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Inspection on 14/12/09 for Brunswick House Nursing and Residential Home

Also see our care home review for Brunswick House Nursing and Residential Home for more information

This inspection was carried out on 14th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Manager provides good leadership and day to day management. The staff feel well supported by her and said that she is approachable. The Manager is proactive in putting the needs of the residents first. The staff are enthusiastic about supporting the residents and are keen to provide a high standard of care. The residents enjoy their meals and receive healthy, appetising meals.

What has improved since the last inspection?

The staff said that on the few occasions when the staffing levels have been increased during the day they have been able to provide a higher standard of care. There is an additional member of staff on duty overnight. The catering hours have been increased and so the residents are now able to have a hot meal at tea time and are offered more choice of meals. The activity co-ordinators hours have been increased a new member of staff recruited but not yet fully started work. The domestic hours have been increased slightly and this has made it easier for the domestic staff to carry out their roles but further improvements are needed in this area.

What the care home could do better:

The residents personal and health care needs are still not all being met. Residents are still having to wait for staff to assist them with personal care and staff do not have time to spend with them on an individual basis. The staffing situation has not been addressed adequately and therefore the staffing levels remain unsatisfactory. Staff have not received adequate training to enable them to carry out their roles. There are some outstanding health and safety issues that need addressing to reduce the possible risks to residents and staff.

Key inspection report Care homes for older people Name: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN     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: Lella Hudson     Date: 1 4 1 2 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 29 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 29 Information about the care home Name of care home: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN 01692405818 01692404423 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.brunswick-house.co.uk Brunswick House Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Brunswick House is a care home providing personal care and nursing care for up to seventy-five people. The Home is located in the town of North Walsham and is close to all local amenities. Brunswick House is a large detached property on two levels and stands in its own grounds with an extensive parking area. It is divided into three units: Grant Hadley, the first floor of Brunswick and the ground floor of Brunswick. The Home provides nursing and residential care. The home also has a day centre in the grounds. The weekly fees are currently between £555 to £730 and are agreed dependent on individual residents needs. Please contact the Manager for up to date information Care Homes for Older People Page 4 of 29 Over 65 0 75 10 0 1 8 0 9 2 0 0 9 Brief description of the care home about fees. In October 2009 the Home went into administration and is now being run by the administrators. They have appointed a management company to oversee the management of the Home. Care Homes for Older People Page 5 of 29 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 report includes information gathered about the Home over the last six months. There have been two Random Inspections and one prior Key Inspection at the Home since September 2009. As part of the Inspection we carried out an unannounced visit to the Home on Monday 14th December 2009. During this visit we spoke to the Manager and to residents and staff. We looked around the Home and inspected a selection of records. There were 59 people living at the Home at the time of our visit. Care Homes for Older People Page 6 of 29 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 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 7 of 29 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 8 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The written information available about the Home is not accurate and does not reflect the care that is provided. The Home cannot clearly demonstrate that it can meet the needs of residents. Evidence: The Statement of Purpose has not been updated to reflect the fact that the Home is now in administration and being managed by a health care management company. The Statement of Purpose that is available describes a range of services that are currently not able to be provided due to the staffing levels. Norfolk County Council are not currently placing residents at the Home. The Home has continued to admit residents who pay their own fees but there have been very few admissions since the last Key Inspection (Sept 09). We did not look at any pre admission assessments during this visit but had seen that effective pre admission assessments were being carried out when we last visited. Care Homes for Older People Page 9 of 29 Evidence: The Home are not able to clearly demonstrate that it can meet the needs of the residents due to the ongoing shortage of staff on duty. This report includes examples of how residents needs are not being met. Care Homes for Older People Page 10 of 29 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 residents personal and health care needs are not always being met. The privacy and dignity of the residents is compromised on occasions due to their personal care needs not always being met. Medication is managed safely. Evidence: In August 2009 we were informed by the previous Manager that the staffing levels had been reduced with immediate effect by the directors of the organisation that previously owned the Home. The reductions were across all levels of staffing including nurses, carers, domestics, catering and activity staff. During September 2009 we received complaints about the reduction in standards of care provided to residents. A Safeguarding referral was made in September with regard to a residents pressure sores possibly being caused by the lack of appropriate equipment. We carried out a Random Inspection on September 18th 2009 during which we confirmed that the staffing levels were not adequate to meet the needs of the Care Homes for Older People Page 11 of 29 Evidence: residents. An Immediate Requirement was issued for the staffing to be increased within 48 hours. This Immediate Requirement has not been met. We carried out a full Key Inspection on the 30th September 2009 and found further examples of residents needs not being met. The previous Manager had left the Home by the time of the Key Inspection and a new manager had started the week prior to our visit. The new Manager agreed to increase the staffing levels following the Key Inspection but during our Random Inspection we could see that these were not being consistently met due to the Manager not being able to use agency staff. At the end of October 2009 we were informed that the Home had gone into administration and that the administrators have appointed Health care Management Solutions to manage the Home on their behalf. We met with the new management company in November 2009 and expressed our concerns about the staffing levels at the Home. The company provided us with a copy of the staffing structure that they implemented in December 2009. This further reduced the care staffing levels during the day to the level that they were at the time of our Inspections in September 2009. The night care staff were increased by one carer. There were also some increases in catering and domestic staff. Following a further meeting with the company on December 11th 2009 the staffing levels were increased during the day by one carer on each shift. We carried out this visit three days later and the Manager was in the process of ensuring that the additional staff were on each shift. The agreed increase in staffing levels mean that there are eleven care staff, including one senior, on duty during the mornings as well as a qualified nurse. There are eight care staff, including a senior, on duty during the afternoon as well as a qualified nurse. During December 2009 we received two complaints from the same complainant about the care being provided to their relative. This included the fact that the resident was not being assisted to get up until late in the morning and that they did not have breakfast until they were up. They were then offered lunch less than 2 hours later. The complaint also stated that the bedroom was dirty. The Manager dealt with the complaints and these were found to be substantiated. The needs of some of the residents are high. On the day of this visit there were 59 residents. 14 have nursing needs, 10 have dementia and 35 have residential care Care Homes for Older People Page 12 of 29 Evidence: needs. Two of the residents are fed via a feeding pump and there are approximately ten who need assistance with meals. Many of the residents need assistance with mobility, including several who need the use of a hoist and two staff. One of the residents needs three staff to assist him with mobility. We spoke to staff during our visit and they all said that, for the current group of residents, when there are less than eleven care staff on duty during the morning that they are unable to assist all residents to get up in a timely way and that residents were often not getting up until nearly lunchtime. They said that they were unable to assist residents with baths on a regular basis. They all said that on the days when they have the increased number of staff on duty they are able to assist residents in a more individualised way. All of the staff who we spoke to said that there is little, if any, time to spend with individual residents, other than when they are assisting them with personal care. All of the staff who spoke to us were frustrated at the lack of time they were able to give to residents. One said that the one of the worst things was that there is no time to talk to residents, even for a quick chat. The requirement for the Home to be conducted so as to promote and make proper provision for the health and welfare of the residents has not been met. Neither has the requirement to ensure that the residents personal care needs are met in a way which promotes their privacy and dignity. During this visit we observed residents sitting in their wheelchairs rather than being assisted into more comfortable armchairs. We observed residents waiting a long time at mealtimes for assistance and also a resident whose dignity was compromised due to the way in which they were dressed. Staff did assist the residents but this was after some considerable time. Staff who spoke to us were positive about working with the residents and keen to provide a good standard of care. We observed staff supporting residents in a kind and caring way. We spoke to one relative during our visit and they said that they were happy with the care that their relative received. We looked at two of the care plans during this visit. These contain detailed guidance about how to meet the residents needs but not all of them have been reviewed and updated. For example, one of the residents has a pressure sore which is being dressed Care Homes for Older People Page 13 of 29 Evidence: by the District Nurse but the care plan has not been updated to reflect this. Another resident does not have a care plan for pressure care even though they are in bed all of the time. We looked at another care plan briefly and could see that this one had been reviewed and updated regularly. The daily notes and some of the daily records relating to nutrition and pressure care are not being completed. For example, one of the residents has a chart to record when they are assisted to change position but this had not been completed as specified in the care plan. The same residents nutritional record has gaps in it. This was true for another resident who has identified nutritional needs. The Manager has recently appropriately made a referral under the Deprivation of Liberty Act. She has liaised with the necessary professionals involved in the residents care and has taken steps to provide protection for the resident and for those around him. We looked at the arrangements in place for the storage, administration and recording of medication in one area of the Home. The nurses and the senior care staff are responsible for the all aspects of the management of medication in the areas in which they work. The senior care staff have all recently attended training with regard to the administration of medication as previously only the qualified nurses administered medication. We saw that there were appropriate records kept for the receipt and return of medication. Medication is stored appropriately and records are kept of administration. There is a need for clear guidance to be in place for the use of PRN (as required) medication. In November 2009 we received an anonymous complaint about the non administration of a controlled drug. The Manager investigated the complaint and found that the medication had been administered but that there had been an error in the recording. Action has been taken to ensure that this does not recoccur. It takes two hours for each nurse/senior carer to administer medication in the mornings. During this time they are not available to assist with other tasks. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are very limited opportunities for residents to take part in meaningful activities. Residents are able to have visitors whenever they wish to. The quality of the meals has improved. Evidence: In August 2009 there was a reduction in the hours that the chef, kitchen assistants and the activities organiser worked. This had an almost immediate impact on the residents as the quality and choice of meals reduced and the opportunities to take part in activities reduced. The new management company increased the hours for all of these posts in November 2009. The Activities organiser left the Home in September 2009 but a new person has been appointed but has not yet started work with the residents. She is currently in the process of assessing what is available in the Home and talking to residents about what they are interested in. There were several Christmas entertainment events planned at the Home at the time of our visit. The chef prepares a choice for each mealtime, including a cooked breakfast. Residents said that they enjoy their meals and that the meals have got better recently. Care Homes for Older People Page 15 of 29 Evidence: Residents are offered hot drinks mid morning, mid afternoon and during the evening. The chef has a good knowledge of the individual likes and dislikes of the residents with regard to meals. The relative who made a complaint was concerned about their relative having breakfast at 11am and lunch at 12.30pm. The Manager has implemented a change in the breakfast routines. Residents are now asked if they would like their breakfast in their bedrooms if they do not wish to get up and dressed, or if there is a delay in staff being available to assist them. This should ensure that residents are having their breakfast at a time they are happy with. As previously mentioned in this report, the care records are not all kept up to date with regard to the nutritional intake for some residents who have an identified nutritional need. Not all of the residents monthly weight charts were being completed either. There are currently approximately ten residents who need full assistance from staff to have their meals. There are considerably more who need a small amount of help, such as assistance with cutting food. There are three dining rooms in the Home and some residents have their meals in their room. These facts mean that the staff are extremely busy at mealtimes. During our visit we spent time in all three dining rooms at lunchtime. Some of the residents are taken to the dining table up to 20 minutes prior to their meal arriving. We also observed residents sitting for a long time with their meal before a member of staff was available to assist them. The meal looked and smelt appetising. Residents were having several different options and one of the residents said that the chef always makes her an alternative as he knows that she doesnt like what was on the menu that day. The requirement with regard to the provision of meaningful activities has not been met but the requirement to provide residents with a choice of meals which are nutritious and which they enjoy has been met. Care Homes for Older People Page 16 of 29 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. Complaints are dealt with appropriately by the Manager. The current staffing levels and the lack of staff training with regard to Safeguarding reduce the protection for residents from abuse. Evidence: We have received two complaints from a relative about the care that their relative has received. The Manager has investigated these and found issues that have been substantiated. The Manager works proactively with the Commission with regard to complaints and safeguarding. The staff that we spoke to were confident that the Manager would deal appropriately with any concerns that they had. During this visit we were told that there had not been any further training provided to staff since the last Key Inspection. At that time only 24 of the 36 care staff had received Safeguarding training and that some of that had been provided over two years ago. The Manager said that there are plans for this training to be provided within the next few months. The current staffing levels meant hat there are often times when staff are not available in the communal areas which means that there is a lack of supervision for residents whose behaviour may be challenging to other residents or for residents who may be at risk of falling. Care Homes for Older People Page 17 of 29 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 provides individual and shared bedrooms which the residents are encouraged to personalise. There is a range of communal lounge and dining areas. The cleanliness of the Home has improved but there are still times when the Home is not kept as clean as it should be. There are some health and safety issues which need addressing to ensure the safety of residents. Evidence: Prior to the last Key Inspection we had received complaints about the reduction in standard of cleanliness in the Home. Since that visit the domestic hours have been increased so that on some days there are three domestic staff on duty. However, additional staff are not utilised to cover for annual leave or sickness and so on these days there are only two domestic staff. One of the issues in the complaint we received in December is that the residents room was not clean. The Manager substantiated this and took action to address the situation. During this visit we spoke to a range of staff about the cleanliness in the Home and also looked around the communal areas and some of the bedrooms. The domestic staff work hard to maintain the cleanliness and hygiene within the Home. They are frustrated at the lack of time that they have to undertake the cleaning. Care Homes for Older People Page 18 of 29 Evidence: Whilst the cleanliness and hygiene in the Home has improved it still takes a long time for bedrooms to be cleaned. For example, we saw a bedroom which needed cleaning at 11am and it still had not been done at 12.30pm. The room was cleaned shortly after this. There were no unpleasant odours in the Home during our visit. The Home is a large building which has been extended. Although there are no physical divisions within the Home it has recently been designated into three seperate areas. There is a 13 bed dementia unit on the ground floor known as the Grant Hadley unit. The additional beds downstairs are designated for residents in need of nursing care. The 39 beds upstairs are designated for people in need of residential care. The majority of the bedrooms have ensuite toilets. The shared rooms have curtains to assist with privacy. Residents are encouraged to personalise their rooms and to make them homely. The Home has several lounge areas, including a large conservatory. There are also three dining rooms. There are communal bathrooms and toilets. However, there are problems with some of the baths and at the time of this visit there were only two baths and one shower in use. The shower is located in one of the bathrooms. The Home has three lifts, although one of these is for limited use. The main passenger lift has been our of order for several months and was still not working during this visit. The second lift has a cracked pane in the door and the button to work the lift is covered with tape. The Manager said that the engineers have concerns about the high useage of this lift as it was only intended to be used as a back up to the main lift. The carpet on some of the staircases is frayed and needs to be replaced as is a possible trip hazard. Some of the corridor carpets have stretched and are also presenting a possible trip hazard. There is a large heated trolley in the Grant Hadley unit. This becomes very hot and is a possible risk to residents. Another area of concern is that one of the shared rooms on the ground floor has large patio doors which were unlocked. These lead out on to a raised concrete area with steps down to the garden. The concrete has a lot of moss on it which could be a slip hazard. There are no restrictions to residents in accessing this area. The Home does not have a secure garden for residents with dementia to use. On the day of our visit there was a large hole in the garden near to the front dining room. Care Homes for Older People Page 19 of 29 Evidence: The outstanding requirements from the last Environmental Health Officers inspection have been addressed. Care Homes for Older People Page 20 of 29 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 are working hard to meet the needs of the residents but the staffing levels are not sufficient to do so. Staff do not have sufficient training to ensure that they are able to carry out their roles effectively. Evidence: As previously described in this report there have been difficulties with the staffing at the Home since August 2009. An Immediate Requirement that was issued in September 2009 still has not been met. Although the management company has increased the catering, night care staff and activities staff they reduced the care staffing further during the day which has had an impact on the care provided to residents. However, following a second meeting with the Commission they agreed to increase this by one carer per shift. During this visit to the Home we spoke to several staff on an individual basis. We also spent time observing staff supporting the residents. Staff have been working hard to meet the needs of the residents and have been upset and frustrated by the limitations placed on them. We did not look at recruitment files during this visit but had looked at a selection of files during our last Key Inspection. At that time we could see that the appropriate Care Homes for Older People Page 21 of 29 Evidence: checks were being carried out prior to staff starting work at the Home. The Manager told us during this visit that no further training has taken place since the last Key Inspection. At that time we could see that the majority of staff had attended Moving and Handling training in the last 12 months but that very little other training has been provided. The Home used to have a full time receptionist Monday to Friday but the management company have reduced these hours so that there is now only a receptionist on duty in the mornings Monday to Friday. At the time of our previous visit the staff told us that at weekends a lot of time is taken up with answering the front door, which is kept locked, and answering the phones. Now care and nursing staff have to do this every afternoon as well as at weekends. Care Homes for Older People Page 22 of 29 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 is providing good leadership and day to day management of the Home. The needs of the residents are put first by the Manager and the care staff. The Home went into administration recently. Evidence: The Home went into administration in October 2009 and the administrators have appointed Healthcare Management Solutions Ltd to oversee the management of the Home. The current Manager of the Home, Lesley Horsfield, was appointed in September 2009. Mrs Horsfield has appropriate skills and experience to manage the Home. She is not yet registered with the Commission. The staff and residents spoke highly of the Manager and said that she has made improvements since she has been at the Home. The Manager very quickly identified areas that were in need of improvement and has kept the previous owners, and the current management company aware of these. She has worked in a creative way with the staff team to try to ensure that the standard of care provided to the residents is Care Homes for Older People Page 23 of 29 Evidence: acceptable. The staff said that the Manager spends time with the residents and puts their needs first. They said that she always deals with issues that they bring to her and that she keeps them informed about progress. The Home does not have a deputy manager but there are plans to recruit to this post. This means that the Manager has little support with regard to management. The Home has an administrator. This report includes examples of poor care being provided to the residents due to the staffing situation. The management company were appraised of the staffing situation when they took over the Home, however they made further reductions in staff numbers as evidenced in this report. There are concerns about the health and safety of the residents. As previously mentioned in this report there are issues regarding the accommodation which need to be addressed to reduce possible risks to residents and staff. The Home does not have a fully developed quality assurance process. The Manager promotes the importance of gathering the views of the residents on an individual basis but there is no formal quality assurance process. Formal supervision has started to be provided to the staff. Some of the senior staff need to have leadership training to ensure that they are providing effective supervision to the care staff. Staff said that they feel well supported by the Manager and that she is very approachable. The Home has recently introduced a new system for looking after residents money. We looked at a sample of the records and could see that these tally with the cash held. We looked at some of the health and safety records during this visit. The records show that regular servicing has taken place of the fire safety equipment but that the fire risk assessment needs to be updated. Care Homes for Older People Page 24 of 29 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 The records within the care plans need to be kept up to date To ensure that accurate records are kept of the care provided to the residents 30/10/2009 2 8 12 That the residents personal 23/09/2009 care needs are met in a way which promotes their privacy and dignity THIS REQUIREMENT WAS MADE DURING THE RANDOM INSPECTION ON 18TH SEPT 2009 To ensure residents needs are met 3 8 12 It is required that the care home is conducted so as to promote and make proper provision for the health and welfare of residents To ensure that the residents personal and healthcare needs are met 30/10/2009 4 9 13 It is required that clear guidance is available for the administration of PRN medication To ensure that residents receive medication at appropriate times 30/10/2009 Care Homes for Older People Page 25 of 29 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 12 16 That meaningful activities are available for the residents to take part in if they wish to THIS REQUIREMENT WAS MADE DURING THE RANDOM INSPECTION ON 18TH SEPT 2009 To ensure that residents have a choice to take part in meaningful activities 30/10/2009 6 18 13 That all staff receive Safeguarding vulnerable adults training To provide increased protection to residents from abuse 31/12/2009 7 22 23 That the necessary 30/09/2009 equipment is provided for the residents and that this is well maintained To ensure that the residents needs are met 8 27 18 To increase the staffing to ensure that the needs of the residents are met To ensure that the needs of the residents are met 22/09/2009 9 27 18 To increase the staffing to 20/10/2009 ensure that the needs of the residents are met PLEASE NOTE THAT THIS IMMEDIATE REQUIREMENT WAS ISSUED ON 18TH SEPTEMBER 2009 DURING THE RANDOM INSPECTION AND HAD A Care Homes for Older People Page 26 of 29 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 TIMESCALE OF 48 HOURS IN WHICH TO BE MET. THE DATE FOR THIS HAS NOT BEEN EXTENDED. To ensure that the needs of the residents are met 10 30 18 that the staff receive training 31/01/2010 which is relevant to their role To ensure that the staff have appropriate skills to carry out their roles effectively 11 38 13 That action is taken to 09/10/2009 address the outstanding health and safety issues THIS REQUIREMENT WAS MADE DURING THE RANDOM INSPECTION ON 18TH SEPT 2009 To ensure that the residents are safe Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the Statement of Purpose is updated To ensure that prospective residents are provided with accurate information about the Home 26/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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