Inspection on 24/11/08 for Bosworth

This inspection was carried out on 24th November 2008.

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

Bosworth 26/08/09

Bosworth 14/05/09

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 18/06/2009.

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 4 1 1 2 0 0 8 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 care home 22 Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 communal lounges and a dining area, together with a bathroom and WC. The current fees range from 391 to 570 pounds. The manager designate told us that the fee Care Homes for Older People Page 4 of 38 Brief description of the care home 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 inspection was to inspect relevant key standards under that Commission for Social Care Inspections Inspecting for Better Lives 2 framework. This focuses on outcomes for residents and measures the quality of the service under four headings, these are excellent, good, adequate and poor. We posted and gave out surveys to people who live and work in the home and health are professionals. We received three completed surveys from relatives and one from a member of staff. The responses are incorporated into this report.None were received from residents but we spoke to several people who live in the home on the day of the visit. Care Homes for Older People Page 6 of 38 The inspection took place over the course of one day and was conducted by two inspectors who ,looked at selected staff and residents files. We spoke to people living and working in the home and undertook a tour of the premises. We also looked at documentation relevant to the running of the home. There were 17 people living in the home on the day of the visit. What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide should make clear that one private Care Homes for Older People Page 8 of 38 room is only accessible via the managers office or kitchen. It should also make clear that the home does not provide lifting equipment such as hoists, so is not able to meet the needs of people with mobility problems,those who have a high level of personal needs or those at high risk of falls. People living in the home should be involved in pre admission assessments, care planning and reviews and should be asked to sign their agreement to the care plan. All documentation should be fully completed, dated and signed. Care plans should cover all the recommended topics so that all of peoples social, health and physical needs can be identified and met. All care plans should be reviewed and updated regularly as necessary so that they reflect peoples current needs.Risk assessments relating to moving and handling, nutrition and pressure sores should be undertaken on admission and regularly afterwards according to changing needs. Any medical treatment such as treating wounds should be undertaken by qualified health care professionals or if this is delegated by them to the care home staff, a record should be kept of the training given and the assessment of competency of staff to do such procedures safely. Improvements should be made in relation to the administration of medicines to make sure that the systems are more robust and protect people who live at Bosworth. The routines of the home are institutionalised and organised to suit the staffing levels and way the home is managed. There are limited opportunities for people to engage in social activities inside or outside the home. Information should be obtained about the nutritional needs of older people including those with dementia to make sure that their nutritional needs are identified and met. Many areas of the home 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, furniture that is in poor condition through wear and tear should be replaced. Serious consideration should be given to employing domestic staff ( laundry and cleaning) to free care staff up to spend more time providing care to residents in an unhurried manner and more person centred way. Serious consideration should be given to current laundry practice and the introduction of industrial equipment better suited to the needs of the home which would free up care staff to spend more time undertaking care tasks. The practice of putting wet washing on radiators as the drying equipment cant cope with the volume of washing should be reconsidered as this impacts on the environment people live in. The laundry should be cleaned and consideration given to improving the ventilation. Recruitment procedures must be improved and the necessary checks undertaken and information obtained before people start working at the home to make sure people who live there are safe. All staff must undertake structured induction training to make sure Care Homes for Older People Page 9 of 38 they have the skills and knowledge to meet peoples needs. Consideration should be given to improving the facilities for staff. All radiators and pipework should be guarded and first floor windows restricted to make the home a safer place to live in. Signage through the home should be improved with signs suitable for the needs of the people who live there put in place so they can retain their independence for as long as possible. Infection control procedures were poor throughout the home and need to be improved to make sure the risk of cross infection and possible illness is reduced for people living and working in the home. The home did not have appropriate procedures in place to dispose of clinical waste, the manager designate advised us on the day of the inspection that these would be put in place as a matter of urgency. Health and safety issues such as the use and storage of cleaning products must be taken seriously and measures put in place to reduce the potential risk of harm to people who live and work in the home. Improvements should be made in the recording of accidents and injuries to people who live at Bosworth to make sure that records clearly show what treatment is given and that the records are checked and audited by the manager designate to see if there are any patterns or trends that can be identified and acted upon to reduce risk. 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 unauthorised people cannot access personal information about people who live and work at the 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 assessments are undertaken by the home but they dont always include the people who are considering moving into the home and their families and friends. Evidence: We looked at the care records for two people who had moved into the home since the last inspection. A pre admission assessment had been completed by the home before the people had moved in and copies of the funding authorities assessments were on file.There was no evidence that the people or their relatives and families had been involved in this. Not all documentation had been fully completed, dated and signed. The needs of one person that had recently moved into the home were significant and they had soon after moving in, been reassessed by the funding authority and moved to another placement . One member of staff commented that they felt that the home Care Homes for Older People Page 12 of 38 Evidence: needed to make sure that people who moved into the home were suitable as we dont have the facilities, knowledge, training and equipment and staff to deal with people who should clearly be in nursing homes. The manager designate told us that the fee structure was flexible according to individuals needs and circumstances. The manager designate told us that another person who lived in the home had moved to a different residential home as Bosworth did not have the necessary equipment to meet their needs. ( please refer to outcome group 5).The statement of purpose and service user guide should make it clear that it cannot accommodate people who have a high risk of falls or who need moving and handling equipment as the home does not have a hoist . One private room is only accessible via the managers office and /or the kitchen( please refer to outcome group 5). This should be made clear in the statement of purpose and service user guide. 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. Care plans do not cover all the recommended topics and are not all reflective of individuals current needs. Appropriate risk assessments are not in place. Medication practice is generally safe but improvements in practice are needed to provide further safeguards for people. Evidence: We looked at three selected care plans in detail. Care plans generally covered a range of topics, for example, one care plan looked at contained several plans including personal care, mobility, mobilising and socialising. The plans were dated January 2008.Whilst there was evidence that some had been reviewed there had been no changes made to reflect any changes in needs or circumstance. One care plan in relation to insulin said that the care staff administered insulin, but the manager designate told us that it was currently, and appropriately, being undertaken by district Care Homes for Older People Page 14 of 38 Evidence: nurses.There were risk assessments in relation to falls, scalding. personal safety and medication on peoples files.There was no moving and handling, nutrition or pressure sore risk assessments. The manager designate told us that they planned to change the care plan format and that senior staff were responsible for undertaking care plan reviews. People who live in the home have access to medical and health care professional as necessary. However, one person who was entitled to free chiropody because of a medical condition had not been made aware of this and was paying for this service privately. The accident book recorded that staff frequently steri stripped open wounds following accidents to people who live in the home. There was no evidence that this task had been delegated by the district nursing service or that staff had received training in how to do this or that their competency to do so had been assessed. Staff were seen to knock on the doors of private rooms before they went in and were observed to be friendly and courteous to people who live in the home. We looked at the administration of medicines and found that controlled drugs records were well kept and correct and records on MAR sheets ( medication administration record) were also well kept. However, there was no records of the signatures of staff who administer medicines, no rationale for as required medication, hand transcribed entries on the MAR chart were not signed by two people and no system was in place to monitor staff competency in managing the administration of medicines. There was no opening or expiry date written on creams and ointments and some creams seen had not been administered as frequently as they should have been. Two relatives surveyed said that the home always or usually met peoples needs and supported people as they would expect. Care Homes for Older People Page 15 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 adequate 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 institutionalised and arranged to suit the staffing structure and do not allow staff to offer person centred care, although the manager designate is trying to address this. There are limited opportunities for people to engage in activities inside and outside the home. Visitors are made welcome to the home and people encouraged to bring their personal possessions with them to make their private rooms homely. People who live at the home are given choices about what they have to eat and are generally satisfied with the food served. Evidence: Some people told us that they were able to go to bed at times to suit themselves but that they were woken up by staff at 7 a.m. because they had to be washed ,dressed and downstairs for breakfast by 8a.m. Some staff spoken to confirmed that night staff Care Homes for Older People Page 16 of 38 Evidence: do get some people up in the morning and that people are taken a cup of tea between 6am and 7.30am. Some staff also told us that people are woken up to take medication.One person living in the home told us you cant have a lie in. One persons care plan stated that the person would eat at Bosworths time. The manager designate acknowledged that the routines of the home are institutionalised and that efforts to update care practices were being made. People who live at the home are encouraged to keep in touch with their relatives and friends and they are made welcome when visiting the home. People were able to see their visitors in their private room if they wanted to. People who live in the home are encouraged to manage their own financial affairs as long as possible and are able to bring personal possessions into the home within the space constraints of their private room. The home does not employ an activities organiser, the AQAA told us that activities are organised by a senior carer ( who does not have any designated time) and that all staff join in. The resources available for activities was limited and the home does not have its own transport, although the manager designate told us that they were planning to use accessible taxis to take people out on trips.One person told us that there were not enough activities and that they were not offered opportunities to go out on trips.Throughout the visit the T.V. was on in the lounge but no one appeared to be watching it.There was no evidence of a formal weekly activities programme available to people. The cook told us that people who live in the home are given a choice of menu on the previous day and that they( the cook) was familiar with individuals likes and dislikes. The menu was on a four week rota and approximately once a year the menu was reviewed by the cook following consultation with people who live in the home. People were able to choose their favourite meal on their birthday and a birthday cake was always presented to them. We were told by some staff that it was difficult to store enough food to be able to offer people regular choices of food due to lack of storage and freezer space. The kitchen did not have a dishwasher and some staff felt that if one was provided it would free staff time for other tasks. One person who lives at the home told us that the food varies, sometimes its good, sometimes it isnt. One person told us that they felt that sometimes there wasnt enough food. People were offered a biscuit with their drink but the biscuit was chosen by the member of staff and handed out, people were not able to choose their own or have one that had not been handled by staff. One person described the food as wonderful, but they went to say that they didnt know what they were going to have Care Homes for Older People Page 17 of 38 Evidence: until they got to the dining table but they went to tell us that we do have a choice. The kitchen is accessible at all times by a resident whose only access to their room is via the kitchen or managers office. There was no risk assessment in place in relation to their access to either room.The cook told us that they had completed a nutritional course but was unaware of current good practice nutritional advice including how to add calories to the diet of those people at nutritional risk. Two relatives surveyed said that they were usually kept up to date by staff about their relatives welfare. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to safeguard people and make sure they know how to complain if they wish to, these need minor amendments to meet the agreed standards. Evidence: The home nor the CSCI have received any complaints about the service since the last inspection.The complaints policies on display and for staff did not make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint and the one on display did not include the current contact details and address of the Commission.Two relatives who were surveyed commented that they did not know how to make a complaint and one said that the home had only sometimes responded to concerns raised. The home has an adult protection policy and the AQAA told us that all staff had completed training in how to protect vulnerable adults. A copy of the locally agreed Dorset safeguarding procedures was available. The home had a whistle blowing policy but this did not include the current contact details of the CSCI or the contact details of Public Concern at Work. A policy on challenging behaviour by people who live at the home was in place but this Care Homes for Older People Page 19 of 38 Evidence: was not dated, was very brief and did not include details of why people may have challenging behaviour such as dementia or illness. 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. The residents room that can only be accessed via the office or kitchen compromises confidentiality and poses a potential health and safety risk. Bathrooms and 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 are bare and institutional in design. Unguarded radiators and pipework could present a scald risk to people living and working in the home. Domestic cleaning arrangements mean that staff spend a considerable time on housekeeping and care tasks and little time interacting positively with people who live in the home. Infection control measures are poor and put people living and working at the home at risk of cross infection. Care Homes for Older People Page 21 of 38 Evidence: The home was clean and tidy on the day of the visit .People who live in the home are able to personalise their private rooms and bring in their own belongings within the space constraints of their room although very few peoples rooms had locks so people could lock their own room if they chose to.The AQAA told us that the home was pleasantly decorated and homely but many areas of the home are shabby, wallpaper was peeling off, paint work flaking,some light fittings did not have a shade and many of the carpets require deep cleaning or replacement. Some of the furniture was worn through wear and tear and needs to be replaced.One member of staff surveyed commented that the home could be improved by bringing it into the 21 st century, listing the kitchen,laundry and office as places that needed to be updated. Some staff told us that the carpets were cleaned in communal areas following accidents but they were not cleaned routinely to make sure they were clean and fresh. An unlocked storage cupboard in the dining room contained several tubes of dental tablets. Although the AQAA told us that there was a finished programme of covering radiators, many radiators and pipework throughout the home were unguarded both in communal areas and in peoples private rooms. 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. One bathroom had no signage and one tap dripped constantly. One of the residents private rooms is only accessible via the managers office or kitchen, the access currently used is via the office. This means that the person living in the room and any visitors to it are able to access confidential information held in the office and also overhear private and confidential telephone calls and discussions between staff and the manager. The lounge has a large fish tank in it but this had not been cleaned for some time and the glass was very dirty. In the laundry hand wash and paper towels were provided for staff. The washers and dryer are domestic in size and staff were seen throughout the day having to load and unload machines as the capacity was not suitable for the volume of laundry generated. The home has special bags to put soiled laundry in . These are meant to dissolve in the washing machine but the temperature on the domestic machine was 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. Some staff told us that as people who lived in the home became more dependant it was difficult to keep up with the demands of the washing and consequences of incontinence. As staff are also responsible for cleaning this means Care Homes for Older People Page 22 of 38 Evidence: that they are not able to spend as much time interacting positively with people who live in the home. Ventilation in the laundry was very poor so the room was extremely hot which would make it very uncomfortable to work in.The cupboards, floor and sink were dirty and soiled clothing was soaking in a bowl which is not good practice. The laundry sink was dirty. One relative surveyed commented that they thought the home could be improved if washing was not hung all over radiators by the laundry. Signage in the home was poor, bathrooms and toilets had no signage, this could reduce peoples independence if they have to ask for staff assistance to find their way around the home, particularly for those people who may be confused. Signs on peoples private rooms were very small and were not specific to the individuals. Although the AQAA told us that the home used the Department of Healths guide in relation to infection control and that 12 members of staff had been trained in infection control, the infection control measures were poor. There were no designated clinical waste bins and waste bins were not lidded or foot operated to reduce the risk of cross infection.Flooring in one toilet was ill fitting and the underneath of some toilet and bath seats were badly stained. The temperature in the home was comfortable and warm. Staff told us that the heating could be controlled by individuals in their private room.However, a person living at the home told us that the central heating is usually on a timer and that the heating was only on during the daytime because you ( referring to the inspectors are here) are here. A member of staff told us that the heating was turned up or down as necessary according to need or the weather. 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 staff undertake several roles within the home. Some improvements are necessary to recruitment practices to make sure people who live in the home are safeguarded from the risk of abuse. The majority of staff are qualified to NVQ level 2 or above. Staff do not undertake formal induction training that meets the national minimum standards. Evidence: The manager designate told us that there are usually two carers on all day, with one person awake at night and one person asleep. Some staff regularly work twelve hour shifts to make sure that the rota is covered. The home does not employ an activities organiser,this role is undertaken by care staff. Two professional cleaners come in one day a week. One member of staff told us that it would be nice if I didnt spend so much time washing pots as it takes away time from residents. It was seen from the rotas that some staff are working 12 hour shifts so that they are covered and some staff told us that you cant give it the same level of care( after a long shift), you dont Care Homes for Older People Page 24 of 38 Evidence: have the same patience. We looked at three staff files. Two files were generally well kept with the majority of the required information. However, one person had started work at the home when the home had only received one telephone reference and a second persons file did not contain any references or an application form. The application form does not ask applicants to sign a rehabilitation of offenders declaration in relation to any criminal convictions or make clear that all convictions must be declared. The AQAA told us that the majority of staff( 72 ) were qualified to NVQ level 2 or above. Staff were seen to be very busy during the visit, 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 people. 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 staff room. The night staff member who sleeps in uses a pull out bed in the office which is as stated elsewhere in this report freely accessible by a resident. The manager designate showed us an induction pack they intended to give to all staff, this contained some of the homes policies and procedures, information about health and safety and dementia.It told us that a new induction programme would be introduced but this was not in place at the time of the visit and there was no evidence on staff files that induction training had taken place. Three relatives responded to our survey, one said that the staff usually had the right skills and experience to care properly and one said that they sometimes did. However, one person commented that the interaction between the staff and those in the care home is exemplary and another person commented that staff especially long serving, were very caring. 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. The manager designate plans to make sure that the home offers a non judgemental 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 as access to a private room may compromises management confidentiality. Health and safety is not seriously to protect people who live and work in the home. Evidence: The manager designate had been in post since June 2008, they told us that they were going to apply to undertake the leadership and management in care award and had applied to the Commission to become the registered manager.They also told us that Care Homes for Older People Page 26 of 38 Evidence: they had obtained information about equality and diversity issues and planned to introduce this to staff to make sure that the home offered a service that was non judgemental and valued all members of the community. The home did not have a clinical waste policy, procedure or contract for its disposal but was disposing of it in domestic waste. We contacted Environmental Health on the day of the inspection who provided information to the manager designate about their legal obligations in relation to clinical waste disposal. The homes infection control policy was dated 2006 and did not reflect current good practice guidelines. The home did not have any policies or procedures in place in relation to COSHH (the Control of Substances Hazardous to Health) to safeguard staff working with chemicals including bleach, or people who live in the home from spillages or accidents. ( The manager designate took immediate action on the day of the inspection to put measures in place in relation to window restrictors, clinical waste and uncovered radiators). The home had an accident book with some people having sustained several accidents in recent months but this was not audited or evaluated to identify trends or look at ways if possible of reducing them. Not all entries recorded if any treatment had been given or in the case of one person who has bumped their head if they had been monitored by staff to make sure there were no adverse effects. On some entries where treatment had been given it was clear that staff were applying steri strips ( please refer to outcome group 2). We checked the records of the personal monies kept by the home on behalf of some people who live there. These were 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. There had been one staff meeting, but no resident or relatives meetings since the manager designate had been in post. One relative surveyed commented that there was a lack of communication and that they had never been introduced to the manager or staff.They went on to comment that the home had had several managers in recent years and that consistency of management would benefit the home. Kitchen records were up to date and well kept to make sure that food was served and stored in line with good practice. The AQAA told us that equipment was serviced regularly and well maintained. Care Homes for Older People Page 27 of 38 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 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 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 02/01/2008 2 9 13(2) 3 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 are eliminated.) This requirement is made for the second time. However the home has already started on a programme to cover radiators and it is anticipated it will be completed by 02/01/08. Page 29 of 38 Care Homes for Older People 4 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 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.) 5 30 18(1)(c) (i) Care Homes for Older People Page 30 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 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 3 14 The registered person must 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. 30/05/2009 2 8 12 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 Care Homes for Older People Page 31 of 38 3 8 13 The registered person must 30/05/2009 ensure that where necessary service users receive treatment from health care professionals. (This refers to open wounds). This is to make sure that service users receive appropriate treatment to injuries. 4 8 13 The registered person must ensure that all service users have a risk assessment for moving and handling and pressure sores. This is to make sure that all risks are identified and any areas of concern can be identified and appropriate action can be taken by staff. 30/05/2009 5 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 6 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. Care Homes for Older People Page 32 of 38 7 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. 8 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 9 22 23 The registered person must ensure that toilet and bath seats are clean and fit for purpose. To reduce the risk of cross infection and to provide equipment that is in good order. 30/05/2009 10 26 13 The registered person shall 30/04/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This is to reduce the risk of cross infection. 11 26 16 The registered person must 31/03/2009 make suitable arrangements for the disposal of clinical waste. This is to reduce the risk of cross infection. 12 29 19 The registered person must ensure that all applicants 30/04/2009 Care Homes for Older People Page 33 of 38 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. 13 29 19 The registered person must make sure that people do not start work at the home until all the required information has been obtained. This is to protect people who live in the home from the risk of abuse. 14 37 17 The registered person must ensure that all records must be kept securely. This is to ensure confidentiality is maintained and records are kept in line with the Data Protection Act. 15 38 13 The registered person must ensure that policies and procedures are developed in relation to the control of substances hazardous to health ( COSHH). This is to ensure the safety of people who live and work in the home. 16 38 16 The registered person must 10/04/2009 make suitable arrangements for the disposal of clinical waste. 30/05/2009 30/04/2009 30/04/2009 Care Homes for Older People Page 34 of 38 This is to ensure that the home meets relevant health and safety legislation and to reduce the risk of cross infection. 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 1 The statement of purpose and service user guide should make clear that one private room is only accessible via the managers office or kitchen. It should also make it clear that the home does not have a hoist and is unable to accommodate people who may need such equipment. 2 3 3 7 All documentation should be dated and signed. All care plans should be reviewed monthly and updated as necessary. Care plans should cover all the recommended topics. 4 5 8 8 All service users should have a risk assessment for pressure sores on admission and thereafter as necessary. All service users should have a risk assessment in relation to nutrition undertaken on admission and thereafter as necessary. A sample staff signature list of all staff who administer medicines should be kept. A rationale for all medicines prescribed as required should be clearly recorded. A system should be put in place to measure the competency of staff who administer medicines. Signatures of two members of staff should be recorded for all hand transcribed records on the MAR ( medication administration records) charts. 6 9 7 9 Opening and expiry dates should be written on all creams and ointments. Care Homes for Older People Page 35 of 38 8 9 10 11 12 15 15 16 Serious consideration should be given to increasing the amount of staff hours designated for activities. Current good practice advice should be obtained about the nutritional needs of older people. Staff should not handle biscuits before offering them to service users. The information about complaints should be consistent and make clear that complainants are able to contact the CSCI at any stage of a complaint. It should include the current contact details of the CSCI. The challenging behaviour policy should be updated to reflect current good practice guidance. The whistle blowing policy should include the current contact details of the CSCI and the contact details of Public Concern at Work. Serious consideration should be given to appropriateness of using the private room that is only accessible via the office and kitchen once it becomes vacant. Serious consideration should be given to the use of electrical extension leads. Urgent consideration should be given to making sure that dental tablets are stored securely to make sure that there is no risk of ingestion. Serious consideration should be given to providing vinyl as well as latex gloves in line with good practice advice from the Health Protection Agency. To reduce the risk of allergic reaction to people living and working in the home. The registered provider should give serious consideration to providing laundry equipment suitable for the volume of laundry and needs of people who live in the home. Equipment should be able to wash at approaprite temperatures to control the risk of infection. Serous consideration should be given to improving the ventilation in the laundry and providing appropriate industrial washing machines and dryers. Soiled clothing should not be left soaking in bowls. All bins should be lined, lidded and foot operated to reduce the risk of infection. 12 13 18 18 14 19 15 16 19 19 17 26 18 26 19 26 20 21 27 27 Serious consideration should be given to improving the facilities for staff including the the sleep in arrangments. Serious consideration should be given to providing Care Homes for Older People Page 36 of 38 adequate facilities for staff. 22 23 24 27 30 35 Urgent consideration should be given to employing daily housekeeping staff. Serious consideration should be given to using the Skills for Care common induction standards for all staff. Serious consideration should be given to having two staff signatures on all service users personal money transactions. All documentation should be fully completed dated and signed. The infection control policy should be checked to make sure it reflects current good practice and current legislation. The emergency lighting should be tested monthly. Serious consideration should be given to auditing and evaluating the accident book.The records should contain details of any treatment given. The accident book should include details of any treatment given to service users by staff. 25 26 27 28 37 38 38 38 29 38 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). 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