Inspection on 06/01/10 for Brincliffe Towers

This inspection was carried out on 6th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brincliffe Towers 02/03/10

Brincliffe Towers 20/01/10

Brincliffe Towers 29/09/09

Brincliffe Towers 01/10/08

Brincliffe Towers 06/05/08

Brincliffe Towers 08/05/07

Brincliffe Towers 11/05/06

Brincliffe Towers 13/12/05

Brincliffe Towers 06/04/05

Brincliffe Towers 21/09/04

Brincliffe Towers 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ     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: Valerie Hoyle     Date: 0 6 0 1 2 0 1 0 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 34 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 34 Information about the care home Name of care home: Address: Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ 01142552821 01142552821 jeanwalker2009@live.co.uk None Ash House (Yorkshire) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: All 24 DE(E) beds are registered `or MD(E)` and are sited in a separate wing. Service users may also be aged 60-65 years. Date of last inspection Brief description of the care home Brincliffe Towers is a care home providing personal care and accommodation for 35 older people, including care for twenty-four people with dementia. The home is privately owned, and is located in a residential area of Sheffield with nearby access to public transport. The home is a large old detached house with a modern annexe attached and has very pleasant well established gardens, which overlook Chelsea Park. Care Homes for Older People Page 4 of 34 Over 65 24 24 11 0 0 0 2 9 0 9 2 0 0 9 Brief description of the care home There is a small car park to the front of the house. All of the bedrooms are single although two are registered, as doubles should there be a request to share. Seven rooms have an ensuite facility. There is a passenger lift. A copy of the previous inspection report Dated 29th september 2009 was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. Care Homes for Older People Page 5 of 34 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 quality rating for this service is 0 star. This means that the people who use the service experience poor quality outcomes. This unannounced inspection took place over 8.5 hours starting at 10:00 finishing at 18.30. The visit included a partial inspection of the home. Three people who use the service, the temporary manager and acting manager were spoken to during this inspection, their views are included within this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations but only when it is considered that the people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 34 Surveys were not used at this inspection. Two peoples care plans were looked at. policies relating to medication, complaints, protection and handling of peoples money were looked at. Five recruitment and training records were looked at to assess how people were protected from harm. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The Annual Quality Assurance Assessment was obtained for the previous inspection dated 29th September 2009. An AQAA is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their services. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 34 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Information received from social services reviewing officers, and information recieved means staff are not able to meet the needs of people who use the service. Evidence: We have not looked at this outcome area at this inspection, however we have received information from social services reviweing officers who have undertaken a number of assessments on people currently living at the home. The outcome of those assessments indicates that some people may not be appropriatley placed and staff were not able to meet their needs. Therefore we have made the judgment that the service is providing an adequate assessment of peoples needs. Care Homes for Older People Page 11 of 34 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. People do not have their health and personal needs met and the principles of privacy and dignity were not put into practice. Medication procedures were extremely poor which fails to protect people from harm. Evidence: We looked at two care plans to assess how peoples needs were being met. The information contained in the plans were insufficient and did not give staff direction to diliver care, people need. There was no evidence to tell us how peoples mental health needs were being addressed and both plans had not been reviewed or updated since October 2009. One of the care plans showed a significant increase in the frequency of falls, although there was no significant risk assessment or plan to tell staff the action they should take to minimise the risk. Nutritional assessments on both care plans looked at had not been reviewed since September 2009 although one clearly identified that the person was at risk. There was no care plan to describe the support people needed to help maintain their weight or if supplements were needed. Weight charts had only one entry dated October 2009. Moving and handling and continence assessments were not completed therefore people were at significant risk from harm, Care Homes for Older People Page 12 of 34 Evidence: if they were not moved currently. Social care plans were incomplete and there was no evidence to confirm how peoples emotional needs were being met. Both care plans identified that they were assessed as having dementia, although both were spending their day in the residential area of the building. This means that their mental health needs may not have been met. Although the home is split into two separate units (one unit designated for dementia and one for residential) it was difficult to determine the area offering care to more dependent people living at the home. Staff working on the dementia unit did not appear to have any skills to meet the needs of people with challenging behaviour. This was confirmed when we observed two people having an altercation in the lounge and staff were unable to diffuse the situation or divert the peoples attention. Training records confirmed most staff had not received training in managing challenging behaviour. We observed staff moving people inappropriately using illegal lifts, which could cause injury to the person. Staff interviewed told us that they had received some training (approx 4 hours) which included the use of equipment, however they said they did not know what a care plan was and had not seen any information about how they were to support people to move safely. The pharmacist inspector examined the medication ordering, storage, handling and disposal arrangements in the home and reveled the following concerns. The storage arrangements for medicines are insecure as all care staff, whether authorised to handle medication or not, carry a master key which unlocks the medication store room. The ground floor store room window is not protected by locks or a security grille and the rooms contents are clearly visible to anyone looking in. The keys to both medication trolleys and to both medication wall cupboards, one of which contains temazepam (a controlled drug), are left in this store room when not in use so are accessible to unauthorised staff. The fridge is not fitted with a lock so its contents are accessible to unauthorised staff. Unwanted medicines awaiting disposal are kept in open skips and bags on the floor and are therefore accessible to unauthorised staff. There are no records of disposal available for these medicines so it would be impossible to determine whether any loss or diversion had occurred. Ordering, receipt and checking arrangements appear not have improved since the meeting held with the PCT on 18th December 2009. Boots failed to deliver some items in time for the start of the 4th January medication cycle. The quantities received were not correctly recorded for all people living in one of the units and carried forward quantities are not recorded on the medication administration record charts (MARs). This means that it is not possible to check whether medicines have been given correctly or whether accurate Care Homes for Older People Page 13 of 34 Evidence: records are being kept. Controlled drugs (CDs) are not kept in a designated secure cupboard but are stored instead in a general medication cupboard with shared key access to another cupboard. The lock on this cupboard may not meet the Misuse of Drugs (Safe Custody) Regulations as amended. There are no records of receipt or administration of CDs in the current CD register nor any records of managerial checks of CD handling. Together, this means that group of medicines are not fully protected from the threat of loss or diversion. No room thermometer or temperature monitoring records were in place to check the temperature of the store room so staff do not know whether medicines are being stored at the correct temperature as recommended by the manufacturer. The unlocked medication fridge is in need of defrosting and no fridge temperature records were available after 12th December 2009. Some fridge contents were labelled to be stored at room temperature, not in a fridge, so were being stored incorrectly. Twelve bottles of Fortisip in the fridge were unlabelled at all so it is impossible to know who was meant to receive them. No opening dates were seen on amoxicillin suspension and omeprazole suspension meaning staff did not know wether these medicines were still fit to use. The environment for handling medicines was unhygienic as the store room was very cluttered, untidy, disorganised and dirty, containing unwashed medicine pots and spoons next to clean unused ones. We also looked at 22 current MARs for completeness and where possible for accuracy. We found that one person was unable to receive a prescribed dose of memantine 10mg on four successive occasions on the 4th and 5th January 2010 as none was available in the home. We were told that the supplying pharmacist had not delivered a new supply. Even though this shortfall had been noticed when checking the receipt of the monthly supply of medicines on 31st December 2009, none was obtained until 6th January 2010. One persons MAR showed a gap on the morning of 6th January for paroxetine 20mg daily, and four gaps between 4th and 6th January for the use of Clotrimazole-HC cream to be applied twice a day meaning that these medicines were not being given correctly. Another persons MAR showed that prednisolone 30mg daily and amoxicillin 500mg three times daily (both prescribed on 30th December for an acute illness were not given at all during the 4th and 5th January. These doses were all found to still be in the trolley. No explanation was given for these omissions. Another persons MAR showed that on 6th January morning doses of amlodipine 5mg, aspirin 75mg, lansoprazole 15mg, sotalol 40mg (all daily) or calcium carbonate cholecalciferol (twice daily) as the person was asleep. No attempt had been made to offer these medicines again by 12:45pm as they were still in the trolley at that time. Another persons MAR showed that a dose of alendronic acid 70mg prescribed to be given weekly each Tuesday had been signed for each day on the 4th, 5th and 6th Care Homes for Older People Page 14 of 34 Evidence: January. Checking the trolley showed that in fact only one tablet had been removed indicating that staff were not keeping accurate records of medication administration. The use of omission codes by staff is inconsistent and does not always follow usual practice e.g. non-acceptance of as required medication is recorded either as refused or gaps are left on the MAR. We observed people being cared for throughout this inspection. Staffing levels were low which was a serious concern, as people did not receive the care and support they needed. People looked unkept, male service users were unshaven and their clothing was dirty. Female service users hair looked dirty and untidy and their clothing was dirty. Some people were wrapped in blankets and one person spent all day in their outside coat. There was very little interaction between staff and people as some staff were very new to the service and did not know how to communicate with them. One staff member was unable to confirm her role, although she said she thought she was a laundry/domestic. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had limited opportunities to take part in meaningful activities, and mealtimes were unorganised which means people may not receive a balanced diet. Evidence: We observed people spending time in the lounges. There was a lack of stimulation, staff interactions were mainly related to personal care tasks. Staffing levels were insufficient and this meant that staff only had time to meet the very basic needs of people. People spent time asleep in their chairs and most were unaware of their surroundings. The television was on but people were taking no interest in the programmes. There was no evidence that any activities take place, although some entertainment had occurred over Christmas. Some people were seen spending time in their bedroom, although it was difficult to judge if they had any contact with staff other than when they were served their meal. One person was in their room with the curtains closed, therefore no natural light came into the room. The person refused to have the curtains opened as the windows were ill fitting and let in the cold air. Mealtimes were poor although people were offered a choice of a hot meal at lunch Care Homes for Older People Page 16 of 34 Evidence: time. Cooked breakfasts were not available and most had cereal and toast. Mealtimes were unorganised and lacked direction. Staff had to be told to lay the tables for lunch and domestics had to be asked to clean the carpet which was dirty with food from breakfast. People receive their meals in their bedrooms if they prefer, although it is difficult to judge if they have a balanced diet as we observed one person who had received some porridge and a cup of tea and it was taken away uneaten later in the morning. The person was brought another drink although the person had not drunk any of the first drink. Staff appeared unaware of the importance to ensure people have a balanced diet which must include sufficient fluids. Care Homes for Older People Page 17 of 34 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. People are not protected by the homes procedures as they are not sufficiently robust to keep people safe from harm Evidence: The outcome area was not fully assessed at this inspection therefore the judgement in this area was made by interviewing a staff member and looking at information received prior to this inspection. We also looked at training records which confirmed a number of staff had not received training so that they would be able to recognise the signs of abuse and take appropriate action to report any incidents of abuse. One member of staff confirmed to us that he had not undertaken training in safeguarding adults. He was unaware of the procedures to follow if he suspected an incident of abuse, although when prompted he said he would speak to the person in charge. We have looked at the notifications (Regulation 37) sent to us by the home and they tell us that a number of concerns/complaints have been received about the care provided at the home. Some have been considered serious and have been referred to safeguarding. These are currently being investigated. The home was asked to investigate two complaints which have been received by us. One of the complaints is still being investigated by the home, the providers have responded to the second complainant, although the complainant is not satisfied with their response and is awaiting further correspondence from the home before agreeing a conclusion. Care Homes for Older People Page 18 of 34 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. The home needs considerable investment to ensure it is fit for purpose and promote a clean and safe environment for people to live in. Evidence: When entering the home the home looked generally untidy and there was offensive odours throughout. The lounges were dirty with food spillages and chair cushions were missing from several chairs, although people were still sitting in the chairs. The home was warm throughout although people sitting near windows said it was quite drafty from ill fitting windows. One room in particular had the curtains drawn and had books to keep the curtains held down to prevent a draft. Bedrooms were untidy and dirty and some of the rooms were poorly decorated with old wallpaper and paint peeling from the walls and ceilings. One bedroom had a plastic sheet covering the mattress which could have caused considerable discomfort to the person sleeping in the bed. We found several commodes that had not been emptied which was unhygienic and added to the odours around the building. The furniture in some of the rooms were in poor repair and drawers did not close and wardrobes were unsafe as they were not secured to the wall and could fall forward and cause a serious injury to the person in the room. Bathrooms and toilets were in poor condition and the sluice areas were unlocked. The Care Homes for Older People Page 19 of 34 Evidence: rooms contained hazardous substances which could pose a significant risk to people with limited capacity. The stairlift on the first floor was not working, this means people may not be able to be moved safely from one area of the home to another. The kitchen area had been recently inspected by the Health Protection Agency and a number of recommendations/requirements had been made to prevent the risk of cross infection. Food safety procedures and recording of cleaning regimes were identified as areas for improvement. We saw paint flaking from the ceiling which could contaminate food. There appeared no timescales for addressing the issue. Care Homes for Older People Page 20 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were not is sufficient numbers or skilled to provide the care and support to people who use the service. Evidence: We looked at staff rotas to assess if there was sufficient number of staff to meet the needs of people who use the service. We were told that a number of staff had phoned in sick and there was only 2 care assistants (agreed levels were 6 staff during the day) and a temporary manager (who works at another home owned by Ash House (Yorkshire ) Limited) who was administering medication. The acting manager told us that they had phoned a number of employment agencies to replace the staff. Two agency staff did arrive at the home at 2pm, neither had worked at the home before. Staff were observed interacting with people who use the service and it was clear that they lacked knowledge and competencies to meet the needs of people who have dementia. The agency staff were seen to stand around in the lounge area and were not given any direction regarding the duties they were expected to undertake. Staff were asked about the recruitment and induction process. One staff member told us that he had a 4 hour induction where he was showed around the home and told about how to provide care to people. The temporary manager told us that the induction was undertaken over approx. one week although none of the induction was Care Homes for Older People Page 21 of 34 Evidence: recorded. he was unable to produce a copy of the homes induction programme. A number of staff recruitment files were looked at and it was clear that there had been a large turnover of staff recently. There was evidence that Criminal Records Bureau (CRB) checks had been obtained and Protection of Vulnerable Adult clearance was obtained prior to the commencement of employment. References were seen although most files were unorganised making auditing difficult. Care Homes for Older People Page 22 of 34 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 management arrangements do not ensure the safety and protection of people who use the service. Evidence: An acting manager was appointed on 29th December 2009. She has the required experience, skills and competencies and holds a required management qualification. She was available throughout the inspection. A social services manager was also on site following serious concerns received in December 2009. Her role was to support the new manager during her first weeks at the home. There was evidence that there has been a lack of direction over the past three months since the previous manager left the organisation. Evidence of serious concerns safeguarding referrals, complaints, and the large changeover of staff all indicates to us that there has been no clear management of the day to day operations of the home. Records were difficult to retrieve and essential health and safety records stop around the end of September 2009. Fire safety checks and drills had not been been undertaken since September 2009 and Care Homes for Older People Page 23 of 34 Evidence: there was no evidence to confirm staff had received fire safety instruction. this means that staff may not know the action they need to take in case of an emergency. We spoke to one member of staff to confirm their understanding of fire procedures and he told us he was shown the fire board and where to evacuate people to. He was not able to confirm where he would sound the alarm or the procedures he would follow in the event of a fire starting in the home. We found substances hazardous to health in sluice rooms (one on each floor) which were unlocked which could pose significant risk of harm to people who use the service. The rooms were locked immediately by the housekeeper. We observed staff moving and handling people using unsafe methods. Training records and discussion with staff members confirmed they had received very little instruction to safely move and handle people. One staff member said the training took place over 4 hours, although he was unable to tell us who delivered the training. There was no evidence of certificates on his staff file. A number of other staff files were looked at and most did not have evidence to confirm they had received training to safely move and handle people. Care Homes for Older People Page 24 of 34 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 15 Each persons care plan must 07/12/2009 contain adequate details to ensure that peoples needs and any changes to these needs are clearly recorded and staff know how to meet their needs. So that peoples health, safety and welfare is protected and promoted. 2 8 15 Peoples health care needs 07/12/2009 must be identified. Then clear records of how peoples health care needs are to be met must be recorded. So that peoples health, safety and welfare is protected and promoted. 3 15 16 All staff must be made aware 26/10/2009 of peoples individual dietary needs, preferences and choices. So that peoples health and welfare is promoted and protected. 4 24 23 People must be provided with 26/10/2009 a clean bed and mattress. So that peoples health, privacy and dignity is maintained and promoted. Care Homes for Older People Page 25 of 34 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 5 26 23 All staff must be provided with training in infection control. So that peoples health and welfare is not put at risk. 07/12/2009 6 29 19 Staff files must contain proof 26/10/2009 of the persons identity and a recent photograph of the person. So that there is full and satisfactory information about each person employed at the home. 7 33 26 The provider, or their representative must carry out a visit and complete a report, as detailed in Regulation 26 of the Care Homes Regulations. This will make the provider aware of the quality of the service, that is being provided and how the service could be improved. 26/10/2009 8 38 13 People must be moved and handled using only techniques that have been recommended as safe. So that peoples health, safety and welfare is not put at risk. 26/10/2009 9 38 13 The missing grate cover must be replaced. So that peoples health, safety and welfare is not put 26/10/2009 Care Homes for Older People Page 26 of 34 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 at risk. 10 38 13 Substances that could pose a 26/10/2009 risk to peoples health and welfare must be kept locked away. So that peoples health, safety and welfare is not put at risk. Care Homes for Older People Page 27 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 12 Arrangements must be made 07/01/2010 to ensure there is an effective system in place to request, obtain and return adequate supplies of medication to meet service users needs as and when needed. This will ensure service users will receive there medication as prescribed. 2 9 13 Arrangements must be made 07/01/2010 for the effective ordering, receipt, safekeeping, safe administration and disposal of all medication received in the home This will ensure service users will receive there medication as prescribed. 3 27 18 Staffing levels must be maintained at all times in sufficient numbers and they must be suitably qualified, competent and experienced To ensure they can safely care for people who use the service 07/01/2010 4 38 23 Substances hazardous to health must be stored securely To ensure people are safe from harm. (timescale 26/10/2009 not met) 07/01/2010 5 38 23 Staff must have the required 07/01/2010 Page 28 of 34 Care Homes for Older People 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 skills and competencies to safely move and handle people who use the service To ensure they can safely deliver the care people require. (timescale 26/10/2009 not met) 6 38 23 Suitable arrangements must be in place to ensure drills and practices, and checks take place a suitable intervals To ensure staff have the knowledge and competencies to take appropriate action in the event of a fire. 7 38 23 Suitable arrangements must 07/01/2010 be in place to ensure staff receive fire safety instruction To ensure staff have the knowledge and competencies to take appropriate action in the event of a fire 07/01/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain sufficient detail to enable staff to deliver appropriate care. Risk assessments and evaluations of care plans must be reviewed at regular 08/02/2010 Care Homes for Older People Page 29 of 34 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 intervals to ensure they are up to date This will ensure people are receive the care they need and they remain safe (timescale 07/12/2009 not met) 2 8 12 Care plans must provide details of how staff manage risks. People who are at risk from falls, and how they manage peoples mental health. This will help people to remain safe while maintaining their independence. (timescale 07/12/2009 not met) 3 9 13 Arrangements must be made to ensure that controlled drugs are stored securely in line with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with current professional guidance. This is to help reduce the risk of loss or diversion of this type of medicine. 08/02/2010 08/02/2010 Care Homes for Older People Page 30 of 34 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 4 10 12 The principles of respect, privacy and dignity must be respected at all times. This means ensuring people are dressed and appropriatley and kept clean and tidy 08/02/2010 5 12 16 Arrangements must be made to enable people to take part in meaningful activities. This means providing activities suitable to the people who use the service at regular intervals 01/03/2010 6 15 12 People must receive a balanced diet to help maintain their health and wellbeing This means ensuring that peoples food and fluid intake is monitored, in particular if people have their meals in their own room. (timescale 26/10/2009 not met) 08/02/2010 7 18 13 Staff must be alert to the 08/02/2010 signs of abuse and must be familiar with the procedures to follow if they suspect any incidents of abuse has taken place Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to protect people who use the service from abuse 8 19 23 Arrangements must be put in place to ensure furniture is fit for purpose in bedrooms This means that wardrobesmust be secured to an outer wall and drawers must be in good repair 9 19 23 Arrangements must be 08/03/2010 made to ensure all parts of the home are kept clean and reasonably decorated This includes peoples bedrooms and the repair to the kitchen ceiling. This will ensure people live in a clean and safe environment. 10 22 23 The stair lift on the first floor 15/01/2010 must be repaired. to ensure people can access all areas of the building safely 11 26 23 Suitable arrangements must be made to ensure good hygiene pratctices take place. This includes adressing the smell of offensive odours, emptying and cleaning commodes, and deep cleaning carpets. 08/02/2010 08/03/2010 Care Homes for Older People Page 32 of 34 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 To control the risk of infection and maintaining a clean, hygienic environment. 12 30 18 Staff must receive a 08/02/2010 comprehensive induction programme which meets the Skills for Care standards This will ensure staff can care and support people who use the 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 2 3 4 5 9 9 9 9 9 Records and checks of controlled drugs usage should be made in the controlled drugs register. The medication policy and procedures should be updated in line with current professional guidance. Regular, monthly prescriptions should be seen and checked before the medication is delivered. Dates of first opening should be marked on containers oral liquids and skin care products. The temperature of all medication storage areas should be monitored regularly. Care Homes for Older People Page 33 of 34 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). 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