Inspection on 03/03/09 for Bon Accord

This inspection was carried out on 3rd March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bon Accord 20/08/09

Bon Accord 10/06/09

Bon Accord 03/04/08

Bon Accord 18/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 40 Information about the care home Name of care home: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB 01273721120 01273730983 bonaccord@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross (Hamilton) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 41 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 41 41 The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies of service: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Bon Accord is a care home with nursing and is registered to provide nursing to 41 older people with mental health needs.It is owned by Southern Cross(Hamilton) Limited.Residents accommodation is spread over three floors and consists of thirtyfive single rooms and two shared double rooms. Twenty-one of the single rooms and three of the shared rooms have ensuite facilities consisting of a washbasin and Care Homes for Older People Page 4 of 40 Brief description of the care home wc.There are four assisted bathing facilities and one assisted shower facility. All staircases and the front door have a secure keypad entrance system.A shaft lift serves all floors.Communal accommodation consists of three lounges and two dining rooms. There is access to a large rear garden. The home has a large garden at the front with limited parking facilities.The roads around the home are metered parking only but the home is served by public transport and there is a train station at Portslade, which is approximately twenty minutes walk from the home.The home maintains links with the local psychiatric hospitals and local General Practitioners and associated health care professionals visit the home. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 3rd March 2009 and was facilitated by the deputy manager. Two inspectors undertook this inspection, one of the inspectors spent around three hours in the home observing interactions between staff and residents,whilst the lead inspector did the general inspection over a period of eight hours. During the inspection four residents were spoken with in depth, and five members of staff and one visitor, gave their views on the home. Documentation, which included care plans, personnel files, medication charts menus , Care Homes for Older People Page 6 of 40 training plans and health and safety files, was examined, and a tour of the home took place. Prior to the inspection surveys were sent out by the CSCI to residents and six were returned. Some of these had been filled out by relatives and representatives, but all surveys gave a valuable insight into the life at the home and information from these were used to inform the inspection. The Annual Quality Assurance Assessment, a document required by regulation in which the provider or manager tells us what they have achieved in the past twelve months and what they hope to achieve, was received when we asked for it and was used to inform the judgements in this report. Residents spoken with said The staff are very good, dont know where they get their patience from. I have lots of friends among the staff, Ive known them for a long time now and I dont know where I would be without them. I quite like the food but we dont get a choice, we have too many baked beans and I wish we could have more fish. I dont know if there is a vegetarian menu. Not sure if the staff are trained but they look after us well A visitor said that Its like one big family and thats very important, I am always made to feel welcome. The last key inspection for this service took place on the 3rd April 2008 and current fees from the service range from five hundred and seventy pounds a week to eight hundred and fifty pounds a week. Fees do not include extra services such as hairdressing, chiropody, reflexology or aromatherapy, and residents or their representatives have to pay for any extra equipment, such as special chairs, that are required. What the care home does well: What has improved since the last inspection? What they could do better: Some requirements made at the last inspection have not been complied with and the CSCI may now take further action. The company have reduced the number of staff in the afternoons, and whilst at the last inspection the number of staff was deemed to be insufficient for the needs of the residents in the home, this has not been reviewed. Care Homes for Older People Page 8 of 40 The bathroom on the first floor is not able to be used, and although the company said that this had been addressed, staff say that they are still unable to use this. The adult safeguarding policy has not been amended to guide staff on how to meet the reporting protocols for safeguarding. It is appreciated that the company did employ an activities organiser for a short while, however the amount of time allocated for activities has not been increased, neither has the variety of activities offered. The home is currently recruiting a new activities person. Recruitment policies were found not to be robust on this occasion and therefore residents are not being safeguarded. Meals are not presented in an appetising manner, and the dietary needs of the residents are not being fully met. Due to the lack of sufficient staff, the care given to residents is not always as is directed in the care planning, and the personal care and grooming of the residents does not promote self pride and dignity. 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 set out 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 40 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 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide do not accurately reflect the management systems in the home or the provision of equipment. The format of these documents is not helpful for older people. Detailed and comprehensive preadmission assessments enable the home to be sure that they can meet the needs of residents admitted, and ensure that staff have a clear assessment of the persons needs to commence care planning and care delivery even in instances where residents cannot communicate. Evidence: All residents have a copy of the Service User Guide and Statement of Purpose although these require reviewing to reflect recent changes. The Service User Guide needs to be presented in a format which is suitable and easily read by people in the home, this was discussed at the last inspection and assurances Care Homes for Older People Page 11 of 40 Evidence: were given by the manager that this would be done. As this has not been reviewed, a requirement has now been made. The Statement of Purpose is also available on audio cassette for those residents with sight impairment. This was not listened to at this inspection so no judgement could be made as to the factual accuracy. All residents receive a contract on admission to the home. A sample of four were examined belonging to residents admitted under different funding options, and these met the National Minimum Standards and the regulations. One of the senior registered nurses or the deputy manager assess the residents prior to their admission to the home. Relevant information regarding the home, such as a brochure and Service User Guide, is taken with the assessor, and prospective residents or their representatives are encouraged to visit the home. Twenty of the places in the home are contracted by the local authority and residents for these places can only be admitted to the home following local authority or PCT referral. The remaining places are available to either privately funded residents or local authority funded placements. Three preadmission assessments were examined and these were very comprehensive, enabling care plans to be written, even when further information was not available from the resident. The prospective resident, or their representative, receive written confirmation that the home can meet their needs. It was noted that the Statement of Purpose states that at the time of assessment, the assessor will Assess any specialist equipment required to meet the identified need; it does not however state that residents or their representatives will be required to pay for this equipment, which happens at present. It is expected that if a nursing home states it can meet a persons needs that they will provide the equipment to ensure the persons care is not compromised, and that this is provided as part of the general fees. Residents are also admitted for respite care but not for intermediate care. Care Homes for Older People Page 12 of 40 Care Homes for Older People Page 13 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of care planning is comprehensive and documentation directs staff to wards the care required in order to meet the health and psychological care needs of the residents. However the delivery of the care does not always follow that which is directed by the care plans, and the delivery of personal care does not always maintain the dignity of the residents, or ensure that those residents nursed in their beds have frequent nursing care interaction. Whilst medication records are up to date and medications kept in stock, some aspects of administration put residents at risk. Evidence: During the inspection three care plans were examined and the residents case tracked. Care planning followed on from a good preadmission assessment and there was a full needs assessment in place in the care plans. Two care plans had been reviewed on a regular basis but the third care plan needed to be updated in parts. Care Homes for Older People Page 14 of 40 Evidence: All parts of the care plan showed evidence of being personal care planning to meet the residents preferred manner of care. Risk assessments for bed rails and call bells were in place, and also for the use of portable heaters in the rooms for the period of central heating failure. The deputy manager stated that the use of a mental health nursing model was difficult with the care planning format currently provided, but staff had managed to plan care for the varied mental health needs of the residents. The provision of a specific mental health care planning system would be beneficial, but care would have to be taken that staff paid as much attention to physical health care planning as is currently taking place. Care planning included plans for personal care, moving and handling, mental health, nutrition and wound care. A social needs care plan detailing the leisure interests and needs of the residents should be put in place to ensure holistic care needs are met. The Malnutrition Universal Screening Tool had been used in the nutritional planning for all residents and clearly identified that monthly weights and BMI ( Basal metabolic Indices) had been undertaken on all residents, and care plans identified action to be taken. Wound care plans showed consultation with the wound care specialist nurse and progression of the wound, although in one case it was unclear whether it was the social worker or the staff in the home who had identified that the wound care specialist nurse was required. Conclusion of wound care was also noted, however in one case the nurse forming the care plan had not signed the plan. Night care plans, with the exception of one, identified the residents preferred times of rising and retiring, but were not clear as to what care the residents required overnight. Whilst there was evidence of annual or six monthly reviews of the care plans with relatives and social workers, there was little evidence of residents or relatives being consulted on the formation, or during the regular reviews, and this is especially important when there has been a change of care. One care plan showed that the resident did not initially need bed rails but when these had been required at a later date, the way this was written in the care plan could have caused confusion for a nurse not familiar with the home. Risk assessments identifying the risks of entanglement in call bell pull cords must be Care Homes for Older People Page 15 of 40 Evidence: contemporaneous and should be quick to identify when this is no longer a risk and the pull cord can be reinstated. Continence care plans require the addition of incontinence aid sizes and reviewing to ensure these are still satisfactory and care plans should have the pressures of electric mattresses added to them and the home should have some system of monitoring this. Generally care plans gave clear instructions for staff, and daily notes identified what care had been given in relation to the care plans. Not all staff have undertaken any form of Dementia care training, and registered nurses and senior staff have not received any instruction in Dementia Care mapping. There was evidence of five weekly surgery consultation in the home with a consultant psychiatrist who addresses the psychiatric needs of all the residents Other health care professionals visit the home as required by the resident. Whilst the documentation relating to the health and personal care needs of the residents were good, the delivery of this care was questionable in some areas. On going around the home there was no evidence that staff had visited the rooms of two residents who were nursed in bed, for a couple of hours. One resident who was unable to help himself, and had been risk assessed as unable to use a call bell without risk, was found, as it was getting dusk, lying in bed without a light on, the windows open and a cold wind in the room which resulted in him feeling cold to the touch and no form of music or any other method of relieving any boredom he may have felt. There was no turn chart or fluid chart. The food chart identified he had been given a drink at teatime, but there was no indication of any further intervention for the subsequent two hours. Another resident was found in bed, unable to use a call bell and no lights on. The deputy manager said that fluid charts are not used to record when drinks are given outside meal times, and therefore it is not clear how often residents are offered drinks or how staff measure intake and output of vulnerable residents. The conservatory is used for those residents who are not able to speak or move for themselves. On the three times the inspector visited the conservatory, there were no staff in this room and all residents were sitting in the same position on each occasion. One member of staff passed through but did not speak to them. Care Homes for Older People Page 16 of 40 Evidence: One residents survey said Whether the staff listen to what I say varies with the member of staff concerned. A survey received from a relative stated There is not enough feedback and information to relatives, a monthly feedback would be welcomed and give me the opportunity to sit and discuss any issues and concerns. Staff listen and act on what is said most of the time, but medical support only seems to be available if relative asks for medical input. However care plans did show that when staff had concerns about a resident, the General Practitioner, psychiatrist or relevant health care professional was contacted in a timely manner. The last inspection report stated that Lack of attention to residents grooming can affect the dignity of the residents. This has not improved since the last inspection, some residents do not have the opportunity for hair dressing other than a dry cut therefore only those residents who can do their own hair or have the benefit of their own hairdresser have the opportunity to have their hair set or permed. It was noted that care had not been taken with the way some residents were dressed, or if they had changed their own clothes during the day, staff had not either noticed or advised. One resident was wearing one blue slipper and one pink slipper and only one sock, which was yellow. Staff must be aware that this impacts on residents pride and dignity. However the company has reduced staffing levels and staff and surveys stated that there was insufficient time to meet all the residents needs as they would wish to do. Currently the home only has one sit in bath that is able to be used, a requirement was made at the last inspection regarding the bathroom on the upper floor which the staff cannot use for residents due to the door to assisted bath being unreliable. Staff said that they cannot use this bathroom as the problem is not resolved or the bathroom on the ground floor as it is too difficult to move wheelchairs and hoists into this. The company is not assisting the home to manage the continence needs of residents, two carpets were malodorous, and this impacts on the dignity of the residents. Whilst requests for a new carpet had been actioned, little thought had been given to providing impermeable flooring in these two rooms, that would have helped with the problems incurred with residents who will not use an continence aid. Poor manual handling techniques were seen, with staff using an underarm lift to stand people up. Staff have received moving and handling training and are therefore aware of the injuries this can cause. Residents were also being moved around on dining room chairs which could lead to injury. Care Homes for Older People Page 17 of 40 Evidence: All floors and the entrance doors are locked by key pads, residents who are sufficiently able to move around the home or take themselves out, are given the code of the key pad. Two of the surveys received, and one of the residents spoken with, praised the patience and perseverance of the staff and the kindness received by the residents. It was noticed during the day of the inspection that all staff were unfailingly patient and kind with residents, showing an understanding of the residents concerns and trying to relate to them Medication policies identifying the receipt, administration and disposal of medications were in place. All medications had been signed for following administration and there was no evidence of medications being out of stock. It was noted that on top of the drug trolleys there were cartons of Nutrilis 225g food thickener, these were prescribed for individual residents but were being used for all those residents who needed their medication with thickened liquid. Creams prescribed for residents were found in other residents rooms. Prescribed creams and medication should only be used for the residents for whom it is prescribed. Whilst the storage and recording of controlled drugs appeared satisfactory, information was given to the inspector that the controlled drugs given at night are not witnessed, but the records are left for a registered nurse on day duty to witness, staff were not aware that medication can be witnessed by care staff. This practice of expecting registered nurses to witness drugs when they are not on duty when the drugs are administered puts residents at risk, the nurses registration at risk and leaves the process of drug administration open to abuse. No residents self medicate at present, but the home should consider how they are going to manage this to conform with the Deprivation of Liberty Safeguarding act coming into force from April 1st End of Life care plans are in place, but only a few of them identify the residents wishes for resuscitation or what is to be done if the residents are unable to make this decision. Although the home deals with end stage Alzheimers disease, no staff have undertaken Liverpool Care Pathway or Gold Standard Framework training ( nursing tools used to ensure that residents are at the end of their lives are kept free from pain and have a nationally recognised standard of care). Some staff have attended end of life care training and Macmillan nurses come in when required. Care Homes for Older People Page 18 of 40 Evidence: There were thanks and compliments seen from relatives of deceased residents who thanked the staff for their kind and caring attitude and the care given. Care Homes for Older People Page 19 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope to increase the allocation of time to activities and for a greater variety to be provided, given the importance of suitable leisure activities for this category of resident. There was evidence that equality and diversity are not always being practised in a manner which would be expected of a home serving this category of resident. The standard of catering shows a disregard for the need to serve meals in an attractive manner to ensure that residents have an enjoyable dining experience. Evidence: Due to the previous activity coordinator having recently resigned, the home does not have a dedicated person for these. A member of care staff is being employed for extra hours to cover this in the meantime and at present there is no formal activity programme in place. The time allocated for activities is thirty hours a week and the company should be aware that for this category of resident the provision of meaningful activities and leisure interests is as important as the care. Care Homes for Older People Page 20 of 40 Evidence: Surveys received by the CSCI identified Sometimes we have activities There are only certain people who are able to participate and carry out the activities and there is nothing for those not so able to do these other than sit in their chairs. Group activities are difficult as there are three small lounges and the activities person can t get around everybody. The provision of activities should include time for one to one time with residents. The carer providing the activities on this day, asked the people in the main lounge what they would like to do, and some of the residents enjoyed playing skittles and hoopla. One resident later said that they I find the activities a bit childish, but dont like to say so. Whilst there was some good interaction taking place with those residents able to respond, one of the residents was very softly spoken and the carer did not hear what she was saying or respond to this. However the carer was attempting to interact with other residents who did not respond to her. There was a very good painting in the lounge painted by one of the residents who likes painting. This person also likes reading and it was gratifying to see a pile of books on her bedside table. Residents who were less able, such as those in the conservatory lounge, did not appear to be offered any interaction, and some residents in the quiet lounge were reading newspapers or interacting with each other. Whilst reflexology and aromatherapy are available, these is charged as an extra service and are only available to those residents with the means to afford them. Visitors are welcomed into the home at any time, and comments from surveys included The staff are very interested in making my partner feel at home and knowing his likes and dislikes. The staff are really helpful and tell us if they have any concerns. A visitor spoken with on the day said Its just like one big family and that is important, I can stay for dinner and they always bring me a cup of tea, the deputy manager is terrific, I can ask him about anything and phone at any time if Im worried. Ministers of religion visit the home and care staff will accompany those residents wishing to attend a church, providing there are sufficient staff available. No services are currently held in the home. The serving of lunches and suppers was observed, the portions at lunchtime appeared Care Homes for Older People Page 21 of 40 Evidence: small and did not appear very appetising. The meal served that day was beef stew or chicken nuggets, both these were served with cabbage and mashed potatoes. The previous practice of serving meals in two sittings is no longer taking place. Previously those residents who required assistance were given their meal first, with other residents therefore having the full attention of staff when they were eating. Currently there are only eleven residents who do not require assistance, consequently the administrator and domestic staff have to assist at mealtimes. Staff were seen to be interacting well with the residents they were assisting, maintaining eye contact and talking to them. Residents have their meals in the dining room, in one of the lounges or in their rooms. Some residents were not being transferred to dining chairs, but were remaining in wheelchairs which were only designed for transferring residents, not for sitting in for long periods. One resident took her meals alone in the decommissioned dining room. The inspector was unable to clarify why, when it is clearly required, this dining room is not used. Whilst the care plans have clearly identified the need to add extra cream and butter to meals and the use of fortified drinks to maximise nourishment, and there were notices on the serving hatch reminding staff, in some cases this was not taking place. One member of staff did not seem aware of this and said I just give out the meals. Staff may require more training in nutrition. One resident did not want his main course and was given two desserts instead, the member of staff did give him a fortified drink, but there was no evidence of an optional main course being offered. The home still runs a Lunch Club, an initiative set up by the previous manager which enables specific residents to sit together and enjoy their lunch with a glass of wine in a quiet area. They are encouraged to invite relatives and friends to this meal. It was noted that the menu displayed was for the following day and not for the meals currently being served. This will easily confuse a resident. The supper meal consisted of scrambled egg and baked beans and bread and butter. The baked beans and scrambled eggs were being kept hot in saucepans of water due to the bain marie not working. The cook said that this had been broken for three weeks and no effort had been made to repair it. Care Homes for Older People Page 22 of 40 Evidence: Two residents spoken with said that we have baked beans a lot and staff also mentioned this. There was a limited amount of food in the food store but there were eight large tins of baked beans. When the cook was asked whether the diabetics were given baked beans and whether she had checked the sugar content in relation to the rest of their diet, she did not appear to realise that this should have be given some consideration. Dessert was jelly, with yoghurts being provided for the diabetics; the cook said they usually have yoghurt at supper. The supper meal was not well presented and did not look at all attractive. Concerns were raised at how rapidly people were eating this meal, as if they were hungry. The staff said that the food budget had been cut down. Susequent to the inspection a response was received from the provider which stated The food budget is reveiwed annually, and has not been cut down. The inspector was very concerned to find out from the cook that there are only one or two people that are vegetarian, and they eat chicken and I have given them lamb sometimes, they eat it. The deputy manager said that there were six vegetarians in the home. It would seem that because people may no longer be aware of what they are eating, they can be given food that they would normally never have eaten. Not only is this discriminatory it also shows a total disregard for residents as individuals who have a right to make their own choice, and when no longer able to do so, the people looking after them should maintain their choices. The catering staff require training both in equality and diversity but also in catering for the older person with mental health needs. A recommendation was made regarding this at the last inspection. The cook said that she is about to commence the National Vocational Qualification in Catering, which may address some of the above issues. Good practice for older people with mental health needs indicates that the provision of finger foods both at mealtimes and throughout the day ensures that they are more likely to eat a balanced and nutritious diet, this is not being done. The menus provided by the company are reasonable and provide for a vegetarian option at meals. The AQAA ( annual Quality assurance assessment) stated that the Nutmeg system is being used in the home which involves the use of menus advised by nutritionists and dieticians. The breakfast options available were cereals, toast or porridge, more nutritious food Care Homes for Older People Page 23 of 40 Evidence: such as bacon and eggs is not available. The company menu did not give the home the option to offer these. One resident said there is no choice for most meals and I would like more fish, there may be a vegetarian option but I am not sure, there are too many baked beans but mostly I like the food. Another resident said today the food is very good but is often very hit and miss. Surveys received gave varied opinions about the standard of catering but one survey said A larger variety of teatime snacks ie crisps, chocolate wrapped biscuits, fruit, would be good. This was provided for short period but has disappeared, and the residents did enjoy them, now they just have biscuits. Menus are taken around the day before and residents are able to make a choice of meals, it was unclear whether they are advised on the options available, and whether some may remember what they have asked for, this is not helped by the inaccuracy of the displayed menu. The cook was asked about the provision of fruit for residents, she said that sometimes fruit was put out and it was noted that there was a small bowl of fruit in the dining room containing two bananas and one small orange. It was not clear whether residents who cannot fetch it for themselves, are offered fruit. Care Homes for Older People Page 24 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints made to the home are recorded, and measures taken to ensure that repetition is avoided and that they are resolved to the residents satisfaction. The adult safeguarding policy in the home does not ensure that residents are adequately safeguarded. Evidence: The home has a complaints policy which is displayed and also included in the Service Users Guide. Some of the residents spoken with, and three of the surveys received, indicated that they were not aware of how to make a complaint, but most said that they would talk to a member of care staff or one of the registered nurses. There have been four complaints since the last inspection, one of which is still in process of being addressed and may need escalating to other authorities. Two complaints were substantiated and addressed and one was unsubstantiated. Records are kept of the complaints received and the manner in which they were addressed and resolved. The AQAA states that there have been seven adult safeguarding issues since the last Care Homes for Older People Page 25 of 40 Evidence: inspection, the CSCI had been made aware of only four of these. During previous inspections requirements have been made to change the adult safeguarding policy to represent the reporting guidelines required by the multi agency adult safeguarding team. This has still not been addressed. The administrator obtained the latest policy off the computer but this was dated 2006. A further requirement has been made. All senior staff have received adult safeguarding training with the local authority, and care staff have received their training in house. Care Homes for Older People Page 26 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement to maintenance and attention to flooring and furniture would improve the home. The numbers of housekeeping staff employed are inadequate to ensure a high standard of cleanliness is in place. Evidence: The home has three communal lounges and a large garden accessible to residents. The standard of maintenance in the home is variable, it is appreciated that in a home such as this it is difficult to maintain a good standard but it was noticed that minor details such as many of the curtains were coming off their hooks had not been addressed, and this is easily put right. Some areas such as communal lounges had very badly stained carpets and two rooms were malodorous. Surveys received said that The home is in need of redecoration, new carpets and new bedding and in general needs a good clean up. The common areas are drab. even with a fairly recent refurb, this is due to very poor and inadequate lighting . No central lighting and low wattage bulbs and poor fittings which could lead to serious injury. Care Homes for Older People Page 27 of 40 Evidence: Staff agreed with this and it was noted at the inspection that areas of the dining room and lounges were quite dark. Residents accommodation is in thirty five single rooms and two double rooms. Residents rooms were cheerful and they have been encouraged to bring in their own possessions to make the rooms homely. All residents had lockable drawers and all doors were lockable but there was no evidence over whether residents had keys for these. Some of the bedlinen was very thin, and replacements are needed. Staff also said that there were insufficient blankets in the home for all residents to have extra covers. Staff said that two of the bathrooms cannot be used, the ground floor bathroom is not suitable for use with hoists or wheelchairs and therefore suitable for only the most mobile of residents, and the assisted bath on the first floor was unreliable. A requirement was made at the last inspection that this bath be maintained. The home therefore has one assisted bath and two showers for use of the residents. Twenty three of the single rooms have en suite facilities but these only consist of a washbasin and bath. The temperature of the hot water in residents rooms and bathrooms is regularly monitored and records showed that these were within recommended parameters. Whilst the company has provided variable height beds and some electric mattresses,cushions and hoists, relatives have to provide other equipment required such as special chairs. The standard of cleanliness in the home requires improvement. Housekeeping staff said that due to staff shortages they only had time to keep a lid on the worst areas and that the home required a deep clean. Several chairs and carpets were badly stained and the housekeeper said that cushions required frequent washing and many of the chairs do not have the proper cushions on them. The house keeper has two trolleys for linen and cleaning materials, one of these falls apart often and is repaired with duct tape. Bare patches on the paintwork of the other trolley could be an infection control risk although currently this trolley is only used for transporting clean linen. Housekeeping staff said that they also had to go into the laundry and assist with meals. Bathrooms were not clean, and there was evidence of insufficient cleaning of baths Care Homes for Older People Page 28 of 40 Evidence: and bath seats and the showers following use. The deputy manager is the infection control champion for the home, and as such liaises with the Health Protection Agency and cascades new information to staff. Staff stated that the company does not permit the home to provide alcohol gel as it is not effective. This is contrary to the advice given by the Health Protection Agency. Not all staff wore aprons whilst assisting service users with meals. However two surveys said that the home was usually fresh and clean. The kitchen was clean, but the bain marie has been broken for three weeks. This is presenting an difficulty in keeping food at the correct temperature which could lead to infection. Care Homes for Older People Page 29 of 40 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 number of staff employed in the home is insufficient to enable residents to receive the standard of care that they and their representatives are entitled to expect. There are insufficient staff to maintain cleanliness of the home to a good standard. Staff training is good, although staff are sometimes dissatisfied with the depth of training received. Recruitment procedures are not sufficiently robust to ensure the safety of residents. Evidence: There was sufficient evidence in the home, which has been showing throughout the report, to identify that the present staffing levels throughout the home are not sufficient for the needs of the residents in the home. This includes catering and housekeeping staff. Two surveys received said that Staffing is often inadequate. Often insufficient staff. There are seven care staff and two registered nurses during the morning, six care staff and two registered nurses in the afternoon and three care staff and one registered nurse at night. The kitchen comprises two staff only, one kitchen assistant and one cook, when one of these members of staff is having a day off, only one member of Care Homes for Older People Page 30 of 40 Evidence: staff is in the kitchen. The home brought an agency cook in to cover annual leave. Domestic staff say that they have to cover laundry duties and assist with meals. Requirements have been made over past inspections for the company to review staffing, the geography of the home and the dependency of the residents indicates that this is a priority but the company have reduced staff since Christmas. The home currently is using a senior member of care staff to undertake staff training, whilst she has completed the Train the Trainer course for moving and handling, she is not qualified to deliver any further training. Specifically qualified health and social care professionals would be expected to deliver training on issues in the home. Staff expressed dissatisfaction at the level of training provided. However staff are also receiving training from the nursing home support team and have attended dementia awareness training. Subsequent to the inspection a response was received from the provider which stated: The company support staff in all statutory training and support staff in any training to support the staff in any training to support their role within the home All staff undertake the Skills for care induction training at the commencement of them working at the home. A good proportion of the staff (68 ) have attained the National Vocational Qualification level 2 in care. Staff have received training in the Mental Capacity Act and the deputy manager has training planned in Deprivation of Liberty Safeguarding. Four Personnel files were examined . Two members of staff had commenced work with only one reference in place, and there was no evidence of a Protection of Vulnerable Adults check on another member of staff, she had commenced work the same day as her CRB check had been received and it was queried whether, had this not been received, she would have still commenced work on that day. Management must ensure that all checks and references are in place prior to a person commencing work at the home. Care Homes for Older People Page 31 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home do not feel supported by current company management and this has led to some breakdowns in the structure of the home.Residents and their relatives feel supported by the staff at the home. Evidence: There is no manager in the home at present and the deputy manager,who works part time, and the rest of the staff have been keeping the home running. A new manager has been recruited and is expected to start in the next week. There is evidence of poor recruitment processes having taken place, shortage of staff and some drug management that does not meet regulations, which should have been picked up by the providers and manager. Staff said that there is a lack of senior management support in home and that they Care Homes for Older People Page 32 of 40 Evidence: hoped, with the new management tiers in the company that they will go through a new lease of life. Staff were working under stress and this was evident on the day of inspection as well as some staff vocalising this. Whilst efforts have been made by the staff to ensure the residents receive the care they deserve, they have been finding this difficult. Residents and relatives spoke of the patience of the staff. Some of us can be very difficult and I dont know where the staff get their patience from The staff are really lovely and they have a very difficult job It is like one big family. The home sent in its AQAA (annual quality assurance assessment required by regulation and which shows what has happened in the past year and the plans for the next year) and this was received when it was asked for. A quality monitoring system is in place; with questionnaires being sent out to residents and health care professionals, the results of this were not available at the inspection. Staff have received regular supervision, and the Regulation 26 visits (monthly provider visits required by regulation) and reports were seen in the home. Residents money is kept in a service user bank account, with interest accrued payable to the individual. Receipts and records were seen and were in order. Policies and procedures have not been reviewed since 2006 and the company has not responded to requests for an amended adult safeguarding policy. There was evidence of regular servicing of equipment and utilities and all staff have had moving and handling and other mandatory training. The CSCI has not been informed of some of the adult safeguarding issues that have taken place, although other notifications are being received. Residents were placed at risk for the second year running due to a breakdown of the central heating system. The company has now confirmed that there is a new boiler in place and another boiler will be put in place in the spring. It has been noted in a previous section that relatives or representatives currently have to fund equipment for residents, this also applies to automatic door closures for residents. If a resident wishes to have their door left open, relatives have to buy one of these appliances for the door. Care Homes for Older People Page 33 of 40 Care Homes for Older People Page 34 of 40 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 8 Reg 23(j) That the bathroom on the first floor is made fit for purpose. 30/05/2008 2 12 Reg 16(m)(n) That the programme of activities provides sufficient activities on daily basis to ensure that all levels of ability are catered for. Reg 13(6) That the adult safeguarding policy shows the reporting protocols in the home to be in line with the `MultiAgency Guidelines. 18/05/2008 3 18 10/05/2008 4 27 Reg 18 That staffing levels are 10/05/2008 reviewed across all grades of staff to ensure that sufficient staff are on duty to meet the needs of the service users according to their dependency, and to maintain the cleanliness of the home and service users bedding and clothing. Care Homes for Older People Page 35 of 40 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 1 4 That the Service User Guide and Statement of Purpose is produced in a format which is in suitable easily read format to be used by the service users admitted to the home. That it is reviewed to showchanges in the management structure of the home and includes the information that the individual service user is financially responsible for providing extra equipment they may required. The Statement of Purpose and Service User guide must be able to be read and understood easily by the service users living in the home. It must be factually accurate, open and transparent and clearly define areas not covered by the fees. 01/05/2009 Care Homes for Older People Page 36 of 40 2 7 15 That care plans are formed 30/04/2009 and reviewed in consultation with the service user or their representative where it is possible to do so To ensure that service users or their representatives are aware of and agree with the care that they receive. 3 8 12 That care is delivered in a 20/04/2009 manner and at a frequency as directed by the care plans and which meets the service users required physical needs and maintains their dignity. That service users receive the appropriate nursing and personal care which meets their needs and enables them to maintain their dignity. 4 9 13 That the standard of medication complies with the Nursing and Midwifery Guidelines and Pharmaceutical regulations. That prescribed creams supplements and medications are only used for the people for whom they are prescribed. To ensure that service users are not put at risk and that there is no risk of misuse of drugs. 30/03/2009 5 12 16 That the programme of activities provides sufficient activities on daily basis to ensure that all levels of 30/04/2009 Care Homes for Older People Page 37 of 40 ability are catered for. This was a previous requirement with a compliance date of 18th May 2008 To enable service users to lead as fulfilled a life as their abilities allow 6 15 23 That advice is sought from 30/04/2009 an appropriate authority regarding the provision of a suitable menu and the presentation of this to ensure optimum nutrition for service users in the category of registration of the home. That catering staff receive training in catering for the older person with mental health illness. To ensure that service users have a well presented diet which is nutritionally sound and that the exerience of meal times is enjoyable 7 19 23 That the provider ensures that the standard of maintenance in the home is improved, that carpets and chairs are cleaned or replaced and that necessary items in the home are repaired or replaced. That lighting in the home is of a sufficient standard to provide suitable lighting for service users and staff. To improve the home for service users and to prevent accidents. 30/06/2009 Care Homes for Older People Page 38 of 40 8 21 23 That the bathrooms on the ground and first floors are`made fit for purpose. To ensure that the home has sufficient bathing facilities for the numbers and needs of the service users. 30/04/2009 9 26 13 That the standard of cleanliness within the home is improved To make the home a pleasant place for service users and prevent the spread of infection 30/04/2009 10 29 19 That the management ensures that no staff are employed without all checks as required by the regulations being in place To ensure the safety of service users. 10/04/2009 11 38 37 That the registered person 23/04/2009 shall ensure that the CSCI is kept informed of any incidents affecting service users including adult safeguarding. To ensure that the CSCI is kept informed of any risk to service user Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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