floor. This was brought to the attention of the provider immediately. We looked at another room and the walls were dirty and the room smelt heavily of urine. The bed-linen was heavily stained. We looked at a number of other rooms which were clean and well maintained. Rooms are of a generous size and some residents had lots of their own personal possessions. The providers stated they were investing money in a new alarm, intercom system for the home. We noted that the stair carpet from the back stairs leading to the first floor were worn and stained in parts. Several of the bathrooms required updating. Toiletries must not be left unlocked. We also noted that in one bedroom the window was cracked. In the large lounge the windows were not clean. We observed satisfactory infection control procedures, although we were concerned about the lack of domestic staff at the weekend and have given two examples of where rooms were not hygienic. We spoke to staff about infection control procedures. The cook had received training in infection control. One staff member commented that staff do not wear gloves when handing out sandwiches/cakes in the evening. Several other people said they sometimes run out of basic equipment such as soap. We noted that the home employs a laundry assistant. On the day of inspection we looked in the laundry room and their was washing and drying that had completed its cycle in the respective machines. We asked who was responsible for laundry and in particular changing beds. We were told in the absence of the laundry lady staff will do it and bed making is often left to the night staff. Further clarification for this would be helpful to ensure hygiene standards are maintained. The front of the property and the gardens were beautifully landscaped and maintained to a high standard. The house is in a quiet no- through road with extensive grounds. Care Homes for Older People Page 20 of 32 Evidence: A number of radiators remain uncovered despite a requirement being made in January 2009. The provider stated that these will be covered by January 2010. The heat in the home fluctuated. A number of residents in the main lounge stated they were cold, although they were well dressed. A number of the bedrooms were very cold and bedding was inadequate. The hall-ways were very hot. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must be adequately staffed to meet the identified physical and social care needs of residents Evidence: The home has had a high turnover of staff. The management have actively recruited to these positions. In the last few months the home has lost its operations manager, acting manager, deputy manager, cook and activities co-ordinator. At this inspection we were met by the new manager who has been in post since the end of November 2009. The home have just recruited a deputy manager who will be in post once her CRB has been received. There is a new operations manager in post. On the day of inspection the manager and provider were at the home. There were four care staff, two of whom were described as Senior staff. There was a domestic, the maintenance person and a new cook in post. There was also an administrator and the providers have offices at the home. One of the providers is available throughout the day. In the afternoon there are three staff and two night workers. The provider stated staff will be employed to cover the busy periods of the day. We looked at the staffing rotas for the month of November, December 2009. This showed the home was adequately covered. We spoke to staff about staffing levels and they stated numbers sometimes drop to three care staff on shift, which made it very difficult to meet residents needs. Staff commented that the manager is very hands on and will help on Care Homes for Older People Page 22 of 32 Evidence: shift which makes a huge difference. We had received concerns last month about staffing levels, but Mrs Rudd had stated that there were four staff on, some staff had been re-deployed from another home, as opposed to using agency staff. We would question if 4 care staff is sufficient to meet residents needs, particularly when staff often have duel roles in the home and may also assist with cleaning, laundry or cooking and thus taking them of the floor. The rotas inspected did not make it clear the role of each member of staff. This was a requirement at the last inspection, so it was considered unmet. We spoke to staff on duty. All were permanent staff. Staff told us there were only five original staff left, all the other staff had been recruited since the new owners had taken over. Staff talked about a high percentage of dependent residents, 11 who needed the support of two care staff, in terms of their manual handling needs. They felt staffing levels were insufficient at times and only allowed them to complete basic physical care needs. Another member of staff felt there had been a lot of changes in the home, mostly for the better. Staff are not always informed of the changes but there had been a recent staff meeting and some staff had received supervision with the new manager. The staff member said the new management arrangements were working very well and ideally there should be five care staff on shift. We spoke to the activities person, the domestic and the cook. The activities person was just finding her feet being her second day. She had already identified a number of changes she wished to make. The cook also had a lot of ideas about how to improve the catering and stated that new menus were to be introduced and more rustic food would be on the menu. This is what residents had requested. Staff stated that they had recent training such as safeguarding in vulnerable adults, (SOVA), first aid, dementia and moving and handling. We looked at five staff files and found recruitment checks were in place including criminal record checks, CRB, Personal identification, ID, completed application form, health declaration, and 2 references, which provided very little information. Protection of vulnerable adult checks (POVA checks) were seen in the file containing documentation for staff who are undergoing pre-employment checks Training records were in place and topics included SOVA, moving & handling, fire, first aid, medication, dementia, food hygiene, health & safety, continence and bereavement. Some training required updating. The manager produced a training matrix showing refresher training for staff in the last month. It did not tell us how training was delivered. Some training Care Homes for Older People Page 23 of 32 Evidence: is completed through video and question and answer sessions. The home must ensure that any training delivered is effective in terms of improving staffs competence and skill level. Supervision records could not be found initially but the manager confirmed these were held regularly. The manager already supervised some staff and was putting together a supervision matrix for the following year. This responsibility would be shared with senior staff when they had received the relevant training. Some staff stated they had not had regular supervision. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have adequate systems in place to promote safe working practices. Equpitment in the home is maintained according to agreed schedules to ensure it is fit for purpose. Evidence: The manager in post was employed at the end of November 2009. The new manager is not registered with the Care Quality Commission and is working a probationary period. The manager told us this was the third home that they had managed. Initial feedback from staff was that he was approachable and led from the front, spending time on shift to observe and support staff. A staff meeting had been held several days earlier and a number of staff had received supervision. A matrix for the forthcoming year was being put in place. Some staff training had been refreshed in the last month. We looked at a sample of records including some case tracking of residents records. A requirement has been made. Staffing records were satisfactory. We looked at a sample of maintenance records which were satisfactory. We noted there had been a Care Homes for Older People Page 25 of 32 Evidence: recent fire drill which included 8 staff, fire alarms and emergency lighting tests had been carried out. Water temperatures were within safe ranges. We saw the electrical wiring and gas safety certificate. There was evidence of staff meetings. We saw no evidence of resident or relative meetings and did not ask about the homes quality assurance systems. We noted from the homes self assessment that the providers stated regular residents meetings were held and the home send out questionnaires to relatives and residents to get their feedback about the home. Generally the maintenance of the home was acceptable. Cleanliness standards were variable. We carried over requirements regarding the staffing rosters and uncovered radiators. Further requirements have been made around safe practices in the administration of medication. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 The home must ensure that 30/10/2009 their staff are suitably qualified, competent and experienced. The home must have a clear audit trail of staffs training and induction received. Training records in themselves are insufficient. The home must evaluate the effectiveness of the training provided. This is to ensure that staff have the neccessary skills to meet the requirements of the job. 2 37 17 The staffing rotas must comply with schedule 4, which states that the duty rota must include the position staff hold, the work they perform and the number of hours they work. This is to ensure that there is a clear audit trail and the home are able to clearly evidence that care hours are sufficiently covered. 30/10/2009 3 38 23 The home must be free from 30/11/2009 hazards. Unguarded radiators must be covered and hot water temperatures regulated so they do not exceed 43 degrees. This was a previous requirement but Page 27 of 32 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 the home have taken steps to minimise the hazards but have not eliminated them. This is to ensure residents are fully protected. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 Care plans must reflect changes in residents needs and agreed actions to be taken to continue to meet those needs. Particular attention must be paid to the reduction in falls. The home must evidence what actions they have taken and draw up individual risk assessments. This is to ensure that residents have their needs met and they are kept as safe as possible without imposing on their independence. 30/12/2009 2 9 15 Where people are prescribed 31/12/2009 medicines on a when required basis, there must be clear guidance in care plans of the circumstances they are used and staff must follow this guidance. Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will protect people from harm and ensure medication is not given inappropriately. 3 9 13 There must be sufficient 31/12/2009 supplies of medicines held in the home for the continued treatment of residents. This will ensure people receive their medicines as prescribed. 4 9 12 Medicines must be given to 31/12/2009 people in accordance with the prescribers instructions. This will ensure people receive their medicines as intended by the prescriber. 5 9 13 Records made when 31/12/2009 medicines are given to people must be accurate and complete. This will demonstrate that people receive the medicines prescribed for them. 6 12 12 The home must demonstrate 30/01/2010 how residents choices are promoted in relation to all aspects of the home. Routines of daily living must reflect the wishes of residents and not be driven by the staffing culture. Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure the home matches the cultural, social and dietary needs and wishes of residents. 7 26 23 The home must be maintained to high standards of cleanliness and adequate arrangements in place to control the spread of infection. This is to ensure residents are safe. 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 30/01/2010 1 9 Hand-written additions or changes to medication records should be signed and dated by the person making the entry and checked for accuracy by a second person who should also sign the form. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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