Inspection on 14/08/09 for Bradley House

This inspection was carried out on 14th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bradley House 19/01/09

Bradley House 23/01/08

Bradley House 21/09/06

Bradley House 25/02/06

Bradley House 24/08/05

Bradley House 10/03/05

Bradley House 19/10/04

Bradley House 30/03/04

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 25/11/2009.

Key inspection report Care homes for older people Name: Address: Bradley House High Street Shirehampton Bristol BS11 0DE     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Clarke     Date: 1 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Bradley House High Street Shirehampton Bristol BS11 0DE 01179235641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: elisabethlaycock@yahoo.co.uk Mrs Elisabeth Laycock care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 10 persons aged 65 years and over requiring personal care. Date of last inspection Brief description of the care home Bradley House is a listed Edwardian building which provides accommodation and personal care for 10 elderly people. The property is arranged over three floors with lift access to one floor and four rooms which are only accessible by stairs. The home has domestic style facilities such as a large kitchen, a large lounge and an extended conservatory which provides additional space which looks out at the large gargen. There is a large dining area, sufficient toilet facilities and bedrooms for single occupancy. The homes aims and objectives are to provide care and to listen to residents concerns and protect them from abuse. The property can be found in the residential area of Shirehampton, in Bristol. The area has a number of amenities on offer such as shops close by, a church and the local bus Care Homes for Older People Page 4 of 33 Over 65 10 0 1 9 0 1 2 0 0 9 Brief description of the care home route which has access into Clifton and the town centre. The home provides twenty four hour staff cover however there is sleep in staff member at night. People can be admitted for emergency admissions. Fees payable and range from £382-£459.23 per week for the total care package; this information was collected during the inspection. People who are funded through the Local Authority have a financial assessment. The home is privately owned and managed by Mrs Elisabeth Laycock. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an inspection which resulted from a number of concerns regarding the care practises in the home. A Safeguarding strategy meeting chaired by a representative of the local authority decided an inspection of the home was required and we agreed with this decision. An unannounced visit to the home was therefore made and the inspector was accompanied by the Commissioning Manager for Bristol Adult services. The concerns related to the following: 1) Working practises in the home regarding the health, welfare and safety of individuals living in the home. 2) Moving and Handling practises in the home. 3) The choice of individuals who live in the home about getting up and going to bed. Care Homes for Older People Page 6 of 33 4) The arrangements for the administration and management of medication. During this inspection we looked specifically at the areas of concern and as a result we have issued this report which forms our conclusions of what we found when we visited the home. We have made a judgement about a number of issues all relating to the quality of care provided at Bradley House and have also reviewed the quality rating as a result of this inspection. The issues, concerns and requirements we have made reflect the level of concern we have as an outcome of this inspection . We acknowledge that our previous inspection of this service in January 2009 gave the home a quality rating of Good. We have identified a number of areas which we have set out in What the service does well reflecting the positive aspects of care provided at Bradley House. We would emphasise that the quality rating we have given is as a direct result of the failures and need for improvements which have been identified as a consequence of our inspection of the service. During our visit to the home we examined a number of documents including care plans, risk assessments, medication records, accident records, daily care records, policies and procedures of the home. There was also an opportunity to discuss with individuals living in the home their experience of the quality of care that is provided. We also spoke with staff about working practises in the home. Present throughout our visit were the manager and a senior care assistant who co-operated fully with our inspection and have also subsequently provided us with further documents about varying aspects of care and procedures at Bradley House. The manager and a senior care assistant were given the opportunity to discuss the concerns and put their views about the actions and practises of the home. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We have identified a number of areas of the homes practises and procedures which must be addressed, they reflect poor practice and failures of the manager to make sure that the health and welfare of those living and working in the home are as far as possible fully protected. 1) The home put in place the locking of an individuals room during the night. They contacted ourselves for advice on this action and were told it was acceptable. We have not been able to establish who provided this advice however the manager failed to follow legislation under the Mental Capacity Act and make an Deprivation of Liberty Safeguard application as a consequence of taking this action. This illustrated a lack of knowledge and understanding of this area of practice and a failure to follow what is required in terms of Safeguarding individuals. We also established that whilst the home completed a risk assessment about the locking of the room they failed to assess the risks to the person being locked in the room which meant that the individual was alone in her room unchecked or monitored by staff for up to a period of possibly 10 hours. The home made no changes to their staffing to account for this action.They retained the sleep in staff at night rather then reviewing this arrangement. This placed the individual at risk of harm and distress particularly when considering that there was clear evidence that they had confusion and Parkinsons Consultant had said she suffers from senile dementia as an aggravation of Parkinsons (from care notes). This diagnosis had not been confirmed by GP or psychogeriatrician. Records we looked at Care Homes for Older People Page 8 of 33 evidenced that it was very much part of the routine of this individual to be up at night and early morning. It is our view that they would not have been able because of their confusion and lack of mental capacity, which we have confirmed as part of this inspection to use the call bell to summon assistance. We have made a number of requirements about the issues raised from this practice: the manager undertaking training and reviewing of staffing arrangements. 2) Unsafe moving and handling practice namely the use of Handling belt to lift individuals from the floor. This was confirmed by the home. We sought advice from experts in this field and their advice was A handling belt is not a weight tested piece of equipment to lift a person with it is only to support to walk an ambulant person. This practice placed individuals and staff at risk of harm and the manager illustrated a lack of knowledge and failed in her duty of care. As Moving and Handling assessor for the home which she advised us was her responsibility we have therefore made requirements about further training for the manager and reviewing of the moving and handling policy in the home. 3) The arrangements for the administering and recording of controlled drugs. We established with the home that where controlled drugs are administered by staff a witness signature is not obtained. The inspector sought advice from the pharmacist inspector regarding this matter. They confirmed that whilst it is considered good practice to have a witness signature this is not laid down in law as being necessary. We also acknowledge that this has been the long standing practice of the home and previous inspections have not raised this as a matter of concern. We were also informed that checking of the stock takes place weekly however there was no evidence of this and we have made a recommendation to that effect. We also established that staff receive a good level of training regarding the use and administration of medication in that this matter had been raised with us as part of the concern. 4) Policies and procedures of the home specifically in relation to staff responding to accidents and emergencies. The homes policy in this regard places the responsibility on staff responding and taking the necessary action. However part of the instruction is to inform the manager or Senior who will decide whether an ambulance is required. This in our view places the individual who may need such assistance at further risk of harm and distress in terms of the possible wait for staff to arrive (despite living next to the home) more so perhaps at night. It is the responsibility of the manager to make sure staff are competent to make such decision and respond to accidents and other incidents. We have made a requirement to review the homes Falls, Accidents or other problems policy and procedure. Our inspection identified that the home failed to act appropriately in the reviewing of an individuals placement in the home. They identified the risk of stairs and there was clear evidence from the records we looked at that their situation had changed considerably since admission to the home. Changes in behaviour were evident , the need for increased supervision particularly during the night, deteriorating mobility and possible associated falls. As part of the managers responsibility a review of the homes suitability for the individual should have taken place with the local authority who were Care Homes for Older People Page 9 of 33 part funding the placement. Certainly the room being up stairs was clearly an increased risk and matter for review. This would apply for any individual living in the home whose needs changed to an extent where their health and welfare is affected and the capacity of the home to meet those needs is under question. We have also made requirements about staff attending Safeguarding training and where there is one individual on duty this individual must have first aid training. The home therefore needs to review its policy around staff having first aid training and consider the differing levels of such training available, its relevance and needs of individuals in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We are satisfied from our inspection of January 2009 that the home undertakes preadmission assessments so that they can make an informed decision about their ability to meet care needs. Evidence: These areas of the homes practice were looked at on our inspection of January 2009 and found to be satisfactory. We did not look at these standards because they were not directly relevant to this inspection. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning practice of the home provides information about the daily and on going care needs of the individual and associated tasks however the home fails to put in place actions and instructions for staff so that the health and welfare of the individual is fully protected. The home fails to take the necessary steps to meet the needs of individuals where their needs change to an extent that their placement in the home is potentially unsafe and not in their interests. The medication practice of the home helps in meeting and protecting the health needs of the individuals in the home. Evidence: We looked at the two care plans relating to the individuals who were the subject of the concerns. There were records of risk assessments being completed for one individual relating to mobility and these had been reviewed following change in their circumstances. The last review reflected the practice of locking an individual in their room. Actions had been noted in relation to leaving door to corridor open (gave access Care Homes for Older People Page 13 of 33 Evidence: to bathroom) and leaving light on, show individual way to bathroom every night before she goes to bed and unlock door when serving breakfast. There were no actions recorded about checking during the night. There was no history recorded of any actions taken to alleviate the risks to the individual before the decision was made to lock the individuals room. The individuals care plan showed no evidence of review of care placement in Bradley House or request for review from placing authority. The record of Health Professional visits showed visits from GP, Optician and district nurse. The individual had been referred to specialist about their health condition. However no evidence of referral to appropriate professional regarding history of falls or falls audit. We looked at the Care Plan for the individual who had bed rails fitted this showed they had consented to their use. A risk assessment had been completed regarding their use. We discussed with the individual concerned the use of rails and they confirmed they had requested them because I felt safer. They then said how they had requested their removal because had to call someone in the middle of the night felt a prisoner. The individual told us they were able to get out of bed on their own once the rails were removed didnt need them. There were no Night Care Plans or risk assessments around potential needs during the nighttime period for individuals living in the home. However it is noted that the daily log detailed an action plan for an individual regarding their needs at night. We looked at the medication records in relation to the administering of controlled drugs. the home has separate secure storage and controlled drugs register. Three individuals require controlled drugs and these had been administered by one individual with no signature of witness, the administering of medication was recorded in CD register and on administering record (MARS). There is only one staff on during the period of time medication is needed by individuals. Stock is audited monthly by the deputy on receipt of new stock. They advised this is undertaken weekly but no signature in records to evidence this weekly check of controlled drug stock. We spoke with a number of individuals about the approach of staff specifically about their privacy being respected. Those we spoke with all were very positive about staff all very good lovely treat me well. One individual told us that they felt staff were very respectful. One individual who needed help with personal care said they were very satisfied with the ladies they help me when I need it. Care Homes for Older People Page 14 of 33 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 home provides good opportunities for individuals to undertake activities and provided an environment where there is flexibility so that individuals can make choices about their daily lives. The meals provided meet the dietary needs of those living in the home. Evidence: Our inspection in January 2009 looked at activities in the home and found that there are a wide range available. Individuals commented at the time of our visit that there are always things available to do. The home employs an activities organiser who at the time of our visit was spoken with and was able to describe each persons interests and their favourite pastime or hobby. She organises activities three times a week. At the time of our visit (14/08/09) a group of individuals were playing dominoes and a summer fair was being organised for the following day. We discussed with a number of individuals the arrangements for getting up and going to bed. All of those we spoke with were satisfied with their arrangement and times. One individual said I get myself to bed and its up to me. Another said that they wait for the night staff to see me to bed and another said they were able to get to bed and sometimes its quite late. Another said they went to bed at 7 but that was their choice. All spoke of getting up when I like and confirmed that breakfast is served in their room. In discussion with Care Homes for Older People Page 15 of 33 Evidence: the manager it was noted that of the current 9 individuals living in the home all but two are able to get themselves to bed and get themselves up in the mornings without full assistance. It was also noted in one individuals care plan that their breakfast time had been changed and another instance where bath time had been changed on request. Since our last inspection we have received a copy of the homes quality assurance questionnaire which was sent to individuals living in the home. One of the questions asked was I have some choice about the time I go to bed and get up in the morning Of the 8 respondents 4 Strongly Agreed 2 Mostly Agreed and 2 Mostly Disagreed. The manager provided an explanation as to the two individuals who Mostly Disagreed and we are satisfied with this explanation and do not have concerns as to this response to the question. We also spoke to one of these individuals on our visit and again were satisfied with their ability to make choices around getting up and going to bed. We discussed with individuals the quality of meals provided in the home. they told us they were satisfied all very good I enjoy the meals here. We looked at the menu and found that there is a varied choice of meals available to individuals. One individual on the day of our visit did not want the meal offered and was given an alternative. On the day of our visit the meal was well presented and looked appetising. Care Homes for Older People Page 16 of 33 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. The home has a complaints procedure in place and individuals are able to express their views about the service and if they are unhappy with the quality of the service they receive. The actions of the home placed an individual at significant risk of harm and they failed to take the necessary steps so that the health and welfare of the individual was fully protected. The failure to provide comprehensive Safeguarding training (such as that provided by local authorities) to all staff potentially places individuals at risk of harm or abuse in that staff may not have the necessary skills and knowledge to identify and respond to possible abuse. Evidence: We did not look at the complaints log on this visit at our visit of January 2009 this area namely making complaints was looked at and found to be satisfactory. However we did speak to individuals about what they would do if they were unhappy about the service. One person told us they would talk to the manager and said would go to her and she would do something...definitelyanother told us would tell the staff if you ask something they will do it. We looked at the practice of the manager and home in relation to the concern about the individual who was locked in her room. We found that written instruction Care Homes for Older People Page 17 of 33 Evidence: confirming this action namely locking in the room and other actions from the risk assessment. To make sure lights on in corridor to toilet which was located next to individuals room. Also to unlock the door at breakfast time. There were no instructions around checking the individual during the night. It was noted from their care records that there was a history of this individual getting up during the night and going downstairs to use the toilet or just getting up and going to the lounge. No referral had been made to Safeguarding or Deprivation of Liberty Safeguards (DOLS) to seek further guidance and support around the needs of this individual. It is noted that one of the senior care assistants had attended Mental Capacity Act (DOLS) training but not the manager. We discussed Safeguarding with staff and they were clear about the action they would take if they had concerns about an individual. They were also able to provide examples of types of abuse that may occur in a care home. All of the staff we spoke with (4) informed us they had completed Safeguarding training however we looked at training records for 4 members of staff (night staff) and found that they had not undertaken Safeguarding training other then that undertaken as part of their induction. Care Homes for Older People Page 18 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is generally suited to the needs of individuals who live in the home. However four rooms where access is by use of stairs would potentially pose a risk to individuals. The home has the necessary adaptations and equipment to meet the needs of individuals living in the home however they lack safe moving and handling equipment to use when individuals are on the floor. Evidence: Our inspection of January 2009 looked at Standards 19 and 26 in relation to the environment and we were satisfied with what we found at this time in terms of the suitability of the environment. It is noted however that there are four rooms in the home which are only accessible by stairs and therefore may not be suitable accommodation for individuals who have or develop difficulties around mobility and safety of using stairs. The home has adaptations and equipment available for individuals such as rails and equipment in toilets. However there is no hoist or other equipment of similar nature to transfer individuals or lift from the floor in a safe manner. Care Homes for Older People Page 19 of 33 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 homes staffing arrangements provide an adequate level of staffing however the practise of having one member of staff on duty at varying times potentially places individuals and staff at risk. The training of staff helps in providing competent and efficient staff to meet the care needs of individuals living in the home. However the failure to provide first aid training to night staff places individuals at risk. Evidence: We looked at staffing arrangements specifically in relation to the concern that individuals do not have choice when getting up or going to bed. We were provided with a copy of the permanent shifts (August 2009) which showed that on 4 days of the week there is only one member of staff on duty 7pm until 9pm. It is also showed that there are further occasions when there is only one carer on duty. As noted elsewhere in this report individuals we spoke with confirmed that they were able to make choices about getting up and going to bed. Staff also told us its down to the resident, no rule about getting up and freedom of choice. We asked individuals who live in the home about the response of staff to requests for assistance particularly at night. One person told us have never pressed buzzer and no-one came and another individual said always good for coming (this when pressed buzzer).In the homes quality assurance questionnaire individuals were asked to respond to the statement: Night Care Homes for Older People Page 20 of 33 Evidence: staff are reliable and helpful 6 replied Strongly Agree, 1 Mostly Agree, 1 Mostly Disagree. They were also asked to respond to the statement I can rely on the staff to respond when I have a problem All of the respondents (8) Strongly Agreed. There was no system in place to review care needs of individuals against the staffing arrangements of having one on duty from 9pm to 9am (7pm too 9pm on 4 days) and sleep in duty for night staff with manager or senior care assistant on call. We looked at the training records for a number of staff and found that they had completed moving and handling, medication training(as part of their induction). In addition some staff have undertaken infection control,Parkinson Disease. All but one (this was member of night staff) had completed first aid training. Another individual who was a member of the night staff had started work on 17/12/08 and completed first aid training 3/07/09. It was noted that there was a good standard of induction provided to staff and the majority of staff have NVQ Level 2 or 3. We are satisfied from our previous inspection of January 09 that the homes recruitment practice meet the requirements and we noted on this visit for those staff records that CRB had been obtained. Care Homes for Older People Page 21 of 33 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 of the home has failed in her duty of care and meet her responsibilities to ensure that the health and welfare of individuals living in the home and staff are as far possible protected. The home has policies and procedures in place so that staff have the necessary guidance and support in carrying their role and responsibilities. However the policies relating to Acidents and Moving and Handling must be reviewed so that it provides instructions which protect the welfare of individuals in the home. The homes health and safety practice specifically around the testing of fire equipment fails in making sure that as far as possible it is good working order so that individuals living and working in the home are protected in the event of a fire in the home. Evidence: The manager is also the owner of the home and has been for a number of years. We spoke to individuals and staff and they told us that Mrs Laycock is someone I would Care Homes for Older People Page 22 of 33 Evidence: go to treats everyone the same (staff member). One individual who lives in the home told us they would always go to her if I had a problem and another she will do something and is always about. In undertaking this inspection and visit it is noted that Mrs Laycock failed to take the necessary action to fully protect the individual concerned. It is also noted that when discussing Moving and Handling practice in the home Mrs Laycock told us she was the Moving & Handling assessor but has nevertheless condoned practice namely the use of Handling belts in situations which potentially place individuals at risk. The manager has not undertaken training (Moving and Handling, Mental Capacict Act/DOLS), which we believe is essential in fulfilling her role and responsibilities in relation to making sure care provided in the home meets the required standard. In examining policies and procedure in the home specifically Accidents, Falls, accidents or other problems, Night Shift policy and procedure it was evident that the expectation is for staff to seek support from the Manager or Senior. However this could entail a delay particularly during the night. The homes Moving and Handling policy states Safe systems of work will be put in place and ensuring that staff are protected from the risk of injury so far as reasonably practicable. The Health and Safety policy states that Elizabeth Laycock accepts the seven responsibilities under the Health and Safety at Work Act 1974 and in so far as it is practical: provides systems of work that are safe. However we noted that the homes practice has been to use a Handling belt when lifting individuals from the floor. We discussed this practice with the manager and senior at the time of our visit and they agreed this had been the practice. In our view the senior has failed to fully accept expert advice and guidance about the use of such equipment despite having directly received such advice. However staff advised us they have recently been told not to use the Handling belt and the manager told us they were looking at alternative equipment to use in these situations. The home has completed a risk assessment around the locking of the front door and this detailed the level of risk in relation to each individual living in the home. This risk assessment was last reviewed in March 2008. This must be referred for possible DOLS. It is our understanding that environment risk assessments have not been undertaken for individual accommodation. We looked at the record relating to the undertaking of fire alarm tests and found that these had not been undertaken weekly since June 09. Monthly emergency lighting tests had been completed. The home has reviewed their evacuation procedure to meet advice received from the fire service and have completed a Fire Risk Assessment for Care Homes for Older People Page 23 of 33 Evidence: the home. Care Homes for Older People Page 24 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 25 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered manager shall make sure that the care home is conducted so as to make proper provision for the care and, where appropriate, treatment and supervision of individuals who live in the home. This refers to the need to have night time care plans in place to identify any potential needs during this period. This is of particular relevance when considering that it is the practice of the home not to have waking night staff. 24/09/2009 2 7 12 The registered manager shall make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals living in the home. 24/09/2009 Care Homes for Older People Page 26 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This relates to the need to undertake reviews of placements in the home where the individual health has changed and their needs are potentially not being met in terms of their safety, health and welfare. 3 7 4 The registered manager to 24/08/2009 make sure that unnecessary risks to the health and welfare or safety of individuals are identified and so far as possible eliminated. This refers to the need to put in place actions and instructions to staff as part of individuals care plan and risk assessments where there are risks to their health, safety and welfare. (In the specific instance this was about not having actions in place to check and monitor the individual who was locked in their room overnite.) 4 18 10 The registered manager 30/11/2009 shall undertake from time to time such training as is appropriate to ensure that he/she has the experience and skills necessary for managing the care home. Care Homes for Older People Page 27 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This relates to the need for the manager to undertake Local Authority Mental Capacity Act and DOLS training so that we are confident she has the necessary knowledge regarding her responsibilities in relation to any situation which requires DOLS. Further to undertake refresher Safeguarding training so that she is updated and fully aware of her role in Safeguarding individuals in the home. 5 18 13 The registered manager shall make arrangements, by training staff or other measures, to prevent individuals living in the home being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to all staff undertaking Safeguarding Adults training. 6 18 12 The registered manager shall make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals living in the 24/08/2009 30/11/2009 Care Homes for Older People Page 28 of 33 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 home and to make proper provision for the care and, where appropriate, supervision of individuals. This relates to the need to take the necessary steps to safeguard the health and welfare of individuals where the manager takes any actions which deprive individuals of their liberty or place restrictions on their freedom of movement and such measures may be seen as a form of restraint. 7 27 18 The registered manager shall, having regard to the size of the care home, the statement of purpose and the number and needs of individuals living in the home shall make sure that all all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of individuals in the home. This relates to the need to evidence through regular review the staffing arrangements in the home. This should be linked to care 24/09/2009 Care Homes for Older People Page 29 of 33 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 plans and level of risk identified through the completion of risk assessments. 8 30 4 The registered manager shall make sure there are suitable arrangements for the training of staff in first aid. This relates to ensuring that at all times there are staff members available who have a level of first aid training required in the home. 9 31 5 The registered manager 30/11/2009 shall undertake from time to time such training as is appropriate to ensure that he/she has the experience and skills necessary for managing the care home. This refers to the need for the manager to undertake moving and handling training and such training as required in her role as moving and handling assessor for the home. 10 31 13 The registered manager 07/09/2009 shall make suitable arrangements to provide a safe system for moving and handling individuals who live in the home. 24/09/2009 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This relates to the need for the manager to make sure that moving and handling practices meet safe requirements and that there are clear instructions available to all staff about the use of moving and handling equipment. 11 38 13 The registered manager shall make arrangements, by training staff or by other measures, to prevent individuals living in the home being harmed or suffering abuse or being place at risk of harm or abuse. This relates to the need to review policy and procedure around actions of staff in the event an individual having an accident or fall. 12 38 12 The registered manager shall make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals living in the home. This refers to the undertaking of fire alarms tests as required and 07/09/2009 24/08/2009 Care Homes for Older People Page 31 of 33 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 recommended by Avon Fire and Rescue service. 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 9 Where stock of controlled drugs is checked this is recorded and signed to that effect by the staff member undertaking the check. This recognises that the home deputy stated that CD drugs are checked by her weekly and this in part addresses the lack of witness signature. Senior staff who have day to responsibility for the welfare of individuals in the home undertake Mental Capacity Act training. Where individuals are placed in rooms where access is by stairs only their placement should be kept under review. As part of individuals contract or letter sent confirming admission to the home it should state that where individual health or safety maybe at risk from occuping these rooms they would need to seek other accomadation or move to another room in the home if this was available. The other option is to install stair lift on the stairs (if this is possible) where this applies which would negate such steps to be taken and secure individuals choice to remain in the home. In reviewing staffing levels in the home refer to the guidance available on the CQC website: How We Assess Staffing Levels and Night Time Care Prompts. Undertake a risk assessment around the need for First Aiders in the home. Refer to CQC Guidance on First Aid. 2 18 3 19 4 27 5 30 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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