Inspection on 14/05/09 for Bosworth

This inspection was carried out on 14th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bosworth 26/08/09

Bosworth 24/11/08

Bosworth 02/10/07

Bosworth 12/02/07

Bosworth 01/11/05

Bosworth 23/05/05

Bosworth 07/03/05

Bosworth 18/05/04

Bosworth 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bosworth 6 Southdown Avenue Preston Weymouth Dorset DT3 6HR     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: Susan Hale     Date: 2 0 0 5 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 38 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 38 Information about the care home Name of care home: Address: Bosworth 6 Southdown Avenue Preston Weymouth Dorset DT3 6HR 01305833100 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Derek Edwin Luckhurst,Mrs Christine Wells,Mrs Meryl Susan Hodder Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 One named service user (as known to the CSCI) within the category of LD(E) may be accommodated to receive care. Date of last inspection Brief description of the care home Bosworth Residential Care Home is located in a quiet residential area of Preston, about 2 miles from the centre of Weymouth. The home looks out over a wildlife reserve and has views of the sea and Portland. The home is registered to accommodate a maximum of 22 older persons over the age of 65 years. Bosworth offers 18 single and two double sized bedrooms, spread over two floors; as the house is set on a hill, a number of first floor bedrooms have direct access to the garden. The home has a passenger lift which gives level access to the main area of the first floor; six bedrooms on this floor have access via 3 steps on the landing. On the ground floor there are Care Homes for Older People Page 4 of 38 Brief description of the care home communal lounges and a dining area, together with a bathroom and WC. The current fees range from 329 to 570 pounds. The registered manager told us that the fee structure is flexible. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the visit was to inspect relevant key standards and to focus on outcomes for residents. We measure the quality of the service under seven outcome groups and these are individually given a rating of excellent, good, adequate or poor. These ratings are collated to give an overall rating of the service provided by the home. The inspection was undertaken over the course of two days. Two inspectors visited on 14 May 2009.The pharmacy inspector visited on 19 May 2009 accompanied by an inspector monitoring the progress of the immediate requirement given on the first visit. We sent out surveys to people who live and work in the home and health and social care professionals.We had received two surveys form professional who have contact Care Homes for Older People Page 6 of 38 with the home at the time of writing this report.The results are incorporated into this report. We spoke to eight residents, the registered provider, Mrs Grinrod the registered manager, and three staff. What the care home does well: What has improved since the last inspection? The statement of purpose and service user guide now make it clear that one private room can only be accessed via the managers office. The manager has started to revise the care plans for some residents, and these cover all the recommended topics so that all of residents social, health and physical needs can be identified and met. An increase in staff hours to provide activities is positive and will lead to a more Care Homes for Older People Page 8 of 38 stimulating environment. Information about the nutritional needs of older people has been obtained to make sure that the home can meet residents individual needs. A new bath seat has been provided since the last inspection. The large fish tank that was seen in the lounge during the last inspection to be very dirty has been removed. A programme of redecoration and refurbishment has been drawn up to improve the environment for residents. A clinical waste contract is now in place to make sure that it is disposed of correctly and in line with relevant health and safety legislation. The accident book now includes details of any treatment given to residents if they sustain an injury and staff no longer carry out unauthorised wound care. The manager has set up a training programme that covers both mandatory and foundation topics.Recruitment practices have improved to make sure that people who live in the home are protected from the risk of unsuitable people working there. What they could do better: People who are considering moving into the home must be involved and consulted during the pre admission assessments and if they move into the home, must be consulted about their care plans and reviews to make sure that they are in agreement with and party to any decisions made about them. All residents must have a care plan that records their assessed needs and gives clear guidance and instruction to staff on how these needs will be met. Risk assessments relating to moving and handling,falls, nutrition and pressure sores should be undertaken on admission and regularly afterwards whenever necessary. Care plans and risk assessments must be kept under review and updated as necessary to make that they reflect individuals current needs. There are still improvements needed to the way medicines are recorded in the home, to show that people receive their medicines in the way their doctor has prescribed for them The routines of the home are organised to suit the staffing levels and the way the home is managed. There are limited opportunities for people to engage in social activities outside the home. Any issues or concern relating to adult protection and the well-being of people who live in the home must be recorded and dealt with in accordance with the homes policies and locally agreed procedures. Many areas of the homes, including the two downstairs toilets need to be redecorated and better maintained to be able to provide a good standard of accommodation for people who live there. Carpets that are stained should be deep cleaned or replaced and furniture that is in poor condition through wear and tear should be replaced. Care Homes for Older People Page 9 of 38 Signage throughout the home should be improved with signs suitable for the needs of people who live there put in place so they can retain their independence as long as possible. All radiators and pipework should be guarded to reduce the risk of burns and scalds to residents. Serious consideration should be given to employing domestic staff and to revising the current laundry practices The introduction of industrial equipment better suited to the needs of the home would free up care staff to spend more time undertaking care tasks and spend more time interacting with residents and providing person centred care. The practice of putting wet washing on radiators and handrails should be reconsidered as this impacts on the environment people live in. The laundry should be cleaned and consideration given to improving the ventilation. All staff must undertake structured induction training and mandatory training to make sure they have the skills and knowledge to meet peoples needs. Consideration should be given to improving the facilities for staff. The staff rota should include the hours worked by the manager so that it is clear when they are on duty. The accident records should be checked and audited by the manager to see if there are any patterns all trends that can be identified and measures put in place to reduce the risk of recurrence. Many of the policies and procedures need to be reviewed and updated to reflect current good practice advice. Records must be stored securely in line with the requirements of the Data Protection Act to make sure that all unauthorised people cannot access personal information about people who live and work at home. All documentation should be fully completed, dated and signed. 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 10 of 38 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 11 of 38 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. Pre admission assessment procedures are in place but they are not always completed and do not always include the people who are considering moving into the home and their family and friends. Evidence: We looked at the care file of two people who had moved into the home since the last inspection. On the first record a pre admission assessment had been undertaken by Mrs Grinrod but this did not record where it had taken place, who was involved or present during the assessment and was not signed by the resident. There was no care plan or any of the recommended risk assessments on file including a falls risk assessment although the pre admission assessment recorded that the resident has had a couple of falls. An immediate requirement was given on the first day of the inspection in relation to the lack of a care plan. We went back to the home the following week and the care plan was in place as required. On the second record Care Homes for Older People Page 12 of 38 Evidence: looked at it, it was recorded where the preadmission assessment had taken place but not who was present and it had not been signed by the resident. The majority of the assessment had not been completed. The file did not contain any risk assessments. Two professionals surveyed told us that the home usually ensured that information was gathered as part of the assessment process. Care Homes for Older People Page 13 of 38 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. One person did not have a care plan so their needs were not identified and no information was provided for staff. Care plans do not cover all the recommended topics and not all reflective of an individuals current needs, but these are currently being updated. Appropriate risk assessments are not in place. There are still improvements needed to the way medicines are recorded in the home, to show that people receive their medicines in the way their doctor has prescribed for them. Evidence: Mrs Grinrod told us that all care plans were being revised and updated to make sure that they reflected peoples current circumstances and needs. The minutes of the staff meeting dated 8th April 2009 advised staff that new care plans were going to be Care Homes for Older People Page 14 of 38 Evidence: implemented but that they would be based on current care plans not on an updated assessment of need. As stated in the previous outcome group one resident did not have a care plan or risk assessments although they had been living in the home for three weeks. The second care plan looked at contained a care plan but no risk assessments. The third care plan looked at contained good detail about some of the persons health needs and the care plans reflected the care given very well. Daily records were well kept and there was a record of the activities they are taken part in and it described the persons well or ill being. However, the care plan had not been routinely reviewed every month and the care plan on diabetes did not record the acceptable parameters for blood sugar levels. On the fourth care plan looked at there was a record of a discussion with the district nurse in relation to a medical problem but this had not been incorporated into the care plan. Although it was recorded that the resident had a recent weight loss and it was recommended they were weighed monthly we could not find any current weight records. There was also no evidence that the person had been referred to the GP in relation to their weight or to the dietitian. On a fifth care plan looked at we noted that the accident book recorded that the person had fell twice recently but there was no falls risk assessment on file. The radiator in this persons room was uncovered and on the day of the visit was too hot to touch and could present a risk of burns and scalds should the person fall against it. People who live in the home generally have access to medical and health care professionals as necessary. Two professionals who completed our survey told us that peoples health care needs were usually met by the home and that the home usually sought advice when necessary and acted upon it. Staff were observed throughout the visit treating people with respect and courtesy. They were seen knocking on the door of residents private rooms before entering to make sure their privacy was respected. However, staff were not seen engaging with residents unless undertaking tasks relating to care or housekeeping.Two professionals surveyed said that the home usually respected people privacy and dignity. On the day of the visit it was hot and sunny but we observed that not all residents had any fluid or a glass in their private room. We followed up on some issues with medication that were found at a previous inspection. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager. We spoke to someone living in the home about how they look after their own medicines. Care Homes for Older People Page 15 of 38 Evidence: Some people look after their own medicines if it is safe for them to do so, and lockable storage is provided for them. Other people living in the home are given their medicines by trained staff. We looked at how medicines are given and recorded. Records are kept of medicines received into the home, and of any unwanted medicines that are returned to the pharmacy. Medicines are given to people using a safe method, and records are kept of medicines given to people, although there are some gaps where staff have not signed the record or recorded a reason for not giving the dose. This was made a requirement at the previous inspection and this is still ongoing as the timescale for achieving this is not yet up. A new system has been set up to record when external preparations such as creams and ointments are applied by carers. Some external preparations, and some other medicines that may have been purchased by, or for residents, are also kept in some residents rooms. The risks to these people, and others living in the home need to be assessed. There is a medicines policy available to staff. Medicines given to people are stored safely for the protection of people in the home.There are separate arrangements for the safe storage of any controlled drugs and a separate medicines refrigerator for any products that need to be kept at lower temperatures. It is important to ensure that temperatures in this refrigerator are monitored. This is to check that these medicines are being stored at the right temperature, so they will still be effective and safe for people. Care Homes for Older People Page 16 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home are arranged to suit the staffing structure, although efforts are being made to improve this to try and suit the needs of the people who live at Bosworth. The increase in staff time allocated for activities offers residents more opportunities. Visitors are made welcome to the home and people are encouraged to bring their personal possessions with them to make their private rooms homely. People living at home are satisfied with the food served. Evidence: It was positive to see that Mrs Grinrod and the staff were making efforts to make the routines of the home more flexible. One resident told us that they were able to get up when they wanted to and were able to decide to join in activities or not to suit themselves.Some residents told us that they now have breakfast in their rooms in they want to. Care Homes for Older People Page 17 of 38 Evidence: The hairdresser was visiting the home on the second day of the inspection and this was taking place very close to the dining room tables. After discussion with the registered provider the hairdresser moved away from the dining room area to reduce the risk of hair being left on tables. The home does not employ an activity organiser but a member of the care staff is allocated some additional time to undertake activities with residents.The allocated time for activities is 12 to 14 hours a week. The activity programme is limited and not displayed for people to see but includes weekly exercise classes, carpet bowls, poetry reading and visits by entertainers. However, some residents spoken to during the inspection said that it suited them, although some people would like the opportunity to go out of the home. One resident told us that it was boring and a long day.Two professionals surveyed said that the home usually supported people to live the life they chose whenever possible. The television was on throughout both days of the visit, although people in the lounge were not really watching it, some were asleep. One resident told us that they stayed in their room all the time as they dont like the TV on all the time. Residents spoken to confirmed that they are able to have visitors whenever they want to and that their visitors are made welcome including the opportunity to maintain contact with family pets It was positive to see that staff no longer choose the biscuits for residents and that they are able to choose their own from a plate . Mrs Grinrod has obtained good practice advice about the nutritional needs of older people and will be looking at how this can be used to further improve the service offered. The home now uses whole milk to enrich the diet of people at nutritional risk. One resident commented that the food is good, but I would like to be able to have fish more often. Another resident told us that the food was alright, there are a choice of two meals, but they went on to say that they didnt know what the choices were until they went to the dining room. The registered provider told us that staff see all residents each morning and make them aware of the days menu. We observed the lunchtime meal and saw that people are offered three courses with two choices of main course available. The atmosphere was relaxed and assistance was available if needed.People told us that they were able to take meals in their private rooms if they wanted to, particularly if they were ill or wanted to watch something on TV. Care Homes for Older People Page 18 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints policy is in place and people spoken to were confident they could raise any concerns and they would be listened to and taken seriously. Policies and procedures are in place to safeguard people who live at the home but these had not been followed correctly when an incident occurred. Evidence: The home has a complaints policy that gives the timescales within which a complaint would be investigated but it does not make clear that complainants are able to contact the Commission at any stage of a complaint. This was identified at the last inspection and we had been advised that the policy had been updated but there was no evidence of this. The home nor the Commission have received any complaints since the last inspection. Mrs Grinrod told us that any complaints would be recorded in the back of the compliments book that is on display in the hallway. Complaints should be recorded and stored securely so that information is confidential and kept in a way that meets the requirements of the Data Protection Act. All the residents spoken to during the visit said that they could raise any concerns or issues with the staff or manager and were confident they would be listened to and taken seriously. The home has an adult protection policy and the AQAA told us that all staff have completed training in how to protect vulnerable adults. A copy of the locally agreed Care Homes for Older People Page 19 of 38 Evidence: Dorset safeguarding procedures was available. However,since the last inspection an adult protection issue occurred at the home but this was not reported in line with either the homes own policy or locally agreed procedures to Social Services. The allegation had not been recorded as an incident and the home had not notified the Commission. The home has a whistle blowing policy but this did not include the current contact details of external agencies such as the Commission or Public Concern at Work. The policy relating to challenging behaviour by people who live at the home was in place but this was not dated, was very brief and did not include details of why people may have challenging behaviour such as dementia or illness. It did not give guidance to staff on how to defuse situations or to make sure that they understood why these may occur. The home has an advocacy policy but this emphasises that residents should be able to advocate for themselves, when some people may not be able to do this.It does not include the contact details of any external agencies including the Commission Care Homes for Older People Page 20 of 38 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. Many areas of the home need to be redecorated and refurbished to bring it up to a reasonable standard. Poor signage does not support or encourage peoples independence. Some toilets do not contain sufficient aids and adaptations to meet the increasing dependency of people who live there or who may move into the home and some are poorly maintained. Unguarded radiators and pipework could present a scald and burn risk to people living and working in the home. Infection control measures have improved but work is still needed to reduce the risk of cross infection and make sure people who live and work at home are safe. Evidence: The home was clean and tidy on the day of the visit.One resident told us that the cleaning has got better. People who live in the home are able to bring in their own belongings within the space constraints of their private room. The AQAA told us that the home was pleasantly decorated and homely but many areas of the home remained shabby and we observed peeling wallpaper, flaking paint and many of the Care Homes for Older People Page 21 of 38 Evidence: carpets required deep cleaning or replacement. Some of the furniture was worn through wear and tear and needs to be replaced. However, Mrs Grinrod told us that she had improved some rooms by rearranging the existing furniture so that it matched better. We were told that one empty room was ready for when anyone chose to move in but the room smelt strongly of urine. It was positive to see that some of the carpeting had been removed from en suites and replaced with washable flooring to make the environment more pleasant for residents. The ground floor toilets are in poor condition, one toilet is under the stairs and is not big enough for staff to go into to help people with personal care so is unsuitable for people who need assistance or who have mobility problems. The wallpaper in both toilets was peeling and the floor in one ill fitting which is potentially an infection control risk. Both rooms had communal toiletries which increases the risk of cross infection. A shower room is available and a bath with an assisted seat. An unlocked storage cupboard in the dining room contains several tubes of dental tablets, although the response to the last report had told us that this cupboard was now securely locked. The registered provider told us that there were no residents currently living at the home to whom this presented a risk to their safety.Although the AQAA told there was a finished programme covering radiators, many radiators and pipework throughout the home were unguarded both in communal areas and in peoples private rooms. Some radiators were too hot to touch. One of the residents private rooms is only accessible via the managers office. This means that the person living in the room and any visitors to it would be able to access confidential information held in the office and may also inadvertently overhear private and confidential telephone calls and discussions between staff and the manager. It was previously accessible via the kitchen but this access has been removed. Although the resident concerned had never used the kitchen access they had not been consulted or notified of this change.The provider told us during the second visit that plans for changing the access were currently being considered. In the laundry hand wash and paper towels were provided to staff. The washers and dryers are domestic in size and the staff were seen throughout the day having to load and unload machines as the capacity was not suitable for the volume of laundry generated. We observed that wet laundry was draped on handrails as the dryers cannot cope with the size and volume of the laundry generated. The home has special bags to put soiled laundry in which are meant to dissolve during the wash cycle but the temperature on the domestic machine is not high enough for this to work. The home does not have a sluice room and soiled laundry is dealt with in the laundry room. Care Homes for Older People Page 22 of 38 Evidence: Ventilation in the laundry was very poor so the room was extremely hot which would make it very uncomfortable to work in. It was positive to see that the home now has vinyl as well as latex gloves available as staff to reduce the risk of allergic reaction to people living and working in the home. Signage in the home is poor, bathrooms and toilets had no signage, this could reduce peoples independence if they have to wait for staff assistance to find their way around the home particularly for those people who may be confused. Care Homes for Older People Page 23 of 38 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 staffing structure does not allow person centred care to be delivered, due to the expectations that they undertake multiple roles within the home. The majority of staff are qualified to at least NVQ level II or above. Recruitment processes have improved and people do not start work at the home until all the required information has been obtained. Staff do not undertake formal induction training in line with the national minimum standards. Evidence: We saw a staff rota that recorded the hours worked by the care staff and cook but not the manager. The manager told us that there is one person awake at night and one person asleep. Staff work 12 hour shifts to make sure that the rota is covered. The home does not employ an activities organiser and this role is undertaken by care staff. However, since the last inspection additional hours have been arranged for one carer to undertake some responsibility for activities and during this time is not expected to undertake care tasks. We looked at the recruitment files of two new members of staff. Both files contained Care Homes for Older People Page 24 of 38 Evidence: an application form, two satisfactory references, a record of interview and evidence of POVA First and CRB checks which had been obtained before they started work. One file did not contain a Rehabilitation of Offenders declaration. The declaration applicants are asked to sign must make clear that jobs at the home are exempt from the Act. Staff were seen to be very busy during the visits, and they wear plastic aprons all the time because of their responsibilities for cleaning and laundry as well as care tasks. They were observed to be courteous and friendly towards people who live there but the routines of the home are not person centred and little positive time was spent with residents. One member of staff told us that they had time to complete their allocated tasks but another person told us that there was not enough time to spend with the residents, due to the housekeeping duties they were also responsible for. One resident commented that they are not interested in us. Staff are able to take an hours break for a meal,but this is unpaid and they are expected to assist other staff during this time if needed. There are no facilities for staff such as a restroom. The night staff member who sleeps in uses a pullout bed in the managers office which as stated elsewhere in this report is freely accessible by a resident. During the second visit, the registered provider told us that there are plans to improve the staff facilities. The AQAA were told us that the majority of staff are qualified to at least NVQ level II or above. The manager told us that they intended to introduce the Skills for Care common induction standards but this was not in place at the time of the visit. Two professionals surveyed told us that the manager and staff usually had the skills and experience to provide the necessary support to residents and usually responded to the diverse needs of people living at the home. Mrs Grinrod told us that several training courses were planned and these included equality and diversity, dementia awareness, health and safety and safe handling of medication. Mrs Grinrod provided a training matrix which records the date training takes place and a reminder when this needs to be renewed. The matrix recorded both mandatory and foundation topics.For comments on mandatory training please look at outcome group seven. Care Homes for Older People Page 25 of 38 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. Adult protection policies and procedures were not followed by the home following a recent allegation. The registered manager plans to make sure that the home offers an non judgmental service to all members of the community Procedures are in place to safeguard residents personal monies. Records are not stored securely and the use of the office to access a private room may compromise management confidentiality. Improvements have been made to the health and safety practices to make sure that people who live and work in the home are safe. Care Homes for Older People Page 26 of 38 Evidence: Since the last inspection the manager,Mrs Grinrod has been successful in her application to the Commission to become the registered manager. Mrs Grinrod has also registered to undertake the leadership and management in care award. It was clear that Mrs Grinrod was making some progress in addressing the outstanding issues identified during the last inspection visit. Some residents spoken to were positive about Mrs Grinrod and were confident that they were well looked after and that she would sort out any problems should they occur. Following the last inspection the home was required to provide us with an improvement plan which they did within a timely manner. This told us that some of the requirements made at the last inspection had been addressed and within what timescale the home was intending to do to address all the outstanding issues. However, some issues particularly those relating to care planning and risk assessments were stated by the home as having been completed but as this report makes clear this was not evident at this inspection. A new storage cabinet was in place in the office so that records could be kept securely. There has been one staff meeting since the last inspection with minutes taken and made available to staff. There had not been any resident or relatives meetings since Mrs Grinrod had been in post. Policies and procedures are in place but many of these need updating to reflect current good practice advice and legislation. Some policies referred to nursing procedures or nurses and they should be amended to make clear that the home does not provide nurses or nursing care. An example of some that dont include up to date guidance or legislation include continence , pressure care, medication, infection control, meals and nutrition and equal opportunities. We checked the records of the personal monies kept by the home on behalf of some people who live there. These are well kept and audited by the manager. However, as only the manager was allowed to sign the records they were in effect auditing their own practice with no other checks, such as a second signature which is good practice. All falls and injuries are recorded in the accident book and entries cross checked with the files looked at were all correct. However, accidents are not audited to see if there are any common factors and if measures can be put in place to reduce risks. A clinical waste contact is now in place to make sure that the home reduces the risk of cross infection and complies with health and safety legislation. Policies and procedures are in place in relation to the control of substances hazardous to health (COSHH ) .However,we noted that some cleaning fluids had been decanted into alternative Care Homes for Older People Page 27 of 38 Evidence: containers these were labeled with the name of the product but not with COSSH information necessary should an accidental spillage occur. The AQAA told us that equipment was serviced regularly and well maintained. The training matrix supplied showed that three staffs food hygiene and four staffs moving and handling certificates were out of date. Care Homes for Older People Page 28 of 38 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 3 14 The registered person must 30/05/2009 ensure that people thinking about moving into the home are involved in pre admission assessments. This is to make sure that people who are considering moving into the home are involved as much as possible in decisions that affect them. 2 7 14(2) The Registered Person must 02/01/2008 ensure that the assessment of the service users needs is (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. The registered person must ensure that the home promotes and makes proper provision for the health and welfare of residents. Risk assessments must be in place and kept under review , this includes pressures sores and nutritional screening. This is to make sure that any areas of concern are identified and appropriate action can be taken by staff. 30/05/2009 3 8 12 Care Homes for Older People Page 29 of 38 4 9 13 The registered person must ensure that all prescribed medication including creams and ointments are given as prescribed. This is to make sure service users receive prescribed medication. 30/05/2009 5 12 12 The registered person shall 30/05/2009 as far as practicable enable service users to make decisions with respect to the care they receive. This is to make sure that the routines in the home are flexible to suit the people who live there as far as possible. 6 19 13 The registered person must 30/04/2009 ensure that all dental tablets are kept securely. This is to reduce the risk of ingestion. 7 19 23 The registered person must ensure that all parts of the home are reasonably decorated and the physical design and layout meet the needs of the service users. To ensure that peoples needs can be met and the accommodation provided is of a reasonable standard. 30/06/2009 8 25 13(4)(c) The Registered Person must 02/01/2008 ensure that unnecessary risks to health or safety of service users are identified and so far as possible eliminated (Where radiators do not have low temperature surfaces steps must be taken to ensure that each are guarded. This is necessary to ensure that risks to residents Page 30 of 38 Care Homes for Older People are eliminated.) This requirement is made for the third time. 9 27 18(1)(a) The registered person must 02/01/2008 ensure that at all time suitably competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (This must include sufficient domestic staff to undertake cleaning duties.) The registered person must ensure that all applicants complete a rehabilitation of offenders declaration.The application form must make it clear that all convictions including those that are spent must be declared. This is to protect people who live at the home from the risk of abuse. 30/04/2009 10 29 19 11 30 18(1)(c) (i) The Registered Person must 02/01/2008 ensure that the persons employed by the Registered Person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (The induction training must include the Skills for Care Common Induction Standards. Training must be given before a new member of staff undertakes moving and handling procedures with any resident.) The registered person must ensure that all records must be kept securely. 30/04/2009 12 37 17 Care Homes for Older People Page 31 of 38 This is to ensure confidentiality is maintained and records are kept in line with the Data Protection Act. Care Homes for Older People Page 32 of 38 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 1 7 15 The registered person shall 18/05/2009 after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. This is to make sure that service users needs have been identified and clear guidance is in place for staff on how they will be met. 2 25 13 The registered person you shall ensure that all parts of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. Unnecessary risk to the health or safety of service users of identified and so far this possible eliminated. This refers to uncovered radiators. To reduce the risk of scalding and burns. 22/05/2009 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 Care Homes for Older People Page 33 of 38 1 8 13 The registered person shall 30/07/2009 ensure that unnecessary risk to the health or safety of service users are identified and so far as possible eliminated. This refers to risk assessments for pressure sores and moving and handling This is to ensure that risks are identified so measures can can be put in place to reduce the risk. 2 18 37 The registered person shall 30/07/2009 give notice to the commission without delay of the occurrence of any event in the care home which adversely affects the wellbeing or safety of any service user and/or any allegation of misconduct by the registered person or any person who works at the care home. To safeguard the well being of people who live in the home. 3 38 13 The registered person shall ensure that all staff undertake mandatory training. This refers to moving and handling and first aid. To make sure staff have the skills and experience necessary. 30/07/2009 Care Homes for Older People Page 34 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 All documentation should be fully completed, dated and signed. This recommendation was first made at the key inspection in November 2008. All documentation should be fully completed. 2 7 All care plans should be reviewed monthly and updated as necessary. Care plan should cover all the recommended topics. This recommendation was first made at the key inspection in November 2008. 3 8 All service users should have a risk assessment in relation to nutrition undertaken on admission and thereafter as necessary. This recommendation was first made at the key inspection in November 2008. 4 8 The pressure care policy (2006) should be updated to reflect current good practice advice and to make clear that the home does not provide nursing care or carry out nursing procedures. A jug of fluid and a glass should be in each residents room. Fluids should be readily available in communal areas at all times. People living in the home should have the opportunity to go out into the community in line with their interests and aspirations. Serious consideration should be given to publicising a weekly programme of events to residents so that they know what is happening and when. Serious consideration should be given to displaying the menu. Complaints shall be recorded in a log and kept securely and confidentially. The information about complaints should be consistent and Page 35 of 38 5 8 6 12 7 12 8 9 10 15 16 16 Care Homes for Older People make clear that complainants are unable to contact the Care Quality Commission at any stage of a complaint. It should include the current contact details of the Care Quality Commission. This recommendation was first made at the key inspection in November 2008. 11 12 17 18 The advocacy policy should make clear that residents are able to access external agencies. The challenging behaviour policy should be updated to reflect current good practice guidance. This recommendation was first made at the key inspection in November 2008. 13 18 The whistle blowing policy should include the current contact details of the Care Quality Commission and the contact details of Public Concern at Work. This recommendation was first made at the key inspection in November 2008. 14 19 Serious consideration should be given to the use of electrical extension needs. This recommendation was first made at the key inspection in November 2008. 15 19 Consideration should be given to making sure the dental tablets are stored securely to make sure that there is no risk of ingestion. This recommendation was first made of the key inspection in November 2008. 16 19 Serious consideration should be given to the appropriateness of using the private room that is only accessible via the office once it becomes vacant. This recommendation was first made at the key inspection in November 2008. 17 26 Serious consideration should be given to improving ventilation in the laundry and providing appropriate industrial washing machines and dryers. This recommendation was first made at the key inspection in November 2008. 18 19 26 26 Toiletries should be kept in residents private rooms to reduce the risk of cross infection. The registered provider should give serious consideration to Page 36 of 38 Care Homes for Older People providing laundry equipment suitable to the volume of laundry and the needs of people who live in the home. Equipment should be able to wash at appropriate temperatures to control the risk of infection. This recommendation was first made at the key inspection in August 2008. 20 26 All the waste bins should be lined, lidded and foot operated to reduce the risk of cross infection. This recommendation was first made at the key inspection in November 2008. 21 33 All policies and procedures should be reviewed and updated to make sure they reflect current good practice advice and legislation. Serious consideration should be given to having to staff signatures on all service users personal money transactions. This recommendation was first made at the key inspection in November 2008. 23 37 All documentation should be fully completed, dated and signed. This recommendation was first made at the key inspection in November 2008. 24 38 The infection control policy should be checked to make sure it reflects current good practice and current legislation. This recommendation was first made at the key inspection in November 2008. 25 38 Serious consideration should be given to auditing and evaluating the accident book. This recommendation was first made at the key inspection in November 2008. 26 38 All cleaning fluids that are decanted into alternative containers should be clearly labelled with COSHH information. 22 35 Care Homes for Older People Page 37 of 38 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. 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